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Hoyek S, Wu F, Berrocal AM, Patel NA. Induction of Posterior Vitreous Detachment Using Perfluorooctane Dissection in a Pediatric Patient. Ophthalmic Surg Lasers Imaging Retina 2023; 54:543-546. [PMID: 37708224 DOI: 10.3928/23258160-20230823-01] [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: 09/16/2023]
Abstract
BACKGROUND AND OBJECTIVE Inducing a posterior vitreous detachment (PVD) may be challenging, especially in pediatric patients with firm vitreo-retinal adherence. This case report will present an alternative method of PVD induction using adjunctive perfluorooctane (PFO). MATERIALS AND METHODS An 11-year-old boy underwent scleral buckle placement and 23-gauge pars plana vitrectomy for macula-off retinal detachment. Triamcinolone acetonide was used for vitreous staining. A flexible loop was used to peel the hyaloid membrane from attached retina nasal to the optic nerve. A small hole was created in the posterior hyaloid, and a small PFO bubble was injected under the detached vitreous to further dissect it from the retina and propagate the vitreous detachment anteriorly. The vitrector was used to lift and complete the PVD peripherally. RESULTS PVD induction was obtained with no iatrogenic retinal breaks or postoperative complications. CONCLUSION PVD induction using a stepwise PFO approach is a safe and effective alternative to conventional techniques. [Ophthalmic Surg Lasers Imaging Retina 2023;54:543-546.].
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Zhu Y, Xu H, Wang X. Optimized design of surgical steps in pars plana vitrectomy for macular hole retinal detachment in pathological myopia decreases rate of iatrogenic retinal break and shortens length of operation. BMC Ophthalmol 2023; 23:150. [PMID: 37041502 PMCID: PMC10088102 DOI: 10.1186/s12886-023-02907-3] [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: 08/08/2022] [Accepted: 04/05/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND To investigate the effect of surgical steps optimization in pars plana vitrectomy (PPV) with internal limiting membrane (ILM) flap for macular hole retinal detachment (MHRD) in pathological myopia. METHODS A retrospective, consecutive, nonrandomized comparative study. High myopic eyes diagnosed with MHRD receiving PPV with ILM flap from March 2019 to June 2020 in Department of Ophthalmology, Xiangya Hospital, Central South University were included in the study. Patients were included into two groups based on different design of surgical steps. In the routine group, extension of posterior vitreous detachment (PVD) towards periphery was performed right after induction of PVD. In the experiment group, the retina was reattached with drainage of subretinal fluid through macular hole before peripheral vitreous was dealt with. Complete ophthalmic examinations were performed before and after surgery. The follow-up time was at least 6 months. The rate of iatrogenic retinal break and length of operation were compared between the two groups. RESULTS Thirty-one eyes from 31 patients were included in the study with 15 in the experiment group and 16 in the routine group. Demographics showed no statistically significant difference between the two groups. Post-op BCVA, rate of macular hole closure and rate of retinal reattachment were similar in the two groups. The rate of iatrogenic retinal break in the experiment group was significantly lower than that in the routine group (6.7% vs. 37.5%, P < 0.05). The average length of operation was 78.6 ± 18.8 min in the routine group and 64.0 ± 12.1 min in the experiment group (P < 0.05). CONCLUSIONS Optimized design of surgical steps in PPV for MHRD could effectively decrease the rate of iatrogenic retinal tear and shorten the length of operation.
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Affiliation(s)
- Ying Zhu
- Eye Center of Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, China
- Hunan Key Laboratory of Ophthalmology, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Huizhuo Xu
- Eye Center of Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, China
- Hunan Key Laboratory of Ophthalmology, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xianggui Wang
- Eye Center of Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, China.
- Hunan Key Laboratory of Ophthalmology, Changsha, Hunan, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.
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Jairath NK, Paulus YM, Yim A, Zhou Y, Parekh BJ, Jairath R, Musch DC, Rosenthal JM. Intra- and post-operative risk of retinal breaks during vitrectomy for macular hole and vitreomacular traction. PLoS One 2022; 17:e0272333. [PMID: 35951646 PMCID: PMC9371285 DOI: 10.1371/journal.pone.0272333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/18/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/OBJECTIVE To evaluate the development of intra- and post-operative retinal breaks after pars plana vitrectomy (PPV) for macular hole (MH) and/or vitreomacular traction (VMT). SUBJECTS/METHODS Medical records of patients who underwent PPV at Kellogg Eye Center between 1/1/2005-6/30/2018, were evaluated in three groups: group 1, MH/VMT (n = 136); group 2, epiretinal membrane (ERM) without VMT (n = 270); and group 3, diagnostic vitrectomy (DV) or vitreous opacities (n = 35). Statistical analyses were conducted using SAS. RESULTS 20.6% of patients with MH/VMT, 8.5% of patients with ERM, and 5.7% of patients with DV or vitreous opacities had either intra-operative or post-operative breaks. Indication of MH/VMT versus ERM was a significant predictor for this outcome (p = .0112). The incidence of retinal breaks was higher in operations using 23-gauge versus 25-gauge PPV (25.0% vs. 7.4%, p < .0001). CONCLUSIONS The presence of MH and/or VMT is a significant risk factor for retinal breaks from PPV, as is use of 23-gauge vitrectomy.
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Affiliation(s)
- Neil K. Jairath
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, United States of America
| | - Yannis M. Paulus
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, United States of America
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States of America
| | - Angela Yim
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, United States of America
| | - Yunshu Zhou
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, United States of America
| | - Bela J. Parekh
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, United States of America
| | - Ruple Jairath
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, United States of America
| | - David C. Musch
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, United States of America
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States of America
| | - Julie M. Rosenthal
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, United States of America
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Ben Ghezala I, Mariet AS, Benzenine E, Gabrielle PH, Baudin F, Quantin C, Creuzot-Garcher C. Incidence of rhegmatogenous retinal detachment following macular surgery in France between 2006 and 2016. Am J Ophthalmol 2022; 243:91-97. [PMID: 35907474 DOI: 10.1016/j.ajo.2022.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/07/2022] [Accepted: 07/15/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To report the incidence of postoperative rhegmatogenous retinal detachment after macular surgery in France between 2006 and 2016 and identify associated factors. DESIGN Nationwide population-based cohort study. METHODS All surgical procedures for an epiretinal membrane or a macular hole performed in France from January 1, 2006 to October 31, 2016 were identified in the French national administrative database (Programme de Médicalisation des Systèmes d'Information). We investigated the incidence of rhegmatogenous retinal detachment occurring within 90 days of a macular surgical procedure. RESULTS From January 1, 2006 to October 31, 2016, 152,034 macular surgical procedures for epiretinal membranes or macular holes were recorded in France. We identified 3,605 cases of rhegmatogenous retinal detachment occurring within 90 days of the procedure. The incidence of rhegmatogenous retinal detachment was 2.37% overall, 1.95% for epiretinal membrane surgery and 3.43% for macular hole surgery. In multivariable Poisson regression analysis, rhegmatogenous retinal detachment was associated with macular hole surgery (incidence rate ratio [IRR], 1.76; 95% CI, 1.63-1.90; P < .001), history of cataract extraction in the previous year (IRR, 1.20; 95% CI, 1.08-1.34; P = .001), age < 60 years (P < .001), and male gender (IRR, 1.63; 95% CI, 1.51-1.76; P < .001). CONCLUSIONS The incidence of rhegmatogenous retinal detachment within 90 days of macular surgery was 2.37% overall in France between 2006 and 2016 and it was higher for macular hole surgery than for epiretinal membrane surgery.
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Affiliation(s)
- Inès Ben Ghezala
- Ophthalmology Department, University Hospital, Dijon, France; Inserm, CIC 1432, Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, University Hospital, Dijon, France
| | - Anne-Sophie Mariet
- Inserm, CIC 1432, Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, University Hospital, Dijon, France; Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France, Bourgogne Franche-Comté University, Dijon, France; Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
| | - Eric Benzenine
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France, Bourgogne Franche-Comté University, Dijon, France
| | - Pierre-Henry Gabrielle
- Ophthalmology Department, University Hospital, Dijon, France; Eye and Nutrition Research Group, CSGA, UMR1324 INRAE, 6265 CNRS, Dijon, France
| | - Florian Baudin
- Ophthalmology Department, University Hospital, Dijon, France
| | - Catherine Quantin
- Inserm, CIC 1432, Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, University Hospital, Dijon, France; Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France, Bourgogne Franche-Comté University, Dijon, France; Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
| | - Catherine Creuzot-Garcher
- Ophthalmology Department, University Hospital, Dijon, France; Eye and Nutrition Research Group, CSGA, UMR1324 INRAE, 6265 CNRS, Dijon, France
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Pan Q, Gao Z, Chen X, Yang Z, Huang S, Hu X, Zheng J, Zhang Z. Outcomes of a novel bubble ultra-wide field viewing system for vitreoretinal surgery. Acta Ophthalmol 2022; 100:e1024-e1030. [PMID: 34403213 DOI: 10.1111/aos.15006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/31/2021] [Accepted: 08/04/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To report the clinical outcomes and evaluate the efficacy of a novel bubble ultra-wide field viewing system for vitreoretinal surgery. DESIGN Prospective, noncomparative, interventional case series. PARTICIPANTS One hundred and fifty-one eyes of 146 consecutive patients with proliferative diabetic retinopathy (PDR), vitreous haemorrhage originating from retinal vein occlusion (VH-RVO), epiretinal membrane (EM), macular hole (MH) or retinal detachment (RD) who underwent vitreoretinal surgery using the bubble ultra-wide field viewing system were included. METHODS A standard phacoemulsification was performed on each patient. Core humour and mid-peripheral vitreous humour were removed using a planoconcave lens. A suitably sized bubble was infused to attach to the posterior capsule or the anterior chamber depending on the integrity of the posterior capsule. The planoconcave lens and the air bubble formed the wide-angle viewing system, through which peripheral vitrectomy was performed. MAIN OUTCOME MEASURES Range of applications, field of view, model validation and complications were recorded. RESULTS The new ultra-wide field viewing system was successfully applied in all eyes, including 34 with PDR, 28 VH-RVO, 28 EM, 25 MH and 36 RD. Peripheral vitrectomy, local or panretinal laser photocoagulation, and removal of the peripheral proliferative membrane were successfully performed while viewing through this system. Maximum peripheral retinal area observable during the procedure was positively correlated with pupil diameter. Model analysis results showed that when the pupil diameter was 6 mm, the maximum field of view was approximately 128.1- 148.0 degrees with this system. Of 142 eyes, the main intraoperative complication was iatrogenic retinal breaks (IRBs) in 8 eyes (5.3%) and posterior capsule injury by vitreous cutter during bubble removal in 6 eyes (4.2%). The postsurgery mean best-corrected visual acuity (BCVA) (0.48 ± 0.39 logMAR) was significantly improved compared with the preoperative mean BCVA (1.60 ± 1.08 logMAR, p < 0.001). No incidents of postoperative choroidal detachment, secondary glaucoma or endophthalmitis were recorded. CONCLUSIONS For patients with lens excision or absence, vitreoretinal surgery can be successfully performed using the novel viewing system described here. The system is a safe, convenient and economical ultra-wide field viewing system with a wide range of applications.
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Affiliation(s)
- Qin‐tuo Pan
- Eye Hospital and School of Ophthalmology and Optometry Wenzhou Medical University Wenzhou China
| | - Zhi‐qiang Gao
- Eye Hospital and School of Ophthalmology and Optometry Wenzhou Medical University Wenzhou China
| | - Xu‐hao Chen
- Eye Hospital and School of Ophthalmology and Optometry Wenzhou Medical University Wenzhou China
| | - Zheng‐wei Yang
- Tianjin International Joint Research and Development Centre of Ophthalmology and Vision Science Eye Institute and School of Optometry Tianjin Medical University Eye Hospital Tianjin China
| | - Sheng‐hai Huang
- Eye Hospital and School of Ophthalmology and Optometry Wenzhou Medical University Wenzhou China
| | - Xu‐ting Hu
- Eye Hospital and School of Ophthalmology and Optometry Wenzhou Medical University Wenzhou China
| | - Jing‐wei Zheng
- Eye Hospital and School of Ophthalmology and Optometry Wenzhou Medical University Wenzhou China
| | - Zong‐duan Zhang
- Eye Hospital and School of Ophthalmology and Optometry Wenzhou Medical University Wenzhou China
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Lee KH, Chung YR, Yeo S, Lee K. Is gas/air tamponade essential for eyes with small peripheral retinal breaks without detachment during vitrectomy? BMC Ophthalmol 2022; 22:186. [PMID: 35459110 PMCID: PMC9027820 DOI: 10.1186/s12886-022-02401-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/11/2022] [Indexed: 12/03/2022] Open
Abstract
Background To investigate the safety of vitrectomy with laser photocoagulation in eyes with small peripheral retinal breaks without air or gas tamponade. Methods Among patients who underwent vitrectomy for various retinal disorders, those with small peripheral retinal breaks treated by laser photocoagulation without air or gas tamponade were included in this study. Their medical records were assessed retrospectively, and we investigated the characteristics of small peripheral retinal breaks and the incidence of postoperative retinal detachment (RD). Results Thirty-one eyes of 31 patients who presented with small peripheral retinal breaks requiring endolaser photocoagulation during vitrectomy were included in this analysis. There were two cases of iatrogenic retinal breaks that occurred during vitrectomy, while others were preexisting lesions, including retinal tears, atrophic retinal holes, and retinal holes with lattice degeneration. There were no cases of RD during the follow-up period of at least 6 months. Conclusions Adequate laser treatment without gas or air tamponade may be sufficient during vitrectomy in cases with small peripheral retinal breaks without concurrent RD, along with complete removal of vitreoretinal traction. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-022-02401-2.
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Affiliation(s)
- Kyung Ho Lee
- Department of Ophthalmology, Ajou University School of Medicine, 164 World Cup-ro, Yeongtong-gu, Suwon, 16499, South Korea
| | - Yoo-Ri Chung
- Department of Ophthalmology, Ajou University School of Medicine, 164 World Cup-ro, Yeongtong-gu, Suwon, 16499, South Korea
| | - Suji Yeo
- Department of Ophthalmology, Ajou University School of Medicine, 164 World Cup-ro, Yeongtong-gu, Suwon, 16499, South Korea
| | - Kihwang Lee
- Department of Ophthalmology, Ajou University School of Medicine, 164 World Cup-ro, Yeongtong-gu, Suwon, 16499, South Korea.
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Linton EF, Kim SJ, Patel SN. Effect of prophylactic laser during small-gauge vitrectomy for epiretinal membranes. Eur J Ophthalmol 2021; 32:514-519. [PMID: 33596685 DOI: 10.1177/1120672121992948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To determine the rate of post-operative retinal detachment after elective pars plana vitrectomy for epiretinal membrane, and to test for the mitigating effect of prophylactic endolaser. METHODS We identified 459 eyes of 411 patients undergoing vitrectomy for epiretinal membrane at Vanderbilt University Medical Center between January 2010 and May 2017. Patients who underwent concurrent endolaser without any identified retinal break were included in the exposure cohort. Patients who underwent no prophylactic retinopexy or ablation were included in the unexposed cohort. Exposure data, demographic data, and outcome data were tabulated for comparison. RESULTS The final analysis included 343 eyes of 343 patients. Approximately 7% of eyes undergoing ERM surgery were found to have a full-thickness retinal break which was not seen preoperatively. The overall rate of postoperative RD was 2.04%. Postoperative retinal detachment occurred in 0 of the 34 eyes exposed to prophylactic laser, and in 7 of the 309 control eyes. Odds ratio was found to be 0.60 (p = 0.598 (95%CI 0.0327-10.7), p = 0.72), indicated the results were not statistically significant. DISCUSSION Looking at patients undergoing routine vitrectomy surgery for epiretinal membrane, no retinal detachments occurred in the group receiving prophylactic treatment, though this association did not reach statistical significance. With modern surgical techniques, post-operative retinal detachment remains relatively rare after vitrectomy for ERM though a thorough intraoperative exam is critical to identify occult retinal breaks.
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Affiliation(s)
- Edward F Linton
- Department of Ophthalmology and Visual Sciences, Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Stephen J Kim
- Department of Ophthalmology and Visual Sciences, Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shriji N Patel
- Department of Ophthalmology and Visual Sciences, Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, USA
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Management of vitreous floaters: an international survey the European VitreoRetinal Society Floaters study report. Eye (Lond) 2020; 34:825-834. [PMID: 32313173 DOI: 10.1038/s41433-020-0825-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 11/19/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND/OBJECTIVES To evaluate the efficacy and safety of pars plana vitrectomy for symptomatic floaters. SUBJECTS/METHODS Forty-eight vitreoretinal surgeons from 16 countries provided information on 581 eyes who underwent vitrectomy for floaters in this retrospective survey study conducted by European VitreoRetinal Society. Percentage symptomatic improvement, incidence of retinal tears/detachment and post-vitrectomy cataract surgery, and the factors associated with satisfaction and complications were investigated. RESULTS Ninety-two percent were satisfied with the results, with 86.3% reporting complete resolution of daily-life symptoms. Overall satisfaction was lower in patients with smaller vitreous opacities at presentation (OR:0.4). Iatrogenic retinal breaks occurred in 29 eyes (5%). Core vitrectomy and cut rates of 1500-4000 or >4000 cuts/min were associated with lower risk of retinal breaks than complete vitrectomy (OR:0.05) and cut rates < 1500 cuts/min (OR: 0.03, 0.12, respectively). Fourteen eyes (2.4%) developed retinal detachment at a median of 3 months; and 84 (48.6%) developed cataract at a median of 16 months post-vitrectomy. CONCLUSIONS Pars plana vitrectomy resulted in high patient satisfaction with relatively low rate of severe complications in a large group of patients. The procedure may be safer when core vitrectomy and cut rates > 1500 cuts/min are favoured. Proper patient selection and informed consent are the most important aspects of surgery.
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Yu Y, Qi B, Liang X, Wang Z, Wang J, Liu W. Intraoperative iatrogenic retinal breaks in 23-gauge vitrectomy for stage 3 and stage 4 idiopathic macular holes. Br J Ophthalmol 2020; 105:93-96. [PMID: 32217539 DOI: 10.1136/bjophthalmol-2019-315579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/28/2020] [Accepted: 03/10/2020] [Indexed: 11/03/2022]
Abstract
AIMS To investigate characteristics of intraoperative iatrogenic retinal breaks in 23-gauge vitrectomy for idiopathic macular hole and classify the breaks based on their causes to analyse the risk factors. METHODS This retrospective study enrolled patients with stage 3 or 4 idiopathic macular hole who underwent 23-gauge vitrectomy in Beijing Tongren Hospital from July 2015 to August 2018. The intraoperative iatrogenic retinal breaks were classified into three types: by induction of posterior vitreous detachment (type 1), by peripheral vitreous cutting (type 2) and by others (type 3). The types, incidence and distribution of the breaks were analysed, and all clinical features were compared between eyes with and without the breaks. RESULTS A total of 364 eyes from 341 patients were recruited. Twenty-five breaks from 24 eyes (6.6%) were encountered, 52% (13/25) of which distributed in the superior region. Type 1 and type 2 breaks contributed 52% (13/25) and 44% (11/25) to all, respectively. Eyes with stage 3 and stage 4 holes showed no significant differences in incidence or distribution in type 2 breaks. No breaks occurred on the surface of lattice degenerations. All clinical features showed no significant differences between eyes with and without the breaks. CONCLUSION Distribution of intraoperative iatrogenic retinal breaks shows no preference for the superior or inferior region. Induction of posterior vitreous detachment and traction from peripheral vitreous cutting are major causes of the breaks, which classify them into two main types. The presence of lattice may not be one of the risk factors if treated properly.
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Affiliation(s)
- Yanping Yu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Biying Qi
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xida Liang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zengyi Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jing Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Wu Liu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Broadhead GK, Hong T, Chang AA. To Treat or Not to Treat: Management Options for Symptomatic Vitreous Floaters. Asia Pac J Ophthalmol (Phila) 2020; 9:96-103. [PMID: 32097127 DOI: 10.1097/apo.0000000000000276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Vitreous floaters are a common cause for presentation to ophthalmologists, and may significantly affect visual function. In the absence of some more serious underlying pathology such as uveitis, many patients may not experience significant persistent visual impairment from floaters. For some patients, the symptomatic effects of floaters may persist. For these patients, treatment options are available, of which the most commonly reported is vitrectomy. Other treatment modalities have also become more common, notably YAG vitreolysis. Selection of appropriate patients for surgery is often difficult, in part due to the relative lack of objective outcomes with which to measure both visual impairment and improvement post-procedure. Although well-tolerated, vitrectomy does carry with it risks, including iatrogenic retinal breaks, retinal detachment, and in phakic patients, subsequent cataract formation. Techniques such as small gauge vitrectomy, intraoperative examination and treatment of breaks or other worrying lesions, and careful consideration of the need for posterior vitreous detachment induction may help limit the incidence of these adverse events. For other treatment options such as YAG vitreolysis, research and clinical experience remain more limited, and as such the long-term efficacy and risks of these therapies are still unclear. Here, we review the evidence surrounding the role of vitrectomy and YAG vitreolysis in the treatment of vitreous floaters and potential means to minimize therapeutic complications.
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Affiliation(s)
- Geoffrey K Broadhead
- Save Sight Institute, The University of Sydney, Sydney, Australia
- Sydney Institute of Vision Science, Sydney, Australia
| | - Thomas Hong
- Sydney Institute of Vision Science, Sydney, Australia
- Sydney Retina Clinic & Day Surgery, Sydney, Australia
| | - Andrew A Chang
- Save Sight Institute, The University of Sydney, Sydney, Australia
- Sydney Institute of Vision Science, Sydney, Australia
- Sydney Retina Clinic & Day Surgery, Sydney, Australia
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11
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International Practice Patterns for the Management of Acute Postsurgical and Postintravitreal Injection Endophthalmitis. ACTA ACUST UNITED AC 2019; 3:461-467. [DOI: 10.1016/j.oret.2019.03.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 03/13/2019] [Accepted: 03/13/2019] [Indexed: 11/19/2022]
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12
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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.].
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Chen GH, Tzekov R, Jiang FZ, Mao SH, Tong YH, Li WS. Iatrogenic retinal breaks and postoperative retinal detachments in microincision vitrectomy surgery compared with conventional 20-gauge vitrectomy: a meta-analysis. Eye (Lond) 2018; 33:785-795. [PMID: 30560911 DOI: 10.1038/s41433-018-0319-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 11/04/2018] [Accepted: 11/17/2018] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To assess the incidence of iatrogenic retinal breaks (IRBs) and postoperative retinal detachments (RDs) in microincision vitrectomy surgery (MIVS) compared with 20-gauge (20 G) vitrectomy. METHODS A comprehensive literature search was performed to find relevant studies and a meta-analysis of the IRBs and postoperative RDs rates after 20 G vitrectomy versus MIVS was conducted. RESULTS Thirty-two studies were selected, including 14,373 eyes (6932 eyes in the 20 G group, 7441 eyes in the MIVS group). The meta-analysis demonstrated that the incidence of IRBs was significantly higher in 20 G vitrectomy vs. MIVS (OR = 2.22, 95% CI, 1.93-2.57, P < 0.00001) and in a subanalysis vs. 23 G MIVS (OR = 2.19, 95% CI, 1.87-2.56, P < 0.00001) and vs. 25 G MIVS (OR = 2.27, 95% CI, 1.62-3.18, P < 0.00001). Similar result was obtained in a subanalysis for macular surgery (OR = 2.44, 95% CI, 1.99-2.99, P < 0.00001), and also for sclerotomy-related IRBs (OR = 3.73, 95% CI, 2.55-5.44, P < 0.00001), but not for surgically induced posterior vitreous detachment-related IRBs (OR = 1.59, 95% CI, 0.89-2.84, P = 0.12). The incidence of postoperative RDs in 20 G vitrectomy was significantly higher compared to MIVS (OR = 1.72, 95% CI, 1.21-2.46, P = 0.003) and in a subanalysis vs. 23 G MIVS (OR = 2.45, 95% CI, 1.50-4.00, P = 0.0003), but not for 25 G MIVS (OR = 1.01, 95% CI, 0.63-1.64, P = 0.96). Similar result was obtained in a subanalysis for macular surgery (OR = 1.89, 95% CI, 1.26-2.85, P = 0.002). CONCLUSION This meta-analysis demonstrated that MIVS is associated with a lower risk of IRBs and postoperative RDs compared to 20 G vitrectomy.
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Affiliation(s)
- G H Chen
- Department of Ophthalmology, Quzhou People's Hospital, Quzhou, Zhejiang, People's Republic of China
| | - R Tzekov
- Department of Ophthalmology, University of South Florida, Tampa, FL, USA
| | - F Z Jiang
- Department of Ophthalmology, Quzhou People's Hospital, Quzhou, Zhejiang, People's Republic of China
| | - S H Mao
- Department of Ophthalmology, Quzhou People's Hospital, Quzhou, Zhejiang, People's Republic of China
| | - Y H Tong
- Department of Ophthalmology, Quzhou People's Hospital, Quzhou, Zhejiang, People's Republic of China
| | - W S Li
- Shanghai Aier Eye Hospital, 1286 Hongqiao Road, Shanghai, People's Republic of China. .,Aier School of Ophthalmology, Central South University, Changsha, Hunan Province, People's Republic of China.
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PARS PLANA VITRECTOMY AND LENSECTOMY FOR ECTOPIA LENTIS WITH AND WITHOUT THE INDUCTION OF A POSTERIOR VITREOUS DETACHMENT. Retina 2017; 38:325-330. [PMID: 28207607 DOI: 10.1097/iae.0000000000001534] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Posterior hyaloid removal during pars plana vitrectomy and lensectomy for ectopia lentis is commonly performed, but may increase the risk of intraoperative retinal breaks and postoperative retinal detachment. This study evaluated outcomes after pars plana vitrectomy and lensectomy with or without posterior hyaloid removal. METHODS This retrospective observational cohort study included ectopia lentis cases that underwent pars plana vitrectomy and lensectomy (2005-2014), with or without intraoperative induction of a posterior vitreous detachment (PVD). The primary outcome was postoperative retinal detachment. The secondary outcomes were the incidence of iatrogenic retinal breaks, and change in visual acuity. RESULTS Twenty-six cases were included. The posterior hyaloid was preserved intraoperatively in 11 cases (non-PVD group). In the remainder (15 cases), the vitreous was removed completely (PVD group). Postoperative retinal detachment occurred in 2 cases in each group (18.2% non-PVD vs.13.3% PVD, P = 0.7). Intraoperative breaks occurred more frequently in the PVD group (2 vs. 9 cases; P = 0.03). There was no difference in mean improvement in visual acuity (7 [PVD] vs. 3 [non-PVD] ETDRS lines; P = 0.2). CONCLUSION The preservation of posterior hyaloid attachment during vitreolensectomy for ectopia lentis was associated with fewer iatrogenic retinal breaks. Postoperative retinal detachment did not seem to be influenced by the choice of surgical technique.
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SURGICAL AND FUNCTIONAL RESULTS OF 27-GAUGE VITRECTOMY COMBINED WITH COAXIAL 1.8 MM MICROINCISION CATARACT SURGERY. Retina 2016; 36:2093-2100. [DOI: 10.1097/iae.0000000000001052] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Intraoperative complications of patients undergoing small-gauge and 20-gauge vitrectomy: a database study of 4,274 procedures. Eur J Ophthalmol 2016; 27:226-230. [PMID: 27646328 DOI: 10.5301/ejo.5000856] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare the intraoperative complications between 23-G and 20-G instrumentation in patients undergoing pars plana vitrectomy (PPV). METHODS This was a retrospective comparative study of 4,274 PPV procedures by the same surgical team between 1998 and 2016. A total of 2,648 operations were carried out with 20-G surgery and 1,626 operations with 23-G surgery. Main outcome measures were the incidence of choroidal haemorrhage, iatrogenic retinal break, and lens touch. RESULTS The most frequent surgical indication in both 20-G and 23-G was rhegmatogenous retinal detachment (RRD), 38.7% (1,026/2,648) and 45.9% (746/1,626), respectively. The frequency of choroidal haemorrhage was 1.0% with 20-G surgery (26/2,648) vs 0.6% with 23-G (9/1,626, p = 0.16). Subgroup analysis showed the increased risk was present in RRD surgery, 1.6% (16/1,026) vs 0.1% (1/746, p = 0.002), but not in all other indications combined, 20-G with 0.6% (10/1,622) and 23-G 0.9% (8/88, p = 0.46). This increased risk was also true for RRD when excluding combined scleral buckle surgery. There was an increased risk of iatrogenic retinal break in RRD cases undergoing 20-G, 5.8% (60/1,026), compared to 23-G vitrectomy, 1.9% (14/746, p<0.0001). There was no difference in rates of lens touch between 20-G and 23-G. CONCLUSIONS 23-G microincisional PPV has a lower risk of choroidal haemorrhage and iatrogenic retinal tears than 20-G vitrectomy particularly for eyes with RRD.
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Tosi GM, Esposti P, Romeo N, Marigliani D, Cevenini G, Massimo P, Nuti E, Esposti G, Ripandelli G. The Incidence of Rhegmatogenous Retinal Complications in Macular Surgery After Prophylactic Preoperative Laser Retinopexy: A Retrospective Study. Medicine (Baltimore) 2016; 95:e3283. [PMID: 27057893 PMCID: PMC4998809 DOI: 10.1097/md.0000000000003283] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of the study is to evaluate the clinical characteristics of intraoperative retinal breaks (RBs) and postoperative retinal detachment (RRD) in patients undergoing pars plana vitrectomy (PPV) for macular disorders, who were treated preoperatively with prophylactic peripheral laser retinopexy.This observational cohort study comprised of 254 patients who underwent macular surgery and were preoperatively subjected to prophylactic laser retinopexy anterior to the equator. The main outcome measures were the incidence and characteristics of intraoperative RBs and postoperative RRD.Intraoperative RBs occurred in 14 patients (5.5%). Ten patients presented a sclerotomy-related RB (3.9%) and 4 patients a nonsclerotomy-related RB (1.6%). Two patients showed postoperative RRD (0.7%). Neither of the 2 patients with postoperative RRD was macula-off at presentation: one of them was successfully operated on with scleral buckling and the other was managed by observation alone. A significantly increased risk for the intraoperative development of sclerotomy-related RB was found in 20-gauge PPV compared with 23/25-gauge PPV.Preoperative prophylactic peripheral laser retinopexy does not guarantee the prevention of intraopertaive RBs or postoperative RRD. However, it might prevent the involvement of the macula when RRD occurs postoperatively.
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Affiliation(s)
- Gian Marco Tosi
- From the Ophthalmology Section of the Department of Medicine, Surgery and Neuroscience (GMT, PE, NR, DM, PM, EN, GE), University of Siena, Siena; Department of Medical Biotechnologies (GC), University of Siena, Siena; and G.B. Bietti Foundation (GR), IRCCS Rome, Italy
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18
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Chuang CC, Chen SN. Induction of Posterior Vitreous Detachment in Pediatric Vitrectomy by Preoperative Intravitreal Injection of Tissue Plasminogen Activator. J Pediatr Ophthalmol Strabismus 2016; 53:113-8. [PMID: 27018884 DOI: 10.3928/01913913-20160209-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 01/01/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To report the efficacy of intravitreal injection of tissue plasminogen activator (tPA) with or without autoserum in induction of posterior vitreous detachment (PVD) in pediatric vitrectomy. METHODS Retrospective, interventional case series of pediatric patients receiving intravitreal injection of tPA preoperatively to facilitate PVD in vitrectomy from January 2011 to December 2014 at the Changhua Christian Hospital, Taiwan. All patients received intravitreal injections of 25 µg of tPA 3 days before vitrectomy. For cases without preexisting vitreous hemorrhage, 0.1 mL of intravitreal autologous serum was co-administered. Main outcome measures included successful rate of posterior vitreous detachment in vitrectomy, visual outcome, and related ocular complications. RESULTS Four boys and 2 girls were included. Ages ranged from 39 weeks' postmenstrual age to 8 years. The indications for vitrectomy were traumatic macular hole (cases 1 and 2); premacular hemorrhage secondary to retinopathy of prematurity (case 3); abusive head trauma with premacular hemorrhage, subinternal limiting membrane hemorrhage, and macular hole (case 4); trauma with dense vitreous hemorrhage (case 5); and vitreous hemorrhage with unknown cause (case 6). Successful PVD was induced intraoperatively in all cases and the macular hole was closed successfully in 3 of 3 cases (cases 1, 2, and 4). No surgical complications were noted. Visual outcome improved in all 3 eyes with checkable preoperative visual acuity (cases 1, 2, and 6). CONCLUSIONS Intravitreal injection of tPA 3 days before vitrectomy may be a helpful adjunct to induce pediatric PVD.
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Surgical and Functional Results of Hybrid 25-27-Gauge Vitrectomy Combined with Coaxial 2.2 mm Small Incision Cataract Surgery. J Ophthalmol 2016; 2016:9186351. [PMID: 26966558 PMCID: PMC4757709 DOI: 10.1155/2016/9186351] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 01/13/2016] [Indexed: 11/27/2022] Open
Abstract
Purpose. To investigate outcomes after coaxial 2.2 mm small incision cataract surgery combined with hybrid 25-27-gauge vitrectomy in eyes with vitreoretinal disease and age-related cataract. Methods. A single-center, retrospective case series study of 55 subjects (55 eyes) with a mean age of 70 years who underwent combined small incision phacoemulsification, intraocular lens (IOL) implantation, and hybrid 25-27-gauge vitrectomy during the 12-month period to December 2014. Intraoperative and postoperative complications and visual results were the main outcome measures. Results. The mean follow-up period was 6 months (range: 2–18 months). Intraoperative findings were 3 retinal breaks (5.5%). No cases required corneal or scleral suture or conversion to larger-gauge vitrectomy. Postoperative complications consisted of posterior capsule opacification (12.7%), elevated intraocular pressure >30 mmHg (1.8%), and fibrin reaction (5.5%). There were no cases of hypotony (<7 mmHg), IOL decentration, or postoperative endophthalmitis. Visual acuity (mean ± SD) improved from 0.52 ± 0.6 logMAR preoperatively to 0.22 ± 0.46 logMAR at final postoperative visit (P < 0.0001). Conclusion. Surgical and visual outcomes suggest hybrid 25-27-gauge vitrectomy combined with small incision phacoemulsification and IOL implantation is feasible, safe, and effective as a one-step surgical procedure for the management of vitreoretinal pathologies and concurrent cataract.
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Mura M, Barca F, Dell'Omo R, Nasini F, Peiretti E. Iatrogenic retinal breaks in ultrahigh-speed 25-gauge vitrectomy: a prospective study of elective cases. Br J Ophthalmol 2015; 100:1383-7. [DOI: 10.1136/bjophthalmol-2015-307654] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 11/30/2015] [Indexed: 11/04/2022]
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TRANSCONJUNCTIVAL NONVITRECTOMIZING VITREOUS SURGERY VERSUS 25-GAUGE VITRECTOMY IN PATIENTS WITH EPIRETINAL MEMBRANE: A Prospective Randomized Study. Retina 2015; 35:873-9. [PMID: 25526101 DOI: 10.1097/iae.0000000000000459] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the clinical outcomes and the rate of complications of 27-gauge transconjunctival nonvitrectomizing vitreous surgery (NVS) and of 25-gauge transconjunctival sutureless vitrectomy surgery for idiopathic epiretinal membrane removal. METHODS In this prospective randomized study, 83 phakic eyes of 83 consecutive patients with an idiopathic epiretinal membrane were randomized to receive 27-gauge NVS (NVS-group) or 25-gauge vitrectomy (Standard-group). Main outcome measures were best-corrected visual acuity, central retinal thickness, nuclear density units' changes, and rate of complications. RESULTS Thirty-nine eyes of the Standard-group and 40 of the NVS-group were considered in final analysis. Mean best-corrected visual acuity improved significantly in both groups, with a significant better result at 12 months in NVS-group (P = 0.039; t-test). Central retinal thickness decreased significantly in both groups (P < 0.001, Tukey test), without significant difference between the two groups at any time point. At 12 months, nuclear density increased significantly in the Standard-group (analysis of variance, P < 0.001), and it did not change in the NVS-group (analysis of variance, P = 0.537). Epiretinal membrane recurred in 5.1% of eyes in the Standard-group and in 7.5% of eyes in the NVS-group (Fisher's exact test, P = 1.000). CONCLUSION The 27-gauge NVS is an effective surgical procedure in eyes with epiretinal membrane and it induces less progression of nuclear sclerosis than 25-gauge vitrectomy.
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Reibaldi M, Rizzo S, Avitabile T, Longo A, Toro MD, Viti F, Saitta A, Giovannini A, Mariotti C. Iatrogenic retinal breaks in 25-gauge vitrectomy under air compared with the standard 25-gauge system for macular diseases. Retina 2014; 34:1617-22. [PMID: 24651259 DOI: 10.1097/iae.0000000000000112] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE To evaluate the incidence rates of iatrogenic retinal breaks in eyes that underwent 25-gauge vitrectomy under air compared with 25-gauge standard vitrectomy for idiopathic macular holes or idiopathic epiretinal membranes. METHODS In this retrospective, comparative interventional study, 435 eyes were enrolled. In all patients after core vitrectomy and epiretinal/inner limiting membrane peeling, complete vitrectomy of the base was performed, respectively under air (air group) or under fluid infusion (standard group). RESULTS The number of eyes with iatrogenic retinal breaks was significantly lower in the air group than in standard group (4/197 and 16/238, 2% and 7%, respectively; P = 0.035). A postoperative retinal detachment developed in 2 eyes (1%) in the standard group, and in no eyes of the air group (0%). Factors related to the occurrence of retinal breaks were surgically induced posterior vitreous detachment (P = 0.006), standard vitrectomy (P = 0.023), and surgery for macular hole (P = 0.030). CONCLUSION The 25-gauge vitrectomy under air is associated with a lower incidence rate of retinal breaks compared with the standard 25-gauge vitrectomy.
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Affiliation(s)
- Michele Reibaldi
- *Department of Ophthalmology, University of Catania, Catania, Italy; †Department of Ophthalmology, Santa Chiara Hospital, Pisa, Italy; and ‡Department of Ophthalmology, University of Ancona, Ancona, Italy
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Conart JB, Selton J, Hubert I, Trechot F, El Adssi H, Creuzot-Garcher C, Berrod JP. Outcomes of macular hole surgery with short-duration positioning in highly myopic eyes: a case-control study. Ophthalmology 2014; 121:1263-8. [PMID: 24480709 DOI: 10.1016/j.ophtha.2013.12.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 11/28/2013] [Accepted: 12/04/2013] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To evaluate the outcomes of macular hole (MH) surgery with 3-day prone positioning in highly myopic eyes and to compare them with those from non-highly myopic eyes. DESIGN Retrospective nested case-control study from a cohort of 496 consecutive patients (496 eyes) who underwent surgery for MH. PARTICIPANTS Forty-seven highly myopic eyes (with axial length >26 mm) were included in the study group and were matched for MH size and duration of symptoms with 47 non-highly myopic control eyes selected from the same cohort. METHODS All patients underwent pars plana vitrectomy, internal limiting membrane peeling, and 17% hexafluoroethane gas filling. Patients then were advised to maintain strict face-down positioning for 3 days only and to avoid the supine position during the night for a minimum of 1 week. MAIN OUTCOME MEASURES The MH closure rate, the relationship between axial length and closure rate, the best-corrected visual acuity (BCVA), and the surgical complications were analyzed. RESULTS The mean axial length was 28.5±2.2 mm in highly myopic eyes and 23.3±1.1 mm in controls (P < 0.001). Closure of the MH was achieved in 39 of 47 eyes (83%) in the study group and in 45 of 47 eyes (95.7%) in the control group (P = 0.045). Anatomic outcomes tended to decrease when axial length increased (P = 0.066). Mean BCVA improved in both groups (0.41±0.39 logarithm of the minimal angle of resolution [logMAR] vs. 0.68±0.34 logMAR) but was significantly lower in highly myopic eyes (P < 0.001). Retinal detachment occurred in 8.5% of highly myopic patients versus 2.1% of controls, but the difference was not significant. CONCLUSIONS Macular hole surgery with 3-day postoperative positioning in highly myopic eyes resulted in satisfactory anatomic and functional outcomes. However, the MH closure rate and mean improvement of visual acuity were less favorable than those in control eyes. Longer axial length may increase the risk of anatomic failure.
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Affiliation(s)
| | - Jérôme Selton
- Department of Ophthalmology, Nancy University Hospital, Nancy, France
| | - Isabelle Hubert
- Department of Ophthalmology, Nancy University Hospital, Nancy, France
| | - Fanny Trechot
- Department of Ophthalmology, Nancy University Hospital, Nancy, France
| | - Haritina El Adssi
- Clinical Epidemiology and Evaluation, Nancy University Hospital, Nancy, France
| | | | - Jean-Paul Berrod
- Department of Ophthalmology, Nancy University Hospital, Nancy, France
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OUTCOMES AFTER COMBINED 1.8-MM MICROINCISION CATARACT SURGERY AND 23-GAUGE TRANSCONJUNCTIVAL VITRECTOMY FOR POSTERIOR SEGMENT DISEASE. Retina 2014; 34:142-8. [DOI: 10.1097/iae.0b013e3182947b29] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Matonti F, Meyer F, Rouhette H, Guigou S, Dumas S, Parrat E, Mérité PY, Pommier S. [Anatomical and functional prognosis of secondary retinal detachments after sutureless macular surgery]. J Fr Ophtalmol 2013; 37:58-63. [PMID: 24210934 DOI: 10.1016/j.jfo.2013.05.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 04/28/2013] [Accepted: 05/27/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate the incidence, characteristics and risk factors for rhegmatogenous complications of transconjunctival sutureless 23-gauge vitrectomy (TSV) in macular surgery. The results were correlated with those reported in the literature. METHODS Multicentric retrospective study of a cohort of patients undergoing macular surgery by 23-gauge TSV between January 2009 and June 2010. RESULTS Four hundred and seventy-four patients divided into: epiretinal membrane (MEM) (n=279), vitreomacular traction (n=65) and idiopathic macular hole n=130. Forty-three percent of patients were pseudophakic. Posterior vitreous detachment (PVD) was absent in 60% of cases and was therefore systematically performed intraoperatively. It was seen that 1.7% of patients developed retinal tears and 2.7% retinal detachment with a higher incidence in the vitreomacular traction (VMT) group and the group in which the PVD was performed intraoperatively. Rhegmatogenous lesions were localized mainly in the inferior retina in the macular hole group. DISCUSSION Results are consistent with the TSV literature. Their location does not appear to be related to the sclerotomies or handedness as in 20-gauge surgery, probably due to sclerotomy trocars. Localization of rhegmatogenous lesions in the inferior retina in macular hole surgery suggests a role of gas in this subgroup. In addition to instrument-retinal touch, the performance of a surgical PVD represents a major independent risk factor for retinal detachment (RD). CONCLUSION Even with limited macular surgery, it is essential to check the retinal periphery for 360 degrees, especially for VMT and intraoperative PVD, and especially inferiorly in the case of gas tamponnade.
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Affiliation(s)
- F Matonti
- Service d'ophtalmologie, université Aix-Marseille, hôpital Nord, chemin de Bourrely, 13915 Marseille cedex 20, France; Équipe InViBe, institut de neurosciences de la Timone, Aix-Marseille université, 27, boulevard Jean-Moulin, 13385 Marseille, France.
| | - F Meyer
- Centre d'ophtalmologie, 44, avenue Maréchal-de-Lattre-de-Tassigny, 13090 Aix-en-Provence, France
| | - H Rouhette
- Clinique Espérance, 122, avenue Dr-Maurice-Donat, 06250 Mougins, France
| | - S Guigou
- Service d'ophtalmologie, hôpital Henri-Duffaut, 305, rue Raoul-Follereau, 84902 Avignon, France
| | - S Dumas
- Centre d'ophtalmologie, 20, rue Ballon, 59000 Lille, France
| | - E Parrat
- Centre d'ophtalmologie, 44, rue Henry-Becquerel-Jarry, immeuble SCI Futur, 97122 Baie-Mahault, Guadeloupe
| | - P-Y Mérité
- Centre d'ophtalmologie, 44, avenue Maréchal-de-Lattre-de-Tassigny, 13090 Aix-en-Provence, France
| | - S Pommier
- Centre d'ophtalmologie, 1 bis, quartier Lices-Berthelot, 84800 Isle-sur-la-Sorgue, France
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Iatrogenic retinal breaks in 20-G versus 23-G pars plana vitrectomy. Graefes Arch Clin Exp Ophthalmol 2013; 251:1463-7. [PMID: 23504085 DOI: 10.1007/s00417-013-2299-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 12/27/2012] [Accepted: 02/25/2013] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND The purpose of this study was to compare the incidence of iatrogenic anterior retinal breaks in 20-G vitrectomy (PPV) with transconjunctival 23-G PPV. METHODS Retrospective, observational review study involving consecutive patients undergoing PPV in a single center in the UK during a 2-year period. RESULTS Sclerotomy-related entry-site breaks (ESB) were found in 50/628 (7.9 %) 20-G PPV cases and 5/296 (1.7 %) 23-G PPV eyes (p<0.0001*). Anterior non-sclerotomy iatrogenic breaks (ANSB) were present in 55/628 (8.7 %) 20-G PPV cases and 18/296 (6.1 %) 23-G PPV eyes (p=0.19). The incidence of total anterior iatrogenic breaks (ANSB + ESB) was 105/628 (16.7 %) for 20-G PPV and 23/296 (7.8 %) for 23-G PPV (p=0.002*). Univariate analysis showed that posterior vitreous detachment induction was the only risk factor significantly associated with the development of anterior retinal breaks for both 20-G and 23-G PPV. Multivariate logistic model of risk factors for development of iatrogenic retinal breaks demonstrated that 23-G PPV was the most important factor reducing the risk of anterior breaks (p<0.0001*). CONCLUSIONS We report the largest series of patients undergoing 20-G and 23-G vitrectomy, where 23-G vitrectomy was associated with a significantly lower incidence of anterior iatrogenic retinal breaks.
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