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74


Ocular decompression retinopathy: a review

Mukkamala, Sri Krishna; Patel, Amar; Dorairaj, Syril; McGlynn, Robert; Sidoti, Paul A; Weinreb, Robert N; Rusoff, Jade; Rao, Sunil; Gentile, Ronald C
Ocular decompression retinopathy (ODR) presents as retinal hemorrhages following acute lowering of the intraocular pressure (IOP). We review 32 articles published from 1992 to 2011 and address the pathogenesis, clinical features, management, and outcomes of ODR. ODR is defined as a multifocal hemorrhagic retinopathy that results from acute lowering of IOP and is not explained by another process. Hemorrhages occur in all retinal layers, and most patients are asymptomatic. The mean drop in IOP in ODR is 33.2 +/- 15.8 mm Hg (range, 4-57 mm Hg). Eighty-two percent are diagnosed by the first postoperative day, all within 2 weeks. ODR resolved in a mean of 13 +/- 12.4 weeks (range, 2-72 weeks). Vitrectomy was required for vitreous and subhyaloid hemorrhage in 14% of cases. Visual outcomes are generally good, with 85% of eyes returning to baseline vision. Although ODR infrequently results in significant ocular morbidity, gradual reduction in IOP might prevent this complication.
PMID: 24160727
ISSN: 0039-6257
CID: 952402

Retinal Vascular Remodeling Following Macular Hole Surgery [Meeting Abstract]

Chen, Gene; Iezzi, Raymond; McLaren, Jay; Gentile, Ronald; Barkmeier, Andrew
ISI:000436232903398
ISSN: 0146-0404
CID: 3566892

Combined Baerveldt Glaucoma Implant and Scleral Buckling Surgery for Patients With Retinal Detachment and Coexisting Glaucoma

Lima VC; de Moraes CG; Gentile RC; Sidoti PA; Prata TS; Liebmann JM; Will DV; Tello C; Rosen RB
PURPOSE:: To report on the usefulness of combined Baerveldt glaucoma implantation (BGI) and scleral buckling surgery for patients with glaucoma requiring a scleral buckle for retinal detachment repair. METHODS:: Retrospective, consecutive, noncomparative, and interventional case series of 30 eyes (30 patients) that underwent simultaneous scleral buckle and BGI surgery, using a staged (group 1, n=21 patients) or nonstaged (group 2, n=9 patients) approach to BGI implantation. Successful intraocular pressure (IOP) control was defined as 6 mm Hg</=IOP</=18 mm Hg. RESULTS:: Although not statistically significant, mean best corrected visual acuity (LogMAR) improved from 2.0 before surgery to 1.7 after surgery (P=0.13) with a mean follow-up of 27.7 months. Of the 21 patients in group 1, only 13 (62%) required second-stage tube insertion at a mean of 7.0+/-8.0 months (range, 1 to 24 mo) postoperatively. For these eyes combined with group 2 eyes, mean IOP was reduced from 31.1+/-10.8 to 12.7+/-6.0 mm Hg (P<0.0001), and the mean number of glaucoma medications was reduced from 2.9+/-1.4 to 1.2+/-1.3 (P<0.001). Life table rates of successful IOP control were 90% and 80% at 12 and 24 months, respectively. CONCLUSIONS:: Combined scleral buckle and BGI is an effective technique for managing coexisting glaucoma and retinal detachment and provides the clinician with a useful surgical option while minimizing surgical risk
PMID: 22210178
ISSN: 1536-481x
CID: 148226

Artificial iris-intraocular lens implantation for traumatic aniridia and aphakia assisted by silicone oil retention sutures [Case Report]

De Grande, Vittorio; Rosenthal, Ken; Reibaldi, Michele; Gentile, Ronald C
UNLABELLED:An 83-year-old pseudophakic woman fell and sustained an open-globe injury to her left eye with traumatic aniridia, aphakia, and a total retinal detachment. Visual acuity was light perception. After primary repair of the ruptured globe, the retina was reattached using silicone oil tamponade with placement of silicone oil retention sutures to prevent the oil from touching the corneal endothelium. Three months later, the oil was removed and with glare, aphakic correction improved the patient's visual acuity to 20/80(-1). A scleral-fixated artificial iris-intraocular lens (IOL) was subsequently implanted. During placement of the IOL through a temporal corneoscleral beveled incision into the anterior chamber, the silicone oil retention sutures supported the optic as it was scleral fixated. The retention sutures aided in the placement of the IOL and prevented it from subluxating and/or dislocating during surgery. Postoperatively, the corrected visual acuity was 20/50(-2). FINANCIAL DISCLOSURE/BACKGROUND:Dr. Rosenthal is a consultant to and clinical investigator for Ophtec USA, Inc. No other author has a financial or proprietary interest in any material or method mentioned.
PMID: 23079319
ISSN: 1873-4502
CID: 3572742

Pars Plana Vitrectomy With or Without Silicone Oil Endotamponade in Surgical Management of Endophthalmitis

Patel, Anu; Gentile, Ronald
PMID: 26107732
ISSN: 2162-0989
CID: 3567132

Modification of silicone oil retention sutures in aphakic eyes with iris loss-reply;

Gentile, Ronald C; Eliott, Dean
PMID: 23754118
ISSN: 1538-3601
CID: 3572752

External limiting membrane and visual outcome in macular hole repair: spectral domain OCT analysis

Landa, G; Gentile, R C; Garcia, P M T; Muldoon, T O; Rosen, R B
PURPOSE/OBJECTIVE:To investigate the relationship between postoperative visual acuity and integrity of the external limiting membrane (ELM) and inner segment-outer segment (IS-OS) junction layers, using spectral domain optical coherence tomography (SD-OCT), in eyes with macular holes (MHs) following surgical repair. METHODS:Medical charts of MH-operated cases were retrospectively identified and reviewed. The primary outcome measures were best-corrected visual acuity (BCVA) and the status of the ELM and IS-OS lines, using SD-OCT, at 6 weeks and 6 months postoperatively. RESULTS:Sixty-two eyes of 62 patients were included. At 6 weeks following surgery, out of 56 (90.3%) eyes with successful MH closure: 0 eyes showed the combination of disrupted ELM and continuous IS-OS layers; 7 eyes (12.5%) demonstrated continuity of both ELM and IS-OS (ELM(c)/IS-OS(c) group); 29 eyes (51.8%) had continuous ELM with discontinuous IS-OS layers (ELM(c)/IS-OS(d) group); and 20 eyes (35.7%) had discontinuities in both the layers (ELM(d)/IS-OS(d) group). The ELM(d)/IS-OS(d) group had the lowest visual gain at 6 months (P = 0.03). At 6 months, a restoration of the integrity of IS-OS layer was observed in 51.7% eyes in the ELM(c)/IS-OS(d) group and in 5% in the ELM(d)/IS-OS(d) group (P = 0.001). CONCLUSIONS:When both ELM and IS-OS layers showed disruptions 6 weeks postoperatively, a significantly worse BCVA was measured at 6 months, compared with the eyes with only IS-OS disruptions, detected 6 weeks following surgery. The integrity of the ELM layer appears to be a critical factor for the restoration of the photoreceptor layer and for predicting a successful visual outcome following MH repair.
PMCID:3259578
PMID: 21979863
ISSN: 1476-5454
CID: 3572732

Kyrieleis plaques in cytomegalovirus retinitis

Patel, Amar; Pomykala, Matthew; Mukkamala, Krishna; Gentile, Ronald C
PURPOSE/OBJECTIVE:The purpose of this study is to report a case of Kyrieleis plaques (segmental retinal periarteritis) associated with cytomegalovirus (CMV) retinitis. METHODS:A 47-year-old female with recently diagnosed human immunodeficiency virus and a CD4 count of 55 cells/µl presented with decreased vision and floaters in her left eye. Ophthalmic examination revealed an advancing border of white granular CMV retinitis extending into the macula. Intraocular aqueous specimen contained 420,000 copies/ml of CMV DNA by polymerase chain reaction. The patient was treated with intravitreal foscarnet and oral valganciclovir. RESULTS:Kyrieleis plaques involving the retinal arteries were noted on presentation and increased during the first 6 weeks of treatment as the retinitis faded. The plaques on fluorescein angiography did not leak fluorescein dye and slowly faded over 5 months. CONCLUSIONS:Kyrieleis plaques can be seen in the setting of CMV retinitis. These plaques can be differentiated from vascular sheathing and frosted branch angiitis by its occurrence only in the retinal arteries and the absence of leakage of fluorescein dye.
PMCID:3223340
PMID: 21833831
ISSN: 1869-5760
CID: 3572722

The expanded spectrum of focal choroidal excavation

Margolis, Ron; Mukkamala, Sri Krishna; Jampol, Lee M; Spaide, Richard F; Ober, Michael D; Sorenson, John A; Gentile, Ronald C; Miller, Joel A; Sherman, Jerome; Freund, K Bailey
OBJECTIVE: To describe the clinical and imaging findings in patients with focal choroidal excavation. METHODS: Retrospective observational case series. The medical records of 12 patients (13 eyes) with focal choroidal excavation were reviewed. Clinical histories and imaging findings (including color photography, fundus autofluorescence imaging, fluorescein angiography, indocyanine green angiography, spectral-domain optical coherence tomography, and enhanced depth imaging spectral-domain optical coherence tomography) were analyzed. RESULTS: The mean age of the patients was 45 years (range, 22-62 years). Four patients were Asian. Mean visual acuity was 20/31 (range, 20/20 to 20/100). Mean refractive error was -3.54 diopters (D) (range, 6.00 to -8.00 D). One patient had bilateral involvement. All patients manifested varying degrees of foveal pigmentary changes that were usually hypoautofluorescent on fundus autofluorescence images. Fluorescein angiographic findings varied with degree of retinal pigment epithelial alterations. Indocyanine green angiography revealed relative hypofluorescence. In 7 eyes, spectral-domain optical coherence tomography revealed outer retinal layers conforming to retinal pigment epithelial alterations within the excavation. In the other 6 eyes, spectral-domain optical coherence tomography revealed a separation between the outer retina and the retinal pigment epithelium within the excavation. In 7 eyes studied with enhanced depth imaging spectral-domain optical coherence tomography, there was no evidence of scleral ectasia. Mean choroidal thickness of the uninvolved choroid was thicker than normal at 319 mum (range, 244-439 mum). All lesions remained stable except for in 1 eye, which had findings of central serous chorioretinopathy and secondary type 2 (subretinal) neovascularization. CONCLUSION: Focal choroidal excavation is a newly described idiopathic entity in eyes having 1 or more focal areas of choroidal excavation. In some patients, there may be an association with central serous chorioretinopathy. Although most lesions remain stable, secondary choroidal neovascularization may occur.
PMID: 21670327
ISSN: 0003-9950
CID: 160592

Taut internal limiting membrane causing diffuse diabetic macular edema after vitrectomy: clinicopathological correlation [Case Report]

Gentile, Ronald C; Milman, Tatyana; Eliott, Dean; Romero, Juan M; McCormick, Steven A
AIMS/OBJECTIVE:To describe 2 cases of diffuse diabetic macular edema (DME) after diabetic vitrectomy caused by a taut internal limiting membrane (ILM), with clinicopathological correlation. METHODS:Interventional case series with immunohistochemical analysis. RESULTS:Two patients were referred for unresponsive diffuse DME after pars plana vitrectomy with removal of the posterior hyaloid. Clinically, a taut ILM was noted over the fovea, and its removal resulted in rapid and long-term resolution of the edema, confirmed by optical coherence tomography with visual acuity improvement. Histopathology with immunostaining revealed a segment of ILM with an inner monolayer of cytokeratin-positive (retinal pigment epithelial cells) and/or glial fibrillary acidic protein-positive cells with smooth muscle actin immunoreactivity. CONCLUSIONS:A taut ILM can cause diffuse DME after vitrectomy, and its removal can restore the normal foveal contour and improve visual acuity. Tangential tractional forces from contractile cells propagated across the fovea via the ILM appear to be the etiology.
PMID: 21597307
ISSN: 1423-0267
CID: 3572712