ISSN:1040-8738    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Macular translocation is a term used to describe any surgical procedure that involves the deliberate detachment of the retina with subsequent repositioning of the macula to a new location relative to the underlying retinal pigment epithelium. By moving the fovea away from abnormal pigment epithelium and/or choroid and repositioning it over more normal tissue, macular function can be stabilized or improved. Various techniques have been developed to accomplish this movement. Although this approach holds great promise for selected conditions (in particular, subfoveal choroidal neovascularization), the optimal technique to be used and the long-term prognosis are uncertain.

ISSN:1040-8738    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Photodynamic therapy is a relatively selective form of treatment for choroidal neovascularization. Unlike standard laser photocoagulation, photodynamic therapy can close choroidal neovascularization with minimal or no detectable damage to surrounding tissues. Therefore, it allows the clinician to treat subfoveal choroidal neovascularization without immediately adversely affecting central visual function. Several dyes for photodynamic therapy have been under various stages of formal clinical investigation. There is now mounting evidence that shows that photodynamic therapy with at least one of these dyes can significantly reduce the risk of visual loss in eyes with subfoveal choroidal neovascularization from age-related macular degeneration. This form of treatment promises to have a major, favorable impact on public health in areas of the world in which age-related macular degeneration is common.

ISSN:1040-8738    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Laser therapy has been shown to be of benefit in eyes with branch retinal vein obstruction. More recently, pars plana vitrectomy with adventitial sheathotomy has also been shown to be of benefit, particularly for those eyes with branch retinal vein obstruction and poorer vision. The technique and results of this new therapeutic modality are discussed herein.

ISSN:1040-8738    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Grid laser therapy has been demonstrated to be of benefit for the treatment of diabetic macular edema. The purpose of the present study was to determine the cost-effectiveness of grid laser therapy for the treatment of diabetic macular edema. The analysis was performed from the perspective of a third-party insurer. Decision analyses and cost-effectiveness analyses were performed by incorporating the data from the Early Treatment Diabetic Retinopathy Study, expected longevity data, and patient-based utilities. Various sensitivity analyses were performed to determine the robustness of the models. Laser treatment conferred an overall improvement in quality-of-life adjusted years of approximately 3 months over the duration of disease for a hypothetical patient. The unadjusted cost per quality-of-life adjusted year (QALY) was US$3,101. Net present value analysis demonstrated that the cost per QALY could increase to $3,655, assuming a 5% discount rate. Overall, grid laser photocoagulation for diabetic macular edema is a very cost-effective treatment based on the results of this cost–utility analysis.

ISSN:1040-8738    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Surgical management of choroidal neovascularization may offer patients with subretinal membranes another therapeutic option. Current techniques allow extraction of subretinal membranes, but not all patients have favorable clinical outcomes with such an approach. This article reviews the current state of subretinal surgery and attempts to summarize those characteristics that may predict good surgical results. Vitreoretinal surgical techniques for the management of subretinal membranes are reasonably well established. Certain characteristics of choroidal neovascularization have been identified that may suggest favorable surgical outcomes; however, no randomized prospective data are yet available to show the role of these procedures. The National Institutes of Health–sponsored Submacular Surgery Trials are designed to determine whether surgery or observation is better for eyes with subfoveal choroidal neovascularization in presumed ocular histoplasmosis syndrome or age-related macular degeneration and in eyes with age-related macular degeneration–associated hematomas.

ISSN:1040-8738    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Patient selection and surgical experience have increased the closure rates for idiopathic macular holes to more than 90%. The best surgical results are obtained in patients with acute idiopathic macular holes. Biologic adjuvants are not as useful as they were once thought to be. Internal limiting membrane peeling and endolaser are useful for failed macular holes, reopened macular holes, and chronic macular holes. Internal limiting membrane peeling may not be necessary for acute idiopathic macular holes, provided a complete posterior vitreous detachment is created. Silicone oil tamponade should be considered in patients who have positioning problems or air travel plans. Humidifying the infusion air may reduce postoperative visual field defects. Every patient with a macular hole should be given the opportunity to improve his or her vision with macular hole surgery.

ISSN:1040-8738    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Visual recovery after successful surgery for the macula-off rhegmatogenous retinal detachment continues to be an important topic for ophthalmologists. Recent studies have shown that despite the intuitive notion regarding outcomes in macula-off detachment, there is no improvement in final visual acuity despite more expedient repair within the first week. Macula-off detachments can therefore be treated with less urgency and can wait for the next scheduled available operating room time. Surgeons involved in retinal detachment surgery should be aware that visual function based on acuity testing may continue to improve in the long term, most notably in those with the following patient characteristics: younger age, no or mild myopia (less than −5.00 D), and shorter duration of macular detachment (30 days or less).

ISSN:1040-8738    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Pneumatic retinopexy is a retinal reattachment procedure involving transconjunctival injection of gas into the vitreous cavity, combined with cryotherapy or laser retinopexy and followed by postoperative positioning. Although generally a safe procedure, it may be associated with certain adverse outcomes. These most commonly include misplaced gas injection, subretinal gas, vitreous hemorrhage, new retinal breaks, failure to reattach the retina, proliferative vitreoretinopathy, and delayed reabsorption of subretinal fluid. Less common problems include endophthalmitis, macular folds, angle-closure glaucoma, and macular hole. In most cases, complications are successfully managed, and a favorable outcome is achieved.

ISSN:1040-8738    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Patients with thick submacular hemorrhage complicating age-related macular degeneration and other disorders typically have a poor visual prognosis. A new outpatient procedure, consisting of intravitreal injection of tissue plasminogen activator and gas followed by brief prone positioning, is effective in displacing thick submacular blood and facilitating visual improvement in most patients. Injection of gas alone also appears to be effective in many eyes. The procedure is technically simple and the rate of serious complications appears to be acceptably low. Although the final visual outcome is often limited by progression of age-related macular degeneration, significant and stable visual recovery is possible in selected eyes. Prospective clinical trials are needed to clarify the role for intravitreal tissue plasminogen activator and to provide definitive outcome comparisons with other management approaches.

ISSN:1040-8738    

出版商:OVID    

年代:2000

数据来源: OVID