ISSN:1040-8738    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The most important ocular opportunistic infection in patients with AIDS is cytomegalovirus (CMV) retinitis. Management of CMV retinitis has become complex, as the life expectancy of many patients has increased exponentially. Most retinal detachments in CMV retinitis are rhegmatogenous in nature. Because of atrophic changes in the retina and alterations in the vitreous, surgical management of these detachments leads to a stepladder approach. Options include laser demarcation, scleral buckle, and vitrectomy with silicone oil. In some patients, a combination of all three procedures may be necessary. Management in all cases should be individualized, with the realization that failure of retinal reattachment may occur.

ISSN:1040-8738    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Silicone plate intraocular lenses do not adhere to the lens capsule and are placed under tension by postoperative contraction of the capsular bag. Recent reports suggest that a defect anywhere in the capsular bag can potentially lead to delayed posterior dislocation of silicone plate intraocular lenses. These implants are more difficult to grasp and manipulate inside the eye than traditional polymethylmethacrylate lenses and therefore, require special microsurgical techniques. Given sufficient anterior capsular support, posteriorly dislocated silicone plate implants can be repositioned in the ciliary sulcus and do not necessarily require intraocular lens exchange. With proper vitreoretinal surgical techniques, posteriorly dislocated silicone plate intraocular lenses can be repositioned or exchanged with excellent visual results and an acceptably low complication rate.

ISSN:1040-8738    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Macular degeneration can result in legal blindness among those with progressive myopia and posterior staphyloma. Programmed photoreceptor death, apoptosis, is operative in some. Electrophysiologic and psychophysiologic techniques can permit detection of functional abnormalities before lesions become clinically apparent. Macular choroidal neovascularization occurs more often in those with moderate staphyloma than in those with advanced atrophy in the posterior pole. Indocyanine green angiography is improving our understanding of this complication, which has been correlated with an increased number of posterior choroidal drainage systems. One study suggests that surgical extirpation of the neovascular network may be beneficial in some, but the role of scleroplasty procedures in prevention remains uncertain. Experimental myopia modeling continues apace, but specific molecular pathways and their genomic control are yet to be elucidated. Clinically, clear lens extraction and biphakia techniques are under investigation to offer refractive relief to the severely myopic patients who are not candidates for current keratorefractive methods.

ISSN:1040-8738    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Subretinal choroidal neovascularization is an important cause of visual loss in adults. Removal of choroidal neovascular membranes using relatively new techniques of subretinal surgery holds promise for improving or stabilizing vision in some patients. A number of factors have been proposed that may affect the outcome of subretinal surgery for choroidal neovascularization, including the degree of involvement of Bruch's membrane, the location of the neovascular complex relative to the retinal pigment epithelium and Bruch's membrane, the location of the ingrowth site, and the etiology of the membranes. Although the surgical techniques are relatively refined, the indications for removal of choroidal neovascular membranes are still under investigation. This article reviews the recent and past literature and summarizes the authors' specific recommendations regarding present indications for removal of choroidal neovascular membranes.

ISSN:1040-8738    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The management of uveal metastasis is focused on both the patient's systemic condition and the ocular condition. If there is evidence of systemic metastatic disease, then treatment of the nonocular and ocular metastatic tumors consists of chemotherapy, hormone therapy, immunotherapy, multiple-site radiotherapy, or observation. If there is no evidence of systemic involvement, then whole-eye treatment with chemotherapy, hormone therapy, immunotherapy, radiotherapy, or, rarely, enucleation is considered. For solitary uveal metastases, plaque radiotherapy is offered, and if the tumor is small, laser photocoagulation, resection, or thermotherapy can be used. Inactive uveal metastases are managed by periodic observation, but active uveal metastases often produce visual loss, secondary glaucoma, and pain, therefore, treatment is usually indicated. Radiotherapy is quite effective for control of most uveal metastasis. The technique of external beam radiotherapy is most often used and is delivered over a 3- to 4-week period in an outpatient setting. For those patients who fail chemotherapy, hormone therapy, immunotherapy, or external beam radiotherapy or those patients with a solitary uveal metastasis, plaque radiotherapy is an alternative method. Plaque radiotherapy is focal radiotherapy delivered to the eye in an inpatient setting over a relatively short period of approximately 3 days. Plaque radiotherapy provides satisfactory tumor control, even in eyes that fail other treatments. Side effects from plaque radiotherapy are comparable to those from external beam radiotherapy. Importantly, the plaque treatment requires less of a time commitment for these patients with a limited life expectancy.

ISSN:1040-8738    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Age-related macular degeneration (AMD) is one of the leading causes of blindness in the world. Most of the severe vision loss associated with AMD is due to the development of choroidal neovascularization (CNV). The specific causes of AMD and in particular, its neovascular phase, remain uncertain. During the past two decades a number of large prospective clinical trials, observational epidemiologic studies, and population- based cohort studies have furthered our understanding of this blinding ocular condition. The Macular Photocoagulation Study has received praise for its many contributions in the laser treatment of neovascular complications of AMD; however, these trials have made other significant contributions by helping to better define the natural history of AMD, and in particular, risk factors for the development of CNV in eyes with non-neovascular disease. This type of information may provide significant clues for researchers regarding disease pathogenesis and identify a high-risk group in whom to target new treatment strategies. For patients currently diagnosed with macular degeneration, this information can lead to a better understanding of their condition and a more accurate prognosis of their ocular health and vision status. This article reviews information from a variety of sources to investigate incidence rates and risk factors for the development of CNV in the fellow eye of patients with AMD and unilateral neovascular maculopathy.

ISSN:1040-8738    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The results of the Central Vein Occlusion Study guide the management of complications of macular edema and neovascularization. Panretinal photocoagulation was shown to be beneficial for eyes with at least 2 hours of iris neovascularization or any angle neovascularization. Grid-pattern laser photocoagulation for perfused macular edema did not show a significant beneficial effect. Recently, several reports have suggested restoring venous outflow by 1) creating a chorioretinal anastomosis, 2) administering recombinant tissue plasminogen activator, 3) cannulating the retinal vein transvitreally, or 4) transecting the posterior scleral ring.

ISSN:1040-8738    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Radiotherapy has become increasingly important for the treatment of complicated choroidal hemangiomas. In recent years, a broad spectrum of different radiotherapeutic options that either replace or complement the conventional therapeutic approach by photocoagulation has been recommended. This article reviews the various treatment modalities and their indications with a special focus on the long-term outcome of low-dose external beam irradiation.

ISSN:1040-8738    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The frequency of inadvertent retinal perforation during routine strabismus surgery has been debated, as patients with such complications are usually asymptomatic. Recent prospective clinical studies indicate a retinal perforation rate of 0.4 to 2.8 per 100 cases using modern surgical techniques and materials. Laboratory studies support close follow-up without treatment as an acceptable mode of management in the majority of these cases.

ISSN:1040-8738    

出版商:OVID    

年代:1998

数据来源: OVID