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PURPOSE: We studied reversible loss of light perception after vitreoretinal surgery to show that functional vision can return in some patients. METHODS: We reviewed the medical records of seven patients who had postoperative reversible loss of light perception in the eye that underwent vitreoretinal surgery. Differences in the postoperative courses and interventions were studied. RESULTS: Five of the seven patients had diabetes mellitus but none had hypertension. The indications for vitreoretinal surgery were severe proliferative diabetic retinopathy in five patients and retinal detachment with advanced proliferative vitreoretinopathy in two patients. Seven patients had reversible loss of light perception within the first three postoperative days. Six of the seven patients had an intraocular pressure greater than 26 mm Hg at the time the eye had no light perception. Decreasing the intraocular pressure was associated with return of light perception in five of seven patients. Return of useful vision was gradual. Four of seven patients had a visual acuity of 20/400 or better one month after surgery, and all seven had a visual acuity of 20/400 or better three months after surgery. Visual acuity in four eyes improved further to 20/70 or better at six months or more after surgery. CONCLUSION: Reversible loss of light perception after vitreoretinal surgery does occur in some patients. Monitoring vision and intraocular pressure is important because prompt treatment may assist in the recovery of functional vision.

A complication of vitrectomy (removal of a portion of the vitreous, a jelly-like substance located behind the lens of the eye) may be the formation of intraocular fibrin (a stringy insoluble protein, and product of the clotting process). Formation of a fibrin membrane on the pupil may cause a form of glaucoma, and fibrin in the vitreous or on the retina can contract, causing retinal detachment. The incidence and risk factors for postvitrectomy intraocular fibrin formation have not been determined. To determine the incidence of this complication and identify patients at risk, 194 patients undergoing vitrectomy were studied. Indications for vitrectomy included retinal detachment, proliferative disease, vitreous hemorrhage, macular pucker, and trauma. Intraocular fibrin formation occurred in 62 patients (32 percent); of these, 24 patients developed severe fibrin formation. Preoperative factors found to be predictive of severe fibrin formation were: severe flare in the anterior chamber (in front of the iris), an indication of breakdown of the blood-aqueous barrier: a scleral buckle from previous retinal detachment surgery; and poor vision preoperatively. An anterior epiretinal membrane dissection during surgery was also associated with fibrin formation. These results may be helpful in determining methods of preventing postvitrectomy fibrin formation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Although the Farnsworth-Munsell 100-hue test is a sensitive means of evaluating congenital and acquired color vision deficiencies, using the data it provides involves complex calculations. We have developed two nomograms that permit the clinician to determine quickly and easily whether a given score is normal for the patient's age and whether the difference between fellow eyes is within the normal range.

We injected 25 μg of recombinant tissue plasminogen activator into the anterior chamber or the vitreous cavity in seven aphakic patients for pupillary block caused by a complete fibrin pupillary membrane that formed after vitrectomy with fluid-gas exchange. Progressive fibrin deposition resulted in pupillary block by three days after vitrectomy surgery in six patients, and seven days after vitrectomy in one patient. The pupillary block was associated with increased intraocular pressure in six patients. Tissue plasminogen activator was injected via the corneoscleral limbus in five patients and via the pars plana in two patients. In all patients, injection of tissue plasminogen activator resulted in complete fibrinolysis of the fibrin pupillary membrane within four hours, associated with a deepening of the anterior chamber. In the six patients with increased intraocular pressure at the time of tissue plasminogen activator injection, dissolution of the fibrin membrane was associated with a decrease in pressure. In all patients, intraocular pressure had returned to normal by three days after the injection. No complications were associated with the injection.