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Macular edema in the reattached retina
CURRENTOPHTHALMOLOGY
285
Comment The lack of relation between the damaging effects of acute glaucoma and the presenting level of intraocular pressure is important, although long known. It helps to emphasize the fact that the height of the pressure is only one of three factors determining the severity of the acute attack, namely: 1) height of the intraocular pressure; 2) the degree of shallowing of the anterior chamber; and 3) probably most important - the degree of vascular congestion and edema. In cases with high pressure but little congestion, the response to medical treatment is usually excellent. This, too, is compatible with the author’s findings except that it seems to be more dependent on the cerebrovascular responses than on the physical cardiovascular state of the patient. It is suggested that earlier presentation of the patient might not significantly improve the final visual acuity. This may well be argued against since the early period is so important. Even an hour of delay then might make the difference between good and poor visual results. We have no choice but to emphasize the importance of early medical attention when symptoms appear, especially in predisposed hyperopes and those with relative chamber shallowness. H. SAUL SUGAR
Macular Edema in the Reattached Retina, by P. G. Nielsen. Acta Ophthalmol 57:522-529, 1979 A retrospective, fluoresceinangiographic study of 24 patients with postoperative retinal reattachment was carried out in order to evaluate the occurrence of macular edema and possible factors predisposing to this complication. Excluded from the group were cases requiring more than a single operation for reattachment, aphakia, excessive myopia, preexisting maculopathy, presumed traumatic detachments and cases with opacities in the ocular media. All the patients were subjected to a scleral buckling procedure with local silicone explant and/or encircling. In addition cryopexia or diathermia was employed in 11 cases and subretinal drainage in 22 of the 24 cases. The followup examinations took place from 3 to 26 months postoperatively. Macular edema was found in nine patients (35%). The clinical examination revealed macular edema in only live patients; fluorescein angiography verified the presence of the condition in those five patients and demonstrated it in four other cases. The presence of macular edema was synonymous with a visual acuity of 6/18 or less and was found to be the most frequent cause of poor recovery of visual function. No correlation could be demonstrated between macular edema and age of the patient, refraction, the duration of the detachment or preoperative macular detachment. There is no evidence in the results indicating that use of cryopexia, diathermia or local explant contra encircling procedures are factors of importance with regard to the development of macular edema. Drainage of subretinal fluid may have played a role in the development of a postdetachment syndrome with macular edema in the present study. Subdivision of the patients according to the estimated extent of subretinal drainage revealed an apparent accumulation of macular edema in the group with excessive drainage. An actual comparison of the drainage technique with the nondrainage technique has, however, not been possible in the present study, where all but two of the relatively small number of patients were subjected to drainage to some extent. It is concluded that macular edema is a frequent complication and that fluorescein angiography is essential for the diagnosis of macular edema following retinal detachment surgery. (Abstract by P. G. Nielsen)
Comment Cystoid macular edema, as the authors point out, is well known to occur after cataract extraction. In this presentation the authors document the occurrence of cystoid macular edema in a significant number of post-retinal-detachment cases. They point out, and rightly so, that fluorescein angiography will perhaps lead to more diagnoses of cystoid macular edema in retinal detachment cases than are presently made. They also observe that in their series the incidence was greater following cases in which subretinal fluid was drained than in those in which it was not. Although the numbers in their series are too small to be statistically significant, the fact that cystoid macular edema did occur more frequently when the tension was rapidly lowered with subretinal fluid drainage parallels the sudden decompression of the eye that occurs in cataract surgery. The role of inflammation, prostaglandins, as well as other factors in the pathogenesis of cystoid macular edema still awaits further clarification. WILLIAM TASMAN
285
Comment The lack of relation between the damaging effects of acute glaucoma and the presenting level of intraocular pressure is important, although long known. It helps to emphasize the fact that the height of the pressure is only one of three factors determining the severity of the acute attack, namely: 1) height of the intraocular pressure; 2) the degree of shallowing of the anterior chamber; and 3) probably most important - the degree of vascular congestion and edema. In cases with high pressure but little congestion, the response to medical treatment is usually excellent. This, too, is compatible with the author’s findings except that it seems to be more dependent on the cerebrovascular responses than on the physical cardiovascular state of the patient. It is suggested that earlier presentation of the patient might not significantly improve the final visual acuity. This may well be argued against since the early period is so important. Even an hour of delay then might make the difference between good and poor visual results. We have no choice but to emphasize the importance of early medical attention when symptoms appear, especially in predisposed hyperopes and those with relative chamber shallowness. H. SAUL SUGAR
Macular Edema in the Reattached Retina, by P. G. Nielsen. Acta Ophthalmol 57:522-529, 1979 A retrospective, fluoresceinangiographic study of 24 patients with postoperative retinal reattachment was carried out in order to evaluate the occurrence of macular edema and possible factors predisposing to this complication. Excluded from the group were cases requiring more than a single operation for reattachment, aphakia, excessive myopia, preexisting maculopathy, presumed traumatic detachments and cases with opacities in the ocular media. All the patients were subjected to a scleral buckling procedure with local silicone explant and/or encircling. In addition cryopexia or diathermia was employed in 11 cases and subretinal drainage in 22 of the 24 cases. The followup examinations took place from 3 to 26 months postoperatively. Macular edema was found in nine patients (35%). The clinical examination revealed macular edema in only live patients; fluorescein angiography verified the presence of the condition in those five patients and demonstrated it in four other cases. The presence of macular edema was synonymous with a visual acuity of 6/18 or less and was found to be the most frequent cause of poor recovery of visual function. No correlation could be demonstrated between macular edema and age of the patient, refraction, the duration of the detachment or preoperative macular detachment. There is no evidence in the results indicating that use of cryopexia, diathermia or local explant contra encircling procedures are factors of importance with regard to the development of macular edema. Drainage of subretinal fluid may have played a role in the development of a postdetachment syndrome with macular edema in the present study. Subdivision of the patients according to the estimated extent of subretinal drainage revealed an apparent accumulation of macular edema in the group with excessive drainage. An actual comparison of the drainage technique with the nondrainage technique has, however, not been possible in the present study, where all but two of the relatively small number of patients were subjected to drainage to some extent. It is concluded that macular edema is a frequent complication and that fluorescein angiography is essential for the diagnosis of macular edema following retinal detachment surgery. (Abstract by P. G. Nielsen)
Comment Cystoid macular edema, as the authors point out, is well known to occur after cataract extraction. In this presentation the authors document the occurrence of cystoid macular edema in a significant number of post-retinal-detachment cases. They point out, and rightly so, that fluorescein angiography will perhaps lead to more diagnoses of cystoid macular edema in retinal detachment cases than are presently made. They also observe that in their series the incidence was greater following cases in which subretinal fluid was drained than in those in which it was not. Although the numbers in their series are too small to be statistically significant, the fact that cystoid macular edema did occur more frequently when the tension was rapidly lowered with subretinal fluid drainage parallels the sudden decompression of the eye that occurs in cataract surgery. The role of inflammation, prostaglandins, as well as other factors in the pathogenesis of cystoid macular edema still awaits further clarification. WILLIAM TASMAN