Aim: To describe the results of combined phacoemulsification, insertion of posterior chamber intraocular lens (PCIOL), and pars plana vitrectomy for patients with macular hole. Methods: A case series of 89 consecutive patients with macular hole who underwent combined phacoemulsification, insertion of PCIOL, posterior capsulectomy, and pars plana vitrectomy. Results: 80 of 89 patients (89%) had their holes closed with the combined surgery. Four of the nine patients who failed had their holes closed with one further procedure. Of the 89 patients operated on, 61 (65%) had vision of 20/40 or better. Three patients (3%) had Snellen acuity of less than 20/400 postoperatively. Three patients (3%) developed retinal detachments, one with proliferative vitreoretinopathy (PVR). Eight patients (9%) developed CMO. Three patients developed late reopening of their macular holes after remaining closed for 9 months or more. Conclusion: Combined phacoemulsification, insertion of PCIOL, and pars plana vitrectomy surgery can be used to treat macular holes. Combining cataract surgery with vitrectomy surgery may prevent a later second operation for post-vitrectomy cataract formation. M acular hole surgery has been shown to be effective in closing macular holes. However, despite closing the macular hole, phakic patients frequently develop progressive nuclear sclerosis after the surgery.1 After vitrectomy, 75% will develop visually significant cataracts within 1 year and 95% within 2 years and require subsequent cataract surgery.2 Before cataract removal, vision often decreases as a result of progressive nuclear sclerotic and posterior cortical changes.2 3 To address this problem, we propose the use of combined cataract surgery and intraocular lens implantation with the initial vitrectomy. This paper describes our experience in 89 eyes with macular hole.
PATIENTS AND METHODSBetween August 1994 and June 1999, 89 eyes with stage III or stage IV macular holes underwent pars plana vitrectomy repair combined with phacoemulsification and insertion of posterior chamber intraocular lens (PCIOL).Our operative technique comprised the following. All operations were done under monitored anaesthesia care with retrobulbar blocks. The lens was removed by phacoemulsification and a posterior chamber intraocular lens inserted. Forty six patients received all PMMA lenses through a scleral tunnel incision, and 43 patients received acrylic lenses through a clear corneal incision. The scleral wounds were all closed with one cross stitch nylon suture. Corneal wounds were left sutureless unless a leak was discovered. In seven patients, the IOL was placed into the ciliary sulcus because of concerns about an intact posterior capsule.
Central retinal vein occlusion is a common cause of permanent visual loss. Work up and laboratory evaluation of patients requires the clinician to rule out hypertension, diabetes, hyperlipidemia, and glaucoma. Patients without an identifiable risk factor are often subject to extensive testing for primary and secondary thrombophilias. The purpose this paper is to review the literature to determine which of these tests is associated with central retinal vein occlusion. Antiphospholipid antibodies and elevated plasma homocysteine levels appear to be the tests associated most commonly in patients with central retinal vein occlusion in most controlled studies. Primary thrombophilias are found rarely when screening patients with central retinal vein occlusion. Extensive testing for thrombophilias is not warranted in the vast majority of patients with central retinal vein occlusion. Older patients with any of the common vascular risk factors do not require thrombophilic screening. By carefully selecting the patients who are evaluated for thrombophilias, the likelihood of finding true-positive tests is increased.
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