This study evaluates the efficiency of fluid-air exchange on the reattachment of the retina and clarifies the possibility that a posterior retinotomy is a cause for intra- and postoperative complications. A consecutive series of 211 eyes with retinal detachments due to P.V.R. (47%), diabetic traction, perforating trauma, macular hole or giant tears is presented. All eyes underwent pars plana vitrectomy, fluid-air exchange, internal drainage of subretinal fluid, laser endophotocoagulation and scleral buckling of the tears; 56% of the eyes were phakic and 55% underwent a posterior retinotomy, 54% underwent tamponade with C3F8 and 46% with silicone oil. Intraoperatively the retina was completely flattened in 91% cases. The causes of incomplete reattachment were residual membranes (6.6%), poor visualization (1.4%) and suprachoroidal hemorrhage (1%). These complications were isolated as being the cause of the bad final results (p < 0.001). Postoperatively, the retina remained attached in 66% of cases after the first procedure and with further surgery in 81% (mean follow up 16 months). Best corrected visual acuity was improved in 73% of eyes, unchanged in 17%, and worse in 10%. Complications were retraction of the retinotomy site in 3 cases and peripheral choroidal hemorrhage in 4 cases. We concluded that fluid air exchange with internal subretinal fluid drainage was an efficient and safe technique even if a posterior retinotomy was necessary.
A 57-year-old man was followed up for multiple myeloma with no lytic bone lesions. During a septicaema, he presented with a pathological fracture of the patella. Despite a poor haematological status, he received surgical treatment, which allowed diagnosis of haematogenous osteomyelitis of the patella. The outcome was favourable, with a 6-week plaster immobilization after cerclage and 4 months of intravenous antibiotic therapy. This case emphasizes the fact that one well-known cause of bone lesions may lead to an erroneous diagnosis. The successful clinical course suggests that accurate therapeutic management may be discussed in haematological malignancies when intensive-care support is available.
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