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Jin KW, Woo SJ, Park KH. Efficacy and safety of primary posterior capsulotomy during phaco-vitrectomy for epiretinal membrane. BMC Ophthalmol 2022; 22:4. [PMID: 34980021 PMCID: PMC8722013 DOI: 10.1186/s12886-021-02226-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 12/17/2021] [Indexed: 11/10/2022] Open
Abstract
Purpose To evaluate the necessity and safety of primary posterior capsulotomy during phaco-vitrectomy for idiopathic epiretinal membrane (ERM). Setting Seoul National University Bundang Hospital, Seongnam, Korea. Design Retrospective consecutive cohort analysis. Methods This study enrolled 219 patients (228 eyes) who underwent combined 25-gauge phaco-vitrectomy for idiopathic ERM and cataract, divided into capsulotomy (−) group (152 eyes, 144 patients) and capsulotomy (+) group (76 eyes, 75 patients). The main outcomes were rate of posterior capsular opacity (PCO) occurrence and postoperative complications. Ophthalmic examinations were performed at baseline, 1, 3, 6, and 12 months postoperatively. Results PCO only occurred in capsulotomy (−) group (20 eyes, 13.2%), with mean onset of 10.59 months. Visually-significant PCO that needed Nd:YAG posterior capsulotomy was present in 9 eyes (45.0% of PCO eyes). The rate of cystoid macular edema (CME) was higher in capsulotomy (+) group (6.6% vs. 15.8%, p = 0.026) with longer duration (1.50 vs. 3.36 months, p = 0.019). Female sex and posterior capsulotomy were significant risk factors for CME occurrence (p < 0.05). Conclusion Primary posterior capsulotomy during phaco-vitrectomy for idiopathic ERM obviated the need for Nd:YAG posterior capsulotomy, but visually-significant PCO that needed Nd:YAG laser was not common. Considering the low rate of visually-significant PCO and high rate of postoperative CME, routine posterior capsulotomy during phaco-vitrectomy may not be necessary for preventing PCO in ERM.
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Affiliation(s)
- Ki Won Jin
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Se Joon Woo
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Kyu Hyung Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea.
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Ortoli M, Blanco-Garavito R, Blautain B, Mastorakos N, Souied EH, Glacet-Bernard A. Prognostic factors of idiopathic epiretinal membrane surgery and evolution of alterations of the central cone bouquet. Graefes Arch Clin Exp Ophthalmol 2021; 259:2139-2147. [PMID: 33625565 DOI: 10.1007/s00417-021-05110-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 01/26/2021] [Accepted: 02/01/2021] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To describe the structural changes observed postoperatively in epiretinal membranes (ERM), in particular the alterations in the central cone bouquet (CB), and to identify prognostic factors that might predict postoperative outcome. METHODS We included 125 eyes of 117 patients who underwent idiopathic ERM removal with at least a 6-month follow-up. For each patient, spectral-domain optical coherence tomography (SD-OCT) was performed and best-corrected visual acuity (BCVA) was measured, before and after surgery. RESULTS Before surgery, 44 eyes (35.2%) presented CB alterations: 65.9% a cotton ball sign, 15.9% a foveolar detachment and 18.2% a pseudovitelliform lesion. Median BCVA increased from 20/63 to 20/32 post-operatively (p = .001) with a mean follow-up of 17 months. The disappearance of CB alterations after surgery was observed in 97.7% of eyes. In stage 3 and 4 ERM, ectopic inner foveal layers persisted in 76.7% of eyes after surgery. Postoperative BCVA was correlated with change in central macular thickness and initial BCVA and was not correlated with the presence of preoperative CB alteration, the initial stage of ERM, the presence of postoperative dissociated optical nerve fiber layer, and the disappearance of ectopic inner fiber layers. The combination of cataract surgery and capsulotomy did not seem to change visual outcome and seemed to accelerate visual recovery. Incidentally, general anesthesia was correlated with final BCVA. CONCLUSION ERM surgery allowed a significant gain in BCVA and the disappearance of CB alterations in the great majority of cases. CB alteration did not show to be associated with poor visual prognosis.
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Affiliation(s)
- Manon Ortoli
- Department of Ophthalmology, Intercommunal Hospital Center and Henri Mondor Hospital, Paris-Est Créteil University (UPEC, Paris XII University), 40 avenue de Verdun, 94000, Creteil, France.
| | - Rocio Blanco-Garavito
- Department of Ophthalmology, Intercommunal Hospital Center and Henri Mondor Hospital, Paris-Est Créteil University (UPEC, Paris XII University), 40 avenue de Verdun, 94000, Creteil, France
| | - Benjamin Blautain
- Department of Ophthalmology, Intercommunal Hospital Center and Henri Mondor Hospital, Paris-Est Créteil University (UPEC, Paris XII University), 40 avenue de Verdun, 94000, Creteil, France
| | - Nikitas Mastorakos
- Department of Ophthalmology, Intercommunal Hospital Center and Henri Mondor Hospital, Paris-Est Créteil University (UPEC, Paris XII University), 40 avenue de Verdun, 94000, Creteil, France
| | - Eric H Souied
- Department of Ophthalmology, Intercommunal Hospital Center and Henri Mondor Hospital, Paris-Est Créteil University (UPEC, Paris XII University), 40 avenue de Verdun, 94000, Creteil, France
| | - Agnès Glacet-Bernard
- Department of Ophthalmology, Intercommunal Hospital Center and Henri Mondor Hospital, Paris-Est Créteil University (UPEC, Paris XII University), 40 avenue de Verdun, 94000, Creteil, France
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Hertzberg SNW, Veiby NCBB, Bragadottir R, Eriksen K, Moe MC, Petrovski BÉ, Petrovski G. Cost-effectiveness of the triple procedure - phacovitrectomy with posterior capsulotomy compared to phacovitrectomy and sequential procedures. Acta Ophthalmol 2020; 98:592-602. [PMID: 32078246 DOI: 10.1111/aos.14367] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 01/10/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE To evaluate the cost-effectiveness of the triple procedure (phacovitrectomy + posterior capsulotomy, PhacoPPVc) compared to the double- (phacovitrectomy, PhacoPPV) or single sequential procedures. METHODS Prospective study on 31 eyes from 31 patients (mean age: 72.1 ± 9.1 years; 55% females) was performed with a preoperative decision to undergo only pars plana vitrectomy (PPV) (26%) or PhacoPPV (74%) and/or posterior capsulotomy based upon presence or absence of lens opacification or pseudophakia. Time during and between surgeries, surgical procedure codes, medical and transport costs, outcome and likelihood of complications after surgery were all included in the analysis. Societal perspectives and visual acuity were considered as measures of quality of adjusted life years (QALYs). RESULTS About 23 eyes underwent triple procedure and eight eyes underwent vitrectomy only (mean surgery times: 35.9 and 24.0 min, respectively). Posterior capsulotomy took on average 30 s, while preparation and cataract procedure took 13.0 min. The patients travelled on average 80km (average cost: $280.12) to the surgery unit. The average reimbursement fee for the day procedures ranged between $174.17 (YAG capsulotomy; Diagnosis Related Group (DRG): 0.034), $1045.48 (Phaco + intraocular lens (IOL); DRG: 0.204) and $1701.32 (PPV; DRG: 0.332). The combined procedures excluded lens and laser reimbursements, while the calculated reimbursements for the double/triple procedures were $2713.08/$2901.45, respectively, without significant loss of QALYs. PhacoPPVc was found to be unequivocally cost-effective, while PhacoPPV remained cost saving compared to sequential procedures. CONCLUSION This study confirms that the triple procedure has benefits to the patients, health institution and surgeon. For patients, it saves them travel and healing time; for health institution, it justifies the calculated higher costs and need for higher reimbursement for the double/triple procedures, which are cost saving.
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Affiliation(s)
| | - Nina C. B. B. Veiby
- Department of Ophthalmology Oslo University Hospital and University of Oslo Oslo Norway
| | | | - Ketil Eriksen
- Department of Ophthalmology Oslo University Hospital and University of Oslo Oslo Norway
| | - Morten C. Moe
- Department of Ophthalmology Oslo University Hospital and University of Oslo Oslo Norway
| | | | - Goran Petrovski
- Department of Ophthalmology Oslo University Hospital and University of Oslo Oslo Norway
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Shin KS, Park HJ, Jo YJ, Kim JY. Efficacy and safety of primary posterior capsulotomy in combined phaco-vitrectomy in rhegmatogenous retinal detachment. PLoS One 2019; 14:e0213457. [PMID: 30849095 PMCID: PMC6407776 DOI: 10.1371/journal.pone.0213457] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 02/21/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy and safety of posterior capsulotomy by analyzing the long-term visual outcomes in patients with rhegmatogenous retinal detachment (RD), who underwent combined phaco-vitrectomy with or without primary posterior capsulotomy. METHODS A retrospective longitudinal cohort analysis was performed by using data of rhegmatogenous RD patients undergoing combined phaco-vitrectomy. Patients were divided into two groups; Group A (68 eyes of 68 patients) with capsulotomy, and Group B (39 eyes of 39 patients) without capsulotomy. We reviewed the best-corrected visual acuity (BCVA), incidence of posterior capsule opacification (PCO), clinical features at the diagnosis of rhegmatogenous RD, and intraoperative or postoperative complications following posterior capsulotomy. RESULTS The modified BCVA measured by the logarithm of the minimum angle of resolution at initial diagnosis and 3, 6, and 12 months after surgery was 0.67 in Group A versus 0.85 in Group B (p = 0.258), 0.40 in Group A versus 0.50 in Group B (p = 0.309), 0.27 in Group A versus 0.45 in Group B (p = 0.055), and 0.21 in Group A versus 0.47 in Group B (p = 0.014), respectively. In subgroup with macula-on RRD, Group A exhibited better visual outcomes compared to Group B at 6(0.17 versus 0.40 [p = 0.037]) and at 12 months(0.14 versus 0.39 [p = 0.030]). The incidence of PCO in Group B was higher than Group A(28.2% versus 4.4% (p < 0.001)). There were no complications associated with posterior capsulotomy. CONCLUSIONS A primary posterior capsulotomy during combined phaco-vitrectomy using a 23-gauge vitreous cutter was a safe and effective surgical procedure in patients with RRD patients for preventing postoperative intraocular lens-related PCO.
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Affiliation(s)
- Kyung-Sup Shin
- Department of Ophthalmology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Hye-Jin Park
- Department of Ophthalmology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Young-Joon Jo
- Department of Ophthalmology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Jung-Yeul Kim
- Department of Ophthalmology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
- * E-mail:
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Souza EVD, Souza NVD, Rodrigues MDLV. Experimental closed system surgical procedures and intraocular pressure fluctuation. Acta Cir Bras 2014; 29:721-6. [PMID: 25424292 DOI: 10.1590/s0102-86502014001800005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 09/22/2014] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To determine the behavior of intraocular pressure and its relationship with infusion pressure in vitrectomy, phacofragmentation and phacoemulsification surgeries in rabbits. METHODS Intraocular pressure fluctuation was measured in 24 eyes of 12 rabbits submitted to vitrectomy, phacofragmentation and phacoemulsification procedures (eight eyes per group). The procedures were divided according to the force of aspiration of the instrument. Intraocular pressure was monitored with a computerized polygraph by means of a cannula introduced into the vitreous chamber. RESULTS Intraocular pressure showed a mean variation from 33 mmHg (maximum) to 6 mmHg (minimum). Vitrectomy showed the greatest difference between weak and strong aspiration. The greatest fluctuations occurred during procedures with strong aspiration, with phacoemulsification showing the widest variation, with maximum peaks almost reaching 50 mmHg. The infusion pressure varied less than the intraocular pressure, especially at the lowest pressures. CONCLUSIONS The fluctuation of intraocular pressure during ocular surgeries was not great. The higher the aspiration pressure, the higher the intraocular pressure. The infusion pressure did not show a good correlation with intraocular pressure.
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Primary posterior capsulotomy and posterior optic buttonholing in eyes with phacovitrectomy and gas tamponade. Retina 2013; 34:610-5. [PMID: 24317293 DOI: 10.1097/iae.0000000000000075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kunikata H, Aizawa N, Meguro Y, Abe T, Nakazawa T. Combined 25-gauge microincision vitrectomy and toric intraocular lens implantation with posterior capsulotomy. Ophthalmic Surg Lasers Imaging Retina 2013; 44:145-54. [PMID: 23510040 DOI: 10.3928/23258160-20130313-07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 12/10/2012] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the efficacy of combined 25-gauge microincision vitrectomy surgery (MIVS) and toric intraocular lens (IOL) implantation with posterior capsulotomy. METHODS Noncomparative, interventional case series performed at a single center. Twelve patients with vitreoretinal disease and cataracts, with preexisting regular corneal astigmatism greater than 1 diopter, underwent 25-gauge MIVS and toric IOL implantation with posterior capsulotomy. RESULTS The toric IOL was successfully implanted in each case. At 6 months postoperatively, mean axis rotation was 5.7° ± 3.1°. At 1 month postoperatively, mean uncorrected and best corrected visual acuity improved; the improvement was maintained after 6 months. The absolute residual refractive cylinder was significantly lower postoperatively than the pre-existing regular corneal cylinder (P = .003). There were no surgical complications except temporary posterior iris synechiae in one case. CONCLUSIONS Combined 25-gauge MIVS and toric IOL implantation with posterior capsulotomy is a practical and safe method to treat vitreoretinal disease and cataracts with pre-existing corneal astigmatism.
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Affiliation(s)
- Hiroshi Kunikata
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan.
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