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Yoon JH, Kim JH, Kim CG, Kim JW. Incidence of early complications requiring treatment plan changes after vitreoretinal surgery: a single-center study in South Korea. BMC Ophthalmol 2023; 23:282. [PMID: 37332012 DOI: 10.1186/s12886-023-03030-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/09/2023] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND Information regarding incidence of treatment plan changes may be useful when discussing postoperative treatment plans for patients. Moreover, it may help establish a standardized postoperative treatment plan. This study aimed to evaluate the incidence of early complications requiring treatment plan changes in patients following vitreoretinal surgery and investigate its risk factors. METHODS This single-center retrospective study included 465 patients who had undergone vitreoretinal surgery. The reasons, incidence, and timing of treatment plan changes within 14 days of surgery were identified. Potential factors associated with the changes, such as patient demographics, surgeon's experience, diagnoses, and type of surgery were also analyzed. RESULTS The treatment plan was changed in 76 patients (16.3%) at a mean of 4.0 ± 3.2 days after vitreoretinal surgery. The reasons for the plan changes were increased intraocular pressure (IIOP) in 66(86.8%), intraocular inflammation in 2(2.6%), corneal edema in 3(3.9%), leakage from the sclerotomy wound in 3(3.9%) patients, and combined IIOP and intraocular inflammation in 2(2.6%). The date of discharge was postponed because of treatment plan changes in 17 patients (22.4%). The incidence of plan changes was higher in patients who underwent gas or oil tamponade (P < 0.001) and those who underwent surgery performed by less experienced surgeons (P = 0.034). CONCLUSIONS Treatment plan was changed in 16.3% of patients after vitreoretinal surgery. The risk of treatment plan changes was associated with the surgeon's experience in vitreoretinal surgery and the type of surgery. These results should be considered when establishing standardized care plans for patients who require vitreoretinal surgery.
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Affiliation(s)
- Ji Hyun Yoon
- Department of Ophthalmology, Kim's Eye Hospital, #156 Youngdeungpo-dong 4ga, Youngdeungpo-gu, Seoul, 150-034, South Korea
| | - Jae Hui Kim
- Department of Ophthalmology, Kim's Eye Hospital, #156 Youngdeungpo-dong 4ga, Youngdeungpo-gu, Seoul, 150-034, South Korea.
| | - Chul Gu Kim
- Department of Ophthalmology, Kim's Eye Hospital, #156 Youngdeungpo-dong 4ga, Youngdeungpo-gu, Seoul, 150-034, South Korea
| | - Jong Woo Kim
- Department of Ophthalmology, Kim's Eye Hospital, #156 Youngdeungpo-dong 4ga, Youngdeungpo-gu, Seoul, 150-034, South Korea
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Jomar DE, AlHilali S, AlMutlak M. Scleral melt and uveal prolapse following 23-gauge pars plana vitrectomy. Am J Ophthalmol Case Rep 2022; 29:101769. [PMID: 36544747 PMCID: PMC9762149 DOI: 10.1016/j.ajoc.2022.101769] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/15/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
Purpose To report a case of uncontrolled juvenile open angle glaucoma (JOAG), with secondary high axial myopia who presented with scleral melting and uveal prolapse post pars plana-vitrectomy. Observations A 17-year-old male juvenile glaucoma patient, not known to have any systemic disease underwent a right eye 23-gauge-pars plana vitrectomy for retinal detachment repair. Three weeks following his surgery he presented complaining of tearing and photophobia in the operated eye in the absence of any ocular pain. Clinical exam revealed enlarged sclerotomy sites with localized conjunctival and episcleral injection, scleral thinning and uveal prolapse. Infectious and serologic work up were obtained to rule out an infectious etiology or underlying autoimmune disease. Patient was successfully managed with topical steroids and a donor scleral patch graft. Conclusion and importance This report addresses multiple risk factors for a devastating complication that may occur in predisposed patients, with primary or secondary axial myopia and a compromised sclera. This group of patients can be at risk of post-operative scleral melting and thinning and should be identified pre-operatively and monitored closely during their post-operative course.
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Affiliation(s)
- Deema E. Jomar
- Corresponding author. Cornea and Anterior Segment Division, King Khaled Eye Specialist Hospital, Uruba Road, Riyadh, 11462, Saudi Arabia.
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Repairing Leaky 23 Gauge Sclerotomies: Surgical Techniques to Enhance Sutureless Self-Sealing Wound Closure. Retina 2022; 42:1399-1402. [PMID: 30908473 DOI: 10.1097/iae.0000000000002473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bisorca-Gassendorf L, Boden KT, Szurman P, Al-Nawaiseh S, Rickmann A, Januschowski K. [Postoperative endophthalmitis-a review of literature]. Ophthalmologe 2021; 118:210-218. [PMID: 33270146 DOI: 10.1007/s00347-020-01271-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Postoperative endophthalmitis is one of the most feared complications for ophthalmologists, and the number of infections after intraocular procedures have been increasing. Nonetheless, a prompt intervention can result in the recovery of vision. In the past, endophthalmitis after cataract surgery was accountable for the majority of cases but is becoming less frequent due to the progress of surgical techniques and demographic developments with a steadily increasing number of intravitreal injections. In this article, the different forms of postoperative endophthalmitis are assessed in terms of pathophysiology and their specific characteristics depending on their etiology.
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Affiliation(s)
- L Bisorca-Gassendorf
- Augenklinik Sulzbach, Knappschaftsklinikum Saar GmbH, An der Klinik 10, 66280, Sulzbach, Deutschland.
| | - K T Boden
- Augenklinik Sulzbach, Knappschaftsklinikum Saar GmbH, An der Klinik 10, 66280, Sulzbach, Deutschland
| | - P Szurman
- Augenklinik Sulzbach, Knappschaftsklinikum Saar GmbH, An der Klinik 10, 66280, Sulzbach, Deutschland
| | - S Al-Nawaiseh
- Augenklinik Sulzbach, Knappschaftsklinikum Saar GmbH, An der Klinik 10, 66280, Sulzbach, Deutschland
| | - A Rickmann
- Augenklinik Sulzbach, Knappschaftsklinikum Saar GmbH, An der Klinik 10, 66280, Sulzbach, Deutschland
| | - K Januschowski
- Augenklinik Sulzbach, Knappschaftsklinikum Saar GmbH, An der Klinik 10, 66280, Sulzbach, Deutschland
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Tosi GM, Malandrini A, Bacci T, Posarelli M, Oddone C, Virgili G. Vitreous incarceration in sutured vs non-sutured sclerotomies after 25-gauge macular surgery. Eye (Lond) 2020; 35:2246-2253. [PMID: 33110248 DOI: 10.1038/s41433-020-01234-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 10/09/2020] [Accepted: 10/14/2020] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To study the patterns of vitreous incarceration in sutured vs non-sutured sclerotomies in patients subjected to 25-gauge macular surgery. METHODS A prospective study of 135 eyes affected by epiretinal membrane or macular hole. Vitreal disposition was evaluated via ultrasound biomicroscopy (UBM) at the sclerotomy sites between 30 and 40 days after surgery, once the tamponade had completely disappeared. RESULTS In total, 349 sclerotomies (86.2%) of 99 patients were non-sutured while 56 sclerotomies (13.8%) of 36 patients were sutured at the end of the surgical procedure. Among the 36 patients with sutured sclerotomies, 15 out of 36 (41.6%) had at least two sclerotomies sutured. All the sclerotomy sites were evaluated (405 sclerotomies). Sclerotomy suture was significantly associated with a less aggressive pattern of vitreal incarceration (OR: 0.16, 95% CI: 0.07-0.35, p < 0.001). Compared to preoperative values, day 1 post operative IOP was not significantly different in patients with sutured sclerotomies, while patients with non-sutured sclerotomies had a significantly lower day 1 post operative IOP. CONCLUSIONS In 25-gauge macular surgery, UBM evaluation documented a higher rate of postoperative vitreous incarceration in the non-sutured sclerotomies, confirming the previously postulated role of the residual vitreous, left at the end of the surgery, in closing the sclerotomy site.
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Affiliation(s)
- Gian Marco Tosi
- Ophthalmology Unit of the Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy.
| | | | - Tommaso Bacci
- Ophthalmology Unit of the Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Matteo Posarelli
- Ophthalmology Unit of the Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Chiara Oddone
- Ophthalmology Unit of the Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Gianni Virgili
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
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Abstract
PURPOSE OF REVIEW The present article reviews the most common and most serious vision-threatening and life-threatening complications of vitreoretinal surgery. RECENT FINDINGS Serious complications after vitreroretinal surgery are rare. Endophthalmitis for example has recently been estimated to occur in 0.08% of small gague vitrectomy. Other complications such as cataract are almost unavoidable, becoming visually significant in up to 80% of patients. The introduction of smaller gauge vitrectomy systems has reduced surgical times, conjunctival scarring and inflammation, and the rate of some complications such as retinal tears. Ocular venous air embolism is an exceedingly rare complication that is potentially life threating and therefore important for all vitreoretinal surgeons to be aware of. SUMMARY Though vitreoretinal surgery is well tolerated and effective, it is inevitable that all surgeons will experience complications and are therefore best served by understanding the potential complications, strategies to reduce the likelihood of them occurring, and ways to address them when they do happen.
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Comparison of 27-gauge versus 25-gauge vitrectomy results in patients with epiretinal membrane: 6-month follow-up. Int Ophthalmol 2020; 40:867-875. [PMID: 31956931 DOI: 10.1007/s10792-019-01250-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 12/16/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To compare the 27G versus 25G vitrectomy in patients with epiretinal membrane (ERM). PATIENTS AND METHODS Sixty pseudophakic eyes of 60 consecutive patients treated by pars plana vitrectomy (PPV) using 27G (30 eyes) or 25G (30 eyes) were prospectively evaluated including eye's inflammation, surgery time, ERM + ILM removal time and complications. Additionally, 1, 3, 7, 14, 30, 90 and 180 days after PPV, the following were estimated: intraocular pressure (IOP), sclerotomy wound closure time, distance best corrected visual acuity (DBCVA), foveal macular thickness (FMT) and surgically induced astigmatism (SIA). RESULTS The eye's inflammation resolved within 30 days after surgery in both groups. The surgery and ERM + ILM times were longer in the 27G group (p ≤ 0.02). The most common postoperative complication was hypotony in both groups, more common in 25G group (23.3% vs. 10% of eyes). In 27G group, the mean IOP prior to 180 days postoperatively was higher (p < 0.05) and the sclerotomy wound closure time was shorter (p < 0.001). Mean DBCVA values (7, 14, 30 days after surgery) were significantly better in 27G group (p < 0.001). The mean FMT values were similarly and significantly reduced in both groups 1 day postoperatively (p < 0.05) as compared to preoperative values and then stabilized during follow-up. Mean SIA was lower in 27G group 30, 90 and 180 days after surgery (p < 0.001). CONCLUSION The use of 27G PPV in patients with ERM significantly reduced sclerotomy wound closure time and surgically induced astigmatism, better stabilized intraocular pressure and allowed to achieve faster visual acuity improvement, as compared to 25G PPV.
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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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Yomoda R, Sasaki H, Kogo J, Shiono A, Jujo T, Sekine R, Tokuda N, Kitaoka Y, Takagi H. Comparative study of straight vs angled incision in 27-gauge vitrectomy for epiretinal membrane. Clin Ophthalmol 2018; 12:2409-2414. [PMID: 30538424 PMCID: PMC6263245 DOI: 10.2147/opth.s183456] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this study was to compare straight and angled incisions in 27-gauge microincision vitrectomy in patients with epiretinal membrane (ERM). Methods Seventy-three eyes of 68 patients with ERM who underwent straight (35 eyes) or angled incision (38 eyes) for 27-gauge microincision vitrectomy were retrospectively evaluated. Results No statistically significant difference was found between the two groups in postoperative logarithm of minimal angle of resolution best-corrected visual acuity. The intraocular pressure and rate of hypotony 1 day postoperatively did not differ between the straight- and angled-incision groups (intraocular pressure: 11.5 vs 13.4 mmHg, respectively; rate of hypotony: 20% vs 8%, respectively). Surgical wound closing occurred by postoperative day 10 in both groups. Conclusion A straight incision is as safe and useful in ERM vitrectomy as an angled one.
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Affiliation(s)
- Ryo Yomoda
- Department of Ophthalmology, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan,
| | - Hiroki Sasaki
- Department of Ophthalmology, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan,
| | - Jiro Kogo
- Department of Ophthalmology, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan,
| | - Akira Shiono
- Department of Ophthalmology, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan,
| | - Tatsuya Jujo
- Department of Ophthalmology, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan,
| | - Reio Sekine
- Department of Ophthalmology, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan,
| | - Naoto Tokuda
- Department of Ophthalmology, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan,
| | - Yasushi Kitaoka
- Department of Ophthalmology, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan,
| | - Hitoshi Takagi
- Department of Ophthalmology, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan,
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Zhang X, Chen B, Yang H, Song Y, Zhang D, Soetikno BT, Sun X. The Correlation of Pars Plana Incision and Transient Hypotony After Silicone Oil Removal. Ophthalmic Surg Lasers Imaging Retina 2018; 49:e44-e51. [PMID: 30222818 DOI: 10.3928/23258160-20180907-06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 02/27/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To evaluate the correlation between pars plana incision and transient hypotony after silicone oil removal in aphakic eyes PATIENTS AND METHODS:Twenty-two patients with aphakia and a high degree of myopia with silicone oil tamponade were recruited for this prospective study and randomly scheduled to two groups for silicone oil removal: 3.5-mm corneal incision with suture corneal or 20-gauge pars plana incision with suture. Intraocular pressure (IOP) was measured and fundus and anterior structure were examined preoperatively on the first, third, and seventh postoperative day and at 1 month after surgery. RESULTS IOPs in the pars plana group were significantly lower than the corneal group on the first and third day after surgery (P < .001). Nine of the 11 patients in the pars plana group suffered ciliary detachment accompanied by hypotony (IOP < 8 mm Hg), among whom three patients exhibited excessive hypotony (IOP < 5 mm Hg), whereas the ciliary bodies remained tightly attached and IOP was normal in the corneal group. Among these nine patients, six eyes were observed to have multiple silicone oil granules in the supraciliary cavity, three exhibited gaps of pars plana below the scleral incision site, and two had vitreous hemorrhage. Hypotony spontaneously relieved at the seventh postoperative day for all patients. CONCLUSION Pars plana incision is the crucial cause of ciliary detachment and consequent transient hypotony after silicone oil removal. Using corneal limbus incision in patients with aphakic eyes to avoid the par plana incision is expected to reduce the incidence of hypotony with minimal complications. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e44-e51.].
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Khan MA, Kuley A, Riemann CD, Berrocal MH, Lakhanpal RR, Hsu J, Sivalingam A, Ho AC, Regillo CD. Long-Term Visual Outcomes and Safety Profile of 27-Gauge Pars Plana Vitrectomy for Posterior Segment Disease. Ophthalmology 2018; 125:423-431. [DOI: 10.1016/j.ophtha.2017.09.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 09/10/2017] [Accepted: 09/12/2017] [Indexed: 11/15/2022] Open
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VITREOUS INCARCERATION IN SCLEROTOMIES AFTER VALVED 23-, 25-, OR 27-GAUGE AND NONVALVED 23- OR 25-GAUGE MACULAR SURGERY. Retina 2018; 37:1948-1955. [PMID: 28085776 PMCID: PMC5642318 DOI: 10.1097/iae.0000000000001445] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To study the patterns of vitreous incarceration at sclerotomy sites by ultrasound biomicroscopy in patients subjected to valved or nonvalved small-gauge pars plana vitrectomy. METHODS A prospective comparative study of 88 eyes affected by epiretinal membrane and macular hole. Patients were divided into four groups: valved or nonvalved 23-gauge (16 eyes each) and valved or nonvalved 25-gauge (20 eyes each); their vitreal disposition was compared by ultrasound biomicroscopy. Vitreal disposition was also assessed in 16 eyes of 16 patients subjected to valved 27-gauge pars plana vitrectomy. RESULTS Three vitreal patterns were identified: P0 (vitreous not visible or vitreous strand distant from the sclerotomy site), P1 (vitreous strand parallel to and in contact with the sclerotomy site), and P2 (vitreous strand entrapped in the sclerotomy site). The effect of valved trocar use on vitreous incarceration seemed to be somewhat beneficial, but no statistically significant effect could be shown (odds ratio: 0.85, 95% confidence interval: 0.42-1.74, P = 0.657). Similarly, no differences in vitreous incarceration were shown among vitrectomy gauges (23, 25, or 27) both in a model including valved trocars only (P = 0.858) and in a model with all available data (P = 0.935). CONCLUSION In 23- and 25-gauge macular surgeries, postoperative vitreous incarceration does not seem to be reduced using valved cannulas and was similar to that observed in 27-gauge surgery.
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Rahmani S, Eliott D. Postoperative Endophthalmitis: A Review of Risk Factors, Prophylaxis, Incidence, Microbiology, Treatment, and Outcomes. Semin Ophthalmol 2017; 33:95-101. [PMID: 29172849 DOI: 10.1080/08820538.2017.1353826] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Postoperative endophthalmitis is one of the most feared complications of intraocular surgery. The most common types of intraocular surgeries performed worldwide are cataract extraction, glaucoma drainage implants/trabeculectomy, and pars plana vitrectomy. This review will focus on the clinical features, risk factors, prophylaxis, and treatment of endophthalmitis in these three main intraocular surgeries.
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Affiliation(s)
- Safa Rahmani
- a Retina Service, Department of Ophthalmology , Massachusetts Eye and Ear , Boston , MA , USA
| | - Dean Eliott
- a Retina Service, Department of Ophthalmology , Massachusetts Eye and Ear , Boston , MA , USA
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Coppola M, Rabiolo A, Cicinelli MV, Querques G, Bandello F. Vitrectomy in high myopia: a narrative review. Int J Retina Vitreous 2017; 3:37. [PMID: 29021916 PMCID: PMC5623972 DOI: 10.1186/s40942-017-0090-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 08/16/2017] [Indexed: 12/26/2022] Open
Abstract
Pathologic myopia is associated with degenerative changes of the globe, especially at the posterior pole. Eyes affected by pathologic myopia have higher odds to undergo posterior segment surgery and, in those eyes, vitreoretinal surgery is challenging. Many practical tips and tricks can make the surgical procedures simpler, significantly preventing sight-threatening intra- and post-operative complications. Moreover, novel surgical techniques and technological advancements (i.e. ad-hoc instrumentation, minimally invasive vitreoretinal surgery, filters, dye staining, intraoperative optical coherence tomography and 3-dimensional surgery) may play role in highly myopic eyes. The aim of the present work is to review practical tips and tricks, novel surgical techniques and technological advancements.
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Affiliation(s)
- Michele Coppola
- Ophthalmology Unit, Azienda Ospedaliera di Desio e Vimercate, Desio, Italy
| | - Alessandro Rabiolo
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy
| | - Maria Vittoria Cicinelli
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy
| | - Giuseppe Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy
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Infusion Misdirection in Microincisional Vitrectomy Surgery. Ophthalmol Retina 2017; 2:112-117. [PMID: 31047337 DOI: 10.1016/j.oret.2017.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 05/26/2017] [Accepted: 06/01/2017] [Indexed: 11/23/2022]
Abstract
PURPOSE To review the incidence and possible mechanisms of 2 problems caused by infusion misdirection during microincisional vitrectomy in 1 physician's practice and to find an estimate of the broader occurrence among other physicians. DESIGN Observational series of 1 surgeon's cases over 2 periods. A survey also was sent to other retinal specialists. PARTICIPANTS Patients undergoing microincisional vitrectomy. METHODS The physician tracked the occurrence of intraoperative hypotony and unintentional anterior chamber air infusion in his practice. A survey was sent to 2000 members of the American Society of Retina Specialists and the Retina Society. MAIN OUTCOME MEASURES Primary outcome measure was the incidence of hypotony during microincisional vitrectomy, defined as softening of the globe to the point of corneal or scleral infolding, or both, that resolved with repositioning of the infusion cannula. The secondary outcome measure was incidence of unplanned air flow into the anterior chamber. Survey questions included frequency of observed infusion interruption and incidence of inadvertent anterior chamber air infusion. RESULTS In the earlier series, of 232 vitrectomies, 37 (16%) showed signs of episodic hypotony after infusion blockage. Seven cases (3%) showed inadvertent air flow into the anterior chamber. One hundred fifty-two physicians responded to the survey. Fifty-seven percent reported infusion blockage and hypotony in 1% to 5% of cases. Fifty-nine percent reported air flow into the anterior chamber in some cases. In the later series, 12 instances of infusion blockage were noted in 118 cases. Awareness of the issue and additional attention to the infusion line taping did not prevent the problem from occurring. In the survey, most respondents reported observing both infusion interruption and inadvertent anterior chamber air infusion on occasion. CONCLUSIONS Infusion misdirection resulting in hypotony or air flow into the anterior chamber seems to be infrequent, but it remains a risk. Awareness of the problem reduces the incidence, but does not eliminate it. The potential inadvertently to touch the retina, choroid, or lens increases when these events occur. Infusion misdirection can be avoided by maintaining the correct position of the cannula, which may be facilitated by an external support to the tubing.
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Takashina H, Watanabe A, Tsuneoka H. Perioperative changes of the intraocular pressure during the treatment of epiretinal membrane by using 25- or 27-gauge sutureless vitrectomy without gas tamponade. Clin Ophthalmol 2017; 11:739-743. [PMID: 28458513 PMCID: PMC5402993 DOI: 10.2147/opth.s133775] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this study was to compare perioperative intraocular pressures (IOPs) in 25- or 27-gauge microincision vitrectomy surgery (MIVS) and to evaluate the stability of postoperative sclerotomy closure. Materials and methods This is a retrospective review of 147 eyes treated for epiretinal membrane by using 25- or 27-gauge MIVS as the initial vitrectomy (25-gauge phacovitrectomy [25-P group]: 73 eyes, 25-gauge vitrectomy alone [25-A group]: 15 eyes, 27-gauge phacovitrectomy [27-P group]: 47 eyes, and 27-gauge vitrectomy alone [27-A group]: 12 eyes). Statistical analyses of perioperative IOPs on preoperative day (PreOp), postoperative day (POD)1, POD2, postoperative week 1, and postoperative month 1 were performed. Results All self-sealing sclerotomies were obtained without gas tamponade at the end of surgery. Also, no significant differences were noted in the age and axial length among the 4 groups and in the surgical time between 25-P and 27-P groups and between 25-A and 27-A groups. Significant decreases in IOP were found at POD1 and POD2 in the 25-P, 25-A, and 27-P groups compared with PreOP, but not in the 27-A group. Conclusion Even though surgeons confirm that there is no leakage from sutureless sclerotomy and that a normal IOP is preserved at the end of 25- or 27-gauge MIVS, there is a possibility of postoperative sclerotomy leakage on the day of the surgery. Furthermore, postoperative sclerotomy self-sealing of the MIVS in previous intraocular lens implantation cases is considered to be acquired easily than that in phacovitrectomy.
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Affiliation(s)
- Hirotsugu Takashina
- Department of Ophthalmology, National Hospital Organization Sagamihara Hospital.,Department of Ophthalmology, Jikei University School of Medicine, Tokyo, Japan
| | - Akira Watanabe
- Department of Ophthalmology, Jikei University School of Medicine, Tokyo, Japan
| | - Hiroshi Tsuneoka
- Department of Ophthalmology, Jikei University School of Medicine, Tokyo, Japan
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Zhang J, Li Y, Zhao X, Yu X, Lu L. Comparison of Clinical Features After 20-Gauge Vitrectomy Versus 23-Gauge Vitrectomy. Asia Pac J Ophthalmol (Phila) 2015; 4:367-70. [PMID: 26716433 DOI: 10.1097/apo.0000000000000139] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To compare the clinical features after 20-gauge (20G) versus 23-gauge (23G) pars plana vitrectomy (PPV). DESIGN This was a prospective observational study. METHODS Patients who underwent 20G or 23G PPV participated in the study. Sutures were used in all patients who had 20G and as necessary in patients who had 23G. All patients were examined with ultrasound biomicroscopy and tonometry for intraocular pressure (IOP) preoperatively and postoperatively at 1 day, 1 week, 1 month, and 6 months. RESULTS Forty-nine eyes underwent 20G PPV and 97 eyes underwent 23G PPV. Hypotony appeared more frequently in the 23G group (9 patients of 97, 9%) than in the 20G group (1 patient of 49, 2%) 1 day after surgery. Mean IOP was statistically significantly lower in the 23G group 1 day after surgery (P = 0.000). Postoperatively, choroidal detachment (CD) was found in both the 23G group (22/97, 23%) and the 20G group (1/49, 2%). In the 23G group, the mean IOP of eyes with CD was significantly lower than those without CD. There was no statistically significant difference in vitreous incarceration between the 2 groups (P = 0.317). CONCLUSIONS Choroidal detachment and hypotony were common complications in the early stages after 23G PPV. The incidence of postoperative vitreous incarceration was similar in both groups.
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Affiliation(s)
- Jinglin Zhang
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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Dave VP, Pathengay A, Schwartz SG, Flynn HW. Endophthalmitis following pars plana vitrectomy: a literature review of incidence, causative organisms, and treatment outcomes. Clin Ophthalmol 2014; 8:2183-8. [PMID: 25382968 PMCID: PMC4222626 DOI: 10.2147/opth.s71293] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Endophthalmitis following pars plana vitrectomy is a very uncommon cause of endophthalmitis. Cases reported over the last decade show a decrease in incidence over time. To optimize visual outcome, early diagnosis and treatment are essential. In this review we report a summary of the incidence of endophthalmitis following vitrectomy, various risk factors for their occurrence, the microbiological profile and the visual outcomes post treatment.
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Affiliation(s)
- Vivek Pravin Dave
- Smt Kanuri Santhamma Center for Vitreoretinal Diseases, LV Prasad Eye Institute, GMR Varalakshmi Campus, Visakhapatnam, India
| | - Avinash Pathengay
- Vitreo-Retina and Uveitis Service, LV Prasad Eye Institute, GMR Varalakshmi Campus, Visakhapatnam, India
| | - Stephen G Schwartz
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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Nagpal M, Paranjpe G, Mehrotra N, Bhardwaj S. Evaluation of Wound Morphology of Sclerotomy Sites of Sutureless Vitrectomy Using Spectralis Anterior Segment Optical Coherence Tomography. Asia Pac J Ophthalmol (Phila) 2014; 3:88-93. [PMID: 26107491 DOI: 10.1097/apo.0b013e3182a141e7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The aim of the study was to evaluate wound morphology in vivo in eyes undergoing sutureless vitrectomy. DESIGN This was a prospective consecutive case series. METHODS Twenty eyes undergoing sutureless vitrectomy were evaluated using anterior segment optical coherence tomography on days 1, 15, and 30. Ten eyes each belonged to 23-gauge (group A) and 25-gauge (group B). Scans were taken on the incision sites. Group A cases were further divided into group A1 and A2 on the basis of the surgical time of less than 15 minutes' and more than 15 minutes' duration, respectively. RESULTS On day 1, the mean outer and inner incision diameters in group A were 236.6 and 146 µm, and those for group B were 118.6 and 90 µm. A significant decrease (P < 0.0001) in both the port sizes was observed in both groups' follow-up. Group B showed significant decrease (P < 0.0001) in the port sizes on l follow-up as compared with group A. Group A1 had smaller incision size as compared with group A2 on the first postoperative day, although not statistically significant(P > 0.05). CONCLUSIONS In both groups, the sclerotomy incisions showed good healing at 1-month duration. The 25-gauge sclerotomies showed better healing characteristics of wound morphology as compared with the 23-gauge sclerotomies.
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Affiliation(s)
- Manish Nagpal
- From the Retina Foundation, Shahibag, Ahmedabad, India
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Hikichi T, Kitamei H, Kosaka S, Shioya S, Takami K. Intraoperative endoscopic observation of sclerotomy site after cannula removal for 23-gauge vitrectomy. Clin Ophthalmol 2014; 8:477-81. [PMID: 24610999 PMCID: PMC3945045 DOI: 10.2147/opth.s59700] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The purpose of this study was to determine the incidence of vitreous incarceration in sclerotomy after cannula removal during 23-gauge vitrectomy. METHODS Thirty-seven eyes underwent 23-gauge sutureless vitrectomy. Oblique sclerotomies were made parallel to the limbus and tangentially to the sclera. Once past the trocar sleeve, the angle was changed to 90 degrees perpendicular to the surface and the trocar and cannula inserted. Vitreous gel was removed until the intraocular edge of the infusion cannula was free from the gel. The cannula was extracted with insertion of a light probe. The sclerotomy site was evaluated endoscopically through another cannula in 32 eyes; in five eyes, another infusion tube was inserted into the cannula to maintain intraocular pressure, the original infusion was removed, and the sclerotomy site observed. RESULTS No vitreous incarceration occurred in 30 (94%) eyes when one cannula was removed with insertion of a light probe, and minimal incarceration occurred in two (6%) eyes. No incarceration occurred in five eyes with observation of the infusion site. CONCLUSION The incidence of vitreous incarceration is low when a light probe or vitreous cutter is inserted. Inserting the light probe through the cannula during its removal and creating an oblique sclerotomy may reduce vitreous incarceration.
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Park JC, Ramasamy B, Ling RH, Prasad S. A review of endophthalmitis following vitrectomy. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/eop.12.25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Garay-Aramburu G, Gómez-Moreno Á, Urcola JA, Diaz-de-durana-Santa-coloma E, Cabrerizo FJ, Larrauri-Arana A. 22-gauge sclerotomy architecture evaluated by anterior segment optical coherence tomography. Br J Ophthalmol 2013; 98:280-1. [DOI: 10.1136/bjophthalmol-2013-303801] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Papaefthymiou I, Petropoulos IK, Mangioris G, Mendrinos E, Pournaras CJ. Safety of 20-gauge transconjunctival sutureless vitrectomy. Ophthalmologica 2013; 230:207-14. [PMID: 24029384 DOI: 10.1159/000346393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 12/03/2012] [Indexed: 11/19/2022]
Abstract
PURPOSE To study the safety of 20-gauge transconjunctival sutureless vitrectomy. METHODS Clinical data of patients who underwent 20-gauge transconjunctival sutureless vitrectomy for the first time, for various disorders, were reviewed retrospectively. The main outcome measures were the number of sclerotomies requiring suturing as well as the intra- and postoperative complications. RESULTS A total of 179 operations were performed. Indications for vitrectomy included 68 idiopathic epiretinal membranes, 26 macular holes, 23 phakic and 16 pseudophakic retinal detachments, and 46 various other, less common etiologies. Of these 179 operations, 166 (93%) were sutureless. Of the 537 sclerotomies created, 25 (5%) received a single transconjunctival-scleral suture. Intraoperative complications included premature dislodging of the cannulas in 2 sclerotomies and an iatrogenic horseshoe tear at 1 sclerotomy site. Postoperative complications comprised transient hypotony in 14 cases, subconjunctival gas in 2 cases, and choroidal effusion in 1 case. No serious complications (such as endophthalmitis) were observed. CONCLUSION 20-gauge transconjunctival sutureless vitrectomy can be considered safe, as the intra- and postoperative complications observed are neither numerous nor significant. Sclerotomies appear to be safe and relatively easy to perform, without compromising the advantages of sutureless surgery.
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Gosse E, Newsom R, Hall P, Lochhead J. Changes in day 1 post-operative intraocular pressure following sutureless 23-gauge and conventional 20-gauge pars plana vitrectomy. Open Ophthalmol J 2013; 7:42-7. [PMID: 24015163 PMCID: PMC3763675 DOI: 10.2174/1874364101307010042] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 07/13/2013] [Accepted: 07/17/2013] [Indexed: 01/07/2023] Open
Abstract
Background/Aims: The benefits associated with transconjunctival sutureless vitrectomy techniques are continuing to be defined. The purpose of this study was to compare the incidence of extreme changes in day 1 intraocular pressure (IOP) following 23-gauge sutureless vitrectomy compared with conventional 20-gauge vitrectomy. Methods: Fifty consecutive 23-gauge and 50 consecutive 20-gauge cases were included; eyes with a history of previous vitreoretinal surgery were excluded. 23-gauge surgery was completed with passive fluid air exchange where no long acting tamponade was indicated. The surgery remained sutureless unless a leak was visible at the end of the procedure. Data were collected by retrospective case note review. Statistical analysis was carried out using Fisher’s exact and chi-square tests. Results: Twenty-two percent (11/50) of 23-gauge vitrectomies required suturing of one or more ports. On the first post-operative day hypotony (IOP<5mmHg) occurred in 1/50 eyes in the 20- and 23-gauge groups. Raised pressure (IOP>21mmHg) occurred in 30% (15/50) of eyes in the 20-gauge group and 8% (4/50) of eyes in the 23-gauge group; IOP>30mmHg only occurred in the 20-gauge group (3/50). Conclusion: Fluid air exchange following 23-gauge vitrectomy is associated with very low risk of day 1 hypotony. This predominantly sutureless technique appears to reduce the incidence and magnitude of early post-operative IOP elevation compared with conventional 20-gauge vitrectomy.
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Affiliation(s)
- Emily Gosse
- Department of Ophthalmology, St Mary's Hospital, Newport, Isle of Wight, UK
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Benitez-Herreros J, Lopez-Guajardo L, Camara-Gonzalez C, Perez-Crespo A, Silva-Mato A, Teus MA. Influence of sclerotomy use on vitreous incarceration in an experimental model of vitrectomized eye. Clin Ophthalmol 2013; 7:1471-6. [PMID: 23983452 PMCID: PMC3748793 DOI: 10.2147/opth.s45875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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 the influence of sclerotomy use during vitrectomy (vitreous cutter, illumination probe, or infusion-line entrance) on postoperative vitreous incarceration using an experimental model of vitrectomized eye. MATERIALS AND METHODS Experimental, randomized, and observer-masked study in which 23-gauge transconjunctival sutureless vitrectomy was performed in cadaveric pig eyes. Postoperative incisional vitreous entrapment was evaluated by direct visualization. No vitreous incarceration was classified as grade 0 (G0), thin vitreous entrapment was classified as grade 1 (G1), and thick vitreous strands as grade 2 (G2). RESULTS A total of 46 eyes were included. Vitreous incarceration was detected in 91.3% (43.5% G1, 47.8% G2) of the sclerotomies used by the vitreous cutter probe, 95.7% (45.7% G1, 50% G2) of the illumination-pipe entrances, and 93.5% (45.7% G1, 47.8% G2) of the infusion-line incisions. No statistical differences were found when comparing incisional vitreous incarceration after vitrectomy according to sclerotomy use. CONCLUSION Different manipulation of the sclerotomies, depending on their use, does not seem to influence postvitrectomy vitreous entrapment in our experimental model.
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Benitez-Herreros J, Lopez-Guajardo L, Camara-Gonzalez C, Perez-Crespo A, Silva-Mato A, Alvaro-Meca A, Teus MA. Evaluation of conjunctival bleb detection after vitrectomy by ultrasound biomicroscopy, optical coherence tomography and direct visualization. Curr Eye Res 2013; 39:390-4. [PMID: 23841594 DOI: 10.3109/02713683.2013.810272] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To compare ultrasound biomicroscopy (UBM), anterior-segment optical coherence tomography (AS-OCT), and direct visualization for detecting conjunctival blebs in sutureless sclerotomies after vitrectomy. Conjunctival blebs are formed by sclerotomy leakage due to incompetent closure. METHODS Experimental, randomized, and observer-masked study in which 23-gauge vitrectomies were performed in cadaveric pig eyes. Postoperative conjunctival blebs were assessed by UBM, AS-OCT, and direct visualization. No conjunctival blebs were classified as Grade 0 (G0), thin blebs (less than or equal to one-half of scleral thickness) as Grade 1 (G1) and thick blebs (greater than one-half of scleral thickness) as Grade 2 (G2). RESULTS Fifty pig eyes were included. Conjunctival blebs were found in 13.3% (8% G1, 5.3% G2) of the incisions analyzed by UBM, in 20% (14.7% G1, 5.3% G2) of the sclerotomies studied by AS-OCT, and in 7.3% (2% G1, 5.3% G2) of the wounds evaluated by direct visualization. AS-OCT was the most sensitive method for identifying conjunctival blebs when compared with UBM and direct visualization (p<0.001). In turn, UBM was better than direct visualization for observing sclerotomy blebs (p=0.004). CONCLUSIONS AS-OCT is the most sensitive technique for detecting subclinical blebs (G1) and thus, it may be useful in research for studying the influence that surgical factors and maneuvers may exert on sclerotomy closure capacity after vitrectomy. Direct visualization, that is used in routine clinical practice to determine which sclerotomies should be sutured, is useful only to identify thick blebs (G2) after vitrectomy.
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Affiliation(s)
- Javier Benitez-Herreros
- Department of Ophthalmology, University Hospital Principe de Asturias, Alcalá de Henares , Madrid , Spain
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Tahiri Joutei Hassani R, El Sanharawi M, Adam R, Monin C, Dupont-Monod S, Baudouin C. Comparison of 23-gauge sutureless sclerotomy architecture and clinical outcomes in macular and non-macular surgery using spectral-domain optical coherence tomography. Acta Ophthalmol 2013; 91:e203-10. [PMID: 23280085 DOI: 10.1111/aos.12015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare the 23-gauge (23-G) sutureless vitrectomy incision architecture in macular and non-macular surgery, using anterior segment spectral-domain optical coherence tomography (SD-OCT), and to evaluated its influence on clinical outcomes. METHODS A prospective, observational case series of 43 patients who underwent primary transconjunctival 23-G pars plana vitrectomy (PPV) for macular and non-macular diseases. All sclerotomy wounds were imaged 1 day after surgery using the anterior segment module of SD-OCT (OCT Spectralis; Heidelberg Engineering, Heidelberg, Germany). Sclerotomy architecture, including good wound apposition, presence of gaping and misalignment of the roof and floor of the incisions were evaluated. Preoperative, intraoperative and postoperative medical record data were also prospectively collected. RESULTS Incision gaping and misalignment of the roof and floor occurred more frequently in the superotemporal and superonasal quadrants than in the inferotemporal quadrant (p < 0.05) and was more frequent in the non-macular group than in the macular group (p < 0.05). The incidence of incision gaping increased significantly as the incision angle increased. In the macular group, the mean postoperative intraocular pressure (IOP) did not change from the preoperative value, whereas in the non-macular group, the mean IOP decreased significantly from 15.09 ± 2.58 mmHg preoperatively to 12.18 ± 3.25 mmHg on the first postoperative day (p < 0.005). The mean IOP did not differ significantly between the two groups of surgery at 1 week, and at 1 month postoperatively. CONCLUSIONS In 23-G PPV, non-macular surgery is associated with a significant postoperative IOP decrease in comparison with macular surgery, which could be explained by the most remodelled wound architecture.
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In vivo comparison of 23- and 25-gauge sutureless vitrectomy incision architecture using spectral domain optical coherence tomography. J Ophthalmol 2013; 2013:347801. [PMID: 23533705 PMCID: PMC3603206 DOI: 10.1155/2013/347801] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 01/30/2013] [Indexed: 11/23/2022] Open
Abstract
Purpose. To investigate the in vivo incision architecture using spectral domain optical coherence tomography (SD-OCT) in 23-gauge and 25-gauge transconjunctival sutureless pars plana vitrectomy (TSPPV). Methods. A prospective observational study of 22 eyes of 22 patients that underwent three-port 25-gauge (10 eyes) or 23-gauge (12 eyes) TSPPV was performed. The three sclerotomies sites in each eye were analyzed by Corneal Adapter Model (CAM) RTVue SD-OCT (Optovue Inc., Fremont, CA, USA) with wound cross-section images (longitudinal and transversal) on days 1, 7, and 30 postoperatively. Transversal and longitudinal length, location, angle between the conjunctival surface tangent and the incision plane, and architecture deformations were evaluated. Results. All patients (22 eyes) completed the study and surgeries lasted less than 60 minutes. All wounds were obliquely performed, 23-gauge mean angle was 23 ± 5°, and 25-gauge angule was 21 ± 4°. Twenty-three-gauge sclerotomy transversal mean length was 1122 ± 242 μm and 25-gauge transversal sclerotomy mean length was 977 ± 174 μm; 23-gauge longitudinal mean length was 363 ± 42 μm and 25-gauge longitudinal sclerotomy mean length was 234 ±19 μm; 23-gauge open wound thickness mean was 61 ± 28 μm and 25-gauge open wound thickness mean was 22 ± 6 μm. All results were statistically significant (P < 0.05). No vitreous incarceration or silicone oil residue was observed in incision sites with both gauges. Conclusions. The 23-gauge and 25-gauge architectural wound constructions were well visualized using CAM SD-OCT. Statistical differences between the two gauges were observed throughout the study period.
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Kim IG, Lee SJ, Park JM. Comparison of the 20-gauge conventional vitrectomy technique with the 23-gauge releasable suture vitrectomy technique. KOREAN JOURNAL OF OPHTHALMOLOGY 2013; 27:12-8. [PMID: 23372374 PMCID: PMC3550306 DOI: 10.3341/kjo.2013.27.1.12] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 03/16/2012] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To compare the efficacy of the transconjunctival releasable suture technique for pars plana vitrectomy using 23-gauge (23G) instruments versus the conventional 20-gauge (20G) technique. METHODS A retrospective and interventional case series was consecutively performed for 199 eyes of the 192 patients that were a part of this study. Clinical data were reviewed retrospectively regarding the operation time, preoperative and postoperative intraocular pressure, visual acuity and astigmatism for 54 consecutive patients who received a 23G releasable suture vitrectomy and for 98 consecutive patients who received a 20G conventional vitrectomy during the period between April 2007 and September 2010. RESULTS Mean operation time based on the operation record was 88.5 ± 20.1 minutes in the 23G releasable suture vitrectomy group and 102.1 ± 23.1 minutes in the 20G conventional vitrectomy group, respectively (p = 0.01). The last best-corrected visual acuity (BCVA) was significantly better than the preoperative BCVA in both patient groups (p = 0.01, p = 0.01). The 23G releasable suture group showed less surgically induced astigmatism than the 20G conventional vitrectomy group. Vitreous bleeding was observed to be in 6 eyes (5.9%) in the 23G group, and in 8 eyes (8.2%) in the 20G group. In addition, ocular hypertension was noted to be in 3 eyes (3.0%) in the 23G group, and 6 eyes (6.1%) in the 20G group. No serious complications such as postoperative hypotony or endophthalmitis were observed in either group. CONCLUSIONS The 23G releasable suture technique is as effective as the 20G conventional technique and offers several advantages.
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Affiliation(s)
- In Geun Kim
- Department of Ophthalmology, Maryknoll Hospital, Busan, Korea.
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Tahiri Joutei Hassani R, Adam R, El Sanharawi M, Nordmann JP, Baudouin C. [Sclerotomies analysis using Spectral Domain OCT in sutureless vitrectomies complicated by endophthalmitis]. J Fr Ophtalmol 2012. [PMID: 23200169 DOI: 10.1016/j.jfo.2012.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Transconjunctival sutureless vitrectomy is a recent advance in vitreoretinal surgery. Some authors have reported an increased risk of postoperative hypotony and endophthalmitis and recommend the creation of oblique incisions, intended to be self-sealing, so as to reduce these risks. However, there is still a debate about the best architecture for transconjunctival sutureless incisions. MATERIALS AND METHODS We report two cases of acute endophthalmitis occurring after 23 and 25 gauge transconjunctival sutureless vitrectomy. We analyzed the scleral incisions using the anterior segment module of the Spectralis(®) OCT. To our knowledge, this is the first direct description of the appearance of sclerotomies associated with endophthalmitis. RESULTS The anterior segment module of Spectralis(®) OCT permitted a high-resolution evaluation of the architecture of the scleral incisions. We found straight, gaping incisions with misaligned edges and vitreous incarceration. DISCUSSION By way of these two case reports and a review of the literature, we discuss the contribution of anterior segment OCT in the analysis of scleral incision architecture in sutureless vitrectomy. Our findings are consistent with those reported in the literature. The presence of a direct incision, wound gap or edge misalignment are associated with an increased risk of early leakage and postoperative hypotony. CONCLUSIONS The anterior segment module of the Spectralis(®) OCT is a valuable tool for non-invasive, painless and high-resolution documentation of sutureless vitrectomy incisions. It allows for causal analysis and better understanding of the conditions associated with endophthalmitis after sutureless vitrectomy.
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Affiliation(s)
- R Tahiri Joutei Hassani
- Service d'ophtalmologie II, centre hospitalier national ophtalmologique des XV-XX, 28, rue de Charenton, 75012 Paris, France
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Mangioris G, Mendrinos E, Papadopoulou DN, Pournaras CJ. Optical coherence tomography of wound architecture of 20-gauge sutureless transconjunctival sclerotomies. Acta Ophthalmol 2012; 90:e648-9. [PMID: 22550997 DOI: 10.1111/j.1755-3768.2012.02441.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lei JQ, Xie AM, Shi Q. Clinical presentation of a mixed 23-gauge infusion and 20-gauge pars plana technique for active silicone oil removal. Int J Ophthalmol 2012; 5:600-4. [PMID: 23166872 DOI: 10.3980/j.issn.2222-3959.2012.05.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 09/18/2012] [Indexed: 11/02/2022] Open
Abstract
AIM To present with a clinical case series of a mixed 23-gauge infusion and 20-gauge pars plana technique for 5,700-centipoise silicone oil removal (SOR), and to discuss its efficacy and safety. METHODS This is a retrospective, non-randomized controlled study. We performed SOR with 23-gauge infusion and 20-gauge active suction technique on 29 patients 29 eyes from April to October, 2011 (mixed group). During the surgeries, a 23-gauge sclerotomy was made for infusion and a 20-gauge sclerotomy was used for active silicone oil suction. Anterior segment optical coherence tomography (OCT) was applied for 23-gauge sclerotomy analysis 1 day post-operation. Traditional 20-gauge SOR was performed on another consecutive 29 patients 29 eyes, the control group (20G group). RESULTS There were 2 eyes (6.9%) in mixed group and 5 eyes (17.2%) in 20G group which had recurrent retinal detachment after surgery. Hopytony (IOP≤6mmHg) occurred in 8 eyes (27.6%) of mixed group and in 10 eyes (34.5%) of 20G group post-operation, but all of them recovered to the normal level finally. There were no statistical significant differences. Final visual acuity was significantly increased after surgery in both groups. Anterior segment OCT images were acquired from 13 eyes of mixed group, and all of them had a proper wound apposition. But local ciliary detachment was found in 9 eyes (69%). It was hard to define the OCT image of the sclerotomies and ciliary body because of the serious conjunctival hemorrhages and chemosis in 20G group. CONCLUSION This mixed technique is a convenient and effective way to remove high viscosity silicone oil. Compared with traditional 20-gauge SOR, it does not increase the risk of post-operative complications and has less conjunctival reactions.. Transient postoperative hypotony is common for this procedure and subclinical ciliochoroidal detachment is a probable cause.
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Affiliation(s)
- Jian-Qin Lei
- Department of Ophthalmology, the First Affiliated Hospital of the Medical College of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
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Lopez-Guajardo L, Benitez-Herreros J, Camara-Gonzalez C, Silva-Mato A. Assessment of Vitreous Incarceration in Sclerotomies With OCT, Ultrasound Biomicroscopy, and Direct Visualization. Ophthalmic Surg Lasers Imaging Retina 2012; 43:S117-22. [DOI: 10.3928/15428877-20120823-02] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 06/20/2012] [Indexed: 11/20/2022]
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Tahiri Joutei Hassani R, El Sanharawi M, Adam R, Monin C, Dupont-Monod S, Baudouin C. Influence of sutureless 23-gauge sclerotomy architecture on postoperative intraocular pressure decrease: results of a multivariate analysis. Graefes Arch Clin Exp Ophthalmol 2012; 251:1285-92. [PMID: 23108510 DOI: 10.1007/s00417-012-2183-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Revised: 09/17/2012] [Accepted: 10/15/2012] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To evaluate the factors affecting the postoperative intraocular pressure (IOP) decrease in 23-gauge (23-G) sutureless vitrectomy, including incision architecture evaluated by anterior segment spectral-domain optical coherence tomography (SD-OCT). METHODS A prospective cohort study of 43 patients who underwent primary transconjunctival 23-G pars plana vitrectomy. All sclerotomy wounds were imaged 1 day after surgery using the anterior segment module of SD-OCT (OCT Spectralis, Heidelberg Engineering, Heidelberg, Germany). 23-G sclerotomy architecture, preoperative and postoperative medical data were also prospectively collected. RESULTS Multivariate logistic regression analysis, with backward elimination, found that surgery duration (adjusted OR = 9.17, p = 0.020) and loss of wound apposition (adjusted OR = 15.12, p = 0.022) were risk factors for significant postoperative IOP decrease (≥3 mmHg) 1 day after surgery; while age, gender, myopia, and gas tamponade were not risk or protective factors for postoperative IOP decrease. CONCLUSIONS In 23-G pars plana vitrectomy, the early postoperative decrease in IOP is mainly influenced by surgery duration and the self-sealing nature of the sclerotomy. The IOP decrease was not influenced by the presence or the absence of gas tamponade.
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Affiliation(s)
- Rachid Tahiri Joutei Hassani
- Department of Ophthalmology II, Quinze-Vingts National Ophthalmology Hospital, 28, rue de Charenton, 75012, Paris, France.
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Incidence of retinal breaks in eyes undergoing 23-gauge or 20-gauge vitrectomy with induction of posterior vitreous detachment. Retina 2012; 32:1100-5. [PMID: 22366906 DOI: 10.1097/iae.0b013e3182349449] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the incidence rates of retinal breaks in eyes in which posterior vitreous detachment was induced during 23-gauge and 20-gauge vitrectomies to treat macular holes or preretinal membranes. METHODS We retrospectively reviewed 122 eyes of 115 patients with a macular hole or preretinal membrane who underwent induction of posterior vitreous detachment during 23-gauge vitrectomy (23-gauge group) and 61 eyes of 58 consecutive patients with the disorders who underwent induction of posterior vitreous detachment during 20-gauge vitrectomy performed by 1 surgeon. RESULTS No difference was found in the incidence rates of intraoperative retinal breaks between the 23-gauge (16% [20/122]) and 20-gauge (16% [10/61]) groups. A postoperative rhegmatogenous retinal detachment developed in 2 (2%) eyes in the 23-gauge group, whereas no eyes in the 20-gauge group had postoperative retinal breaks or rhegmatogenous retinal detachment. The incidence rates of retinal breaks in eyes with a macular hole and preretinal membrane did not differ significantly. CONCLUSION Posterior vitreous detachment induced during vitrectomy frequently results in intraoperative retinal breaks, the incidence of which may be independent of the gauge of the vitreous instruments. Surgeons should be alert to the development of retinal breaks.
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Benitez-Herreros J, Lopez-Guajardo L, Camara-Gonzalez C, Silva-Mato A. Effect of interposition maneuver during cannula removal on vitreous incarceration rate in vitrectomized eyes measured by ultrasound biomicroscopy. Curr Eye Res 2012; 37:809-12. [PMID: 22686527 DOI: 10.3109/02713683.2012.678545] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To evaluate the influence of the cannula removal maneuver on the postoperative incisional vitreous incarceration using an experimental model of vitrectomized eye. METHODS Prospective, experimental, randomized and observer-masked experimental study in which 23-gauge transconjunctival sutureless vitrectomy was performed through oblique sclerotomies in cadaveric pig eyes. Once the vitrectomy was finished, one of the superior cannulas was removed with the light probe introduced through it, and the other cannula was extracted with the cannula plug inserted. Postoperative incisional vitreous incarceration was evaluated by ultrasound biomicroscopy (UBM). RESULTS 60 eyes included. Considering the 60 superior sclerotomies whose cannulas were extracted with the light pipe inserted, vitreous incarceration was observed in 35% of them. On the other hand, 71.6% of the incisions whose cannulas were removed with the cannula plug inserted showed vitreous incarceration (p = 0.00013). CONCLUSIONS Interposing the light probe through the cannula when it is removed seems to reduce the postoperative wound vitreous incarceration rate in our experimental model.
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Affiliation(s)
- Javier Benitez-Herreros
- Department of Ophthalmology, University Hospital Principe de Asturias, Alcalá de Henares (Madrid), Spain
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López-Guajardo L, Benítez-Herreros J. Vitreous incarceration in sclerotomies. Ophthalmology 2012; 119:204-5; author reply 205-6.e1. [PMID: 22214953 DOI: 10.1016/j.ophtha.2011.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 09/06/2011] [Indexed: 10/14/2022] Open
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Author reply. Ophthalmology 2012. [DOI: 10.1016/j.ophtha.2011.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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BLOOD CLUMP–ASSISTED VITRECTOMY AND INTERNAL LIMITING MEMBRANE PEELING FOR MACULAR HOLE REPAIR. Retina 2011; 31:2014-20. [DOI: 10.1097/iae.0b013e31821504a5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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