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Tumors of the Nervous System
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Visual loss: Because of enlargement of retinal hemangioblastoma.Exudative retinopathy/macular edema.Retinal detachment.Vitreous hemorrhage.Retinal lesions are often in the periphery of the retina, but large draining veins may be seen at the disc.
Flashing Lights and Floaters
Published in Amy-lee Shirodkar, Gwyn Samuel Williams, Bushra Thajudeen, Practical Emergency Ophthalmology Handbook, 2019
A vitreous detachment occurs when the ageing vitreous body, which is 4 mL in volume and occupies almost the entirety of the posterior segment, collapses forward and pulls its posterior aspect free from the retina. This can either be a smooth collapse with no retinal tears or haemorrhages, or the blood vessels and retina can be damaged in the separation, resulting in pigment and blood released into the vitreous cavity, and even parts of the retina itself in the form of an operculated tear. Blood and inflammatory debris from diabetes, infection or inflammation of the posterior segment may also cause floaters (see Chapter 14). Diabetic retinopathy is a common cause of posterior segment haemorrhage.
Management of endophthalmitis
Published in A Peyman MD Gholam, A Meffert MD Stephen, D Conway MD FACS Mandi, Chiasson Trisha, Vitreoretinal Surgical Techniques, 2019
Mandi D Conway, Gholam A Peyman
Early diagnosis and appropriate treatment with intraocular antibiotics are important factors in the successful management of endophthalmitis. Emerging resistance of organisms to standard antibiotic therapy has forced clinicians to continually evaluate the best intraocular antibiotics for the treatment of endophthalmitis. Although drug combinations are necessary to cover the full range of bacteria causing endophthalmitis, antimicrobial synergy is probably less important in endophthalmitis treatment, because of the high intravitreal concentrations of individual antibiotics achieved by intravitreal injection. Acute postoperative endophthalmitis is treated by a combination of broad-spectrum antibiotics (either vancomycin or clindamycin, with either amikacin or ceftazidime), which are administered intravitreally, subconjunctivally, or topically. In vitrectomized eyes, the dose of antibiotic must be reduced to one-quarter of the nonvitrectomized dose (Table 52.5).80 This is recommended because antibiotic toxicity has been evaluated most often in the nonvitrectomized eye, where the vitreous prevents rapid diffusion of antibiotics toward the retina. The vitreous reduces the concentration of antibiotic that reaches the retina, while allowing the antibiotic to be cleared through the anterior chamber. The recommended doses of common antibiotics are shown in Table 52.5.
Autologous retinal graft for the management of large macular holes associated with retinal detachment
Published in Libyan Journal of Medicine, 2023
Hsouna Zgolli, Hamad K H Elzarrug, Chiraz Abdelhedi, Sonya Mabrouk, Olfa Fekih, Ines Malek, Imen Zghal, Leila Nacef
We first performed a central vitrectomy with mechanical detachment of the posterior vitreous. Then, a peripheral vitrectomy under indentation was done. Vitreoretinal proliferations were dissected. The retinal patch was taken by performing a circular retinectomy of one papillary diameter at the superior temporal level under Perfluorocarbon liquid (PFCL). The retinal tissue was prehended by a 23 G microforceps (Figure 1a) then inserted at the level of the macular hole (Figure 1b). Laser retinopexy was performed for the peripheral tears as well as the iatrogenic posterior tear. Air-PFCL exchange was performed and then a final silicone oil tamponade (Polydimethylsiloxane, Baush and Lomb Oxane® 1300) was performed while ensuring that the patch was still in place.
Outcomes of Laser Retinopexy for Retinal Tears in Pseudophakic Eyes with Multifocal Versus Monofocal Intraocular Lenses: A Matched Cohort Study
Published in Current Eye Research, 2023
Taku Wakabayashi, Hannah E. Anderson, Annika G. Samuelson, Ava Torjani, Abtin Shahlaee, Raziyeh Mahmoudzadeh, Mirataollah Salabati, Michael A. Klufas, Yoshihiro Yonekawa
In the current study, the presence of vitreous hemorrhage and worse preoperative VA were significantly associated with the failure of laser treatment, regardless of the IOL type (multifocal or monofocal). Vitreous hemorrhage has also been reported as a risk factor for the failure of laser demarcation in patients with peripheral RRD.17 Several studies have reported that vitreous hemorrhage is associated with larger retinal breaks and ERM formation.18,19 In addition, laser delivery may be disturbed in cases of vitreous hemorrhage, potentially resulting in insufficient photocoagulation to seal the tears. These multifactorial causes may be responsible for the failure of laser treatment in patients with vitreous hemorrhage. Worse VA may be associated with more severe vitreous hemorrhage preoperatively, although we could not evaluate the association between the severity of vitreous hemorrhage and worse VA.
Malpractice Cases Arising From Telephone Based Telemedicine Triage in Ophthalmology
Published in Seminars in Ophthalmology, 2023
Elias H Kahan, Joshua D Shin, Michael E Jansen, Rebecca Hughes Parker, Ravi Parikh
This analysis showed that most medical malpractice lawsuits related to teleophthalmology resulted from delays in evaluation and/or treatment secondary to telephone visits. Although synchronous live audio-visual evaluation and high-resolution images generated through mobile health applications will become more prominent in the coming years, it is unlikely that telephone communication will ever be completely phased out of ophthalmic practice, and these learnings should be leveraged for mitigating future malpractice across all teleophthalmic encounters. Regarding telephone triage in particular, certain steps can be implemented in current practice to avoid the likelihood of malpractice litigation. Based on our findings, certain symptoms that may portend to endophthalmitis or retinal detachment, such as flashes and floaters, especially in the context of previous vitreous hemorrhage, detachment, or retinal repair, should warrant immediate in-person evaluation.