1
|
Lee D, Lee S, Choi KS. Clinical Performance Comparison of Ultrahigh-speed Dual Pneumatic Vitrectomy Probes: Is Faster and Smaller Better? KOREAN JOURNAL OF OPHTHALMOLOGY 2024; 38:122-128. [PMID: 38351482 PMCID: PMC11016684 DOI: 10.3341/kjo.2023.0109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/27/2023] [Accepted: 02/08/2024] [Indexed: 04/16/2024] Open
Abstract
PURPOSE Various vitrectomy probes are currently being used commercially, and there are ongoing efforts toward developing probes with higher cutting rates and smaller gauges. This study aimed to compare the efficiency and safety of various commercially available small gauge ultrahigh-speed dual pneumatic vitrectomy probes. METHODS We retrospectively analyzed the medical records of patients and recorded intraoperative videos while they underwent microincision three-port vitrectomy surgery for idiopathic epiretinal membrane at Soonchunhyang University Seoul Hospital. The patients were categorized into four groups based on the vitrectomy probe used during surgery: 23-7500 (UltraVit 23-gauge 7,500 cuts per minute [CPM]), 23-7500 (UltraVit 25-gauge 7,500 CPM), 25-10K (Advanced UltraVit 25-gauge 10,000 CPM), and 27-10K (Advanced UltraVit 27-gauge 10,000 CPM). RESULTS In total, 82 eyes from 82 patients were included in this work, with 16, 11, 26, and 29 eyes in groups 23-7500, 25-7500, 25-10K, and 27-10K, respectively. The corresponding vitrectomy times were 295.56 ± 53.55, 293.09 ± 50.28, 299.92 ± 59.42, and 349.38 ± 67.23 seconds, respectively. There was a significant difference in the vitrectomy time between the groups (p = 0.004). The mean number of sutures was 3, 3, 2.96, and 0.83, respectively. In the 23-7500 group, there was one case of iatrogenic retinal break, while in the 27-10K group, there was one case of postoperative hypotony. CONCLUSIONS Although advancements have been made in the 27-gauge vitrectomy probe, it still takes more vitrectomy time than it does when using the 23- and 25-gauge probes. However, the delay was within an average of 1 minute, and considering the significantly reduced need for sutures, there is a substantial benefit in terms of postoperative discomfort. Therefore, when choosing a probe for epiretinal membrane surgery among the four options, it is reasonable to select the 27-gauge probe according to the surgeon's preference.
Collapse
Affiliation(s)
- Donghyeon Lee
- Department of Ophthalmology, Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Sooyeon Lee
- Department of Ophthalmology, Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Kyung Seek Choi
- Department of Ophthalmology, Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| |
Collapse
|
2
|
Crincoli E, Savastano A, Ferrara S, Caporossi T, Miere A, Souied EH, Savastano MC, Kilian R, Rizzo C, Faraldi F, Rizzo S. Refractive outcome in combined phacovitrectomy: Anterior segment changes and corrective factor for IOL power calculation improvement. Eur J Ophthalmol 2024; 34:549-557. [PMID: 37401268 DOI: 10.1177/11206721231184502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
PURPOSE To analyze differences in refractive outcome Δ (difference between postoperative and expected refractive error) and in anterior segment changes between cataract surgery patients and combined phacovitrectomy patients. We also aimed to provide a corrective formula allowing to minimise the refractive outcome Δ in combined surgery patients. METHODS Candidates for phacoemulsification and combined phacovitrectomy (respectively PHACO and COMBINED groups) were prospectively enrolled in two specialised centres. Patients underwent best corrected visual acuity (BCVA) assessment, ultra-high speed anterior segment optical coherence tomography (OCT), gonioscopy, retinal OCT, slit lamp examination and biometry at baseline, 6 weeks postoperatively and 3 months postoperatively. RESULTS No differences in refractive Δ, refractive error and anterior segment parameters were noted between PHACO and COMBINED group (109 and 110 patients respectively) at 6 weeks. At 3 months, COMBINED group showed a spherical equivalent of -0.29 ± 0.10 D versus -0.03 ± 0.15 D in PHACO group (p = 0.023). COMBINED group showed a significantly higher Crystalline Lens Rise (CLR), angle-to-angle (ATA) and anterior chamber width (ACW) and a significantly lower anterior chamber depth (ACD) and refractive Δ with all 4 considered formulas at 3 months. For IOL power lower than 15, a hyperopic shift was observed instead. CONCLUSIONS Anterior segment OCT suggests anterior displacement of the effective lens position in patients undergoing phacovitrectomy. A corrective formula can be applied to IOL power calculation to minimize undesired refractive error.
Collapse
Affiliation(s)
- Emanuele Crincoli
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Fondazione Policlinico Universitario A Gemelli, Catholic University of "Sacro Cuore", Rome, Italy
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Verona, Italy
| | - Alfonso Savastano
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Fondazione Policlinico Universitario A Gemelli, Catholic University of "Sacro Cuore", Rome, Italy
| | - Silvia Ferrara
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Fondazione Policlinico Universitario A Gemelli, Catholic University of "Sacro Cuore", Rome, Italy
| | - Tomaso Caporossi
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Fondazione Policlinico Universitario A Gemelli, Catholic University of "Sacro Cuore", Rome, Italy
| | - Alexandra Miere
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Verona, Italy
| | - Eric H Souied
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Verona, Italy
| | - Maria Cristina Savastano
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Fondazione Policlinico Universitario A Gemelli, Catholic University of "Sacro Cuore", Rome, Italy
| | | | - Clara Rizzo
- Ophthalmology, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Francesco Faraldi
- Department of Ophthalmology, Istituto Oftalmico di Torino, Torino, Italy
| | - Stanislao Rizzo
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Fondazione Policlinico Universitario A Gemelli, Catholic University of "Sacro Cuore", Rome, Italy
- "Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze" Pisa, Pisa, Italy
| |
Collapse
|
3
|
Caporossi T, Governatori L, Baldascino A, Savastano A, De Vico U, Rizzo S. Wedge-Shaped Pars Plana Sclerotomies: Is It Still an Actuality in the Era of Microincision Vitrectomy? Retina 2023; 43:1811-1815. [PMID: 34101694 DOI: 10.1097/iae.0000000000003228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe and evaluate the effectiveness of wedge-shaped sclerotomies to close 25-gauge and 23-gauge transconjunctival pars plana vitrectomies. MATERIALS AND METHODS This prospective, consecutive, interventional study examined 50 eyes of 50 patients who underwent 25-gauge and 23-gauge vitrectomy with wedge-shaped sclerotomies. RESULTS The number of eyes requiring a wedge shape for sclerotomy closure and sclerotomies requiring sutures was collected. Three eyes had hypotony on Day 1. No statistically significant difference was observed between preoperative intraocular pressure and postoperative intraocular pressure on Days 15 and 30. No postoperative complications were observed during the follow-up period. CONCLUSION The wedge-shaped sclerotomy is a simple, fast, and effective technique that does not require extra surgical materials and could be applied to microincision vitrectomy.
Collapse
Affiliation(s)
- Tomaso Caporossi
- Department of Ophthalmology, Catholic University of Sacred-Heart Foundation "Policlinico Universitario A. Gemelli" IRCCS, Rome, Italy; and
| | - Lorenzo Governatori
- Department of NEUROFARBA, Ophthalmology, University of Florence, Florence, Italy
| | - Antonio Baldascino
- Department of Ophthalmology, Catholic University of Sacred-Heart Foundation "Policlinico Universitario A. Gemelli" IRCCS, Rome, Italy; and
| | - Alfonso Savastano
- Department of Ophthalmology, Catholic University of Sacred-Heart Foundation "Policlinico Universitario A. Gemelli" IRCCS, Rome, Italy; and
| | - Umberto De Vico
- Department of Ophthalmology, Catholic University of Sacred-Heart Foundation "Policlinico Universitario A. Gemelli" IRCCS, Rome, Italy; and
| | - Stanislao Rizzo
- Department of Ophthalmology, Catholic University of Sacred-Heart Foundation "Policlinico Universitario A. Gemelli" IRCCS, Rome, Italy; and
| |
Collapse
|
4
|
Wu PY, Fung AT, Dave VP, Iu LPL, Sjahreza E, Chaikitmongkol V, Sivagurunathan PD, Ahn J, Misra DK, Wong CW, Chou HD. COVID-19 reduced scleral buckling training in fellows and shifted young ophthalmologists' preference toward vitrectomy: An Asia-Pacific survey. Clin Exp Ophthalmol 2023; 51:585-597. [PMID: 37170410 DOI: 10.1111/ceo.14236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/14/2023] [Accepted: 04/22/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND To assess rhegmatogenous retinal detachment (RRD) surgery trends and training among young ophthalmologists (YOs, vitreoretinal fellows or attendings/consultants with ≤10 years of independent practice) and the impact of the COVID-19 pandemic. METHODS An anonymous online survey was completed by 117 YOs in the Asia-Pacific regarding their RRD surgery experiences in 2021-2022. RESULTS To achieve a 90% probability of surgical competency, 91 vitrectomy and 34 scleral buckling (SB) completions during fellowship were needed. In total, 49 (41.9%) YOs had fellowship affected by COVID-19. In the COVID versus pre-COVID era, however, the volume of SB completions per fellowship year decreased significantly (median [IQR] 3.3 [1.5, 9] vs. 13 [6.5, 23]; p < 0.001) and was lower than the required volume to achieve competency. YOs were less confident in conducting SB versus vitrectomy (3.5 ± 1.1 vs. 4.2 ± 0.8, p < 0.001), and they reported a decrease in the proportion of SB (-3.1%, p = 0.047) and an increase in the proportion of vitrectomy (+4.8%, p < 0.001) after the pandemic outbreak. Apart from RRD clinical characteristics, surgical confidence is among the main factors that affect surgical method decisions. During the pandemic, more YOs may have avoided SB due to the need for general anaesthesia, leading to longer surgical time and risk of viral transmission during intubation/extubation. CONCLUSIONS SB surgical exposure is suboptimal in most fellowship programs in the 11 Asia-Pacific countries/regions we surveyed and further declined during the COVID-19 pandemic. YOs are less confident in performing SB, leading to a trend toward primary vitrectomy since the COVID-19 outbreak.
Collapse
Affiliation(s)
- Po-Yi Wu
- Department of Medical Education, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Adrian T Fung
- Westmead and Central (Save Sight Institute) Clinical Schools, Specialty of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, Australia
- Department of Ophthalmology, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Vivek P Dave
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, Anant Bajaj Retina Institute Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
| | - Lawrence P L Iu
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
| | | | - Voraporn Chaikitmongkol
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Premala D Sivagurunathan
- Department of Ophthalmology, Hospital Raja Perempuan Zainab II, Malaysian Ministry of Health, Kota Bharu, Kelantan, Malaysia
| | - Jeeyun Ahn
- Department of Ophthalmology, Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
- College of Medicine, Seoul National University, Seoul, Korea
| | - Diva K Misra
- Vitreo-Retina Services, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
| | - Chee Wai Wong
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
| | - Hung-Da Chou
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| |
Collapse
|
5
|
Hossain RR, Guest S, Wallace HB, McKelvie J. Ophthalmic surgery in New Zealand: analysis of 410,099 surgical procedures and nationwide surgical intervention rates from 2009 to 2018. Eye (Lond) 2023; 37:1583-1589. [PMID: 35906418 PMCID: PMC10219977 DOI: 10.1038/s41433-022-02181-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 05/18/2022] [Accepted: 07/11/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Surgical intervention rates (SIR) provide a proxy measure of disease burden, surgical capacity, and the relative risk-benefit ratio of surgery. The current study assessed decade trends in ophthalmic surgery and calculated SIRs for all major classes of commonly performed ophthalmic procedures in New Zealand. METHODS Retrospective population-based analysis of all ophthalmic surgical procedures performed in New Zealand from 2009 to 2018. National and regional datasets from public and private health sectors and industry were analysed. SIRs were calculated for all major ophthalmic procedures, and subgrouped by patient demographics. RESULTS There were 410,099 ophthalmic surgical procedures completed with a 25.3% overall increase over 10 years. Procedures were mostly government-funded (51%, n = 210,830) with 71% of patients aged over 64 years. Cataract surgery (78%, n = 318,564) had the highest mean SIR (703/100,000/year) and increased by 25% during the study period, consistent with population growth in the over 64 years old age group. Vitrectomy surgery had the second highest mean SIR (67/100,000/year) and increased by 50%, well above national population growth during the study period. Other SIRs included conjunctival lesion-biopsy (38/100,000/year), glaucoma (33/100,000/year), strabismus (20/100,000/year), dacryocystorhinostomy (10/100,000/year), and keratoplasty surgery (4/100,000/year). CONCLUSIONS This comprehensive review of New Zealand ophthalmic surgery reports increasing SIRs that cannot be explained by population growth alone. Cataract surgery numbers increased year on year consistent with the increase in the over 64 years old population. Vitrectomy surgery growth exceeded that of the national population, including those over 64 years.
Collapse
Affiliation(s)
- Ruhella R Hossain
- Department of Ophthalmology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Ophthalmology, Hawkes Bay District Health Board, Hastings, New Zealand
| | - Stephen Guest
- Department of Ophthalmology, Waikato District Health Board, Hamilton, New Zealand
| | - Henry B Wallace
- Department of Ophthalmology, Capital & Coast District Health Board, Wellington, New Zealand
| | - James McKelvie
- Department of Ophthalmology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
- Department of Ophthalmology, Waikato District Health Board, Hamilton, New Zealand.
| |
Collapse
|
6
|
Vagaggini T, Adams OE, Curran CD, Prairie ML, Baker MJ, Sastry A, Ryan EH, Parke DW, Mittra RA, Tang PH. Clinical Factors and Outcomes of Acute-Onset Endophthalmitis Following Small-Gauge Pars Plana Vitrectomy Surgery. Ophthalmic Surg Lasers Imaging Retina 2023:1-6. [PMID: 37418667 DOI: 10.3928/23258160-20230614-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2023]
Abstract
BACKGROUND AND OBJECTIVES Describe risk factors, findings, and outcomes of acute endophthalmitis (AE) following small-gauge pars plana vitrectomy (PPV). PATIENTS AND METHODS This was a retrospective single-center, nonrandomized study of post-PPV AE patients from 2013 to 2021. All received vitreous biopsy before treatment. Patients were divided into cohorts: 1) PPV within 3 days of diagnosis (Urgent-PPV), and 2) no urgent PPV (Other-treatment [Tx]). Main outcome was best-corrected visual acuity (BCVA) at 6 months. RESULTS Twenty-one patients were analyzed. Epiretinal membrane was most common indication for PPV (48%). Incidence was 0.074%. Culture-positive rate was 57%. For final BCVA, there was no significant (P = 0.85) difference between Urgent-PPV (median = 0.40 logMAR) and Other Tx cohorts (median = 0.35 logMAR). Sclerotomy wounds were not sutured in 71% of patients. Approximately 24% and 38% of patients analyzed had either no tamponade or partial tamponade, respectively. CONCLUSION Tamponade agents and sclerotomy suturing may be important factors when evaluating post-small-gauge PPV-associated AE. Further studies are necessary for clarification. [Ophthalmic Surg Lasers Imaging Retina 2023;54:xx-xx.].
Collapse
|
7
|
Abu-Ain M, Shatnawi R, Shehadeh I, Khan MI. Long-Term Visual Acuity and Optical Coherence Tomography Changes After Vitrectomy for Idiopathic Epiretinal Membranes. Clin Ophthalmol 2023; 17:693-700. [PMID: 36880022 PMCID: PMC9985397 DOI: 10.2147/opth.s401017] [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: 12/23/2022] [Accepted: 02/22/2023] [Indexed: 03/06/2023] Open
Abstract
Objective To evaluate the long-term visual acuity and retinal thickness changes after pars plana vitrectomy (PPV) for idiopathic epiretinal membranes (ERM). Methods We performed a retrospective analysis of 72 patients who underwent PPV for idiopathic ERM in a tertiary hospital over 5 consecutive years. The main outcome measurement was change in visual acuity and macular thickness as recorded with optical coherence tomography (OCT). Results Medical records of 239 patients with a diagnosis of ERM who underwent PPV with or without internal limiting membrane (ILM) peeling were reviewed; of these, 72 patients with idiopathic ERM were included in the final analysis. All patients completed at least one year of follow-up, and 23 patients (30%) had 5 or more years of follow-up. The mean preoperative best corrected visual acuity (BCVA) was 20/65, and mean preoperative central macular thickness (CMT) on OCT was 434 microns (µm). Mean postoperative BCVA and CMT at one year were 20/40 and 303 µm, respectively (p<0.0001). A total of 42 patients (58%) improved by 2 or more lines; BCVA and CMT continued to improve postoperatively for up to 5 years of the follow-up period. There was no significant difference in BCVA or CMT between phakic and pseudophakic patients, and ILM peeling was performed in 67% of patients. Improved BCVA at 1 year was associated with younger age (p<0.0001) and ILM peeling (p=0.020). Conclusion PPV is an effective treatment for idiopathic ERM, and ILM peel may be of benefit. BCVA continues to improve up to 2 years and beyond after surgery regardless of the duration of symptoms.
Collapse
Affiliation(s)
- Mohammad Abu-Ain
- Department of Special Surgery, Faculty of Medicine, The Hashemite University, Zarqa, Jordan.,Prince Hamzah Hospital, Department of Ophthalmology, Amman, Jordan
| | - Raed Shatnawi
- Department of Special Surgery, Faculty of Medicine, The Hashemite University, Zarqa, Jordan.,Prince Hamzah Hospital, Department of Ophthalmology, Amman, Jordan
| | - Ibrahim Shehadeh
- Prince Hamzah Hospital, Department of Ophthalmology, Amman, Jordan
| | - Mohammad Irfan Khan
- Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| |
Collapse
|
8
|
Muns SM, Villegas VM, Murray TG, Latiff A, Gold AS. Clinical Outcomes of Combined Phacoemulsification With Intraocular Lens Placement and Microincision Vitrectomy in Adult Vitreoretinal Disease. JOURNAL OF VITREORETINAL DISEASES 2023; 7:27-32. [PMID: 37008401 PMCID: PMC9954161 DOI: 10.1177/24741264221118185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose To evaluate the safety and clinical outcomes of combined phacoemulsification with intraocular lens (IOL) placement and microincision vitrectomy surgery (MIVS) in adult patients with concomitant cataract and vitreoretinal disease. Methods A consecutive series of patients with comorbid vitreoretinal disease and cataract who had combined phacoemulsification with IOL placement and MIVS was retrospectively analyzed. The main outcome measures were visual acuity (VA) and intraoperative and postoperative complications. Results The analysis comprised 648 eyes of 611 patients. The median follow-up was 26.9 months (range, 12-60 months). The most common vitreoretinal pathology was intraocular tumor (53%). The best-corrected Snellen VA improved from 20/192 at baseline to 20/46 at the 12-month follow-up. The most frequent intraoperative complication was capsule tear (3.9%). The most common postoperative adverse events after 3 months of follow-up (mean, 24 months) were vitreous hemorrhage (3.2%) and retinal detachment (1.8%). No patient developed endophthalmitis. Conclusions Combined phacoemulsification with IOL placement and MIVS is a safe, effective technique to manage a broad range of vitreoretinal diseases in patients with significant cataract.
Collapse
Affiliation(s)
- Sofía M. Muns
- Department of Ophthalmology, University
of Puerto Rico, San Juan, PR, USA
| | - Victor M. Villegas
- Department of Ophthalmology, University
of Puerto Rico, San Juan, PR, USA
- Bascom Palmer Eye Institute, University
of Miami Miller School of Medicine, Miami, FL, USA
- Department of Surgery, Ponce Health
Sciences University, School of Medicine, Ponce, PR, USA
| | | | | | | |
Collapse
|
9
|
Two Year Randomized Prospective Comparison of Ahmed Valve Versus Baerveldt Implant in Vitrectomized Eyes. J Glaucoma 2023; 32:27-33. [PMID: 36223288 DOI: 10.1097/ijg.0000000000002129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 09/17/2022] [Indexed: 11/07/2022]
Abstract
PRCIS Ahmed Valve and Baerveldt shunt are efficacious options in vitrectomized eyes. Baerveldt implant achieves a lower mean intraocular pressure (IOP) at 2 years, with fewer medications and a higher percentage of medication-free patients. PURPOSE To investigate and compare the efficacy and complications between Ahmed FP7 Glaucoma Valve (AGV) and Baerveldt 101-350 Glaucoma Implant (BGI) in vitrectomized eyes. MATERIALS AND METHODS In this single-center randomized clinical trial, 43 vitrectomized eyes (39 patients) underwent glaucoma drainage device implantation. Eyes were randomized to receive either an AGV (FP7) or a BGI (101-350) and were followed for 2 years. Surgical success was defined as an IOP measurement≤18 mm Hg and≥5 mm Hg with or without glaucoma medication at 2 or more sequential visits after 3 months. The primary outcome was the comparison of the success rate at 2 years, while mean IOP, mean number of medications, and number of complications were considered secondary outcomes. RESULTS Kaplan-Meier estimates of the 2-year success rates in IOP control after GDD implantation were similar between the 2 groups; AGV group 81.8% (95% CI: 67.2%-99.6%) and BGI group 85.7% (95% CI: 72.0%-100.0%), (log-rank test P value = 0.74). Patients in the BGI group had a statistically significant lower mean IOP compared with the AGV group in all follow-up visits at 2, 6, 12, and 24 months (11.62 vs. 17.45 mm Hg at the latter P value <0.001). The BGI group required a significantly lower number of medications for IOP control at the 2-year visit compared with the AGV group (0.76±0.99 vs. 1.5±1.06 P value = 0.02) but had a higher number of complications (62% vs. 41%, respectively). CONCLUSIONS GDDs provide a viable solution for IOP control in vitrectomized eyes. Based on our prospective comparison, both Ahmed FP7 Glaucoma Valve and Baerveldt 101-350 Glaucoma Implant are efficacious options.
Collapse
|
10
|
Meng Y, Xu Y, Li L, He L, Yi Z, Chen C. Retinal arterial macroaneurysm rupture by Valsalva maneuver: a case report and literature review. BMC Ophthalmol 2022; 22:461. [PMID: 36451117 PMCID: PMC9710132 DOI: 10.1186/s12886-022-02662-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 10/28/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Retinal artery macroaneurysms (RAMs) are focal dilations of the large retinal arteries. Most RAMs are asymptomatic, however, when hemorrhage or exudation caused by a RAM involves the macula, patients can experience marked vision loss. This article reported a rare case of a ruptured RAM due to the Valsalva maneuver in an elderly female with constipation and offered a review of the relevant literature. CASE PRESENTATION A 78-year-old woman with several risk factors presented with multi-level retinal hemorrhages following a Valsalva maneuver during constipation. Due to the poor coagulation and heavy bleeding in this case, the blood broke through the internal limiting membrane and drained "on its own" into the vitreous cavity. First, we observed the patient and controlled for her risk factors. After the blood was completely drained into the vitreous cavity, the root cause of the bleeding was found to be a RAM rupture. After laser photocoagulation, the patient's vision recovered significantly and remained stable for a long time despite the presence of an epiretinal membrane and a lamellar macular hole. CONCLUSIONS This is the first reported case of a RAM rupture by Valsalva maneuver during constipation. For multi-level hemorrhages caused by RAM, measures should be taken to drain out the sub-internal limiting membrane hemorrhage and simultaneously control for risk factors. After the RAM is exposed, laser photocoagulation can be performed.
Collapse
Affiliation(s)
- Yang Meng
- grid.412632.00000 0004 1758 2270Department of Ophthalmology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, China
| | - Yishuang Xu
- grid.412632.00000 0004 1758 2270Department of Ophthalmology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, China
| | - Lu Li
- grid.412632.00000 0004 1758 2270Department of Ophthalmology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, China
| | - Lu He
- grid.412632.00000 0004 1758 2270Physical Examination Center, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, China
| | - Zuohuizi Yi
- grid.412632.00000 0004 1758 2270Department of Ophthalmology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, China
| | - Changzheng Chen
- grid.412632.00000 0004 1758 2270Department of Ophthalmology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, China
| |
Collapse
|
11
|
Trese MGJ, Lee R, Garretson BR, Mahmoud TH. Preventing Iatrogenic Retinal Breaks in Cutter-Associated Traction from Chronic Vitreous Hemorrhage (CATCH). Ophthalmic Surg Lasers Imaging Retina 2022; 53:584-585. [PMID: 36239678 DOI: 10.3928/23258160-20220920-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND OBJECTIVE To describe an under-recognized complication in the surgical management of dense, nonclearing vitreous hemorrhage, specifically, the development of iatrogenic retinal breaks as a result of cutter-associated traction. STUDY DESIGN/PATIENTS AND METHODS Review of surgical cases with cutter-associated traction from chronic vitreous hemorrhage (CATCH). RESULTS Cutter-associated traction from chronic vitreous hemorrhage is a commonly encountered surgical entity that may result in complications such as iatrogenic retinal breaks, including giant retinal tears. These complications can be minimized or potentially avoided through the use of open sclerotomies or potentially mixed-gauge vitrectomy. CONCLUSION Careful surgical planning in cases of dense or chronic vitreous hemorrhage is required to prevent cutter-associated tractional retinal breaks. [Ophthalmic Surg Lasers Imaging Retina 2022;53:584-585.].
Collapse
|
12
|
Sun Y, Zhang Z, Wei Y, Chi W, Zhang S. Intraocular Lens Fixation Technique Without Corneal Incision in Minimally Invasive Vitrectomized Eyes. Ophthalmol Ther 2022; 11:729-737. [PMID: 35122608 PMCID: PMC8927512 DOI: 10.1007/s40123-022-00464-4] [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: 10/25/2021] [Accepted: 01/12/2022] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION To introduce a modified technique for primary/secondary intraocular lens (IOL) fixation without corneal incision in vitrectomized eyes. METHODS Consecutive case series who had undergone previous or concomitant pars plana vitrectomy (PPV) to have primary/secondary IOL fixation were prospectively included. A self-sealing scleral incision was made underneath the superior scleral flap, through which the IOL was inserted into the anterior chamber. The suture tied with the IOL passed through the sclera to fix the IOL in the ciliary sulcus. Patients were followed up for at least 3 months. Main outcomes were best corrected visual acuity (BCVA), intraocular pressure (IOP), surgically induced astigmatism (SIA), and intraoperative and postoperative complications. RESULTS A total of 31 patients were included in the study. The mean follow-up time was 5.35 ± 4.14 months. The BCVA (log MAR unit) improved from 0.97 ± 0.58 preoperative to 0.42 ± 0.36 postoperative (P < 0.001). Mean IOP remained unchanged (preoperative IOP 14.03 ± 2.90 mmHg, postoperative IOP 13.26 ± 3.46 mmHg, P = 0.130). The mean SIA was 0.91 ± 0.76 diopters. No obvious intraoperative and postoperative complications were observed. CONCLUSION This method has favorable postoperative visual recovery and IOP control. This modified method could be taken into account as an option by surgeons in vitreoretinal surgery.
Collapse
Affiliation(s)
- Yimeng Sun
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China
| | - Zhaotian Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China
| | - Yantao Wei
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China
| | - Wei Chi
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China
| | - Shaochong Zhang
- Shenzhen Key Laboratory of Ophthalmology, Shenzhen Eye Hospital Affiliated to Jinan University, 18 Zetian Road, Shenzhen, 518040, Guangdong, China.
| |
Collapse
|
13
|
Inoue M, Koto T, Hirakata A. Comparisons of flow dynamics of dual-blade to single-blade beveled-tip vitreous cutters. Ophthalmic Res 2021; 65:216-228. [PMID: 34942621 DOI: 10.1159/000521468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/27/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION To compare the flow dynamics of the dual-blade to the single-blade beveled-tip vitreous cutters. METHODS The aspiration rates of balanced salt solution (BSS) and swine vitreous were measured for the 25-gauge and 27-gauge dual- and single-blade vitreous cutters. The flow dynamics of BSS and diluted vitreous mixed with fluorescent polymer at the maximal cutting rates and the reflux of BSS were measured in images obtained by a high-speed camera. The distal end of the cutter was defined as the head end. RESULTS The aspiration rates of BSS and vitreous by the 25- and 27-gauge dual-blade cutters were significantly higher than those of both single-blade cutters at the maximal cutting rate (all P≤0.01). The mean aspiration flow of BSS in front of the port from a lateral view was significantly faster for both dual-blade cutters than for both single-blade cutters (P=0.003, P=0.019). The angle of the mean flow of BSS of both dual-blade cutters was from the distal end (P<0.001, P<0.001) but that of the single blade-cutters was from the proximal end. The velocity and angle of the mean reflux flow of both types of cutters were not significantly different. The mean aspiration flow of diluted vitreous was significantly faster for 25-gauge dual-blade cutters with the angle more from the proximal end and 27-gauge dual-blade cutters more from the distal end than both single-blade cutters (P=0.018, P=0.048). CONCLUSION The dual-blade beveled-tip vitreous cutters improve the efficiency of the vitrectomy procedures and maintain the distal aspirating flow by the beveled-tip.
Collapse
Affiliation(s)
- Makoto Inoue
- Kyorin Eye Center, Department of Ophthalmology, Kyorin University School of Medicine, Mitaka, Japan
| | - Takashi Koto
- Kyorin Eye Center, Department of Ophthalmology, Kyorin University School of Medicine, Mitaka, Japan
| | - Akito Hirakata
- Kyorin Eye Center, Department of Ophthalmology, Kyorin University School of Medicine, Mitaka, Japan
| |
Collapse
|
14
|
Starr MR, Hsu J, Yonekawa Y, Mittra RA, Ryan C, Forbes NJ, Ammar M, Patel LG, Obeid A, Capone A, Emerson GG, Joseph DP, Eliott D, Gupta OP, Regillo CD, Ryan EH. Surgical techniques for primary rhegmatogenous retinal detachments between surgeons with high versus low single surgery success rates. Acta Ophthalmol 2021; 99:e1501-e1508. [PMID: 33720540 DOI: 10.1111/aos.14821] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/25/2020] [Accepted: 02/08/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND/AIMS To identify differences in preoperative characteristics and intraoperative approaches between surgeons with higher versus lower single surgery success rates (SSSR) for repair of rhegmatogenous retinal detachments (RRDs). METHODS This study is a sub-analysis of subjects who underwent RRD repair in the Primary Retinal Detachment Outcomes (PRO) study, a multi-institutional, retrospective comparative interventional study. The PRO study examined consecutive primary RRD surgeries from January 1, 2015 through December 31, 2015. The primary outcome was variations in surgical approach to different types of RRDs with secondary analyses of pre and intraoperative metrics for surgeons with SSSR > 90% compared to those <80% who performed at least 40 operations during the study period. RESULTS A total of 689 surgeries were included in the analysis. The mean SSSR was 94% for the higher tier and 75% for the lower tier (p < 0.0001). Surgeons with >90% SSSR were more likely to have graduated fellowship more recently (p = 0.0025), use less perfluorocarbon liquid (p < 0.0001), perform less 360 degree laser retinopexy (p < 0.0001), and perform a higher percentage of primary buckles and combined PPV/SB (p < 0.0001). For pseudophakic eyes there was no difference between PPV and PPV/SB use (p = 0.6211). CONCLUSION Surgeons with high SSSR typically performed SB as well as combination PPV/SB for more RRDs. Similar numbers of PPV and PPV/SB were performed for pseudophakic eyes, suggesting that the difference in SSSR between the two groups may be related to a combination of preoperative and intraoperative decisions as well as differences in technique.
Collapse
Affiliation(s)
- Matthew R. Starr
- Wills Eye Hospital Mid Atlantic Retina Thomas Jefferson University Philadelphia PA USA
| | - Jason Hsu
- Wills Eye Hospital Mid Atlantic Retina Thomas Jefferson University Philadelphia PA USA
| | - Yoshihiro Yonekawa
- Wills Eye Hospital Mid Atlantic Retina Thomas Jefferson University Philadelphia PA USA
| | | | | | | | - Michael Ammar
- Wills Eye Hospital Mid Atlantic Retina Thomas Jefferson University Philadelphia PA USA
| | - Luv G. Patel
- Wills Eye Hospital Mid Atlantic Retina Thomas Jefferson University Philadelphia PA USA
| | - Anthony Obeid
- Wills Eye Hospital Mid Atlantic Retina Thomas Jefferson University Philadelphia PA USA
| | - Antonio Capone
- Associated Retinal Consultants Oakland University William Beaumont School of Medicine Royal Oak MI USA
| | | | | | - Dean Eliott
- Massachusetts Eye and Ear Harvard Medical School Boston MA USA
| | - Omesh P. Gupta
- Wills Eye Hospital Mid Atlantic Retina Thomas Jefferson University Philadelphia PA USA
| | - Carl D. Regillo
- Wills Eye Hospital Mid Atlantic Retina Thomas Jefferson University Philadelphia PA USA
| | | | | |
Collapse
|
15
|
SUTURELESS CLOSURE OF 23- AND 25-GAUGE LEAKING SCLEROTOMIES WITH THE SCLERAL NEEDLING TECHNIQUE. Retina 2021; 40:838-844. [PMID: 30821730 DOI: 10.1097/iae.0000000000002484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe and evaluate the efficacy of a novel technique, scleral needling (SN), for securing 23- and 25-gauge leaking sclerotomies in microincision vitrectomy surgery. METHODS A retrospective comparative review of consecutive cases of 23- and 25-gauge pars plana vitrectomy performed by a single vitreoretinal surgeon before the introduction of the SN technique (pre-SN; November 2016 to January 2017) and after the introduction of the SN technique (post-SN; November 2017 to January 2018) was conducted. The SN technique was implemented as an alternative to suturing, using a 30-gauge needle inserted perpendicularly through the full thickness of the sclera adjacent to the scleral opening, with the needle then immediately removed and sclerotomy closure confirmed. RESULTS A total of 203 eyes, 105 from pre-SN and 98 from post-SN, were included in the study. The number of eyes requiring suture closure was significantly reduced from 39% in the pre-SN group to 2% in the post-SN group (P < 0.001). The mean postoperative intraocular pressure and incidence of hypotony on Days 1 to 2, Days 3 to 20, and Days 21 to 50 was not significantly different between the pre-SN and post-SN groups. No major complications associated with the SN technique were noted during the study period. CONCLUSION The SN technique is a safe and simple method for effectively securing leaking sclerotomies in microincision vitrectomy surgery.
Collapse
|
16
|
Abstract
PURPOSE OF REVIEW Symptomatic vitreous opacities are increasingly recognized as a significant burden to patient well-being. There is growing interest in the use of vitrectomy or laser treatment to address these problems. This review is intended to update current assessment, management, and risks of treatment for persistent severely symptomatic vitreous opacities. RECENT FINDINGS Despite studies showing the value of quantitative ultrasound, reading speed measurements, and contrast sensitivity for assessing dysfunction caused by vitreous opacities, the decision of whether to proceed with surgery remains a very subjective, clinical one. Visual Function Questionnaire-25 score studies show a very large improvement postvitrectomy consistent with relief from symptoms and patient satisfaction. The risk of retinal tear and detachment appears to be higher than in most conditions treated with vitrectomy. SUMMARY Vitrectomy for the management of severe vitreous opacities is increasingly accepted because of the tremendous relief of symptoms reported by patients. The risks of retinal tear and detachment remain a concern, particularly in patients who have an attached posterior hyaloid. Yttrium-aluminum-garnet laser treatment of floaters may offer benefit in a subset of patients but appears to be less definitive than vitrectomy, and also may carry significant risk.
Collapse
Affiliation(s)
- Edwin H Ryan
- 3601 West 76th Street, Suite 300, Edina, Minnesota, USA
| |
Collapse
|
17
|
Chen PL, Chen YT, Chen SN. Comparison of 27-gauge and 25-gauge vitrectomy in the management of tractional retinal detachment secondary to proliferative diabetic retinopathy. PLoS One 2021; 16:e0249139. [PMID: 33765074 PMCID: PMC7993849 DOI: 10.1371/journal.pone.0249139] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 03/09/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To compare surgical outcomes between 27 and 25-gauge vitrectomy in proliferative diabetic retinopathy (PDR) with tractional retinal detachment (TRD). METHODS This retrospective study was conducted to compare the intraoperative status, operation time, use of instruments, endotamponade substance, wound suture number, and iatrogenic break, between 27 and 25-gauge vitrectomy in 43 eyes afflicted by PDR with TRD. The post-surgical results, best-corrected visual acuity, intraocular pressure, recurrent vitreous haemorrhage, and re-operation rate were regularly followed up for 6 months. RESULTS Patients in the 25 and the 27-gauge groups did not differ significantly in terms of pre-surgical conditions, such as age, gender, pre-existing glaucoma, best-corrected visual acuity (BCVA) and the severity of their TRD. The mean operation time was 56.7 minutes in the 27-gauge group and 63.7 minutes in the 25-gauge group (p = 0.94). There is significantly less use of micro forceps in the 27-gauge group (p = 0.004). No difference between micro scissors and chandelier usage were noted; neither was their difference in iatrogenic retinal breaks. Significantly fewer wound sutures were noted in the 27-gauge group (p < 0.001). The post-operative results revealed no significant difference in ocular hypertension, hypotony, BCVA improvement, recurrent vitreous haemorrhage and re-operation rate. CONCLUSIONS The 27-gauge vitrectomy system offers comparable surgical outcomes in PDR with TRD. The 27-gauge vitrectomy system is suitable for complicated retinal surgery.
Collapse
Affiliation(s)
- Po-Lin Chen
- Department of Ophthalmology, Changhua Christian Hospital, Changhua, Taiwan
| | - Yan-Ting Chen
- Department of Ophthalmology, Changhua Christian Hospital, Changhua, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Optometry, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - San-Ni Chen
- Department of Ophthalmology, Changhua Christian Hospital, Changhua, Taiwan
- College of Medicine, Chung-Shan Medical University, Taichung, Taiwan
- Department of Optometry, Da-Yeh University, Changhua, Taiwan
- * E-mail:
| |
Collapse
|
18
|
Echegaray JJ, Vanner EA, Zhang L, Fortun JA, Albini TA, Berrocal AM, Smiddy WE, Flynn HW, Sridhar J, Gregori NZ, Townsend JH, Davis JL, Haddock LJ. Outcomes of Pars Plana Vitrectomy Alone versus Combined Scleral Buckling plus Pars Plana Vitrectomy for Primary Retinal Detachment. Ophthalmol Retina 2021; 5:169-175. [PMID: 32980532 DOI: 10.1016/j.oret.2020.09.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/29/2020] [Accepted: 09/21/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE We compared the outcomes of primary uncomplicated rhegmatogenous retinal detachment (RRD) repair using pars plana vitrectomy (PPV) alone versus combined scleral buckling plus PPV (SB+PPV). DESIGN Retrospective, observational study. PARTICIPANTS Patients with primary RRD who underwent PPV or SB+PPV from June 1, 2014, through December 31, 2017. METHODS We performed a single-institution, retrospective, observational study of 488 consecutive patients with primary RRD repaired via PPV alone or SB+PPV and gas tamponade. We excluded patients younger than 18 years and those with advanced proliferative vitreoretinopathy, giant retinal tear, trauma, or secondary forms of RRD. We performed logistic regression and Cox proportional hazard regression analyses to identify potential risk factors associated with a retinal redetachment. MAIN OUTCOME MEASURES Single-operation anatomic success (SOAS), defined as adequate retinal reattachment achieved with only 1 procedure. RESULTS The mean follow-up interval was 14.3 months. Single-operation anatomic success and final anatomic success were achieved in 425 eyes (87.1%) and 487 eyes (99.8%), respectively. Single-operation anatomic success was achieved in 90 of 111 eyes (81.1%) with PPV alone compared with 345 of 374 eyes (92.2%) with SB+PPV (P = 0.0010). Scleral buckling plus PPV showed greater SOAS than PPV alone in phakic eyes (P < 0.0001), but not in eyes with a posterior chamber intraocular lens (PCIOL). Retinal redetachments occurred on average at 1.5 and 9 months after the initial surgery. Significant best-corrected visual acuity improvement was associated with SOAS (P < 0.0001). CONCLUSIONS Scleral buckling plus PPV resulted in greater SOAS outcomes than PPV alone for primary RRD repair. Phakic eyes achieved greater surgical success with SB+PPV, whereas eyes with a PCIOL achieved similar results with both methods. Most retinal redetachments occurred within the initial postoperative 3-month period. Single-operation anatomic success was associated with statistically significant visual improvement.
Collapse
Affiliation(s)
- Jose J Echegaray
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Elizabeth A Vanner
- Department of Biostatistics, University of Miami Miller School of Medicine, Miami, Florida
| | - Lily Zhang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Jorge A Fortun
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Thomas A Albini
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Audina M Berrocal
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - William E Smiddy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Jayanth Sridhar
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Ninel Z Gregori
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Justin H Townsend
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Janet L Davis
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Luis J Haddock
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
| |
Collapse
|
19
|
Starr MR, Yonekawa Y, Obeid A, Ryan EH, Ryan C, Ammar M, Patel LG, Forbes NJ, Capone A, Emerson GG, Joseph DP, Eliott D, Regillo CD, Hsu J, Gupta OP, Kuriyan AE. Comparison of Visual and Anatomic Outcomes Following RRD Surgery Using 23-Gauge Versus 25-Gauge Vitrectomy: PRO Study Report No. 12. Ophthalmic Surg Lasers Imaging Retina 2021; 52:70-76. [PMID: 33626167 DOI: 10.3928/23258160-20210201-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 01/05/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Most surgeons now utilize small-gauge (23- or 25-gauge) pars plana vitrectomy (PPV) with or without scleral buckling for repair of rhegmatogenous retinal detachments (RRD), in addition to primary scleral buckle (SB), but comparative data between the two gauges are limited. PATIENTS AND METHODS This study is an analysis of primary RRD repairs comparing 23- versus 25-gauge vitrectomy for PPV or combination PPV/SB from January 1, 2015, through December 31, 2015, across multiple institutions. The primary outcome was single-surgery success and secondary outcomes included postoperative complications. RESULTS There were 1,932 eyes that met inclusion criteria. There was no statistically significant difference in single-surgery success (82.9% vs. 83.8%; P = 0.6329). There were similar rates of postoperative hypotony, endophthalmitis, vitreous hemorrhage, and choroidal detachment. The findings were similar when analyzing only eyes that underwent primary PPV without SB. CONCLUSION Both 23- and 25-gauge vitrectomy systems have similar anatomic and visual outcomes in the primary repair of RRD. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:70-76.].
Collapse
|
20
|
Antoszyk AN, Glassman AR, Beaulieu WT, Jampol LM, Jhaveri CD, Punjabi OS, Salehi-Had H, Wells JA, Maguire MG, Stockdale CR, Martin DF, Sun JK. Effect of Intravitreous Aflibercept vs Vitrectomy With Panretinal Photocoagulation on Visual Acuity in Patients With Vitreous Hemorrhage From Proliferative Diabetic Retinopathy: A Randomized Clinical Trial. JAMA 2020; 324:2383-2395. [PMID: 33320223 PMCID: PMC7739132 DOI: 10.1001/jama.2020.23027] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
IMPORTANCE Vitreous hemorrhage from proliferative diabetic retinopathy can cause loss of vision. The best management approach is unknown. OBJECTIVE To compare initial treatment with intravitreous aflibercept vs vitrectomy with panretinal photocoagulation for vitreous hemorrhage from proliferative diabetic retinopathy. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial at 39 DRCR Retina Network sites in the US and Canada including 205 adults with vison loss due to vitreous hemorrhage from proliferative diabetic retinopathy who were enrolled from November 2016 to December 2017. The final follow-up visit was completed in January 2020. INTERVENTIONS Random assignment of eyes (1 per participant) to aflibercept (100 participants) or vitrectomy with panretinal photocoagulation (105 participants). Participants whose eyes were assigned to aflibercept initially received 4 monthly injections. Both groups could receive aflibercept or vitrectomy during follow-up based on protocol criteria. MAIN OUTCOMES AND MEASURES The primary outcome was mean visual acuity letter score (range, 0-100; higher scores indicate better vision) over 24 weeks (area under the curve); the study was powered to detect a difference of 8 letters. Secondary outcomes included mean visual acuity at 4 weeks and 2 years. RESULTS Among 205 participants (205 eyes) who were randomized (mean [SD] age, 57 [11] years; 115 [56%] men; mean visual acuity letter score, 34.5 [Snellen equivalent, 20/200]), 95% (195 of 205) completed the 24-week visit and 90% (177 of 196, excluding 9 deaths) completed the 2-year visit. The mean visual acuity letter score over 24 weeks was 59.3 (Snellen equivalent, 20/63) (95% CI, 54.9 to 63.7) in the aflibercept group vs 63.0 (Snellen equivalent, 20/63) (95% CI, 58.6 to 67.3) in the vitrectomy group (adjusted difference, -5.0 [95% CI, -10.2 to 0.3], P = .06). Among 23 secondary outcomes, 15 showed no significant difference. The mean visual acuity letter score was 52.6 (Snellen equivalent, 20/100) in the aflibercept group vs 62.3 (Snellen equivalent, 20/63) in the vitrectomy group at 4 weeks (adjusted difference, -11.2 [95% CI, -18.5 to -3.9], P = .003) and 73.7 (Snellen equivalent, 20/40) vs 71.0 (Snellen equivalent, 20/40) at 2 years (adjusted difference, 2.7 [95% CI, -3.1 to 8.4], P = .36). Over 2 years, 33 eyes (33%) assigned to aflibercept received vitrectomy and 34 eyes (32%) assigned to vitrectomy received subsequent aflibercept. CONCLUSIONS AND RELEVANCE Among participants whose eyes had vitreous hemorrhage from proliferative diabetic retinopathy, there was no statistically significant difference in the primary outcome of mean visual acuity letter score over 24 weeks following initial treatment with intravitreous aflibercept vs vitrectomy with panretinal photocoagulation. However, the study may have been underpowered, considering the range of the 95% CI, to detect a clinically important benefit in favor of initial vitrectomy with panretinal photocoagulation. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02858076.
Collapse
Affiliation(s)
| | | | | | - Lee M. Jampol
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Chirag D. Jhaveri
- Retina Research Center, Austin, Texas
- Dell Medical School, University of Texas, Austin
| | - Omar S. Punjabi
- Charlotte Eye, Ear, Nose & Throat Associates, Charlotte, North Carolina
| | | | | | | | | | | | - Jennifer K. Sun
- Joslin Diabetes Center, Beetham Eye Institute, Department of Ophthalmology, Harvard University, Boston, Massachusetts
| |
Collapse
|
21
|
Segal O, Mimouni M, Rabina G, Yavnieli R, Nemet AY. Predicting response of ischemic central retinal vein occlusion to bevacizumab injections: 1 year follow-up. Int Ophthalmol 2020; 41:533-540. [PMID: 33094440 DOI: 10.1007/s10792-020-01604-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 10/01/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To identify baseline optical coherence tomography (OCT) factors in ischemic central retinal vein occlusion (CRVO) that predict response to bevacizumab injections. METHODS Patients underwent OCT at diagnosis and the central macular thickness, subretinal fluid width and height as well as the presence of intraretinal cysts were measured. The extent of disorganized retinal inner layers, outer plexiform layer (OPL), external limiting membrane, ellipsoid zone and cone outer segment tips (COST) was recorded. Patients received three consecutive monthly injections of bevacizumab followed by pro re nata treatment. RESULTS Overall 32 eyes of 32 patients aging 69.4 ± 12.7 years were included. In univariate correlational analyses baseline OPL disruption (- 41, p = 0.02), EZ disruption (r = - 0.36, p = 0.05) and COST disruption (r = - 0.37, p = 0.04) correlated with deterioration in BCVA at 1 year. Partial least squares demonstrated that the factors most largely associated with deterioration in BCVA were COST disruption and OPL disruption followed by EZ disruption, while worst vision at baseline was associated with improvement in vision. CONCLUSION In patients with ischemic CRVO treated with bevacizumab, BCVA improvement at 1 year can be partially predicted from baseline OCT measurements by the extent of COST, OPL and EZ disruption.
Collapse
Affiliation(s)
- Ori Segal
- Department of Ophthalmology, Meir Medical Center, Kfar Sava and the Sackler School of Medicine, Tel Aviv University, Kfar Saba, 44281, Israel.
| | - Michael Mimouni
- Department of Ophthalmology, Rambam Health Care Campus and the Technion-Israel Institute of Technology, Haifa, Israel
| | - Gilad Rabina
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roy Yavnieli
- Department of Ophthalmology, Rambam Health Care Campus and the Technion-Israel Institute of Technology, Haifa, Israel
| | - Arie Y Nemet
- Department of Ophthalmology, Meir Medical Center, Kfar Sava and the Sackler School of Medicine, Tel Aviv University, Kfar Saba, 44281, Israel
| |
Collapse
|
22
|
Li MS, Horng YH, Lin HS, Sheu SJ. Factors impacting gas fill after microincision vitrectomy surgery combined with fluid-gas exchange. Taiwan J Ophthalmol 2020; 10:284-288. [PMID: 33437602 PMCID: PMC7787100 DOI: 10.4103/tjo.tjo_1_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 11/30/2019] [Indexed: 11/04/2022] Open
Abstract
PURPOSE The objective of the study was to investigate possible factors influencing gas fill after microincision vitrectomy surgery (MIVS) combined with fluid-gas exchange. MATERIALS AND METHODS This was a retrospective chart review of patients who underwent MIVS combined with fluid-gas exchange (20% C3F8) from February 2017 to December 2017. RESULTS Sixty-one eyes of 58 patients were identified. The mean age was 59.97 ± 9.65 years. The mean gas fill percentage was 76.28% ± 14.29% on day 1, 65.49% ±13.65% on day 3, 60.03% ± 14.53% on day 4, and 43.9% ± 20.88% on day 7 postoperatively. Compared to phakic eyes, eyes that were pseudophakic prior to surgery had a lower gas fill on days 1-3, but the difference did not reach significance on day 3. Eyes that underwent phacovitrectomy had a significantly lower gas fill on days 1-3 than eyes that did not. CONCLUSION Postoperative pseudophakic status is associated with lower gas fill after MIVS. Adjusted gas fill should be considered in these cases.
Collapse
Affiliation(s)
- Meng-Syuan Li
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yu-Harn Horng
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Huey-Shyan Lin
- Department of Health-Business Administration, Fooyin University, Kaohsiung, Taiwan
| | - Shwu-Jiuan Sheu
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Ophthalmology, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| |
Collapse
|
23
|
Markan A, Kumar A, Vira J, Gupta V, Agarwal A. Advances in the tools and techniques of vitreoretinal surgery. EXPERT REVIEW OF OPHTHALMOLOGY 2020. [DOI: 10.1080/17469899.2020.1810018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Ashish Markan
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Aman Kumar
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Jayesh Vira
- Department of Ophthalmology, Sankara Eye Hospital, Coimbatore, India
| | - Vishali Gupta
- Department of Ophthalmology, Sankara Eye Hospital, Coimbatore, India
| | - Aniruddha Agarwal
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| |
Collapse
|
24
|
Pastore MR, De Giacinto C, Cirigliano G, Turco G, Borelli M, Tognetto D. Comparative analysis of 23-, 25-, and 27-gauge forceps stiffness and related displacement. Eur J Ophthalmol 2020; 31:1313-1319. [PMID: 32460546 DOI: 10.1177/1120672120926861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To test the stiffness and displacement of different vitreous forceps. Physical features and deformation after multiple procedures were also measured. METHODS Eleven different 23-, 25-, and 27-gauge vitreous forceps were studied. The measurements were repeated loading the probe at different distances from the tip: at the top of the tip and 10 and 20 mm from the tip, respectively. For each probe, 10 successive identical bending tests were performed. The total length and the internal and external diameters of each forceps were also measured. RESULTS A total of 330 successive identical bending tests were performed. No progression in deformation after the repeated measurements was recorded (p > 0.05). In each gauge group, displacement differences were detected according to the manufacturing metal properties, the total length, and the thickness of the shaft wall. A minimal adequate model to describes forceps displacements in terms of their significant predictors, such as gauge, model, and load distance from the tip, was created. CONCLUSION We provided a precise assessment of the stiffness and displacement of different vitreous forceps to enable surgeons to select the optimal instrument according to the benefits and limitations of each forceps.
Collapse
Affiliation(s)
- Marco R Pastore
- Department of Medical Surgical Sciences and Health, Eye Clinic, University of Trieste, Trieste, Italy
| | - Chiara De Giacinto
- Department of Medical Surgical Sciences and Health, Eye Clinic, University of Trieste, Trieste, Italy
| | - Gabriella Cirigliano
- Department of Medical Surgical Sciences and Health, Eye Clinic, University of Trieste, Trieste, Italy
| | - Gianluca Turco
- Department of Medical Surgical Sciences and Health, University of Trieste, Trieste, Italy
| | - Massimo Borelli
- Department of Mathematics and Geosciences, University of Trieste, Trieste, Italy
| | - Daniele Tognetto
- Department of Medical Surgical Sciences and Health, Eye Clinic, University of Trieste, Trieste, Italy
| |
Collapse
|
25
|
Flaxel CJ, Adelman RA, Bailey ST, Fawzi A, Lim JI, Vemulakonda GA, Ying GS. Diabetic Retinopathy Preferred Practice Pattern®. Ophthalmology 2019; 127:P66-P145. [PMID: 31757498 DOI: 10.1016/j.ophtha.2019.09.025] [Citation(s) in RCA: 294] [Impact Index Per Article: 58.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 09/20/2019] [Indexed: 12/15/2022] Open
Affiliation(s)
| | | | - Steven T Bailey
- Casey Eye Institute, Oregon Health & Science University, Portland, OR
| | - Amani Fawzi
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | - G Atma Vemulakonda
- Department of Ophthalmology, Palo Alto Medical Foundation, Palo Alto, CA
| | - Gui-Shuang Ying
- Center for Preventative Ophthalmology and Biostatistics, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
26
|
Hayashida M, Miki A, Imai H, Otsuka K, Azumi A, Nakamura M. Impact of Early Vitrectomy for Dense Vitreous Hemorrhage of Unknown Etiology. Ophthalmologica 2019; 242:234-238. [PMID: 31480058 DOI: 10.1159/000501723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 06/25/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Surgical intervention for dense vitreous hemorrhage (DVH) with unclear etiology is often delayed in favor of conservative follow-up despite possible disease progression and the availability of safe minimally invasive vitrectomy. OBJECTIVES The aim of this study is to investigate the efficacy of early surgical intervention for DVH with unknown etiology. METHODS Eighty-eight cases (88 eyes) of DVH with unknown origin were retrospectively reviewed. Inclusion criteria were as follows: (1) measured visual acuity (VA) of 20/200 or worse and (2) fundus invisibility requiring B-scan ultrasonography. Eyes with a history of diabetic retinopathy, recent trauma, or likely retinal detachment (RD) as revealed by B-scan ultrasonography were excluded. Outcome measures were a cause of vitreous hemorrhage and final VA following early (≤2 weeks after symptom onset) or delayed vitrectomy. RESULTS The most frequently occurring causes of DVH were central or branch retinal vein occlusion (30 eyes, 34%) and retinal tear or RD (29 eyes, 33%). logMAR VA significantly improved after treatment (p < 0.001). Final VA was significantly higher for eyes treated within 2 weeks compared with eyes treated later than 2 weeks after symptom onset (p = 0.020). CONCLUSIONS Surgical intervention within 2 weeks after symptom onset may prevent a lower visual outcome.
Collapse
Affiliation(s)
- Mayuka Hayashida
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Akiko Miki
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan,
| | - Hisanori Imai
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Keiko Otsuka
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Atsushi Azumi
- Department of Ophthalmology, Kobe Kaisei Hospital, Kobe, Japan
| | - Makoto Nakamura
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan
| |
Collapse
|
27
|
Horowitz S, Damasceno NA, Muralha F, Pereira MB, Maia M, Damasceno EF. Diathermy for 23-gauge sclerotomy: a functional and morphologic study to avoid ocular hypotony. Clin Ophthalmol 2019; 13:1703-1710. [PMID: 31564819 PMCID: PMC6732740 DOI: 10.2147/opth.s209813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 08/19/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate diathermy to minimize sclerotomy leakage during small-gauge vitrectomy and prevent ocular hypotony. Methods This observational prospective study included 327 patients (327 eyes) who underwent diathermy to close the sclerotomy sites during 23-gauge pars plana vitrectomy (PPV). All patients were operated by a single surgeon (ED) and evaluated at 30 and 60 days postoperatively. Patients with glaucoma, topical/systemic steroids use exceeding 30 days, ocular inflammation, or trauma were excluded. Chi-square, Kruskal–Wallis, Fisher Exact test, and multivariate statistical analyses were performed to evaluate potential risk factors. The primary outcomes were open sclerotomies, leakage, and ocular hypotony. Results Sclerotomies remained open in 12 (3.6%) and 2 (0.6%) patients, respectively, at 30 and 60 days postoperatively, revealing no case of ocular hypotony. Leakage only occurred in four patients (1.2%) during week 1 postoperatively. Multivariate analysis indicated that additional vitreoretinal surgeries and longer surgeries were risk factors for persistent sclerotomy opening. Conclusion Diathermy was safe and feasible to close sclerotomies. Vitreoretinal surgery reoperations and longer surgeries were the most significant (P<0.05) risk factors for persistent sclerotomy opening, which may be functionally closed without evidence of leakage or ocular hypotony.
Collapse
Affiliation(s)
- Soraya Horowitz
- Department of Ophthalmology, Hospital Naval Marcilio Dias, Rio de Janeiro, Brazil
| | - Nadyr A Damasceno
- Department of Ophthalmology, Hospital Naval Marcilio Dias, Rio de Janeiro, Brazil
| | - Felipe Muralha
- Department of Ophthalmology, The Universidade Federal de São Paulo, Brazil
| | - Maurício B Pereira
- Department of Ophthalmology, Universidade Federal Fluminense, Niterói, Brazil
| | - Mauricio Maia
- Department of Ophthalmology, The Universidade Federal de São Paulo, Brazil
| | - Eduardo F Damasceno
- Department of Ophthalmology, Universidade Federal Fluminense, Niterói, Brazil
| |
Collapse
|
28
|
Sborgia G, Niro A, Sborgia L, Grassi MO, Gigliola S, Romano MR, Boscia F, Sborgia A, Alessio G. One-year outcomes of 27-gauge versus 25-gauge pars plana vitrectomy for uncomplicated rhegmatogenous retinal detachment repair. Int J Retina Vitreous 2019; 5:13. [PMID: 31171987 PMCID: PMC6547499 DOI: 10.1186/s40942-019-0164-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 04/20/2019] [Indexed: 11/26/2022] Open
Abstract
Background 27-gauge (27G) and 25-gauge (25G) transconjunctival sutureless vitrectomy (TSV) were considered equal about safety, effectiveness and vitrectomy time for the treatment of rhegmatogenous retinal detachment (RRD), although larger and long-term comparative studies are needed to confirm previous knowledge. Furthermore, a combined comparison of time duration of surgery and vitreous removal was never performed. Our purpose was to compare the safety and efficacy of 27G versus 25G TSV for the treatment of uncomplicated RRD over a 1-year follow-up. Methods A 12-months single-center prospective, randomized, interventional study of 92 consecutive patients was performed. 46 patients underwent 27G TSV (Group 1) and 46 underwent 25G TSV (Group 2). Primary outcomes were primary and final reattachment rate, and final functional success (visual acuity ≥ 20/200, 1 LogMar). Secondary outcomes were the surgical and vitrectomy time. Complications were recorded. Results All functional and morphologic data at baseline and at all follow-up time points up to 12 months after surgery were available for only 88 patients. Four patients in Group 1 dropped out of the study after surgery. There was no significant difference in baseline characteristics between the two groups. Primary and final reattachment rates were 90.5% and 100% in Group 1, and 95.6% and 100% in Group 2, respectively (p > .05, p > .05, respectively). Visual acuity improved from 1.5 ± 1.09 LogMar to 0.38 ± 0.55 LogMar in Group 1 (p < .001) and 1.2 ± 0.9 LogMar to 0.49 ± 0.53 LogMar in Group 2 (p < .001), without significant difference between the groups (p > .05). The surgical time was 73.2 ± 11.3 min with 27G TSV and 64.4 ± 9.5 min with 25G TSV (p = .0001). The vitrectomy time was 19.9 ± 3.8 min with 27G TSV and 20.8 ± 3.8 min with 25G TSV (p > .05). One single case of choroidal detachment occurred. Conclusions Reattachment rates, functional success and vitrectomy time were comparable between 27G and 25G TSV for RRD. Surgical time was significantly longer using 27G vitrectomy.
Collapse
Affiliation(s)
- Giancarlo Sborgia
- 1Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, Bari, Italy
| | - Alfredo Niro
- Eye Clinic, Hospital "S. G. MOSCATI", ASL TA, Via per Martina Franca, 74010 Statte, Taranto, Italy
| | - Luigi Sborgia
- 1Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, Bari, Italy
| | - Maria Oliva Grassi
- 1Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, Bari, Italy
| | - Samuele Gigliola
- 1Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, Bari, Italy
| | - Mario R Romano
- 3Department of Ophthalmology, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Francesco Boscia
- 4Department of Surgical, Microsurgical and Medical Sciences, Eye Clinic, University of Sassari, Sassari, Italy
| | - Alessandra Sborgia
- 1Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, Bari, Italy.,Eye Clinic, Hospital "S. G. MOSCATI", ASL TA, Via per Martina Franca, 74010 Statte, Taranto, Italy
| | - Giovanni Alessio
- 1Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, Bari, Italy
| |
Collapse
|
29
|
Zhao M, Yu Y, Liu W. Vitreous Biopsy Under Air: Technique, Complications, and Volume Outcomes. Ophthalmic Surg Lasers Imaging Retina 2019; 50:365-370. [PMID: 31233153 DOI: 10.3928/23258160-20190605-04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 01/17/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Classic vitreous biopsy, which targets the vitreous with an undiluted sample of 1 mL to 2 mL, has been used as a diagnostic analysis. Vitrectomy under air infusions have been reported to be able to extract more vitreous sample. In this study, the authors introduce a way of obtaining vitreous sample under air irrigation using 23-gauge vitrectomy and discuss the benefits and potential risks of this procedure. PATIENTS AND METHODS In this retrospective case series study, a total of 65 eyes of 65 patients with macular epiretinal membrane (ERM) or macular hole (MH) were enrolled. A vitreous biopsy was carried out with air infusion. Vitrectomy with fluid infusion was then carried out to remove the residual vitreous. Medical records of patients with macular ERM or MH were reviewed and analyzed. Clinical data, including age, sex, best-corrected visual acuity (BCVA), optical coherence tomography (OCT), axial length, presence of posterior vitreous detachment (PVD), presence of liquefication of vitreous, and refraction, were recorded and investigated. The volume of vitreous sample, visual outcome, and complications related to vitreous biopsy at 1-month follow-up were recorded and analyzed. RESULTS The mean of undiluted vitreous sample volume was 2.1 mL ± 0.2 mL. There were seven patients whose vitreous samples were less than 2 mL during the vitreous biopsy. The mean age of patients was 62.9 years ± 8.4 years (range: 35 years to 85 years) at diagnosis. There were 18 male and 47 female patients. At 1-month follow-up, no patient had decreased visual acuity. There was one patient who had a peripheral retinal break and was treated with photocoagulation during the operation (1.5%). The insufficient vitreous sample that may occur during the vitreous biopsy under air infusion was related to liquefication of vitreous (28.8%). CONCLUSION In summary, vitreous biopsy with air infusion is a safe and effective maneuver to harvest undiluted vitreous in patients without significant vitreous inflammation. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:365-370.].
Collapse
|
30
|
Abstract
PURPOSE To study a prototype of an ultrasound-based vitrector, and to try to understand the physical phenomena underlying this new technology. METHODS We tested the ultrasound-based vitrector prototype (UV) (ultrasonically-driven handpiece obtained from a modified version of the Alcon CONSTELLATION Vision System [Alcon]) using an automatic experimental setup. Balanced saline solution (BSS) and vitreous (from fresh postmortem enucleated porcine eyes) flow rates were analyzed using three different tips. RESULTS In general, BSS solution flow rates increased with increasing aspiration levels and decreased when we used % US power. Vitreous flow rates were influenced by aspiration levels, % US power, and ultrasound-related phenomena: cavitation phenomenon and "jet streaming." CONCLUSION Ultrasound-based vitrectomy may represent an important alternative to traditional vitrectomy. Such a tool, capable of liquefying and excising the vitreous body using ultrasound, could overcome all the limits of the guillotine-based technique (GV). Knowledge of the physical phenomena underlying ultrasound-based technology is a necessary prerequisite for further development of this new technology.
Collapse
|
31
|
Besozzi G, Di Salvatore A, Cardillo D, Finzi A, Pinackatt JS, Baldi A, Monfardini A, Forioli V, Frisina R, Parolini B. Intracameral cefuroxime in combined pars plana vitrectomy and phacoemulsification: a study of safety. Clin Ophthalmol 2018; 12:1567-1570. [PMID: 30214140 PMCID: PMC6118255 DOI: 10.2147/opth.s170751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Postoperative endophthalmitis is a severe complication after intraocular surgery. The aim of this pilot study was to investigate the safety of intracameral cefuroxime in combined vitrectomy and phacoemulsification for cataract and various vitreoretinal disease. Methods The charts of 152 patients who underwent combined phacoemulsification, intraocular lens implant and pars plana vitrectomy were reviewed. The final tamponade was chosen among fluid, air, gas or silicone oil, based on the requirement of each single case. Patients were operated on by four different surgeons. At the end of surgery, 1 mg/0.1 mL of intracameral cefuroxime (Aprokam) was administered. Results The mean follow-up was 6.26±7.78 months (range 1–12). No retinal complication, such as retinal infarction or hemorrhages were observed. No acute macular serous detachment and no new intraretinal cysts were noted, in those patients who received optical coherence tomography within the fifth day after surgery. No endophthalmitis was recorded. Conclusion Intracameral cefuroxime, at the end of combined phacoemulsification and pars plana vitrectomy, is safe as it has no toxicity on the retina and maybe could be considered effective in endophthalmitis prevention. Due to the relatively small number of patients, further studies are advisable. Summary statement The standard dose of intracameral cefuroxime at the end of combined phacoemulsification and pars plana vitrectomy has no toxic effects on the retina. This paper/The abstract of this paper was presented at the European Vitreo Retinal Society Conference 2017 as a conference talk with interim findings. The poster’s abstract was not published.
Collapse
Affiliation(s)
| | | | - Daniele Cardillo
- Department of Ophthalmology, Sant'Anna Clinical Institute, Brescia, Italy
| | - Alessandro Finzi
- Department of Ophthalmology, Sant'Anna Clinical Institute, Brescia, Italy
| | | | - Andrea Baldi
- Department of Ophthalmology, Sant'Anna Clinical Institute, Brescia, Italy
| | | | - Valeria Forioli
- Department of Ophthalmology, Sant'Anna Clinical Institute, Brescia, Italy
| | - Rino Frisina
- Department of Ophthalmology, Padova University Hospital, Padova, Italy
| | - Barbara Parolini
- Department of Ophthalmology, Sant'Anna Clinical Institute, Brescia, Italy
| |
Collapse
|
32
|
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.].
Collapse
|
33
|
|
34
|
The Evolution of Pars Plana Vitrectomy to 27-G Microincision Vitrectomy Surgery. Int Ophthalmol Clin 2018; 56:97-111. [PMID: 27575761 DOI: 10.1097/iio.0000000000000131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
35
|
Amram AL, Mandviwala MM, Ou WC, Wykoff CC, Shah AR. Predictors of Visual Acuity Outcomes Following Vitrectomy for Idiopathic Macular Hole. Ophthalmic Surg Lasers Imaging Retina 2018; 49:566-570. [PMID: 30114300 DOI: 10.3928/23258160-20180803-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 11/02/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To investigate predictors of visual outcomes in patients who underwent vitrectomy for full-thickness macular hole (FTMH) with at least 1 year of follow-up. PATIENTS AND METHODS Retrospective, noncomparative, consecutive case series of 132 eyes of 122 patients who underwent surgical repair of idiopathic FTMH with at least 1 year of follow-up. Predictors of visual acuity (VA) outcomes were analyzed using linear regression. RESULTS Mean follow-up time was 22.2 months. Twenty-three eyes (17.4%) had age-related macular degeneration (AMD), of which 17 (73.9%) cases were mild and nonexudative. At final follow-up, poor preoperative VA (P < .001), perioperative complications (P < .001), AMD (P < .001), and delay from preoperative evaluation to surgery (P = .037) were significant predictors of final VA. In multiple regression, these variables remained significant (P < .001, P = .011, P < .001, and P = .002, respectively). CONCLUSION Poor preoperative VA, perioperative complications, AMD, and delay to surgery were significant predictors of final VA following FTMH repair. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:566-570.].
Collapse
|
36
|
Yospaiboon Y, Intarapanich A, Laovirojjanakul W, Ratanapakorn T, Sinawat S, Sanguansak T, Bhoomibunchoo C. Factors affecting visual outcomes after treatment of infectious endophthalmitis in northeastern Thailand. Clin Ophthalmol 2018; 12:765-772. [PMID: 29740209 PMCID: PMC5931196 DOI: 10.2147/opth.s160758] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Objective To determine factors affecting visual outcomes after treatment of infectious endophthalmitis during 2012-2016 at a large referral eye center in northeastern Thailand. Patients and methods Medical charts of patients with a diagnosis of infectious endophthalmitis including demographic data, types of endophthalmitis, causative organisms, methods of treatment, anatomical, and functional outcomes were retrospectively reviewed. Factors associated with improved visual outcomes were analyzed. Results Four hundred and eleven patients (417 eyes) were recruited for the study. The three most common types were post-traumatic (44.53%), post-operative (31.87%), and endogenous endophthalmitis (17.52%). Vitreous cultures revealed causative organisms in 41.25%. Most common Gram-positive organisms were coagulase-negative Staphylococcus 30% (36/120), Bacillus spp. 20% (24/120), and Streptococcus pneumoniae 18.33% (20/120). Most common Gram-negatives were Pseudomonas spp. 24.32% (9/37), Klebsiella spp. 24.32% (9/37), and Enterobacter spp. 16.21% (6/37). Methods of treatment were medical treatment (18.71%) and surgical treatment (81.29%), including pars plana vitrectomy with or without silicone oil tamponade (62.59%) and destructive surgery (18.71%). After treatment, visual improvement was noted in 44.6%, stable vision in 18.47%, and worse vision in 36.93%. Factors associated with improved visual outcomes were post-operative endophthalmitis (P<0.001), coagulase-negative Staphylococcus (P=0.003), and initial visual acuity before treatment of hand motion or better (P=0.017). Conclusion Most infectious endophthalmitis patients were post-traumatic, post-operative, and endogenous. The most common method of treatment was pars plana vitrectomy. Treatment could improve visual outcomes and at least stabilize the vision in 63.07%. Factors associated with improved visual outcomes were types of endophthalmitis, causative organisms, and initial visual acuity before treatment.
Collapse
Affiliation(s)
- Yosanan Yospaiboon
- KKU Eye Center, Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Anocha Intarapanich
- KKU Eye Center, Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Wipada Laovirojjanakul
- KKU Eye Center, Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Tanapat Ratanapakorn
- KKU Eye Center, Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Suthasinee Sinawat
- KKU Eye Center, Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Thuss Sanguansak
- KKU Eye Center, Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chavakij Bhoomibunchoo
- KKU Eye Center, Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| |
Collapse
|
37
|
Grosso A, Ceruti P, Scarpa G, Giardini F, Marchini G, Aragona E, Bert F, Bandello F, Siliquini R. Choosing wisely and the use of antibiotics in ophthalmic surgery: There is more than meets the eye. Eur J Ophthalmol 2018; 28:625-632. [PMID: 29577739 DOI: 10.1177/1120672117747043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND: One of the directions of modern ophthalmology is toward an odontoiatric model, and new settings of eye care are becoming the standard of care: one day surgery and also office-based therapies. METHODS: Retrospective analysis of three tertiary-care centers in Italy and analysis of the literature. RESULTS: We provide readers with state-of-the-art measures of prophylaxis in ophthalmic surgery. DISCUSSION AND CONCLUSION: Role of antibiotics is criticized in the light of stewardship antimicrobial paradigm.
Collapse
Affiliation(s)
- Andrea Grosso
- 1 Santo Spirito Hospital, Casale Monferrato, Italy.,2 Centre for Macular Research, San Mauro Torinese, Italy
| | | | | | - Franco Giardini
- 5 Microbiological Laboratory, Turin Eye Hospital, Turin, Italy
| | | | - Emanuela Aragona
- 6 Scientific Institute San Raffaele, University Vita-Salute, Milan, Italy
| | - Fabrizio Bert
- 7 Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Francesco Bandello
- 6 Scientific Institute San Raffaele, University Vita-Salute, Milan, Italy
| | - Roberta Siliquini
- 7 Department of Public Health and Pediatrics, University of Turin, Turin, Italy.,8 Consiglio Superiore di Sanità, Rome, Italy
| |
Collapse
|
38
|
Influence of Surgical Procedures and Instruments on the Incidence of Suprachoroidal Hemorrhage during 25-gauge Pars Plana Vitrectomy. Ophthalmol Retina 2018; 2:888-894. [PMID: 31047220 DOI: 10.1016/j.oret.2018.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 01/09/2018] [Accepted: 01/17/2018] [Indexed: 11/22/2022]
Abstract
PURPOSE To evaluate the influence of surgical procedures and instruments that are associated with intraocular pressure (IOP) fluctuations on the incidence of suprachoroidal hemorrhage (SCH) during 25-gauge pars plana vitrectomy (25G-PPV), and to investigate the clinical features of SCH during 25G-PPV. DESIGN Retrospective, comparative case series. PARTICIPANTS A total of 3034 cases that underwent initial 25G-PPV at a single surgical center. METHODS Univariate analysis was performed to evaluate the relationships between the incidence of SCH during 25G-PPV and the surgical procedures and instruments that were associated with IOP fluctuations. The participants were divided into 4 groups that underwent the following procedures: neither fluid-air exchange nor vitreous shaving under scleral depression (group 1, n = 1144); fluid-air exchange alone (group 2, n = 463); vitreous shaving under scleral depression alone (group 3, n = 639); and both procedures (group 4, n = 788). The incidence of SCH in each group was compared. The clinical features and surgical outcomes of SCH during 25G-PPV were also investigated. MAIN OUTCOME MEASURES The incidence of SCH during 25G-PPV and the clinical features and surgical outcomes of SCH during 25G-PPV. RESULTS The incidence of SCH was significantly higher in cases that underwent fluid-air exchange (P = 0.0047) or vitreous shaving under scleral depression (P = 0.0157). There were no significant relationships between the incidence of SCH and the use of surgical instruments. The incidence of SCH in group 4 (8/788, 1.02%) was significantly higher than that in groups 1 (1/1144, 0.09%), 2 (0/463, 0%), and 3 (0/639, 0%) (P = 0.01). Almost all SCH cases were localized, and there were no cases of SCH involving the posterior pole. Of all the SCH cases, only one case required reoperation for retinal redetachment. No cases required secondary surgical management for SCH. CONCLUSIONS There remains a slight risk of SCH during 25G-PPV in cases that require both fluid-air exchange and vitreous shaving under scleral depression. Even if SCH occurs during 25G-PPV, the surgical outcomes after SCH may not be substantially worse.
Collapse
|
39
|
|
40
|
Liu B, Li Y, Li T, Lin Y, Ma W, Lu L. Transscleral tunnel incision related arterial hemorrhage in 23-gauge Vitrectomy: case report. BMC Ophthalmol 2018; 18:9. [PMID: 29343222 PMCID: PMC5773091 DOI: 10.1186/s12886-018-0677-6] [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: 12/06/2016] [Accepted: 01/11/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transscleral tunnel incisions are commonly made to avoid postoperative leakage in small gauge sutureless vitrectomy. We present an unreported intraoperative complication, tunnel incision related arterial hemorrhage from sclerotomy, in 23-gauge (23G) vitrectomy. CASE PRESENTATION Two cases of intraocular arterial hemorrhage from superonasal sclerotomy were observed at the beginning of vitrectomy. The bleeding filled the vitreous cavity quickly and gushed out from the incision port after the involved supronasal cannula was removed. The active bleeding seemed not to stop spontaneously. We controlled the active bleeding by relocating the involved cannula, elevating the intraocular pressure and compressing the sclera wound. Post-operative intraocular hemorrhage from the sclerotomy was not found in any of the two cases. CONCLUSIONS We suggest that the bleeding was from injured ciliary artery when the incision crossed 3 or 9 o'clock accidently. Surgeons might avoid this complication by locating the superior incisions away from the horizontal axis, and should be aware the proper management.
Collapse
Affiliation(s)
- Bingqian Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, 510060, China
| | - Yonghao Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, 510060, China
| | - Tao Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, 510060, China
| | - Ying Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, 510060, China
| | - Wei Ma
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, 510060, China
| | - Lin Lu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, 510060, China.
| |
Collapse
|
41
|
Abstract
In this review, the authors present special considerations a vitreoretinal surgeon should take into account before embarking on surgery in a pediatric eye. First, the anatomy of a pediatric eye is different from an adult and changes as the child grows. This is important especially in relation to the placement of transconjunctival ports. The structural characteristics of the sclera are also different, with lower scleral rigidity found in pediatric eyes. When considering vitrectomy, a posterior pars plicata lens-sparing technique should be considered. However, this may not be possible in complicated total detachments where anterior translimbal vitrectomy may be the method of choice. Scleral buckles are preferred for certain cases, and division of the encirclage is advocated in children below the age of 2 years, once the retina has stabilized. Enzymatic vitreolysis has been described as a preoperative adjunct to enhance complete detachment of the posterior hyaloid and reduce iatrogenic retinal breaks. However, its use in pediatric eyes has been limited, and larger studies are warranted. Finally, postoperative visual rehabilitation and treatment of amblyopia are key to maximizing functional outcomes in the pediatric patient. Co-management with a pediatric ophthalmologist and enlisting the co-operation of the parents are essential.
Collapse
Affiliation(s)
- Nicola Y Gan
- Department of Ophthalmology, Tan Tock Seng Hospital, National Healthcare Group, Singapore
| | - Wai-Ching Lam
- Department of Ophthalmology, The University of Hong Kong, Hong Kong.,Department of Ophthalmology and Vision Science, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
42
|
Abstract
PURPOSE To assess the posterior vitreous release rates following a single, office-based intravitreal injection of expansile gas in treating vitreomacular traction. METHODS Thirty eyes of 29 consecutive patients with symptomatic vitreomacular traction received a single, office-based intravitreal injection of up to 0.3 mL of 100% perfluoropropane (C3F8). RESULTS Overall, vitreomacular traction release occurred in 25 of 30 eyes by the final follow-up visit (83% final release rate); furthermore, 90% (9 of 10 eyes) with diabetes mellitus released, 83% (5 of 6 eyes) with concurrent epiretinal membrane released, and 83% (5 of 6 eyes) previously treated with ocriplasmin released. Vitreomacular traction release occurred overnight in some patients and was documented on spectral domain optical coherence tomography at an average of 13 days (range, 1-62 days). The phakic release rate was 89% (16 of 18 eyes) versus a 75% pseudophakic release rate (9 of 12 eyes) (P = 0.3173). Ellipsoid zone changes on spectral domain optical coherence tomography occurred in 1 of 30 gas-treated eyes. One patient developed pupillary block. CONCLUSION Office-based intravitreal injection of C3F8 offers an inexpensive and effective treatment for vitreomacular traction, including for patients who underwent previous ocriplasmin administration and in patients with diabetes mellitus or epiretinal membrane.
Collapse
|
43
|
PARS PLANA VITRECTOMY FOR LATE VITREORETINAL SEQUELAE OF INFECTIOUS ENDOPHTHALMITIS: Surgical Management and Outcomes. Retina 2017; 37:651-656. [PMID: 27465568 DOI: 10.1097/iae.0000000000001208] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report the visual acuity outcomes after pars plana vitrectomy for delayed vitreoretinal sequelae of infectious endophthalmitis. All eyes were initially treated with intravitreal antibiotics (Abx). METHODS Multicenter, retrospective, consecutive case series. RESULTS Forty-two eyes met the study criteria. The mean follow-up was 48 weeks (SD ± 61.8). Mean interval from Abx to pars plana vitrectomy was 13 weeks (SD ± 14.3, range 2-70). Indications for pars plana vitrectomy included vitreous opacities (VO) (n = 22), epiretinal membrane (n = 9), and retinal detachment (n = 11). LogMAR visual acuity improved from 1.87 (Snellen equivalent: 20/1,482) preoperatively to 1.35 (Snellen equivalent: 20/447) at final evaluation (P < 0.001). LogMAR visual acuity improved significantly for patients with vitreous opacities (P < 0.01) and retinal detachment (P = 0.02) but not for patients with epiretinal membranes (P = 0.08). CONCLUSION Patients with infectious endophthalmitis can gain vision if they have a pars plana vitrectomy for delayed sequelae such as vitreous opacities or for retinal detachment.
Collapse
|
44
|
|
45
|
Review of Small Gauge Vitrectomy: Progress and Innovations. J Ophthalmol 2017; 2017:6285869. [PMID: 28589037 PMCID: PMC5447313 DOI: 10.1155/2017/6285869] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 03/29/2017] [Indexed: 11/24/2022] Open
Abstract
Purpose. To summarise the surgical advances and evolution of small gauge vitrectomy and discuss its principles and application in modern vitreoretinal surgery. The advent of microincisional vitrectomy systems (MIVS) has created a paradigm shift away from twenty-gauge vitrectomy systems, which have been the gold standard in the surgical management of vitreoretinal diseases for over thirty years. Advances in biomedical engineering and surgical techniques have overcome the technical hurdles of shifting to smaller gauge instrumentation and sutureless surgery, improving surgical capabilities and expanding the indications for MIVS.
Collapse
|
46
|
Ho VY, Shah GK. Short- and Long-Term Outcomes of Vitreoretinal Surgeries With Deferred First Postoperative Visits at Day 3 or Later. ACTA ACUST UNITED AC 2017. [DOI: 10.1177/2474126416685632] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background and Objective: Postoperative (PO) day 1 visits can be challenging for certain patients (eg, satellite office patients). This study analyzes the proportion of eyes requiring changes in management on the first PO visit day ≥3 following vitreoretinal surgery. Study Design/Materials and Methods: A retrospective, consecutive case series of 1 vitreoretinal surgeon was conducted on 246 surgeries of 231 patients with the first PO examination day ≥3 from January 1, 2008 to December 31, 2013. Clinical parameters were statistically analyzed to identify eyes with pressure issues or early interventions. Short- and long-term outcomes were assessed at PO weeks 1 to 4 and months 3 to 8. Results: At the first PO visit ≥3 (mean 4.5) days, 3.3% eyes had intraocular pressure (IOP) ≤5, 3.3% IOP ≥30, 0.8% choroidal detachments, 0.4% vitreous hemorrhage, and 0% endophthalmitis. About 2.0% of eyes required intervention (IOP medications). Surgical indications, procedure, and tamponade were not predictive of pressure issues or early intervention ( P > .05). At weeks 1 to 4 and month 3 to 8, 4% to 6% of eyes required additional intervention or surgery. Conclusion: The first PO visit day ≥3 after vitreoretinal surgeries had low intervention rates. Few complications or additional surgeries occurred throughout the study period.
Collapse
|
47
|
Singh AD. Small incision guarded hydroaspiration of iris lesions. Br J Ophthalmol 2017; 101:1570-1575. [DOI: 10.1136/bjophthalmol-2016-310093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 02/09/2017] [Accepted: 02/18/2017] [Indexed: 11/03/2022]
|
48
|
Sahanne S, Tuuminen R, Haukka J, Loukovaara S. A retrospective study comparing outcomes of primary rhegmatogenous retinal detachment repair by scleral buckling and pars plana vitrectomy in Finland. Clin Ophthalmol 2017; 11:503-509. [PMID: 28331284 PMCID: PMC5354527 DOI: 10.2147/opth.s128746] [Citation(s) in RCA: 14] [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
Background Rhegmatogenous retinal detachment (RRD) is the most common form of retinal detachment and an ophthalmic emergency. Here, we compared outcomes of primary RRD eyes operated with conventional scleral buckling (SB) with cryoretinopexy to those operated with standard pars plana vitrectomy (PPV). Methods This is an institutional, retrospective, register-based, observational, comparative study. Based on the surgical procedure, 319 eyes of 319 patients were divided into two groups: SB plus cryotherapy (n=50) and PPV (n=269). Changes in intraocular pressure (IOP) and best-corrected visual acuity (BCVA) were recorded at 30 days and reoperation rates within 180 days postoperatively. Results Eyes operated with PPV had less reoperations within the first 180 days as compared with SB eyes (P=0.001, log-rank test); however, changes in IOP were more prominent (mean ± standard deviation: +8.1±8.8 vs. +4.4±7.0 mmHg, respectively; P=0.006). Changes in BCVA did not differ between the surgical procedures. Conclusion PPV was associated with higher primary anatomic success rates and lower risk of reoperation but significant IOP elevation when compared to SB. These factors should be case-specifically considered when choosing treatment modality for primary RRD.
Collapse
Affiliation(s)
- Sari Sahanne
- Department of Anesthesiology, Helsinki University Central Hospital, Helsinki
| | - Raimo Tuuminen
- Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka
| | - Jari Haukka
- Hjelt Institute, Faculty of Medicine, University of Helsinki
| | - Sirpa Loukovaara
- Unit of Vitreoretinal Surgery, Department of Ophthalmology, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
| |
Collapse
|
49
|
de Oliveira PRC, Chow DR. Twenty-Seven-Gauge Vitrectomy. CURRENT OPHTHALMOLOGY REPORTS 2017. [DOI: 10.1007/s40135-017-0122-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
50
|
Shahzadi B, Rizwi SF, Qureshi FM, Latif K, Mahmood SA. Outcomes of transconjunctival sutureless 27-gauge micro-incision vitrectomy surgery in diabetic vitreous haemorrhage. Pak J Med Sci 2017; 33:86-89. [PMID: 28367178 PMCID: PMC5368336 DOI: 10.12669/pjms.331.11617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective: To evaluate the visual outcomes of 27-gauge transconjunctival sutureless vitrectomy surgery and its complications in patients with diabetic vitreous hemorrhage. Methods: A quasi-experimental study was conducted where eighty seven eyes of 87 uncontrolled type II diabetes mellitus patients presenting with diabetic vitreous hemorrhage were selected to undergo 27-gauge transconjunctival sutureless micro-incision vitrectomy surgery. Main outcome measured was best corrected visual acuity (BCVA). Post-operative complications were also screened for at each visit. The follow ups were at post-operative day one, one month, three months and six months respectively. Results: Out of 87 patients, 52 (59.8%) were males and 35 (40.2%) were females. The mean age of the patients was 52.32 ± 6.78 years (95% CI: 53.13 - 55.57). For most of the patients, the BCVA improved progressively with each subsequent follow up visit. Pre-operative BCVA was 1.01 ± 0.206 logMar, compared to BCVA at final follow up of 0.44 ± 0.231 (p-value < 0.001). Six (6.9%) patients developed recurrent vitreous hemorrhage during the study period, four (4.6%) developed cataract, one (1.1%) had increased intraocular pressure and sub conjunctival hemorrhage was present in two (2.3%). Conclusion: 27-gauge micro-incision vitrectomy surgery is an effective sutureless surgery with favorable outcomes, in terms of vision, in patients with diabetic vitreous hemorrhage. The associated complications are few which can be easily managed.
Collapse
Affiliation(s)
- Bashiran Shahzadi
- Dr. Bashiran Shahzadi, FCPS. Department of Ophthalmology, LRBT Free Eye Hospital, Karachi, Pakistan
| | - Syed Fawad Rizwi
- Prof. Syed Fawad Rizwi, FCPS. Department of Ophthalmology, LRBT Free Eye Hospital, Karachi, Pakistan
| | - Faisal Murtaza Qureshi
- Dr. Faisal Murtaza Qureshi, FRCS. Department of Ophthalmology, LRBT Free Eye Hospital, Karachi, Pakistan
| | - Kanwal Latif
- Dr. Kanwal Latif, FCPS. Department of Ophthalmology, LRBT Free Eye Hospital, Karachi, Pakistan
| | - Syed Asaad Mahmood
- Dr. Syed Asaad Mahmood, FCPS. Department of Ophthalmology, LRBT Free Eye Hospital, Karachi, Pakistan
| |
Collapse
|