We describe the surgical excision of submacular scar in end-stage age-related macular degeneration and transplantation of autologous and homologous retinal pigment epithelial (RPE) cells. The technique involves the preparation of a large retinal flap encompassing the macula and the arcades, removal of the submacular scar, and replacement of the RPE cells, using either an autologous pedido graft or homologous RPE cells and Bruch's membrane. Fourteen months following the procedure, visual acuity in a patient with a pedicle graft had improved from counts fingers to 20/400 and the patient fixated over the transplanted RPE cells. After 10 months, a homologous graft in a second patient had become encapsulated with a fine subretinal membrane without neovascular tissue; visual acuity had not improved. No intraoperative or postoperative complications resulting from the surgery occurred in either patient.

The objective of this paper is to describe outcomes of endovascular therapy in patients with symptomatic common femoral artery (CFA) lesions. Symptomatic atherosclerotic disease of the common femoral artery is an uncommon clinical entity, and there is no consensus regarding the suitability of catheter-based therapy. We reviewed the records of 26 consecutive patients treated with catheter-based therapy for symptomatic CFA lesions between 1994 and 2009. Angiographic success and procedure success were obtained in all vessels and in all patients. At 1 year, 100% (16/16) of the claudication patients and 70% (7/10) of the critical limb ischemia (CLI) patients maintained clinical success. The anklebrachial index (ABI) significantly improved from a baseline of 0.47 ± 0.18 to 0.77 ± 0.18 (p < 0.001) after the procedure. At their most recent clinic visit (31 months ± 14 months), clinical success was maintained in 100% of the claudication patients and in 70% (7/10) of the CLI patients. During the follow-up period, femoral vascular access for an unrelated procedure was obtained through the CFA stent. In conclusion, patients with symptomatic CFA atherosclerotic disease obtained excellent clinical outcomes with angioplasty with stenting. We found that angioplasty with stenting of the CFA did not preclude future CFA vascular access. Our data suggest that catheter-based therapies should be considered as an option to open surgery in selected patients with symptomatic CFA disease.

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(BrJ Ophthalmol 1992; 76: 525-528)

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Retinal hemorrhages occur with increased frequency in neonates following prolonged or difficult labor, especially if associated with primipara, surgical or mechanical intervention, low Apgar scores, perinatal hypoxia, low birth weight or coagulopathy. When involvement occurs peripheral to the arcades resolution occurs generally without sequelae. Hemorrhages involving the macula are much more serious since resolution in these cases may result in degenerative changes or an exudative or glial scar, resulting in amblyopia and possible strabismus. Early examination is warranted in high-risk infants in order to facilitate intervention and the prevention of more serious visual sequelae.

We used tissue plasminogen activator (tPA) to aid in the surgical evacuation of subretinal hemorrhages. Subretinal hemorrhage secondary to a ruptured retinal macroaneurysm was treated in two patients. The surgical technique involved using a micropipette to fashion a small retinotomy through which tPA was injected into the subretinal space and through which the dissolved clot was removed. Visual acuity improved from counts fingers to 20/50 in one patient and from counts fingers to 20/70 in the other. Three additional patients, with massive subretinal hemorrhages secondary to age-related macular degeneration, were similarly treated. In one, visual acuity improved from counts fingers to 20/400; in two others, visual acuity was stabilized; in the first patient, at 20/300, and in the second patient at 20/400. The use of tPA minimizes surgical manipulation of the sensory retina and greatly reduces the size of the retinotomy required for evacuation of subretinal blood.

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