A 50-year review of minimal extraocular surgery for retinal detachment: five hurdles had to be overcome for its acceptance.

The non-drainage segmental buckling procedure by Custodis for repair of a retinal detachment harboured serious postoperative complications. To amend this new technique to a minimal extraocular surgery with practically no intra- nor postoperative complications, four hurdles had to be overcome: diathermy was replaced by cryosurgery, polyviol plombe by the silicone sponge, eight rules were defined to find the break in a primary retinal detachment or in an eye up for reoperation and a subsequent 15-year follow-up of anatomical and functional results confirmed that minimal extraocular surgery for repair of retinal detachment suffices for optimal long-term results without harbouring secondary complications threatening regained visual acuity.

Primary retinal detachment: A review of the development of techniques for repair in the past 80 years.

Background/purpose: The evolution of present surgical techniques for reattaching a primary retinal detachment will be reviewed starting from 1929, and the present techniques analyzed in regard to their morbidity, reoperation, and long-term visual function.

Methods: Literature of retinal detachment operations during the past 80 years is reviewed, of which the author has first-hand experience during the past 40 years. There had been a change from surgery of the entire detachment to a surgery limited to the retinal break and a change from extraocular to intraocular surgery.

Retinoschisis associated with optic nerve pits. 1988.

Stereoscopic transparencies studied with magnification and projection suggest that the retinal elevation that communicates with optic pits is frequently a schisislike separation of the internal layers of retina. Thirteen of 15 eyes with optic pits and maculopathy fit the schisis pattern. Separation of the outer layers of the retina is a secondary phenomenon that starts in the macula.

Surgical techniques for repair of primary retinal detachment: Part II. Comparison of present techniques in relation to morbidity.

Purpose: To compare present surgical techniques for repair of primary retinal detachment. AIM of each technique is closing the retinal break(s), but the approach is either extraocular (e.o.

Surgical techniques for repair of primary retinal detachment: part I. Review of their development during the last 80 years.

Objective: To analyse the evolution of surgical approaches to repairing primary rhegmatogenous retinal detachment and the issues which had determined the changes starting from 1929 to the present.

Material And Methods: Literature of retinal detachment surgery during the past 80 years is reviewed. There was a change from surgery of the entire retinal detachment to surgery limited to the retinal break and a change from extraocular (e.

Minor surgery for the repair of retinal detachment emanating from retinoschisis.

Purpose: To propose a mechanism for the development of the outer layer retinal tears that occur with retinoschisis and the detachment emanating from it that is consistent with the limited extent of the detachment and the response to binocular occlusion and local buckles.

Methods: A consecutive series of 24 patients with retinoschisis, collected over 15 years, was analysed. Seven patients developed a symptomatic retinal detachment emanating from breaks in the outer layers of retinoschisis.

Intravitreal bevacizumab versus triamcinolone acetonide for exudative age-related macular degeneration.

Background: To compare an intravitreal high-dose injection of triamcinolone acetonide with an intravitreal injection of bevacizumab for the treatment of progressive exudative age-related macular degeneration (AMD).

Method: The comparative nonrandomized retrospective clinical interventional study included 305 patients with progressive AMD, divided into a bevacizumab group of 36 patients (1.5 mg bevacizumab) and a triamcinolone group of 269 patients (about 20 mg triamcinolone).

A 40 degrees gaze down position for pneumatic displacement of submacular hemorrhage: clinical application and results.

Purpose: To test the validity of the geometric conclusion that 40 degrees gaze down is optimal for pneumatic displacement of a subretinal hemorrhage (SRH) in the macula.

Methods: Nine consecutive patients with SRH in the macula had an intravitreal injection of perfluorocarbon gas sufficient to cover the macula when the patient gazed down 40 degrees below the horizontal. They were asked to maintain the gaze down position for 20 minutes every hour while awake.

Visual acuity change after intravitreal bevacizumab for exudative age-related macular degeneration in relation to subfoveal membrane type.

Purpose: To examine an association between the subfoveal neovascular membrane type and visual acuity change after intravitreal bevacizumab injection for exudative age-related macular degeneration (AMD).

Methods: We carried out a clinical, retrospective, interventional case-series study including 66 consecutive patients (67 eyes) with exudative AMD who received an intravitreal injection of 1.5 mg bevacizumab.

Cutting the encircling band.

Purpose: To report the effect of cutting the encircling band on ocular blood flow.

Methods: In an interventional case series of 27 eyes with an encircling band, the ocular pulse amplitude (OPA) was measured and pulsatile ocular blood flow (POBF) derived and compared with fellow eyes. The bands were cut in 11 eyes and the POBF measured at 1 month, 3 months, and 1 year.

Duration of the effect of intravitreal triamcinolone acetonide in eyes with exudative age-related macular degeneration.

Objective: The aim of this study was to evaluate the duration of the effect of an intravitreal injection of approximately 20 mg of triamcinolone acetonide (TA) on visual acuity and intraocular pressure (IOP) in patients with exudative age-related macular degeneration (AMD) with subfoveal choroidal neovascularization.

Participants: The prospective, clinical, interventional, case series study included 69 patients (71 eyes) with exudative AMD who showed an increase in visual acuity by at least 2 Snellen lines after an intravitreal injection of approximately 20 mg TA. Mean follow-up was 11.

Infectious and noninfectious endophthalmitis after intravitreal high-dosage triamcinolone acetonide.

Purpose: To evaluate the rate of infectious and noninfectious endophthalmitis after intravitreal injection of a high-dosage of triamcinolone acetonide.

Design: Clinical interventional case-series study.

Methods: The study included 1135 intravitreal injections of approximately 20 mg triamcinolone performed for 915 eyes with diabetic macular edema (n = 257), exudative age-related macular degeneration (n = 561), retinal vein occlusions (n = 82), and other reasons.

Predictive factors for visual acuity after intravitreal triamcinolone treatment for diabetic macular edema.

Objective: To evaluate which factors influence maximum gain in best-corrected visual acuity after intravitreal injection of triamcinolone acetonide as treatment for diffuse diabetic macular edema.

Methods: This prospective clinical interventional study included 53 eyes with diffuse diabetic macular edema receiving an intravitreal injection of about 20 mg of triamcinolone. The mean +/- SD follow-up was 10.

Intravitreal triamcinolone acetonide for treatment of intraocular proliferative, exudative, and neovascular diseases.

Within the last three years, triamcinolone acetonide has increasingly been applied intravitreally as treatment option for various intraocular neovascular edematous and proliferative disorders. The best response in terms of gain in visual acuity after the intravitreal injection of triamcinolone acetonide was found in eyes with intraretinal edematous diseases such as diffuse diabetic macular edema, branch retinal vein occlusion, central retinal vein occlusion, and pseudophakic cystoid macular edema. Visual acuity increased and degree of intraocular inflammation decreased in eyes with various types of non-infectious uveitis including acute or chronic sympathetic ophthalmia and Adamantiadis-Behcet's disease.

Intraocular pressure elevation after intravitreal triamcinolone acetonide injection.

Purpose: To report on intraocular pressure (IOP) after intravitreal injections of triamcinolone acetonide.

Design: Meta-analysis of previously reported data and case series studies.

Participants: The study included 272 patients (305 eyes) receiving an intravitreal injection of approximately 20 mg triamcinolone acetonide as treatment for diffuse diabetic macular edema (n = 84 patients), exudative age-related macular degeneration (n = 181 patients), retinal vein occlusions (n = 20 patients), uveitis (n = 9), pseudophakic cystoid macular edema (n = 6), and other reasons (n = 5).

Safety of intravitreal high-dose reinjections of triamcinolone acetonide.

Purpose: To report side effects after intravitreal high-dose reinjections of triamcinolone acetonide.

Design: Clinical interventional case series.

Methods: Forty-six patients (47 eyes) received at least two intravitreal injections of approximately 20 to 25 mg triamcinolone acetonide for treatment of diabetic macular edema (n = 6 eyes), exudative age-related macular degeneration (n = 23), and other diseases.

Duration of the effect of intravitreal triamcinolone acetonide as treatment for diffuse diabetic macular edema.

Purpose: To evaluate the duration of the effect of intravitreal triamcinolone acetonide on visual acuity in patients with diffuse diabetic macular edema.

Design: Clinical interventional case series.

Methods: Subjects were 31 patients (38 eyes) with diffuse diabetic macular edema who received an intravitreal injection of 20- to 25-mg triamcinolone acetonide.

Ambulatory binocular occlusion.

Purpose: To show the efficacy of ambulatory binocular occlusion in the management of vitreous hemorrhage and rhegmatogenous retinal detachment.

Methods: Nine eyes with a vitreous hemorrhage, rhegmatogenous retinal detachment, or both were managed initially by ambulatory binocular occlusion before the definitive treatment of the underlying cause was carried out.

Results: In four eyes with a vitreous hemorrhage of rhegmatogenous origin, binocular occlusion resulted in sufficient clearing of the media to allow visualization and treatment of the breaks.

Intravitreal reinjection of triamcinolone for exudative age-related macular degeneration.

Objective: To evaluate the outcome of repeated intravitreal injections of triamcinolone acetonide for the treatment of exudative age-related macular degeneration.

Methods: This prospective, comparative nonrandomized clinical interventional study included 13 patients with progressive exudative age-related macular degeneration with occult, or predominantly occult, subfoveal neovascularization. All patients had shown an increase or stabilization of visual acuity after a first intravitreal injection of 25 mg of triamcinolone acetonide.

A modified laser test for the identification of retinoschisis.

Purpose: To describe a modified laser technique for identification of bullous retinoschisis.

Design: Retrospective interventional case series collected over 10 years.

Methods: Forty-one eyes with presumed bullous retinoschisis and breaks in the inner layers underwent a low-energy argon green laser application at the same energy as a control spot in adjacent retina.