Cure Eye Floaters Naturally

Eye Floaters No More

Eye Floaters (Also known as Eye Flashes) are deposits of various sizes and shapes that float within the eye. They are caused by degenerative changes of the vitreous humour the clear gel that fills the eyeball. Eye infections, inflammation, wounds and damage to the eye can lead to eye floaters. A sudden increase in floaters can be one of the first signs of retinal detachment or other severe eye conditions. In Eye Floaters No More, you'll discover: How to finally get rid of your stressful eye floaters, blocks of vision, the flashing lights using a safe, natural and easy system. Eliminate your annoying eye floaters from the comfort of your home. How to prevent more eye floaters from forming. How to find out if your eye floaters are a sign of other eye conditions. Easy, natural ways to drastically improve your vision. Continue reading...

Eye Floaters No More Summary

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Medical Treatment of Retinal Detachment

Stellwag in 1861 and Donders in 1866 proposed rest as essential for treatment of retinal detachment 11,12 . By rest, it was meant the immobility of the body and the eyes, with the latter being the more important component both eyes were bandaged, atropine was applied for intraocular immobility, and complete immobility of the body was achieved by laying on the back with the head sandwiched between sandbags. Samelsohn in 1875 suggested compression bandaging combined with rest for many weeks 13 . Mendoza in 1920 recommended a plaster mould that would fit the eye and the orbital ridges and therefore apply even pressure to the eye 14 . Further, Marx in 1922 advised a salt-free diet to promote the absorption of subretinal fluid 15 .

Surgical Treatment of Retinal Detachment

The first operation attempted for treatment of retinal detachment was by James Ware in 1805 who drained the subretinal fluid by puncturing the sclera with a knife 16 . In i863,von Graefe modified this method by also puncturing the retina and creating a second hole for the drainage of the subretinal fluid into the vitreous cavity i7 .G. Martin in 1881 and de Wecker in 1882 introduced the thermocautery (later popularized by Dor (1895-1907) as the method of puncture 18-20 ). There were numerous other surgical methods attempted for retinal detachment. Subconjunctival injections were first suggested by Grossman in 1883 and then popularized by Mellinger in 1896 who used hypertonic saline to extract the subretinal fluid by osmotic forces 25, 26 . Division of vitreous fibers to treat retinal detachment was attempted by Deutschmann in 1895 27 . Reduction of the globe capacity on the basis of von Graefe's theory that the cause of detachment was an increase in the volume of the eye in myopia was...

Age Related Senile Macular Degeneration

An important cause of visual impairment in the elderly, often leading to legal blindness within five years after onset, is senile macular degeneration or age-related macular degeneration (ARMD or AMD) (7-10,107,108). The disease accounts for nearly half of the registered (legal) cases of blindness in the United States and England. The incidence of ARMD increases with increasing age, from about 4 in the 66 to 74 years age group, to 17 in the 75 to 84 years age group, and 22 in the > 84 years age group. The macula lutea is an area of retina 6 mm in diameter that is located at the posterior end of the eye's visual axis (Fig. 2B). Through its high density of cones and involvement in day and color vision, the macula, and in particular its central zone, the fovea, provides the structural basis for high visual acuity. Hence, macular degeneration, more than any other eye disease, affects visual acuity and central vision. This disease occurs generally in both eyes and more often (50 ) in...

The History of Retinal Detachment Surgery

Gonin Retina

The history of retinal detachment surgery is one of the great success stories in the history of medicine. The first descriptions of retinal detachment were by Ware in 1805, Wardrop in 1818, and Panizza in 1826 1-3 . These descriptions relied mainly on pathological observations. The introduction of the ophthalmoscope by Fig. 1.1. Jules Gonin. (Reproduced with permission Wilkinson CP, Rice TA (1997) Michels retinal detachment, 2nd edn. Mosby St. Louis MO. pp 241-333 10 ) Fig. 1.1. Jules Gonin. (Reproduced with permission Wilkinson CP, Rice TA (1997) Michels retinal detachment, 2nd edn. Mosby St. Louis MO. pp 241-333 10 ) Helmholz in 1850 made an accurate and reliable clinical diagnosis possible 4 . Coccius in 1853 followed by von Graefe in 1854, who also portrayed the course of retinal detachment, observed the first retinal tear 5,6 . The history of retinal detachment surgery can be divided into pre- (before 1920) and post-Jules Gonin's era (after In 1920, Gonin reported the first...

Prophylaxis in Fellow Eye of Primary Retinal Detachment What Not to Do and What to Do

It is generally very helpful in understanding the present to make a retrospective survey of the thinking of the past, which has led us to our present concepts. The progression of ideas in the case of prophylactic treatment of retinal detachment first developed from a few correct elementary clinical observations, but then proceeded on the basis of mostly theoretical reasoning because of the profound dearth of empirical data. Along with the early realization that some retinal detachments could be successfully treated, other observations also began to be made. Certain associated pre-existing retinal lesions began to be observed in eyes in which causative retinal tears had led to retinal detachment. It was thought that perhaps these associated lesions were responsible for the onset of the retinal tears and, therefore, were of prognostic importance. With the advance of more careful retinal examination, more of these lesions began to be discovered in the fellow eyes of patients who had had...

Conclusion Of Retinal Detachment

In the beginning of the twenty-first century, the present state-of-the-art for repair of a primary retinal detachment has reverted from a local to a barrier concept of treatment - as has happened several times during the past 75 years. Of the four surgical techniques in use at present for repair of a primary rhegmatogenous retinal detachment, two are extraocular operations (minimal segmental buckling with sponges or a balloon without drainage and cerclage with drainage) and two are intra ocular (pneumatic retinopexy and primary vitrectomy). To succeed with any of these methods, the leaking break still has to be found and sealed. Therefore, finding and closing the retinal break in a rhegmatogenous retinal detachment will continue to be the primary purpose of any surgical effort. With any of the four presently applied surgical techniques, retinal attachment can result in 94-99 of primary rhegmatogenous retinal detachments, but with different degrees of morbidity. At this point in time,...

Retinal Detachment Repair Outlook for the Future

Due to the pioneering work of many ophthalmologists, including Gonin, Lincoff, and others, the basic pathophysiology of rhegma-togenous retinal detachment has been established. A retinal tear is caused by a vitreous detachment and traction on the retinal tear, and peripheral retina is responsible for fluid currents, which go through the break and detach the retina. More fundamental questions remain to be answered and will have important implications for our ability to detect, prevent, and treat rhegmatogenous retinal detachment and its complications. Fig. 10.1. Radial sponge has cured a retinal detachment without the need for drainage treatment. For this reason, much of the debate revolves around theory and philosophy, not hard clinical data. There is little doubt that the most minimal operation that would be highly effective would be the procedure of choice. Highly effective should include minimal complications and inconveniences, such as the induction of refractive error (Lincoff,...

Retinal detachment 175

A Proliferative diabetic retinopathy, sickle-cell disease, advanced retinopathy of prematurity and penetrating trauma give rise to tractional and or rhegmato-genous retinal detachment. Tumour growth and inflammation give rise to exudative or serous detachments. E Retinal detachment usually occurs in persons aged 40-70 years. H Initial symptoms include the sensation of a flashing light (photopsia) accompanied by a shower of floaters. A wavy distortion of objects (metamorphop-sia) may occur if the retina is involved. to diagnose retinal detachment, but they may be necessary to detect intraocular foreign bodies and tumours. If the retina cannot be visualised because of corneal changes or cataracts, USG is necessary. _P Ultimate outcome depends upon the time, type of retinal detachment and whether the macula is involved. Prognosis is related inversely to the degree of macular involvement and the length of time the retina has been off. 15 of people with retinal detachments in one eye...

Complications of Drainage

Complications of drainage include hemorrhage, choroidal detachment, retinal incarceration, iatrogenic retinal holes, and infection. Cibis wrote about the uncertain nature of a release of subretinal fluid This is perhaps the most dangerous step in any of the retinal detachment procedures presently employed, except where Custodis' technique is used 25 .

Materials and Methods

A Medline search was made of all reports that were identified by the search terms retinal detachment, segmental buckling, minimal extraocular surgery, and nondrainage. Reports published in English, German, Italian, French, Spanish, and in some East European journals were reviewed and analyzed. The majority of reports did not contain homogenous data suitable for the analysis. Many included both complicated and uncomplicated detachments, primary detachments and reoperations, or no preoperative characteristics. In many series, primary segmental buckling was combined with a cerclage. The buckling was performed with or without drainage of subretinal fluid. Primary segmental buckling was sometimes combined with an injection of air, an expanding gas, or silicone oil. After excluding these reports, an analysis was made of a relatively homogenous series of mostly primary retinal detachments, some with preoperative PVR stage C1-C2. The primary procedure in all eyes was minimal segmental...

Intraocular Tamponade

Cibis in 1962 was the first to report the use of silicone oil for treatment of retinal detachment 143 . The complications of sili-cone oil made its usage unfavorable at that time. Haut in 1978 introduced the use of silicone oil with vitrectomy 144 . Zivojnovic became the major advocate of silicone oil in combination with retinal surgery (relaxing retinectomy) to treat severe proliferative vitreoretinopathy and traumatic retinal detachments 145 . Parke and Aaberg first reported the technique of argon laser endo-photocoagulation in conjunction with vitrectomy, retinectomy, and intraocular gas for the management of PVR 146 . Development of air pumps was also an important landmark, so retinas could be reattached with a fluid-air exchange in a controlled fash ion 147 . Perfluorocarbon liquids which were originally evaluated as blood substitutes were first used as a vitreous substitute by Haidt in 1982 148 . Chang later popularized the use of perfluorocarbon liquids for the clinical...

The Cell Biology of PVR

PVR is the most common cause of failure following attempted retinal reattachment repair in primary cases, as well as complex forms of retinal detachment. The precise initiating events remain poorly understood, but it is known that the disease is characterized by cell-mediated tractional forces exerted on both preretinal and subretinal membranes, as well as more diffusely to the vitreous gel itself 9,14,15 . These contractile forces lead to stiffening and elevation of the retina, leakage through retinal breaks, and retinal re-detachment typically between 4 weeks and 8 weeks following attempted repair. The condition is more commonly encountered in eyes with large or multiple breaks and is more frequently seen in males and in patients with a history of trauma, hemorrhage, choroidal detachment, or giant retinal tear 5,10 . The membranes associated with this condition are composed of a variety of cell types, principally pigment epithelial, glial and myofibroblastic elements, either...

The Present State of the Art and How It Came About

A major advance in the concept of treating a primary rhegmatoge-nous retinal detachment was the realization that the surgical problem was solely closing the leaking retinal break and that the extent of the detachment or tractional configurations remote from the break are of no consequence. Let us share with you this change in concept over time 1 . Recall, Gonin 2 postulated - for the first time - that a leaking break is the cause of a retinal detachment, and his treatment was limited to the area of this break. With his operation, the attachment rate increased from 0 to 57 . However, this localized procedure was soon modified to coagulations of the entire quadrant of the leaking break. In 1931, Guist and Lindner 3, 4 circumvented further the need for localizing the leaking break by doing multiple cauterizations posterior to the estimated position of the break Safar 5 applied a semicircle of coagulations posterior to the break. The intent was to create a barrier of retinal adhesions...

Some Basics of Surgical Technique

Retinal Break Without Detachment

This surgery, performed under local anesthesia, is suitable for primary retinal detachments caused by one or several breaks. It consists of cryosurgery under ophthalmoscopic control and a sponge, preferably radially oriented, to the break. Consequently, the size of the buckle is determined only by the size of the break(s) and not by the extent of the detachment. The treatment of the two detachments, presented in Fig. 6.1, is the same and consists of a sponge buckle of equal size. After an analysis of 1,000 detachments, we

Origins of Minimal Segmental Buckling Without Drainage

Minimal segmental buckling without drainage for repair of a primary rhegmatogenous retinal detachment is an extraocular technique in which the buckle and the coagulations are limited to the area of the break. The two components of this procedure can be traced back over several decades. The present minimal surgery developed in small steps over the years. Eliminating drainage of subretinal fluid and applying the surgery only in the area of the break was a change from treating the entire extent of the detachment to a surgery of the retinal break (Fig. 6.1). For the first time since Gonin (1929), the coagulations were limited to the break 1 . However, the advantage of this limited and focused treatment was given up over the years, and coagulation of the entire periphery of the detached retina again was recommended to create a secure barrier against redetachment 2,3 . Coagulating limited to the leaking break was taken up again - for the second time - by Rosengren in 1938 4 . However, with...

Improvement in Visual Acuity

It may also be possible to improve visual acuity through the enhancement of photoreceptor regeneration in eyes with macula-off retinal detachments. Processes governing photoreceptor renewal and normal alignment of the outer segments following retinal reattachment are still poorly understood, and the potential use of pharmacological agents and, specifically, cytokines may be a promising avenue to restoring visual function above and beyond that which might be expected simply by reattachment of the macula, particularly in eyes with more longstanding retinal detachments. To date, there are no well-defined or well-controlled clinical trials that would suggest such an agent is available or on the near horizon, but it is anticipated that in the future this approach may be feasible.

Advantages of the Balloon Operation

All of the listed advantages can be achieved by applying a temporary and not suture-fixated balloon buckle without drainage as treatment for a primary retinal detachment. But the conditio sine qua non for success with this minimal procedure is experience in the non-drainage operation. The surgeon has to be an expert in indirect binocular ophthalmoscopy and has to be able to locate a balloon correctly in the parabulbar space beneath a highly detached break.

How Drainage Works

Schepens reserved bed rest for macula-on retinal detachments. For all other detachments, subretinal fluid was desirable, since it made volume reduction more effective and safer In all other cases, the patients are encouraged to be up and about, in order to keep the retina detached prior to surgery, because the scleral buckling operation, which necessarily decreases the volume of the eye, requires the loss of ample subretinal fluid at the time of operation 2 . The amount of fluid to be removed from the eye was investigated by Thompson and Michels. The volume displacement of a 2.5-mm-wide band was measured to be 0.5 ml with explants, the displaced volume could be close to 2 ml or up to 45 of the vitreous cavity 24 .

Case Selection

Proper case selection is critical to success with PR. The ideal scenario involves an acute, phakic retinal detachment due to a single break or small cluster of breaks located in the superior 8 clock hours of the fundus. Careful preoperative examination is exceedingly important when considering PR. Clear ocular media are essential to allow visualization of all breaks. Sector cataract, vitreous hemorrhage, and pseudophakic lens capsular opacification are relative contraindications. In general, pseudophakic and aphakic detachments are more prone to multiple small breaks than phakic cases. However, if the view to peripheral retina affords a view sufficient to disclose all the breaks, these detachments can be managed with PR. A single break is most easily covered with bubble tamponade. If multiple, the breaks must be close enough together to be covered by a single bubble. Breaks greater than 90-120 apart require large volume injections and, as a result, are relative contraindications....

New Possibilities

Surgeons continue to push the limits for detachments amenable to treatment using PR. Detachments with breaks in more than one quadrant may be repaired by augmenting the bubble size via a second injection on the first or second postoperative day, or by flattening one break over a 72-h period, then changing patient positioning to address the second area in another quadrant 21 . The treatment of detachments with large breaks has been controversial. Gas is more prone to migrate into the subretinal space, and the arc of contact may not be broad enough to tamponade the entire break. Nevertheless, reports exist of the successful use of PR for RRDs due to giant retinal tear (4 of 5-80 ), retinal dialysis (4 of 4-100 ), and other large breaks 22-24 . These reports demonstrate that PR can be effective for cases with large breaks if they are located superiorly and lack significant vitreoretinal traction. Pneumatic retinopexy has generally been avoided for RRD with breaks in the inferior 4 clock...

Discussion

Rhegmatogenous retinal detachment is a very heterogeneous disease state, and, as a result, comparison of surgical results of different techniques is difficult. Certainly PR, primary PPV, and SB each have a place in a surgeon's armamentarium of treatment modalities. The use of PR is limited by anatomic considerations -number, location and size of breaks, chronicity, preoperative PVR, and lens status - while primary PPV and SB techniques can be used for most cases of RRD. Nevertheless, PR has advantages in certain clinical situations.

Advantages of PR

Functional visual results of the three techniques is an area of significant controversy. It is well recognized that PR and primary PPV both avoid the significant induced myopia and astigmatism associated with SBs. The induced changes in refractive error can, in some cases, produce significant anisometropia, requiring contact lens use or even refractive surgery. A large multicenter trial comparing SB and PR found a significant visual benefit with PR. For eyes with preoperative macular detachment of less than 2 weeks duration, the percentage of patients achieving 20 50 or better best-corrected visual acuity was 80 for PR and 56 for SB 13 . Two retrospective, comparative series by Han 17 and McAllister 61 , however, found no statistically significant difference in visual outcomes between the two procedures. Similar data for primary PPV is unavailable for a meaningful comparison however, the positive impact of the clearance of vitreous floaters and debris cannot be underestimated.

Outcomes

The increasing use of vitrectomy for the primary management of retinal detachment was studied at one hospital that compared the characteristics of the surgical procedures used in 1979-1980 with their cases 20 years later (in 1999) 6 . Of 124 eyes managed in 1979-1980, only one had vitrectomy as the primary mode of treatment. In 1999,79 of 126 (63 ) were managed with vitrectomy. The severity of cases did also differ, however, with more complex cases, such as pseudophakic retinal detachments, giant retinal tears, and proliferative vitreoretinopathy cases managed in 1999. eyes after one operation and 96.7 after multiple operations. The surgical techniques did vary and might explain some of the differences in anatomic outcomes. In some series, concomitant scleral buckling was done 10 , but in others, a scleral buckle was not used in any of the eyes 9 . Also, vitrectomy was done only in pseudo-phakic eyes, compared with other series that were operated without regard to the lens status. The...

Specifics

In subsequent years, the preconditions for this specific break surgery were further improved by better fundus examination techniques binocular indirect ophthalmoscopy, as developed by Schepens, biomicroscopy, as introduced by Goldmann, development of various direct and indirect contact lenses, the 4 Rules for finding the primary break 19,20 , and the subsequent 4 Rules for finding a missed break in an eye requiring reoperation 21, 22 . Today, these 8 Rules represent essential guidelines for the detection of the leaking break in a detachment, which is the precondition for surgery limited to the area of the break. By performing this kind of a minimal extraocular surgery, the time required for a retinal detachment operation became dramatically reduced however, the time needed for preoperative study increased.

Anatomical Results

Primary attachment after minimal segmental buckling (sponges or balloons) without drainage of 1,462 retinal detachments Table 6.2. Primary attachment after minimal segmental buckling (sponges or balloons) without drainage of 1,462 retinal detachments Table 6.3. Final attachment after minimal segmental buckling (sponges or balloons) without drainage and reoperation of 1,462 primary retinal detachments during 2-year follow-up Table 6.3. Final attachment after minimal segmental buckling (sponges or balloons) without drainage and reoperation of 1,462 primary retinal detachments during 2-year follow-up

Functional Results

These pending questions can be answered by the second series of 107 primary retinal detachments treated by minimal segmental sponge buckle(s) without drainage and with a complete follow-up of 15 years 40 . The mean preoperative visual acuity was 0.3 it improved to 0.5 during the first 6 months after surgery, and reached a maximum of 0.6 at 1 year. The increase was statistically significant (P< 0.001). After 1 year, a slight linear decrease of 0.07 lines on the Snellen chart per year was observed over 15 years. In one patient, a cataract operation was done during the follow-up. The long-term functional results, including the surgical failures, are depicted in Fig. 6.15. Fig. 6.15. Course of mean visual acuity of fellow and operated eyes during 15 years. Left Course of mean visual acuity in the 107 unoperated fellow eyes during the 15-year follow-up. Right Course of mean visual acuity in the 107 eyes with retinal detachment operated with extraocular minimal surgery (segmental sponge...

Daunomycin

Another chemotherapeutic agent useful in cancer and also in the treatment of coronary restenosis, Taxol, has been tested for efficacy in experimental models in the eye. It appears to act as a promoter rather than an inhibitor of microtubular assembly and inhibits cell-mediated contraction of a collagen gel as well as experimental retinal detachment in various animal models 46 . A related cytoskeletal agent, Colchicine, also inhibits RPE astrocyte and fibroblast proliferation in addition to migration and was shown in one animal model to have some beneficial effects on PVR, although it has not yet been proven to be beneficial in any human studies 47 .

Summary

Pharmacological methods remain a promising potential adjunct to the successful treatment of retinal detachment. In addition to conventional strategies, including adequate pupillary dilatation, control of inflammation by anti-inflammatory agents, and intraocular pressure by ocular hypotensive agents, drugs may play a further role by inhibiting other late complications. These include proliferation and macular edema. Steroids, fluoropyrimidines, and he-

Inadequate Training

Vitrectomy is being increasingly employed for primary retinal detachments because the number of doctors trained to do vitrectomy has markedly increased in the past decade, as have the indications for vitrectomy. In addition to the original indications, traction detachment in the diabetic eye and PVR after failed retinal surgery, vitrectomy is done for macular holes, macular puckers, dropped lens and particles, to clear vitreous hemorrhage, and, more recently, to dissect subretinal proliferative lesions in the macula. The indications keep expanding. Retinal detachment can be a relatively infrequent indication for operation on a busy retinal service and of secondary interest. As a result, training for the treatment of retinal detachment may be limited. There are few opportunities outside of the fellowship to learn about buckling. Retinal programs rarely include papers on the subject it has all been said. Except for William Mieler's short course at the Academy and Ingrid Kreissig's...

Peer Review

A third factor operating against the buckle operation for primary detachment, beyond the lack of training and the limit of reimbursement for the time spent, is the absence of peer review. Preop-erative surgical rounds, where the surgical plan for retinal detachment was open for review, suggestion, criticism, and even censure, have disappeared with 1-day surgery, there is not time for it. The surgeon admits his patient on the day of the operation with as much preparation as his schedule allowed, and, when the patient leaves the hospital later in the day with the eye filled with gas, there is no opportunity to evaluate the effort by his or her peers.

Retinopexy

In 1954 closed retinal breaks with intraocular diathermy through the pars plana he used a needle that was insulated except at its tip 60 . Although diathermy alone (with or without drainage of sub-retinal fluid) was the treatment of choice for retinal detachment prior to 1950, between 1955 and 1960, in most cases an indentation by a scleral buckle or scleral resection was added 61 . Light photocoagulation was first described by Czerny in 1867 who used a concave mirror and convex lens to focus sun light to induce retinal burns in animals 62 . Maggiore, in 1927, did the first experimental photocoagulation of the human retina when he focused sunlight for 10 min on the retina of a patient prior to enucleation for a malignant tumor 63 . Moran-Sales first used photocoagulation therapeutically in humans however, Meyer-Schwickerath, in 1949, was the first to publish this technique 64, 65 . Due to his pioneering work, Meyer-Schwickerath is considered the father of photocoagulation. His work...

Indications

The indications for the choice of vitrectomy as the primary method for managing retinal detachment is quite varied among surgeons. Some believe that it should be used in every case, and others feel that a scleral buckle should be attempted first in all cases before vitrectomy is done. Until the clinical evidence can be established for each end of the spectrum, I have chosen an approach that is somewhat more conservative and that balances the risks of vitrectomy with its benefits. Table 5.1. Indications for vitrectomy in primary retinal detachment Table 5.1. Indications for vitrectomy in primary retinal detachment Large posterior retinal tears usually associated with lattice Giant retinal tears Retinal detachment following open globe injury Primary management with vitrectomy is reserved for selected types of retinal detachment that are more difficult to manage with scleral buckling alone. These types of retinal detachment are often more complicated using an external episcleral approach...

Vitreous Surgery

Von Graefe and Deutschmann were the first clinicians to advocate cutting vitreous and or retina in order to treat retinal detachment however, they did not cut vitreous gel, but mainly cut vitreous membranes with a knife 17,110 . Von Hippel in 1915 cut a vitreous membrane and successfully treated a tractional retinal detachment 111 . The first modern intraocular instruments, made specifically for cutting vitreal membranes, were developed in the second half of the twentieth century. Neubauer in 1963 described intravitreal scissors that were activated by finger pressure 112,113 . Cibis in 1965 devised a tissue cutter that consisted of a hook and a trephine 114 . Kasner in 1962 was the first to advocate open-sky vitrectomy to remove vitreous gel for the treatment of eye diseases 115-118 . Kasner engaged the vitreous with cellulose sponges and cut it with scissors. He proved that the eye can tolerate the removal of the vitreous gel. Stimulated by the pioneering work of Kasner, Robert...

Surgical Technique

Advances in surgical instrumentation and technique have made vitrectomy a safer and more effective procedure in an eye with a detached, mobile, elevated retina. Critical components of the surgical instrumentation should include a high-speed vitreous cutter (2,500 cuts min), a panoramic viewing system, and perfluoro-carbon liquids. High-speed vitreous cutters allow shaving of the vitreous near mobile retina. The vitreous traction can be relieved around the tear, and it is possible to shave vitreous around areas of lattice degeneration, even with a mobile retinal detachment. The intraoperative use of perfluorocarbon liquids flattens the retinal detachment and reduces the potential for iatrogenic retinal breaks, as the vitreous instruments pass in and out of the sclerotomy sites. Also, the perfluorocarbon liquids reduce the mobility of the retina, as the cortical vitreous is shaved near the vitreous base (Figs. 5.1, 5.2). Panoramic viewing allows better visualization of the periphery and...

Scleral Buckling

Ernst Custodis. (Reproduced with permission Wilkinson CP, Rice TA (1997) Michels retinal detachment, 2nd edn. Mosby St. Louis MO. pp 241-333 10 ) Fig. 1.2. Ernst Custodis. (Reproduced with permission Wilkinson CP, Rice TA (1997) Michels retinal detachment, 2nd edn. Mosby St. Louis MO. pp 241-333 10 ) Fig. 1.3. Charles L. Schepens. (Reproduced with permission Wilkinson CP, Rice TA (1997) Michels retinal detachment, 2nd edn. Mosby St. Louis MO. pp 241-333 10 ) Fig. 1.3. Charles L. Schepens. (Reproduced with permission Wilkinson CP, Rice TA (1997) Michels retinal detachment, 2nd edn. Mosby St. Louis MO. pp 241-333 10 ) midpoint of the scleral dissection was slightly posterior to the breaks and surface diathermy was placed in the bed of the lamellar dissection along this line at the posterior edge of the breaks and extended anterior, at each end of the retinal detachment. The goal of the operation was to form a permanent barrier with the buckle and the diathermy-induced adhesion...

Mechanisms producing structural plasticity in photoreceptors

Blockage of L-type and cGMP-gated channels affects plasticity. Retraction in rod axons can be prevented by blocking L-type channels (Nachman-Clewner et al., 1999) in cultured salamander rod cells. It is not known whether blocking L-type channels also affects the more subtle shape changes seen in cone cells. If blockage prevents retraction, it follows that influx of calcium must help initiate this activity. Retinal detachment, the injury associated with retraction, is accompanied by spreading depression, a depolarization that affects ion influxes and presumably would open L-type calcium channels. Thus, a possible scenario is that detachment causes an influx of calcium into the rod axon terminal and initiates cytoskeletal changes, which may include contraction of actinomyosin, that result in movement of the axon and terminal towards the cell body.

Remodeling Models Rewiring and Selfsignaling Retinal remodeling overview

Retinal remodeling is phrase that refers to an array of molecular and cellular phenotype revisions of the neural retina in response to inherited or acquired degenerations of the sensory retina. Remodeling phenomena were first clearly defined for inherited retinal degenerations by Ann Milam and her colleagues (1995, Fariss et al., 2000, Milam et al., 1996, Milam et al., 1999) and for retinal detachments by Steven K. Fisher, Geoff Lewis and colleagues (reviewed in Fisher and Lewis, 2003). It has since become apparent that glial, vascular and neural remodeling are stereotyped responses to retinal disease stress (reviewed in Marc et al., 2003). Most of this review will deal with remodeling patterns associated with inherited retinal degenerations, where the development of natural genetic, crafted genetic and induced models have allowed us to screen a broad spectrum human disease homologues. In virtually all systems studied to date, retinal remodeling follows three well-defined phases....

CD and Visual Science

The outer segments of rod cells (rod outer segment or ROS) consist of about 1500 thin membranes called disks that are formed at the basis of the rod visual cells by pinching off sections of the plasma membrane. The disks, which embed the 40 kDa Rh molecules consistin of 348 amino acids, move towards the tip of the cell in about 15 days where they are phagocytosed. Phagocytosis of debris by the retinal pigment epithelial cells (RPE) leads to accumulation of orange fluorescent pigments, A2E and others, resulting in age-related macular degeneration (AMD).

Laboratory Diagnosis In Humans

Immunological reactions in aqueous and vitreous humour may be a more reliable indicator of toxocaral eye disease but such measurements are made only infrequently. Petithory et al. (1993) reported a comparison of sera and vitreous humour antibody studies in 10 subjects. In eight patients sera were negative for T. canis antibody, while vitreous humour antibody was found in nine subjects. Furthermore, for six (out of a total of nine) patients, antibody to T. cati was detected in the vitreous humour. Petithory et al. (1987) have suggested the following criteria for the diagnosis of ocular larva migrans (a) positive immunologic tests for nematode antigens in aqueous or vitreous humour (b) eosinophilia of aqueous or vitreous humour (c) ocular lesions. However, few ophthalmologists have aqueous or vitreous humour material available to them, and in most cases the diagnosis is based on the

Epic Dreaming and Complex Nocturnal Visual Hallucinations

Silber et al. have recently reported a series of 12 patients (11 of whom were females) with vivid, silent, often distorted images of people and animals occurring after waking, disappearing with increased light. Idiopathic hypersomnia, beta-blocker use, dementia with Lewy bodies, macular degeneration and anxiety were associated factors 81 .

Diabetes Ocular Disease and Travel

Some forms of diabetic retinal disease and surgery could be relative contraindications to prolonged flights requiring pressurized cabins. Daniele and Daniele (1995) reported a 62-year-old woman who had bilateral panretinal laser treatment (argon photocoagulation) for diabetic re-tinopathy and cystoid macular degeneration. Prolonged flights, totaling 42 h, may have severely exacerbated retinal hypoxia and cystoid macular degeneration. The authors postulated an inability of the diabetic retina to respond to hypoxia nearly 1 year after laser treatments. These authors also warn that recent operations on cornea, retina or cataracts must be closely monitored. Cases of central retinal vein occlusion and other forms of chor-ioretinopathy have been linked to air travel.

Biological Significance Of These Effects

There is anecdotal evidence that acoustic streaming occurs in vivo in clinical practice (Duck 1998). It has been seen in cysts in the breast, ovary and testicle and in liquefied vitreous humour. Although it seems unlikely that it presents a significant biological risk, it may be useful as a diagnostic indicator of a fluid-filled (as opposed to solid) lesion (Nightingale et al. 1995). There is more, circumstantial, evidence for radiation pressure effects occurring in biological systems in vivo. Lizzi et al. (1981) reported transient blanching of rabbit eye choroid at high pulse amplitudes during work on the sealing of retinal tears with focused ultrasound surgery. This has also been reported by ter Haar (1977) in mouse uterine vessels. This has been attributed to radiation stress-induced compression of the blood vessels. There have been a number of reports that sensory receptors can be stimulated by ultrasound. Gavrilov (1984) reported stimulation of temperature and pain receptors....

Clinical Features

The ocular lesions in these patients were posterior pole mass peripheral mass (unilateral pars planitis) posterior pole and peripheral mass peripheral mass with retinal detachment diffuse endophthalmitis. Gillespie et al. (1993a) recorded the following causes of severe visual loss in ocular toxocariasis fibrous traction band endophthalmitis macular lesion retinal detachment pars planitis papillitis.

Anterior Chamber and Vitreous Gel Humor

The vitreous humor, also called vitreous gel, is a mass of gellike substance filling the eye's posterior chamber. It gives the eye globe its shape and internal mechanical support (Fig. 2B). With age, the vitreous humor loses its gel-like structure and support, becoming more fluid and pigmented. The increasing inhomo-geneity in its gel structure, a process called syneresis, can lead to vitreous collapse or its detachment from the retina during this process, often vitreous floaters (inclusion bodies) are released in the process, which are responsible for occasional visual flashes. These physical changes in the vitreous humor may also be due to aging changes in its collagenous fibrous skeleton, which has attachments to the retina, particularly in the vitreous gel base near the periphery. These attachments change with age, moving posteriorly and decreasing in number (9,10,12).

Ophthalmic System and Vision

Environmental factors, including hypoxia, hyperoxia, variations in blood pressure, sepsis, and acidosis, may injure the endothelia (the cells that line) of the immature retinal blood vessels. The retina then enters a quiescent phase for days to weeks and forms a pathognomonic ridge-like structure of mesenchymal cells between the vascularized and the avascular regions of the retina by 33 to 34 weeks of postmenstrual age. In some infants, this ridge regresses, and the remaining retina is vascularized. In other infants, abnormal blood vessels proliferate from this ridge and progressive disease can cause exudation, hemorrhage, and fibrosis, with subsequent cicatrical scarring or retinal detachment (i.e., the retina is pulled off the back of the eye). The presence of plus disease, in which dilated and tortuous blood vessels occur in the posterior pole of the eye, is especially ominous for an adverse visual outcome. Other ophthalmologic complications of...

Cataracts

Surgical Phacoemulsification (using ultrasound probe) followed by aspiration of lens material and insertion of intraocular lens implant is curative. Specific complications include posterior capsule opacification, vitreous humour loss, and endophthalmitis. Usually done as day surgery. Post-op care should include steroid drops (for inflammation), antibiotic drops (infection prophylaxis), avoidance of strenuous exercise and ocular trauma.

Remodeling Phase

The emerge of new processes from bipolar cells that have previously ablated their dendrites (Pignatelli et al., 2004, Strettoi and Pignatelli, 2000, Strettoi et al., 2003, Strettoi et al., 2002) does not appear to be dendritogen-sis, but rather production of supernumerary axons, as microneuromas display numerous profiles containing synaptic ribbons. While bipolar cells appear to able to generate new, mistargeted dendrites in retinal detachments (Lewis et al., 1998), this occurs in cells that have not lost their dendrites. The slow, persistent phenotype deconstruction of bipolar cells in retinal degenerations

Surgical Procedures

Retinal detachments in our laboratory are created by first removing the lens and vitreous and then infusing a solution of sodium hyaluronate (Healon 0.25 ), a natural component of the vitreous and interphotoreceptor matrix, in a balanced salt solution between the retina and RPE via a glass micropipette (Lewis et al., 1999a). The Healon is used to prevent the retina from spontaneously reattaching. The pipette, which is secured to a micromanipulator, is attached to tubing that connects to an infusion pump. This allows precise control of the position and size of the detachment. The pipette, which creates a small hole as it passes through the retina, produces what we believe models rhegmatogenous detachments. In humans, a rhegmatogenous detachment refers to the fact that a hole or tear is present in the retina. As a result, fluid passes through the break in the neural retina to the subretinal space, thus creating the detachment. This is an important distinction since retinal detachments...

Constrictor Muscle

Most of the retina receives its nutrition from branches of the central retinal artery, which lie within the retina. The photoreceptor cells, however, receive their nutrition largely by diffusion from the choroid. In retinal detachment, the retina separates from the pigment epithelium, a single layer of cells that lies closely adherent to the choroid. If not repaired with several days, the photoreceptors may be irreversibly damaged from prolonged hypoxia.

Visual Impairment

Although late or severe ophthalmic findings, including cataracts, angle closure glaucoma, and retinal detachment, are uncommon in children born preterm, they can interfere with function and quality of life in children, adolescents, and adults who were born preterm (Kaiser et al., 2001 Machemer, 1993 Repka, 2002). Cataracts have been associated with untreated ROP and severe ROP (Kaiser et al., 2001 Repka et al., 1998). Glaucoma presents as an acute illness because of the severely increased pressure within the eye globe. The abnormal neovascular tissue of ROP can progressively and silently fold, exert traction, and tear or even detach the retina, causing a loss of vision (Kaiser et al., 2001 Machemer, 1993). Although most retinal tears or detachments occur in those with severe ROP, some children born preterm had mild or no ROP but a high degree of myopia (Kaiser et al., 2001). Surgical treatments, which include placement of a flexible band (i.e., a scleral buckle) around the eye to...

Age years

Various degrees of vision loss and blindness, commonly caused by senile cataract, glaucoma, macular degeneration, and diabetic retinopathy, represent the extreme consequences of age-related ocular pathologies (Table 1). Diabetic retinopathy is discussed in Chapter 14. In the United States, for patients in the age range of 75 to 85 years, the prevalence of cataracts is 46 , macular degeneration 28 , and glaucoma 7.2 (8,11). Screening for these disorders includes testing visual acuity, ophthalmo-scopic examination, and checking IOP. As a result of increased occurrence of eye diseases with age, the incidence of blindness shows a 25-fold increase with age, from about 0.1 in the middle-age group to 2.5 in the elderly (> 75 years) (8). As a result of the above pathologies in senile cataract, the lens interior becomes cloudy and opaque, light refraction is greatly reduced, and light scattering is markedly increased. These effects lead to loss of visual acuity, reduced patterned vision, and...

Available Doses

Macular Degeneration Macular degeneration (MD) is the leading cause of legal blindness in the United States, accounting for 25 to 60 of all new cases. The pathogenesis of MD is unknown and currently there is no effective medical therapy, with surgical photocoagulation being useful in only a limited number of patients. Multiple retrospective studies as well as data from the WHI has suggested that HRT may decrease the incidence of MD.

Visual problems

Premature infants may develop visual problems secondary to damage to the retina, the visual pathways, or to the visual cortex. Retinopathy of prematurity (ROP) causes retinal damage either secondary to retinal detachment, or as a result of treatment which aims to prevent such detachment. It has been known for some time that hyperoxia is a risk factor for the development of ROP but, despite the reduction in indiscriminate oxygen therapy with strict monitoring of saturation levels, ROP remains a significant problem. It is likely that this is due to the increased survival of smaller babies who are more at risk of ROP. The blood vessels grow out of the optic disk to supply the retina. When a child is born prematurely the peripheral retina is still avascular. During the first few weeks of life the vessels will continue to grow and will, in most children, complete the normal supply to the whole retina. However, if this process is interrupted there is a risk that the avascular retina will...

Ocular complications

Vaso-occlusion of retinal and other vascular beds in the eye can lead to grave complications. Patients with SCD can develop abnormal (comma-shaped) conjunctival vessels, iris atrophy, retinal pigmentary changes and retinal haemorrhages. Much more serious, however, is neovascularization causing proliferative retinopathy appearing as a 'sea fan' with its potential for vitreous haemorrhage and retinal detachment. Such patients are treated with laser photocoagulation or vitrectomy. The incidence of proliferative changes is substantially higher in HbSC and S-P+-thalassaemia patients than in HbSS. All patients with SCD should have annual ophthalmological evaluation, beginning in the second decade.

Tissues

There are several tissues over which there is little, or no, dispute regarding the value of ms m. Firstly, a number of uniform media within the body (in the absence of pathology) appear not to scatter the sound at all, at least at frequencies in the normal range of medical use. Examples are amniotic fluid, aqueous humour, vitreous humour, the lens of the eye (internal) and cyst liquids. Secondly, there is no dispute that it is the presence of air tissue interfaces in the inflated lung that is responsible for the very high ultrasonic attenuation in this organ. The equations for attenuation due to gas bubbles (Section 4.3.3) were used by Dunn and Fry (1961) to model the level and frequency dependence of attenuation in lung, although a predicted minimum in the region of 4-7 MHz was not later observed experimentally (Dunn 1974). Instead, attenuation in lung increases progressively with frequency over the 1-6 MHz range. In any event, it has been observed that the measured attenuation...

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