fibrin and Retinal-Detachment

Topics: Achilles Tendon; Animals; Choroid; Dogs; Fibrin; Humans; Light Coagulation; Polymers; Postoperative Complications; Retinal Detachment; Sclera; Silicones; Transplantation, Autologous

To report the intra-and postoperative complications and visual acuity outcomes in pars plana vitrectomy (PPV), phacoemulsification and intraocular lens (IOL) implantation in patients with cataract and proliferative diabetic retinopathy (PDR). A comparison of the combined versus two-step surgical approach is given.. Retrospective uncontrolled interventional clinical trial. Forty-eight eyes of 48 consecutive patients with PDR were included. Twenty-eight (58.3%) eyes with combined surgery and 20 (41.7%) eyes with sequential surgery were analyzed.. Postoperative follow-up time was between 6 and 63 months (mean: 18 months). 1) Combined surgery: Preoperative best-corrected visual acuity (BCVA) ranged from 20/200 to hand motions, and postoperative BCVA ranged from 20/30 to hand motions. BCVA improved in 17 eyes (60.7%), while in 7 (25%) eyes there was no change (> or =2 ETDRS lines) in VA, and in 4 (14.3%) eyes BCVA decreased. Postoperative complications included vitreous hemorrhage (VH) in 10 (35.7%) eyes, and fibrinous exudation in 9 (32.1%) eyes. 2) Two-step surgery: Preoperative BCVA ranged from 10/200 to light perception, and from 20/40 to light perception in the postoperative period. Best-corrected visual acuity improved in 15 (75%) eyes, remained the same in 4 (20%) eyes, and decreased in 1 (5%) eye. Postoperative complications included fibrinous exudation in 6 (30%) eyes, and VH in 3 (15%) eyes.. Combined PPV, phacoemulsification and IOL implantation as well as the two-step procedure are safe and effective for the management of cataract in PDR. Sequential surgery could be advantageous to BCVA outcomes by minimizing postoperative VH, which is significantly more frequent after combined surgery.

Topics: Adult; Aged; Aged, 80 and over; Cataract; Diabetic Retinopathy; Exudates and Transudates; Female; Fibrin; Follow-Up Studies; Humans; Intraoperative Complications; Ischemia; Lens Implantation, Intraocular; Macula Lutea; Male; Middle Aged; Phacoemulsification; Postoperative Complications; Retinal Detachment; Retrospective Studies; Time Factors; Visual Acuity; Vitrectomy; Vitreoretinopathy, Proliferative; Vitreous Hemorrhage

To evaluate the efficacy of low molecular weight heparin (LMWH) in prevention of postoperative fibrin formation following vitreoretinal surgery with proliferative vitreoretinopathy (PVR).. Thirty consecutive patients of retinal detachment with advanced PVR were enrolled in the study. They were randomised to study and control groups (n = 15 each). Study group patients received vitreoretinal surgery with 5 IU/cc of LMWH in vitrectomy infusion fluid. The control group patients received vitroretinal surgery without heparin in the infusion fluid. Patients were followed up at 1 week, 1 month and 3 months after surgery. Postoperative bleeding, media clarity, best-corrected visual acuity and success of the surgery at the end of 3 months were compared between the two groups.. At each follow-up visit, the study group showed a better media clarity, which was statistically significant (P = 0.0042). The study group had a 50% better chance of retinal reattachment compared to the control group. Five patients had intraoperative bleeding in the study group (33%) compared to 3 patients in the control group (20%).. Use of intravitreal LMWH prevents postoperative fibrin formation and is beneficial in repair of retinal detachments with PVR.

Topics: Adult; Aged; Female; Fibrin; Fibrinolytic Agents; Heparin, Low-Molecular-Weight; Humans; Male; Middle Aged; Postoperative Complications; Retinal Detachment; Treatment Outcome; Visual Acuity; Vitrectomy; Vitreoretinopathy, Proliferative

Topics: Adult; Central Serous Chorioretinopathy; Diagnosis, Differential; Exudates and Transudates; Fibrin; Humans; Macula Lutea; Male; Retinal Detachment; Tomography, Optical Coherence

To determine if the inflammatory composition of subretinal fluid in Vogt-Koyanagi-Harada (VKH) serous retinal detachments is predictive of photoreceptor injury, and to quantify photoreceptor recovery, following resolution of these detachments.. Optical density (OD) measurements of spectral-domain optical coherence tomography (SD-OCT) scans were used to derive the fibrinous index, a measure of the inflammatory composition of subretinal fluid. In order to assess photoreceptor status, photoreceptor outer segment (PROS) volume was measured from SD-OCT scans.. The fibrinous index of subretinal fluid in VKH uveitis was strongly correlated with the PROS volume following resolution of subretinal fluid (r = -0.70, p = 0.006). Following fluid resolution, both PROS volume (p < 0.0001) and visual acuity (p = 0.0015) improved.. The fibrinous index of subretinal fluid during the acute stage of VKH can predict photoreceptor status following resolution of subretinal fluid. PROS volume is a useful measure of photoreceptor recovery in VKH.

Topics: Adult; Female; Fibrin; Humans; Male; Panuveitis; Recovery of Function; Retinal Detachment; Retinal Photoreceptor Cell Outer Segment; Subretinal Fluid; Tomography, Optical Coherence; Uveomeningoencephalitic Syndrome; Visual Acuity

Topics: Exudates and Transudates; Fibrin; Fluorescein Angiography; Humans; Imaging, Three-Dimensional; Laser Coagulation; Male; Middle Aged; Pigment Epithelium of Eye; Retinal Detachment; Tomography, Optical Coherence

Twenty two eyes of 22 cases with severe intraocular fibrin formation after vitrectomy who had been all unresponsive to conventional therapy were treated with tissue plasminogen activator (t-PA), including complicated retinal detachment (14 eyes), intraocular foreign body (3 eyes), vitreous hemorrhage (2 eyes), traumatic cataract (2 eyes) and endophthalmitis (1 eye). The fibrin formation appeared 1-5 days with a mean of 2 days after operation. Of these 22 eyes, fibrin was seen in the pupillary area in 11, in the anterior chamber in 10 eyes and in the vitreous cavity in 1 eye. The initial injection of t-PA was given between the 5th and 15th (mean, 8.6 days) postoperative days after vitrectomy. The t-PA (5-30 micrograms) was injected into the anterior chamber in 21 cases and into the vitreous cavity in 1 case (25 micrograms). Once injection resulted in complete fibrinolysis in 19 of 22 eyes and partial fibrinolysis in 3 eyes, and the complete dissolution with one injection was achieved within 0.5-2.5 hours with a mean of 1 hour. 1 eye required repeated t-PA injection for recurrent fibrin formation and the repeated injection resulted in complete fibrinolysis in this case. The follow-up periods ranged from 1 to 20 months (mean period, 10 months). At the final follow-up examination, the retina was totally attached in 16 of 22 eyes and partially attached and detached in 6. Visual acuity improved in 13 eyes. Complications of t-PA injection included hyphema, elevated intraocular pressure (IOP) and hyphema with elevated IOP in 1 case respectively. Factors affecting the therapeutic effect of t-PA and methods preventing the complications of t-PA injection were discussed.

Topics: Adolescent; Adult; Child; Female; Fibrin; Follow-Up Studies; Humans; Male; Middle Aged; Plasminogen Activators; Postoperative Complications; Retinal Detachment; Time Factors; Tissue Plasminogen Activator; Vitrectomy

To report unusual and heretofore unreported visually damaging manifestations of severe central serous chorioretinopathy.. Case studies.. Each of six male patients (average age, 40 years) had a form of severe central serous chorioretinopathy with at least one eye containing fibrin in the subretinal space that then developed into a subretinal fibrotic scar. Scar formation was followed by a tenting up of the macula, vascularization of the fibrosis (subretinal neovascularization), or a retinal pigment epithelial rip. Four of the seven eyes with subretinal fibrosis had severe visual loss (20/400 or worse).. Subretinal fibrin and other extracellular matrix molecules appear to stimulate the retinal pigment epithelium to undergo fibrous metaplasia, which results in subretinal fibrotic scar formation and other sequelae, all of which can lead to severe visual loss.

Topics: Adult; Body Fluids; Choroid Diseases; Exudates and Transudates; Fibrin; Fibrosis; Fluorescein Angiography; Fundus Oculi; Humans; Male; Middle Aged; Retina; Retinal Detachment; Retinal Diseases; Vision Disorders; Visual Acuity

Tissue plasminogen activator (tPA) has been shown to be effective at a dose of 25 micrograms in the treatment of severe postvitrectomy fibrin. However, a recent report based on an animal model indicates that retinal toxicity may occur at doses as low as 25 micrograms. This study uses a low dose (1.5 micrograms to 3 micrograms) of tPA for 34 injections in 26 eyes, and determines the lowest effective dose to be between 1.5 and 3 micrograms. Complete fibrinolysis was achieved in all 28 eyes in which 3 micrograms of tPA was administered within 10 days of vitrectomy, whereas partial fibrinolysis was achieved in eyes treated with 3 micrograms of tPA 27 days and 82 days after vitrectomy. Complete fibrinolysis occurred in only 1 of 4 eyes that receive 1.5 micrograms of tPA. A dose of 3 micrograms of tPA is recommended for treatment of severe fibrin after vitrectomy, as it has a wider margin of safety than do higher doses.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Female; Fibrin; Fibrinolysis; Humans; Male; Middle Aged; Postoperative Complications; Recombinant Proteins; Retinal Detachment; Retrospective Studies; Tissue Plasminogen Activator; Vitrectomy

Topics: Female; Fibrin; Humans; Middle Aged; Postoperative Complications; Recurrence; Retinal Detachment; Tissue Plasminogen Activator; Vitrectomy

Subretinal blood within the macula may cause visual loss in a number of macular diseases. The clinical and histopathologic effects of experimental subretinal hemorrhage were evaluated in the cat. Subretinal hemorrhages were produced by creating a focal neurosensory retinal detachment with micropipette techniques, then inserting a needle tip transsclerally to allow choroidal blood to fill the bleb. Experimental lesions were examined clinically and with light and electron microscopy during a 14-day postoperative period. Initial observations included clot organization with retraction of fibrin strands. In six of nine clots more than 1 hour old, fibrin was associated with tearing of sheets of photoreceptor inner and outer segments. Later degeneration progressed to involve all retinal layers overlying the densest areas of fibrin in the clots. Hemorrhages into subretinal blebs containing tissue plasminogen activator did not form fibrin strands or cause photoreceptor tearing. These findings highlight the potential for improved retinal survival if organized subretinal clot can be eliminated soon after formation.

Topics: Animals; Cats; Disease Models, Animal; Fibrin; Fundus Oculi; Retina; Retinal Degeneration; Retinal Detachment; Retinal Hemorrhage

The authors injected 25 micrograms of recombinant tissue plasminogen activator (tPA) into the anterior chamber or vitreous cavity of 23 eyes of 22 patients with severe intraocular fibrin formation that developed after vitrectomy surgery for complicated cases of proliferative vitreoretinopathy (PVR) (13 eyes), diabetic traction retinal detachment (TRD) (7 eyes), or endophthalmitis (3 eyes). Tissue plasminogen activator injected an average (+/- standard deviation) of 73 +/- 63 hours after vitrectomy surgery resulted in complete fibrinolysis in 21 of 23 eyes and partial fibrinolysis in one eye. The mean time to fibrin resolution was 3.0 +/- 1.0 hours. Four eyes required repeat tPA injection for recurrent fibrin formation; repeat injection resulted in complete fibrinolysis in each case. The mean follow-up duration after tPA administration was 6 months. At the final follow-up examination, the retina was totally attached in 18 of 23 eyes and was partially attached in 2. Visual acuity improved in 12 eyes (52%); it was at least 20/400 in 8. Complications of tPA injection included hyphema (2 patients) and corneal stromal thickening (2 patients). Mild, transient, periocular pain that was easily managed with non-narcotic analgesia developed in three patients.

Topics: Adolescent; Adult; Aged; Anterior Chamber; Child; Endophthalmitis; Female; Fibrin; Follow-Up Studies; Humans; Male; Middle Aged; Pilot Projects; Recombinant Proteins; Retinal Detachment; Retinal Diseases; Tissue Plasminogen Activator; Visual Acuity; Vitrectomy; Vitreous Body

Human recombinant tissue plasminogen activator (25 micrograms) was injected into seven eyes of six patients who had developed massive fibrin deposition after vitrectomy surgery for diabetes. Six eyes had developed pupillary membranes and recurrence of tractional retinal detachment from fibrin membranes, and one eye had developed only a pupillary membrane. All pupillary membranes resolved within one hour of administration of tissue plasminogen activator, and five tractional retinal detachments resolved within 24 hours. All eyes developed evidence of intraocular bleeding after tissue plasminogen activator injection. Subsequently, six of seven eyes developed recurrence of fibrin accumulation and tractional retinal detachment.

Topics: Adult; Diabetic Retinopathy; Eye Diseases; Female; Fibrin; Hemorrhage; Humans; Male; Middle Aged; Postoperative Care; Postoperative Complications; Retinal Detachment; Tissue Plasminogen Activator; Vitrectomy

We injected 25 micrograms of recombinant tissue plasminogen activator into the anterior chamber or the vitreous cavity in seven aphakic patients for pupillary block caused by a complete fibrin pupillary membrane that formed after vitrectomy with fluid-gas exchange. Progressive fibrin deposition resulted in pupillary block by three days after vitrectomy surgery in six patients, and seven days after vitrectomy in one patient. The pupillary block was associated with increased intraocular pressure in six patients. Tissue plasminogen activator was injected via the corneoscleral limbus in five patients and via the pars plana in two patients. In all patients, injection of tissue plasminogen activator resulted in complete fibrinolysis of the fibrin pupillary membrane within four hours, associated with a deepening of the anterior chamber. In the six patients with increased intraocular pressure at the time of tissue plasminogen activator injection, dissolution of the fibrin membrane was associated with a decrease in pressure. In all patients, intraocular pressure had returned to normal by three days after the injection. No complications were associated with the injection.

Topics: Adult; Aged; Anterior Chamber; Female; Fibrin; Humans; Insufflation; Intraocular Pressure; Iris Diseases; Male; Middle Aged; Recombinant Proteins; Retinal Detachment; Tissue Plasminogen Activator; Vitrectomy; Vitreous Body; Vitreous Hemorrhage

Cryoprecipitate and thrombin were used to prevent bleeding and induce permanent conjunctival attachment in ten cases of retinal detachment, 40 cases of extracapsular cataract extraction, and ten cases of strabismus. This method proved to be a good alternative to suturing the conjunctiva in each of the above-mentioned surgical procedures, and appears to result in a better and more comfortable postoperative course.

Topics: Adhesives; Cataract Extraction; Eye; Fibrin; Humans; Ophthalmologic Surgical Procedures; Postoperative Period; Retinal Detachment; Scleral Buckling; Strabismus

Certain types of intermediary uveitis are accompanied by proliferative vitreoretinopathy and retinal detachment. As a rule both complications are confined to the fundus periphery; they often occur simultaneously but they are not always related to one another. Exudate plaques and/or neovascularizations at the base of the vitreous are the precursors of peripheral proliferative vitreoretinopathy. Clinical findings and their therapeutic consequences are discussed.

Topics: Fibrin; Humans; Retina; Retinal Detachment; Retinal Vessels; Uveitis; Vitreous Body

Two hundred eighty consecutive vitrectomies in diabetic patients were studied retrospectively. In 15 eyes, interlacing fibrin-like strands appeared on the surface of the retina and behind the iris plane from two to 14 days postoperatively. One or two days later, a gelatinous mass formed in the center of the vitreous activity, leading to the development of tractional retinal detachment and rubeosis iridis with neovascular glaucoma. Large doses of systemic and topical corticosteroids reversed the fulminating course of this complication in six of 15 eyes. The combination of lens surgery or scleral buckling procedure with vitrectomy, and the presence of retinal detachment preoperatively seemed to predispose to this complication. It is possible that multiple surgical procedures performed during the same operation cause an increase in vascular permeability resulting in the formation of a gelatinous, fibrin-like material in the diabetic eye.

Topics: Adult; Aged; Diabetic Retinopathy; Eye Diseases; Female; Fibrin; Glaucoma; Humans; Intraocular Pressure; Iris Diseases; Male; Middle Aged; Postoperative Complications; Retinal Detachment; Retrospective Studies; Syndrome; Vitreous Body

Subtotal open-sky vitrectomy can be used to improve visual function in some eyes for which closed vitrectomy is useless. Open-sky vitrectomy allows easier access for surgical instruments, especially to anterior fundus structures. The technique also improves the visibility of intraocular structures. The surgical procedure, which uses special instruments and high-molecular-weight hyaluronic acid, is divided into four stages: preparation, operating inside the vitreous cavity, wound closure, and retinal reattachment. In 290 consecutive operations for which complete follow-up data are available, retinal reattachment was achieved in 61 eyes (21%). The greatest number of successes (16 of 30 cases [53%]) was achieved in severe tractional retinal detachments. Such results are encouraging because these eyes were considered inoperable by other techniques. Open-sky vitreous surgery is performed through a corneal incision, but a scleral incision over the pars plana may become the method of choice in selected cases. The development of a preretinal fibrin membrane, as a result of either a closed vitrectomy or an open-sky procedure, may be a major cause of postoperative failure. Hypotony during surgery is probably the main precipitating factor of intraocular fibrin membrane formation.

Topics: Adolescent; Adult; Cataract; Child; Child, Preschool; Eye Diseases; Eye Foreign Bodies; Eye Injuries; Female; Fibrin; Humans; Lens Subluxation; Male; Middle Aged; Retinal Detachment; Scleral Buckling; Vitreous Body

In 21 patients with macular hole and retinal detachment a macular buckling procedure was performed including diathermic or cryogenic coagulation. An absorbable fibrin sponge (Fibrospum) was used as a new buckling material, which needs not to be sutured to the sclera at the posterior pole. In comparison to other procedures the use of fibrin sponge seems to be more simple and at least of the same results.

Topics: Cryosurgery; Electrocoagulation; Fibrin; Humans; Postoperative Complications; Refraction, Ocular; Retinal Detachment; Surgical Equipment; Visual Acuity

Clot formation occurs preferentially in the choriocapillaris. With intraocular inflammation this clotting begins along the inner surface of the choriocapillaris suggesting that dilatation of the vessels and opening of the endothelial fenestra have initiated the process. With the systemic coagulopathy of thrombotic thrombocytopenia (TTP) and disseminated intravascular coagulopathy (DIC) clotting occurs preferentially in the submacular choriocapillaris, sometimes associated with choroidal hemorrhage and detachment of the retina. These complications are illustrated in the present paper by a patient with TTP showing relatively chronic coagulopathy and by three patients with DIC showing variations of acute coagulopathy.

Topics: Adult; Choroid; Disseminated Intravascular Coagulation; Female; Fibrin; Humans; Male; Middle Aged; Pregnancy; Purpura, Thrombotic Thrombocytopenic; Retinal Detachment

The study includes a series of 38 patients with retinal detachment of different aetiology. Scleral reduction combined with the intrascleral implantation of absorbable Bioplast fibrin scleral buckling rods was performed and reattachment achieved in 31 cases. The implant material is biocompatible and is eliminated from the eye in the course of a few weeks.

Topics: Adolescent; Adult; Aged; Eye Injuries; Fibrin; Humans; Middle Aged; Myopia; Retinal Detachment; Scleral Buckling

Topics: Acute Disease; Antithrombins; Blood Cell Count; Blood Coagulation Tests; Disseminated Intravascular Coagulation; Fibrin; Fibrinogen; Fibrinolysis; Hemorrhage; Humans; Leukemia; Leukemia, Monocytic, Acute; Leukemia, Myeloid; Leukemia, Myeloid, Acute; Liver Cirrhosis; Lymphatic Diseases; Platelet Adhesiveness; Prothrombin Time; Retinal Detachment; Thrombin; Thrombophlebitis

Topics: Animals; Antioxidants; Blindness; Choroid; Darkness; Diet; Fatty Acids; Fibrin; Hydrophthalmos; Light; Lipid Metabolism; Macrophages; Melanins; Oxidation-Reduction; Peroxides; Photochemistry; Retina; Retinal Degeneration; Retinal Detachment; Time Factors; Turkeys

Topics: Adolescent; Adult; Aged; Female; Fibrin; Humans; Male; Middle Aged; Retinal Detachment

Topics: Anemia, Aplastic; Child; Eye Diseases; Female; Fibrin; Hemorrhage; Humans; Retina; Retinal Detachment; Retinal Hemorrhage; Vitreous Body

Topics: Choroid; Fibrin; Humans; Injections; Prothrombin; Retinal Detachment; Sclera; Syringes

Topics: Fibrin; Humans; Hydroxides; Potassium Compounds; Retinal Detachment