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Internal gas tamponade is employed with no episcleral buckle and can be combined with or without a vitrectomy for the surgical treatment of some forms of retinal detachment. These techniques are for forms of retinal detachment with no proliferative vitreoretinopathy that are being operated upon for the first time and have one or several breaks located on the superior half of the retina. We compare these two techniques, their anatomical results, and their complications. [ABSTRACT FROM AUTHOR]

Purpose: Heidelberg retina tomograph II (HRTII) examination was performed with cornea module in one patient with Acanthamoeba keratitis (AK) to provide images detailing characteristic findings of the disease., Methods: A 34-year-old woman presented with clinical signs and symptoms of AK. HRTII with cornea module was performed and the patient underwent laboratory investigations., Results: HRTII examination with cornea module revealed numerous 20-26-micro m diameter high-contrast round particles within the corneal epithelium and anterior stroma, resembling Acanthamoeba cysts. Stellate cells as well as ovoid irregular objects, possibly inflammatory cells, trophozoites, altered cysts, or activated keratocytes, were also present in the area of stromal infiltrates. Laboratory investigations confirmed the diagnosis of AK., Conclusions: HRTII cornea module can be helpful in the diagnosis of AK by identifying acanthamoeba cyst-like structures in the cornea. This technique also has potential uses in monitoring the efficiency of anti-infective treatment.

Purpose: To evaluate the clinical outcome and medical management in a series of patients diagnosed with acute retinal necrosis., Material and Methods: Between 1993 and 2000, 22 patients suffering from acute retinal necrosis were referred to our department. We retrospectively reviewed the clinical course, delay between diagnosis and first clinical manifestation, biological profiles, treatment and complications., Results: All patients had vitreous inflammation; retinitis was seen upon examination in 82% of the cases. Nevertheless, for six patients (27% of the cases), failure to recognize the diagnosis led to delay (mean, 5.5 days) between the first ophthalmological examination and antiviral therapy. Nineteen patients underwent laboratory evaluation, and virological diagnosis was made in 16 of them: varicella zoster virus was found in 11 cases, herpes simplex type 1 in three cases, and herpes simplex type 2 and cytomegalovirus in one case each. Nine patients were treated with a combination of aciclovir and foscarnet and 13 with aciclovir alone. Among the 16 patients who received aciclovir, one did not respond to therapy after 2 days and was cured only after foscarnet was added. Recurrence occurred at the end of treatment in only one patient. Retinal detachment complicated the course for 11 patients and was always associated with proliferative vitreoretinopathy. Among those, seven of the ten patients who accepted surgery were successfully treated. Eleven out of 22 patients had a final visual acuity up to 20/200 and two up to 20/40., Conclusion: In our series, acyclovir alone was sufficient to cure the majority of cases. Even with antiviral therapy, the prognosis of acute retinal necrosis remains poor. Retinal detachment is the main complication.

Purpose: To analyze the features of retinal detachment (RD) occurring after cataract surgery performed by Kelman phacoemulsification (KPE) and to identify any potential correlations between KPE intraoperative complications and the features of RD (incidence apart) as well as the final visual outcome., Design: Interventional consecutive case series., Methods: Retrospective review of 114 eyes of 114 consecutive patients with RD occurring after KPE and followed for 6 months or more after surgery., Results: Removal of posteriorly dislocated lens fragments during KPE by pars plana vitrectomy (PPV) was associated with a significantly shorter time interval between KPE and RD (3.89 vs. 15.7 months, P =.0044). Once RD occurred, no other statistically significant correlation between its features or the final visual outcome and KPE intraoperative complications (posterior capsular rupture, vitreous loss, posteriorly dislocated lens fragments) was detected. The overall anatomic reattachment rate was 94%. Only redetachment associated with the development of proliferative vitreoretinopathy (PVR) was significantly correlated with ultimate anatomic failure (P =.0036). A best-corrected visual acuity of 20/60 or better was achieved in 58 out of 114 eyes (51%). Three variables were independently correlated with visual results: more extensive RD (P =.0001), redetachment associated with the development of PVR (P =.0029), and failure to identify retinal breaks (P =.0114)., Conclusions: Posterior capsular rupture and vitreous loss during KPE do not seem to affect the features (incidence apart) or the final visual outcome of RD occurring afterwards, except for a shorter time interval between KPE and RD in eyes that underwent PPV to remove posteriorly dislocated lens fragments.

Purpose: To assess the long term anatomic and functional follow-up of large relaxing retinotomies performed with liquid perfluorocarbon in severe vitreoretinal proliferation surgery., Methods: A large relaxing retinotomy (more than 90 degrees) was realized in 40 eyes of 39 patients for anterior vitreoretinal proliferation (30 rhegmatogen retinal detachments, 8 intraocular foreign bodies, 2 ocular traumas). Follow-up was always longer than 6 months. Vitreoretinal proliferation secondary to ischemic or inflammatory retinopathy were excluded. The liquid perfluorocarbon was perfluorodecalin and was used for all eyes, as well as final intraocular tamponade by silicon oil ended every intervention., Results: Sixty-seven % of patients had already had a former vitrectomy, and 75% a retinal surgery. Mean size retinectomy was 170 degrees. Nine patients underwent a new vitreoretinal procedure which included in 7 cases a necessary new retinectomy. Silicon oil could be removed in 55%, after a mean period of 6, 5 months. Mean time follow-up was 13 months. At the end of follow-up, 80% of retina were attached. Visual acuity remained low with 25% equal to 1/20 or more; 45% of eyes increased their acuity, 25% remained stable and 30% worsened. Main complications were epimacular proliferation, keratopathy and increased intraocular pressure., Conclusion: Relaxing retinotomies provide satisfying anatomic results and allow a preservation of some visual function. The use of liquid perfluorocarbons facilitates their realization. The initial size of retinectomy should be sufficient.

Severe ocular injuries may occur during a new war game in France, called "paint ball". A high pressure carbon dioxide powered gun fires pellets filled with dye. The pellet is coated with a semisoft gelatin and filled with a "nontoxic" dye mixture. We observed six consecutive cases during a ten month-period. In two cases (both due to a shot at point-blank range), mature cataract occurred. Consequently, lensectomy was achieved, preceded by a prophylactic scleral buckle. In one case, a retinal detachment due to a localized retinal necrosis occurred. With endocular surgery and temporary silicone oil tamponade, we achieved retinal reattachment. The three remaining cases did not require surgery. They suffered blunt ocular lesions of the anterior and/or posterior segment. One of these cases showed permanent tattooing to the cornea. After a mean follow-up lasting six months, all patients had, at least, a 40/100 vision. Some recommendations can reduce the incidence and the severity of ocular injuries due to paint balling. Firstly, eyeguards (made of polycarbonate) must be worn before receiving guns and pellets. Secondly, a kind of safety gun stopper can avoid gun firing by accident apart from practices. Thirdly, according to others publications, alcohol or drugs should not be consumed before the game. Lastly, gun fire at point-blank range or toward the head must be forbidden. We hope that wide distribution of such recommendations will help reducing the frequency of this type of ocular traumas.

Prophylactic retinal detachment with laser photocoagulation is ineffective for some vitreo-retinopathies in which vitreous traction is predominant (non traumatic giant retinal tears, Wagner Stickler's syndrome, Marfan's syndrome...). Twenty eyes were operated by prophylactic episcleral circular buckling. In eighteen cases, the fellow eyes had previously presented a retinal detachment. We performed two types of encircling buckle. We only observed minor operative complications, without any functional consequences, attesting to the innocuity of this type of treatment. But we have to wait for vitreous detachment to know the efficacy of this prophylactic treatment. This detachment occurs at different time in each vitreoretinopathy, but with a specific rate of retinal detachment for each pathology.

Surgical procedures used today to treat retinal detachment with an inverted giant retinal tear have considerably improved. Vitrectomy associated with perfluorocarbon liquid injection has replaced old procedures necessary to unfold the inverted retinal flap. Seventeen patients were operated on with an anatomic success rate of 76% and an average follow up of fifteen months. The successive surgical stages (lensectomy, retinopexy, internal tamponade, circular scleral buckle) are discussed. Proliferative vitreoretinopathy is the maill postoperative complication explaining the high rate of reoperation (56%). In high myopia, a prophylactic circular scleral buckle of the fellow eye has become systematic.

Removal of ten encircling scleral buckles and section with relaxation of nine encircling buckles are displayed. Only episcleral buckles with oval or round silicone sponge exoplants are analyzed. Besides infection (three eyes), removal or section was required because of too tight encircling elements (16 eyes). Anterior buckles created by invagination of encircling elements, without horizontal shortening avoids this risk of constriction.

Composition of gas generated by the utilisation of Nd-Yag laser in eyes filled with silicone oil were studied by means of an in vitro optical breakdown in silicone oil. The newly formed gas were analysed by headspace gas chromatography on two separate columns. The secondary gas were mainly methane and ethylene which might be potentially harmful to the ocular tissues.

The authors analyse the operative results of 92 cases of retinal detachment with macular hole, treated by internal tamponade, since 1976. Three technics were used: vitrectomy + silicone oil injection (75 cases), vitrectomy + SF6 gas injection (9 cases), intra-ocular liquid suction + SF6 gas injection (8 cases). Silicone vitrectomy is particularly advisable in the case of large, old retinal detachment with proliferative vitreoretinopathy. This form of treatment is imperative when there is no hope of a satisfactory postoperative positioning, or after an unsuccessful gas treatment due to epiretinal macular membrane. Suction gas is a new and simple technique which is recommended when the macular hole is isolated and without epiretinal membranes. A lattice pattern argon-laser retinopexy is performed, by means of a series of laser impacts at the posterior pole, up to the edge of the macular hole. Treatment of isolated macular holes in a flexible retina by silicone vitrectomy achieved a 78.5% success rate; suction + gas achieved a similar success rate; this last method appears to be the ideal first choice for most of the cases, i-c the two failures which were subsequently turned into successes by silicone vitrectomy.

In less than 15 years old children 33 post-traumatic retinal detachments were operated during these last four years (postocular wound retinal detachment with or without intraocular foreign body, post contusion retinal detachment). A very close posterior pole monitoring of these high risk eyes is mandatory to prevent late diagnosed retinal detachments. The post-contusion retinal detachment surgery good results are quite opposite to the bad results of the postocular injury retinal detachment with intraocular foreign body and secondary proliferative vitreoretinopathy. These retinal detachment severity must lead to a strict prophylactic laser therapy of all the traumatic eyes.

40 patients with an operable epiretinal membrane were divided into two groups: patients of group 1 were operated without intraocular silicone oil, patients of group 2 were operated with silicone oil. The operation was carried out with simple instruments. The percentage of anatomic success (complete removal in 62% of cases) and functional success (increase of visual acuity in 58% of the cases) opens new perspectives in retinovitreous microsurgery.