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Park SH, Kwon HJ, Park SW, Byon IS, Lee SM. Iatrogenic Retinal Breaks in Macular Hole and Epiretinal Membrane Using 25-gauge Vitrectomy. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2021. [DOI: 10.3341/jkos.2021.62.6.806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Hu Z, Qian H, Fransisca S, Gu X, Ji J, Wang J, Liu Q, Xie P. Minimal internal limiting membrane peeling with ILM flap technique for idiopathic macular holes: a preliminary study. BMC Ophthalmol 2020; 20:228. [PMID: 32539696 PMCID: PMC7296741 DOI: 10.1186/s12886-020-01505-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/03/2020] [Indexed: 11/17/2022] Open
Abstract
Background Internal limiting membrane (ILM) peeling increases the idiopathic macular hole (IMH) closure rate but causes the inner retina dimplings. This study is to introduce a method to minimally peel the ILM, and with the ILM flap to ensure the IMH closure. Methods Twelve consecutive IMH eyes were treated with the minimal ILM peeling with ILM flap technique. The ILM around the MH is peeled off in an annular shape with a width of approximately 200 to 300 μm. A tongue-shape ILM flap is created in the superior retina and the inferior margin of ILM is not peeled off. The ILM flap is then inverted to cover the MH, followed by fluid-air exchange and air or silicon tamponade. Spectral domain-optical coherence tomography (SD-OCT) and en face OCT for morphological assessment, best corrected visual acuity (BCVA) and multifocal electroretinogram (ERG) for functional evaluation were performed at baseline and at each postoperative follow-up. Results All the 12 eyes achieved macular hole closure on SD-OCT after surgery (100%). At baseline, the mean preoperative BCVA was 0.83 ± 0.33 and it improved to 0.39 ± 0.28 postoperatively (p < 0.001). En face OCT showed the inner retinal dimplings were localized only in superior ILM-free retinas (7 eyes). The mERG response density in the central (R1), para-central (R2), R1/R2 ring ratios were remarkably improved at the last follow-up (p = 0.001, p = 0.033, p = 0.018, respectively). Conclusions The minimal ILM peeling with ILM flap technique can achieve favorable MH closure with less inner retinal dimplings and has promising visual recovery for IMH eyes.
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Affiliation(s)
- Zizhong Hu
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, Jiangsu, 210029, People's Republic of China
| | - Huiming Qian
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, Jiangsu, 210029, People's Republic of China
| | - Silvia Fransisca
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, Jiangsu, 210029, People's Republic of China
| | - Xunyi Gu
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, Jiangsu, 210029, People's Republic of China
| | - Jiangdong Ji
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, Jiangsu, 210029, People's Republic of China
| | - Jianan Wang
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, Jiangsu, 210029, People's Republic of China
| | - Qinghuai Liu
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, Jiangsu, 210029, People's Republic of China
| | - Ping Xie
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, Jiangsu, 210029, People's Republic of China.
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Broadhead GK, Hong T, Chang AA. To Treat or Not to Treat: Management Options for Symptomatic Vitreous Floaters. Asia Pac J Ophthalmol (Phila) 2020; 9:96-103. [PMID: 32097127 DOI: 10.1097/apo.0000000000000276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Vitreous floaters are a common cause for presentation to ophthalmologists, and may significantly affect visual function. In the absence of some more serious underlying pathology such as uveitis, many patients may not experience significant persistent visual impairment from floaters. For some patients, the symptomatic effects of floaters may persist. For these patients, treatment options are available, of which the most commonly reported is vitrectomy. Other treatment modalities have also become more common, notably YAG vitreolysis. Selection of appropriate patients for surgery is often difficult, in part due to the relative lack of objective outcomes with which to measure both visual impairment and improvement post-procedure. Although well-tolerated, vitrectomy does carry with it risks, including iatrogenic retinal breaks, retinal detachment, and in phakic patients, subsequent cataract formation. Techniques such as small gauge vitrectomy, intraoperative examination and treatment of breaks or other worrying lesions, and careful consideration of the need for posterior vitreous detachment induction may help limit the incidence of these adverse events. For other treatment options such as YAG vitreolysis, research and clinical experience remain more limited, and as such the long-term efficacy and risks of these therapies are still unclear. Here, we review the evidence surrounding the role of vitrectomy and YAG vitreolysis in the treatment of vitreous floaters and potential means to minimize therapeutic complications.
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Affiliation(s)
- Geoffrey K Broadhead
- Save Sight Institute, The University of Sydney, Sydney, Australia
- Sydney Institute of Vision Science, Sydney, Australia
| | - Thomas Hong
- Sydney Institute of Vision Science, Sydney, Australia
- Sydney Retina Clinic & Day Surgery, Sydney, Australia
| | - Andrew A Chang
- Save Sight Institute, The University of Sydney, Sydney, Australia
- Sydney Institute of Vision Science, Sydney, Australia
- Sydney Retina Clinic & Day Surgery, Sydney, Australia
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Saleh OA, Al-Dwairi RA, Mohidat H, Jusufbegovic D, Nesmith B, Barak Y, Mimouni M, Schaal S. International multi-center study of iatrogenic retinal tears in pars plana vitrectomy. Int J Ophthalmol 2019; 12:996-1000. [PMID: 31236359 DOI: 10.18240/ijo.2019.06.19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 07/05/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To study and compare the effect of different surgical settings on the development of iatrogenic retinal tears (IRT) in conventional (20-gauge) and microincisional vitrectomy. METHODS An international retrospective comparative study of 394 patients who had simple vitrectomy at three tertiary centers. Surgeries were performed by four retina surgeons using different viewing systems. Two groups of eyes were compared: microincisional vitrectomy (327 eyes) and conventional (67 eyes) vitrectomy. An iatrogenic tear was defined as the occurrence of one or more peripheral retinal tears during surgery or at any visit in the first 6wk postoperatively. RESULTS Mean age was 67±12y and 55% were female. Iatrogenic tears occurred in 11/394 (2.8%) of eyes. The rate of tears was similar among different surgeons and viewing systems (P=0.93 and P=0.76, respectively). Surgical indication, preexisting pseudophakia/aphakia, induction of posterior vitreous detachment (PVD) during surgery, and the use triamcinolone acetonide didn't significantly affect the rate of tears (P>0.1 for all factors). A higher rate of tears was found in the conventional group compared to the microincisional group (respectively, 7.5%, 1.8%, P=0.02). CONCLUSION The rate of IRT in vitrectomy is not significantly affected by surgical indication, preexisting PVD or pseudophakia, or use of triamcinolone or different viewing systems but is significantly higher in conventional vitrectomy. Microincisional platforms improve the safety of vitrectomy regardless of the viewing system used.
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Affiliation(s)
- Omar A Saleh
- Department of Ophthalmology, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Rami A Al-Dwairi
- Department of Ophthalmology, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Hasan Mohidat
- Department of Ophthalmology, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Denis Jusufbegovic
- Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, Kentucky 40202, United States
| | - Brooke Nesmith
- Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, Kentucky 40202, United States
| | - Yoreh Barak
- Department of Ophthalmology, Rambam Health Care Campus, Haifa 3109601, Israel
| | - Michael Mimouni
- Department of Ophthalmology, Rambam Health Care Campus, Haifa 3109601, Israel
| | - Shlomit Schaal
- Department of Ophthalmology and Visual Sciences, University of Massachusetts Medical School, Worcester, Massachusetts 01605, United States
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Characteristics and Outcomes of Pars Plana Vitrectomy for Proliferative Diabetic Retinopathy Patients in a Limited Resource Tertiary Center over an Eight-Year Period. J Ophthalmol 2019; 2019:9481902. [PMID: 31007953 PMCID: PMC6441510 DOI: 10.1155/2019/9481902] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 02/26/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose To report characteristics and visual results in patients with PDR-associated complications following pars plana vitrectomy (PPV) in a tertiary center over an eight-year period. Methods Medical records of diabetic retinopathy patients receiving PPV between January 2007 and December 2014 for PDR-related complications were reviewed. Results A total of 890 consecutive PDR patients were included in the study. PPVs were performed for tractional retinal detachment (36.6%), persistent vitreous hemorrhage (VH) (35.4%), combined tractional and rhegmatogenous retinal detachment (14.5%), and vitreoretinal abnormalities (13.5%), respectively. Preoperative intravitreal bevacizumab injection (IVB) within two weeks prior to PPV and 23G vitrectomy systems was found to decrease the risk for intraoperative retinal break development (P=0.045 and P=0.015, respectively). The incidence of early dense postoperative VH decreased significantly with the administration of preoperative or intraoperative IVB at the end of PPV. Postoperative visual results significantly correlated with the initial visual acuity level, intraoperative retinal break development, and retained silicone oil tamponade at the final visit (P < 0.001, P=0.040, and P=0.044, respectively). Administration of adjuvant IVB either before or at the end of PPV had no significant association with the final visual outcomes. Conclusions This study reported an improvement in visual acuity in nearly half of patients receiving PPV for PDR-associated complications in a limited resource center. The incidence of intraoperative retinal break and early postoperative VH decreased significantly with the application of IVB injections. Poor final visual outcomes were related to the lower initial visual acuity levels, intraoperative retinal breaks, and postoperative retained silicone oil.
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Macular Hole in Myopic Eyes: A Narrative Review of the Current Surgical Techniques. J Ophthalmol 2019; 2019:3230695. [PMID: 30984418 PMCID: PMC6432738 DOI: 10.1155/2019/3230695] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 02/21/2019] [Indexed: 02/03/2023] Open
Abstract
Macular hole (MH) in myopic eyes is a disease arising from complex tractional forces exerted by vitreomacular interface, epiretinal tissue, and progressive scleral ectasia of the posterior ocular globe wall. This retinal disease requires vitreoretinal treatment for its repair, and the surgical intervention remains a challenge also for experienced surgeons. The aim of this review is to describe the current knowledge regarding the pathogenesis of MH in myopic eyes and to detail novel surgical techniques and technological advancements in its surgical management.
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Chen GH, Tzekov R, Jiang FZ, Mao SH, Tong YH, Li WS. Iatrogenic retinal breaks and postoperative retinal detachments in microincision vitrectomy surgery compared with conventional 20-gauge vitrectomy: a meta-analysis. Eye (Lond) 2018; 33:785-795. [PMID: 30560911 DOI: 10.1038/s41433-018-0319-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 11/04/2018] [Accepted: 11/17/2018] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To assess the incidence of iatrogenic retinal breaks (IRBs) and postoperative retinal detachments (RDs) in microincision vitrectomy surgery (MIVS) compared with 20-gauge (20 G) vitrectomy. METHODS A comprehensive literature search was performed to find relevant studies and a meta-analysis of the IRBs and postoperative RDs rates after 20 G vitrectomy versus MIVS was conducted. RESULTS Thirty-two studies were selected, including 14,373 eyes (6932 eyes in the 20 G group, 7441 eyes in the MIVS group). The meta-analysis demonstrated that the incidence of IRBs was significantly higher in 20 G vitrectomy vs. MIVS (OR = 2.22, 95% CI, 1.93-2.57, P < 0.00001) and in a subanalysis vs. 23 G MIVS (OR = 2.19, 95% CI, 1.87-2.56, P < 0.00001) and vs. 25 G MIVS (OR = 2.27, 95% CI, 1.62-3.18, P < 0.00001). Similar result was obtained in a subanalysis for macular surgery (OR = 2.44, 95% CI, 1.99-2.99, P < 0.00001), and also for sclerotomy-related IRBs (OR = 3.73, 95% CI, 2.55-5.44, P < 0.00001), but not for surgically induced posterior vitreous detachment-related IRBs (OR = 1.59, 95% CI, 0.89-2.84, P = 0.12). The incidence of postoperative RDs in 20 G vitrectomy was significantly higher compared to MIVS (OR = 1.72, 95% CI, 1.21-2.46, P = 0.003) and in a subanalysis vs. 23 G MIVS (OR = 2.45, 95% CI, 1.50-4.00, P = 0.0003), but not for 25 G MIVS (OR = 1.01, 95% CI, 0.63-1.64, P = 0.96). Similar result was obtained in a subanalysis for macular surgery (OR = 1.89, 95% CI, 1.26-2.85, P = 0.002). CONCLUSION This meta-analysis demonstrated that MIVS is associated with a lower risk of IRBs and postoperative RDs compared to 20 G vitrectomy.
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Affiliation(s)
- G H Chen
- Department of Ophthalmology, Quzhou People's Hospital, Quzhou, Zhejiang, People's Republic of China
| | - R Tzekov
- Department of Ophthalmology, University of South Florida, Tampa, FL, USA
| | - F Z Jiang
- Department of Ophthalmology, Quzhou People's Hospital, Quzhou, Zhejiang, People's Republic of China
| | - S H Mao
- Department of Ophthalmology, Quzhou People's Hospital, Quzhou, Zhejiang, People's Republic of China
| | - Y H Tong
- Department of Ophthalmology, Quzhou People's Hospital, Quzhou, Zhejiang, People's Republic of China
| | - W S Li
- Shanghai Aier Eye Hospital, 1286 Hongqiao Road, Shanghai, People's Republic of China. .,Aier School of Ophthalmology, Central South University, Changsha, Hunan Province, People's Republic of China.
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Reply. Am J Ophthalmol 2018; 195:244-245. [PMID: 30177217 DOI: 10.1016/j.ajo.2018.07.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 07/28/2018] [Indexed: 11/21/2022]
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Elwan MM, Hagras SM, Kasem MA. Soloist performance of vitrectomy probe in proliferative diabetic retinopathy. Eur J Ophthalmol 2018; 29:251-256. [DOI: 10.1177/1120672118785103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To evaluate the feasibility and outcomes of the sole use of 23g pars plana vitrectomy in cases with diabetic vitreous hemorrhage with vitreoretinal traction. Methods: Prospective interventional case series involving patients between January 2013 and January 2018. All eyes underwent 23g pars plana vitrectomy with internal tamponade. Intraoperative parameters including ancillary instruments, the methods used for hemostasis and complications were all recorded. Postoperative parameters including anatomic success rate, functional success, and postoperative complications were recorded and analyzed. Patients were followed up for at least 12 months. Results: A total of 68 eyes of 66 patients were included. Intraoperative ancillary instruments were required in 5 (7.4%) eyes. None of the cases required the use of chandelier illumination, endodiathermy, or scissors. Mean best-corrected visual acuity improved significantly from LogMAR 1.67 ± 0.63 preoperative to 1.22 ± 0.38 at 1-year follow-up (P = 0.005). Functional success was achieved in 37 (54.4%) eyes at 1-year follow-up. Iatrogenic breaks occurred in 3 (4.4%) eyes, vitreous hemorrhage in 4 (5.9%) eyes, and epiretinal membranes in 3 (4.4%) eyes. Repeated vitrectomy was done in 3 (4.4%) eyes. Conclusion: The 23g vitrectomy probe proved to be a safe, effective, and beneficial single tool that could accomplish the diabetic vitrectomy mission exclusively with minimal aid from other instruments in cases with vitreous hemorrhage associated with vitreoretinal traction.
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Affiliation(s)
- Mohammed M Elwan
- Department of Ophthalmology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Sherein M Hagras
- Department of Ophthalmology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Manal A Kasem
- Department of Ophthalmology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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SURGICAL REMOVAL OF DENSE POSTERIOR CAPSULE OPACIFICATION AND VITREOUS FLOATERS IN ADULTS BY POSTERIOR CONTINUOUS CURVILINEAR CAPSULORHEXIS THROUGH THE PARS PLANA AND 23-GAUGE VITRECTOMY. Retina 2016; 36:2080-2086. [DOI: 10.1097/iae.0000000000001037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Intraoperative complications of patients undergoing small-gauge and 20-gauge vitrectomy: a database study of 4,274 procedures. Eur J Ophthalmol 2016; 27:226-230. [PMID: 27646328 DOI: 10.5301/ejo.5000856] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare the intraoperative complications between 23-G and 20-G instrumentation in patients undergoing pars plana vitrectomy (PPV). METHODS This was a retrospective comparative study of 4,274 PPV procedures by the same surgical team between 1998 and 2016. A total of 2,648 operations were carried out with 20-G surgery and 1,626 operations with 23-G surgery. Main outcome measures were the incidence of choroidal haemorrhage, iatrogenic retinal break, and lens touch. RESULTS The most frequent surgical indication in both 20-G and 23-G was rhegmatogenous retinal detachment (RRD), 38.7% (1,026/2,648) and 45.9% (746/1,626), respectively. The frequency of choroidal haemorrhage was 1.0% with 20-G surgery (26/2,648) vs 0.6% with 23-G (9/1,626, p = 0.16). Subgroup analysis showed the increased risk was present in RRD surgery, 1.6% (16/1,026) vs 0.1% (1/746, p = 0.002), but not in all other indications combined, 20-G with 0.6% (10/1,622) and 23-G 0.9% (8/88, p = 0.46). This increased risk was also true for RRD when excluding combined scleral buckle surgery. There was an increased risk of iatrogenic retinal break in RRD cases undergoing 20-G, 5.8% (60/1,026), compared to 23-G vitrectomy, 1.9% (14/746, p<0.0001). There was no difference in rates of lens touch between 20-G and 23-G. CONCLUSIONS 23-G microincisional PPV has a lower risk of choroidal haemorrhage and iatrogenic retinal tears than 20-G vitrectomy particularly for eyes with RRD.
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Oellers P, Stinnett S, Hahn P. Valved versus nonvalved cannula small-gauge pars plana vitrectomy for repair of retinal detachments with Grade C proliferative vitreoretinopathy. Clin Ophthalmol 2016; 10:1001-6. [PMID: 27313445 PMCID: PMC4892836 DOI: 10.2147/opth.s104901] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose Valved cannulas are a recent addition to small-gauge pars plana vitrectomy (PPV) and provide stable intraocular fluidics. The goal of this study was to compare outcomes and postoperative complication rates of valved vs nonvalved cannula small-gauge PPV for repair of retinal detachments (RDs) complicated by Grade C proliferative vitreoretinopathy (PVR). Methods A retrospective chart review of 364 consecutive eyes with either valved or nonvalved cannula PPV for RD repair was performed. The primary outcomes were single surgery and final anatomic success and change in best-corrected visual acuity for repair of RDs complicated by Grade C PVR. Results We identified 36 eyes in the valved group and 31 eyes in the nonvalved group with Grade C PVR RD. The single surgery success was 83% vs 77% (P=0.555) and the final anatomic success was 94% vs 87% (P=0.404) in the valved vs nonvalved eyes, respectively. The mean final visual acuity gain was −0.36 logarithm of the minimum angle of resolution (logMAR; approximate Early Treatment Diabetes Retinopathy Study [ETDRS] score =17 letters) in valved eyes vs −0.33 logMAR (approximate ETDRS score =16 letters) in nonvalved eyes (P=0.81). Postoperative complication rates including postoperative day 1 hypotony, hypertony, and anterior chamber fibrin formation; postoperative retention of intraocular or subretinal perfluorocarbon liquid; and subsequent epiretinal membrane peel were not statistically different between groups. Conclusion Valved cannula PPV yields equivalent visual acuity and anatomic outcomes without increased postoperative complication rates compared to traditional nonvalved cannula PPV for Grade C PVR-associated RD repair.
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Affiliation(s)
- Patrick Oellers
- Duke Eye Center, Duke University School of Medicine, Durham, NC, USA
| | - Sandra Stinnett
- Duke Eye Center, Duke University School of Medicine, Durham, NC, USA
| | - Paul Hahn
- Duke Eye Center, Duke University School of Medicine, Durham, NC, USA
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Celik E, Sever O, Horozoglu F, Yanyalı A. Segmentation and removal of fibrovascular membranes with high-speed 23 G transconjunctival sutureless vitrectomy, in severe proliferative diabetic retinopathy. Clin Ophthalmol 2016; 10:903-10. [PMID: 27274192 PMCID: PMC4876088 DOI: 10.2147/opth.s95145] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim To evaluate the effectiveness and safety of high-speed (5,000 cuts per minute) 23 G transconjunctival sutureless vitrectomy (TSV) in severe diabetic fibrovascular proliferation (DFVP). Patients and methods In this retrospective consecutive case series, patients who underwent 23 G TSV for severe DFVP between October 2011 and March 2014 at our institution were evaluated. 23 G TSV was performed with a high-speed (5,000 cuts per minute) cutter without a chandelier light. Results The mean follow-up period was 8 months (range: 4–23 months). Of the 27 eyes of 27 patients, 14 eyes (52%) underwent concomitant phacoemulsification with posterior chamber intraocular lens implantation, nine eyes (33%) were pseudophakic, and four eyes were phakic (15%). DFVP was removed with ease in all, and visual acuity was improved in 18 (67%) eyes. Iatrogenic retinal tear was observed in four eyes (15%) and treated successfully during surgery. Suture placement to a single sclerotomy was performed in eight eyes (30%). Postoperative intraocular hemorrhage was observed in five eyes (18%). Cataract formation was observed in two of the four phakic eyes. Three (11%) patients had postoperative intraocular pressure rise. Postoperative hypotony (≤6 mmHg) and endophthalmitis were not observed in any eye. Conclusion The segmentation and removal of fibrovascular membranes with high-speed 23 G TSV seems to be a safe and easy method in severe diabetic eye disease.
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Affiliation(s)
- Erkan Celik
- Sakarya University Medical Education and Research Hospital, Sakarya, Turkey
| | - Ozkan Sever
- Namik Kemal University, School of Medicine, Tekirdag, Turkey
| | - Fatih Horozoglu
- Namik Kemal University, School of Medicine, Tekirdag, Turkey
| | - Ates Yanyalı
- Haydarpasa Numune Medical Education and Research Hospital, Istanbul, Turkey
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COMPARISON OF SURGICAL OUTCOME OF 23-GAUGE AND 25-GAUGE MICROINCISION VITRECTOMY SURGERY FOR MANAGEMENT OF IDIOPATHIC EPIRETINAL MEMBRANE IN PSEUDOPHAKIC EYES. Retina 2015; 35:2115-20. [DOI: 10.1097/iae.0000000000000598] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
PURPOSE OF REVIEW To review the pros and cons of small-gauge vitrectomy for symptomatic floaters. RECENT FINDINGS Current treatment options for floaters include Nd:YAG vitreolysis and pars plana vitrectomy. There are risks and benefits associated with vitrectomy for floaters. However, small-gauge vitrectomy is a minimally invasive way of removing the floaters. The current literature demonstrates vitrectomy has some risk, but is highly effective at improving vision, symptoms, contrast sensitivity, and quality of life. SUMMARY Small-gauge vitrectomy for floaters is a well tolerated and effective procedure to remove the symptomatic floaters. Symptomatic patients are willing to take some risk to have their troublesome vitreous floaters removed, often resulting in an improvement in their vision and quality of life.
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Murakami T, Uji A, Ogino K, Unoki N, Yoshitake S, Dodo Y, Horii T, Nishijima K, Yoshimura N. Macular morphologic findings on optical coherence tomography after microincision vitrectomy for proliferative diabetic retinopathy. Jpn J Ophthalmol 2015; 59:236-43. [DOI: 10.1007/s10384-015-0382-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 04/06/2015] [Indexed: 11/24/2022]
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Guthrie G, Magill H, Steel DHW. 23-gauge versus 25-gauge vitrectomy for proliferative diabetic retinopathy: a comparison of surgical outcomes. Ophthalmologica 2014; 233:104-11. [PMID: 25471620 DOI: 10.1159/000369258] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 10/17/2014] [Indexed: 11/19/2022]
Abstract
PURPOSE This study compared clinical outcomes and complications between 23-gauge (23g) and 25-gauge (25g) transconjunctival sutureless vitrectomy in patients with proliferative diabetic retinopathy. STUDY DESIGN It was a retrospective study using data prospectively defined and collected. 80 eyes underwent 23g transconjunctival sutureless vitrectomy, and 80 eyes underwent 25g surgery using the same vitrectomy system by one surgeon. Primary outcome measures were best-corrected visual acuity, intraocular pressure (IOP), and incidence of intraoperative and postoperative complications. RESULTS Vision was significantly improved after intervention in both groups (p ≥ 0.0001). There was no significant difference in visual outcomes between the groups (p = 0.43) or in the type and frequency of retinal breaks occurring during surgery (p = 0.63). The 23g group had significantly more patients with a day 1 IOP of <6 mm Hg (p = 0.034) and significantly more patients requiring a sclerostomy suture postoperatively (p = 0.014). CONCLUSION AND MESSAGE Both gauges are equally effective for the treatment of proliferative diabetic retinopathy.
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Feltgen N, Walter P. Rhegmatogenous retinal detachment--an ophthalmologic emergency. DEUTSCHES ARZTEBLATT INTERNATIONAL 2014; 111:12-21; quiz 22. [PMID: 24565273 PMCID: PMC3948016 DOI: 10.3238/arztebl.2014.0012] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 09/09/2013] [Accepted: 09/09/2013] [Indexed: 12/29/2022]
Abstract
BACKGROUND Rhegmatogenous retinal detachment is the most common retinological emergency threatening vision, with an incidence of 1 in 10 000 persons per year, corresponding to about 8000 new cases in Germany annually. Without treatment, blindness in the affected eye may result. METHOD Selective review of the literature. RESULTS Rhegmatogenous retinal detachment typically presents with the perception of light flashes, floaters, or a "dark curtain." In most cases, the retinal tear is a consequence of degeneration of the vitreous body. Epidemiologic studies have identified myopia and prior cataract surgery as the main risk factors. Persons in the sixth and seventh decades of life are most commonly affected. Rhegmatogenous retinal detachment is an emergency, and all patients should be seen by an ophthalmologist on the same day that symptoms arise. The treatment consists of scleral buckle, removal of the vitreous body (vitrectomy), or a combination of the two. Anatomical success rates are in the range of 85% to 90%. Vitrectomy is followed by lens opacification in more than 70% of cases. The earlier the patient is seen by an ophthalmologist, the greater the chance that the macula is still attached, so that visual acuity can be preserved. CONCLUSION Rhegmatogenous retinal detachment is among the main emergency indications in ophthalmology. In all such cases, an ophthalmologist must be consulted at once.
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Gonzalez MA, Flynn HW, Smiddy WE, Albini TA, Berrocal AM, Tenzel P. Giant retinal tears after prior pars plana vitrectomy: management strategies and outcomes. Clin Ophthalmol 2013; 7:1687-91. [PMID: 24039388 PMCID: PMC3770346 DOI: 10.2147/opth.s48930] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate management strategies and outcomes for patients with giant retinal tear (GRT)-associated retinal detachment (RD) that had undergone previous pars plana vitrectomy (PPV). Methods A noncomparative consecutive case series between January 2005 and July 2010. Patients with a preceding history of PPV undergoing retinal reattachment surgery for GRTs were identified. Results Using International Classification of Diseases 9 codes for GRTs, 227 cases were identified. A total of eight eyes in eight patients were identified as having had preceding PPV for non-RD-related pathology. The mean age was 45.5 (range of 10–79) years. The mean time between PPV and diagnosis of GRT was 2.4 months. The mean follow-up after RD surgery was 24.3 months. Presenting visual acuity was 20/400 or better in four of eight patients (50%). All patients underwent repeat PPV with either gas or oil tamponade. A scleral buckling procedure was performed in seven patients (88%). Perfluorocarbon liquid was used during reattachment surgery in four patients (50%). Although anatomic success was achieved in all patients, visual acuity at last follow-up was 20/400 or better in 6 patients (75%). Conclusion GRTs are an uncommon complication of PPV. The majority of patients underwent repeat PPV, scleral buckling procedure, perfluorocarbon liquid use and silicone-oil tamponade. Patients presenting with GRT-associated RD after PPV undergoing additional surgery achieved high rates of anatomic success, but visual outcomes were variable.
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Affiliation(s)
- Marco A Gonzalez
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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Wong D, Zhao P, Joussen A. No excuse for not looking. Graefes Arch Clin Exp Ophthalmol 2013; 251:1461-2. [PMID: 23652466 DOI: 10.1007/s00417-013-2305-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 02/26/2013] [Indexed: 11/29/2022] Open
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