1
|
Baldwin G, Miller JB. Heads-up 3-Dimensional Visualization to Enhance Video Endoscopy During Vitreoretinal Surgery. JOURNAL OF VITREORETINAL DISEASES 2024; 8:428-434. [PMID: 39148569 PMCID: PMC11323506 DOI: 10.1177/24741264241249527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
Purpose: To describe 2 cases in which video endoscopy was combined with heads-up 3-dimensional (3D) visualization. Methods: The imaging modalities of the heads-up 3D visualization system and video endoscopy were combined by converting the endoscope's S-Video output into a high-definition multimedia interface. The technique was used in 2 cases that included lens dislocation and endophthalmitis. Results: In the 2 cases, the heads-up split-screen view simplified the surgical setup. Simultaneously viewing the endoscopic image and widefield 3D image anecdotally appeared to improve ergonomics, help keep the probe oriented, and assist in guiding surgical movements endoscopically. Conclusions: These cases show the advantages of a heads-up 3D system to simultaneously view endoscopic and widefield images during ophthalmic endoscopy in vitreoretinal surgery.
Collapse
Affiliation(s)
- Grace Baldwin
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, Boston, MA, USA
| | - John B. Miller
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, Boston, MA, USA
| |
Collapse
|
2
|
Ajlan RS, Pfannenstiel M, Kam Y, Sciulli H. Endoscopy-assisted pars plana vitrectomy in retinal detachments associated with anterior proliferative vitreoretinopathy and epiciliary membranes. BMC Ophthalmol 2023; 23:376. [PMID: 37710237 PMCID: PMC10500874 DOI: 10.1186/s12886-023-03120-y] [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: 12/22/2022] [Accepted: 08/31/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Proliferative vitreoretinopathy (PVR) is the leading cause of recurrent retinal detachment. Anterior PVR can contribute to recurrent retinal detachment and is often difficult to remove during conventional pars plana vitrectomy. The purpose of this study is to report surgical outcomes of single endoscopy-assisted pars plana vitrectomy (E-PPV) in patients with tractional retinal detachments associated with anterior proliferative vitreoretinopathy and epiciliary membranes. METHODS Retrospective review of E-PPV between 2017 and 2021 at a tertiary referral center. Inclusion criteria involved adult patients who underwent E-PPV for tractional retinal detachment with anterior PVR and epiciliary membranes. Data collection included patients' demographics, ophthalmic exam findings, and surgical outcomes. A series of independent sample tests of proportion were conducted using a p-value of 0.05 as the threshold for statistical significance. RESULTS Eighteen out of 55 patients who underwent E-PPV met the inclusion criteria. There were six females (33%) and 12 males (p-value = 0.096). Age ranged between 27 and 82 years old (mean age 52.1 ± 17.3 years). Nine patients (50%) had a history of ipsilateral retinal detachment repair. Single E-PPV success rate was 100% after three months, and 94.4% at the latest follow up visit. Recurrent retinal detachment with posterior PVR occurred in one patient four months after surgery. Cataract progressed in 57% (8/14) of phakic patients, with 63% (5/8) undergoing cataract extraction surgery within the first postoperative year. CONCLUSION E-PPV enabled epiciliary membrane and anterior PVR visualization and removal. The single E-PPV success rate remained high at the latest follow up visit. E-PPV enabled the preservation of the phakic lens in all study patients. Larger prospective studies are needed on the role of E-PPV in retina surgeries.
Collapse
Affiliation(s)
- Radwan S Ajlan
- Department of Ophthalmology, University of Kansas School of Medicine, 7400 State Line Road, Prairie Village, 66208, Kansas City, KS, USA.
| | - Matthew Pfannenstiel
- Department of Ophthalmology, University of Kansas School of Medicine, 7400 State Line Road, Prairie Village, 66208, Kansas City, KS, USA
| | - Yong Kam
- Department of Ophthalmology, University of Kansas School of Medicine, 7400 State Line Road, Prairie Village, 66208, Kansas City, KS, USA
| | - Harrison Sciulli
- Department of Ophthalmology, University of Kansas School of Medicine, 7400 State Line Road, Prairie Village, 66208, Kansas City, KS, USA
| |
Collapse
|
3
|
Shahlaee A, Woeller CF, Philp NJ, Kuriyan AE. Translational and clinical advancements in management of proliferative vitreoretinopathy. Curr Opin Ophthalmol 2022; 33:219-227. [PMID: 35220328 DOI: 10.1097/icu.0000000000000840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Despite advancement in the surgical instrumentation and techniques, proliferative vitreoretinopathy (PVR) remains the most common cause for failure of rhegmatogenous retinal detachment (RRD) repair. This review discusses ongoing translational and clinical advancements in PVR. RECENT FINDINGS PVR represents an exaggerated and protracted scarring process that can occur after RRD. The primary cell types involved are retinal pigment epithelium, glial, and inflammatory cells. They interact with growth factors and cytokines derived from the breakdown of the blood-retinal barrier that trigger a cascade of cellular processes, such as epithelial-mesenchymal transition, cell migration, chemotaxis, proliferation, elaboration of basement membrane and collagen and cellular contraction, leading to overt retinal pathology. Although there are currently no medical therapies proven to be effective against PVR in humans, increased understanding of the risks factors and pathophysiology have helped guide investigations for molecular targets of PVR. The leading therapeutic candidates are drugs that mitigate growth factors, inflammation, and proliferation are the leading therapeutic candidates. SUMMARY Although multiple molecular targets have been investigated to prevent and treat PVR, none have yet demonstrated substantial evidence of clinical benefit in humans though some show promise. Advancements in our understanding of the pathophysiology of PVR may help develop a multipronged approach for this condition.
Collapse
Affiliation(s)
- Abtin Shahlaee
- Mid Atlantic Retina, Retina Service of Wills Eye Hospital
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Collynn F Woeller
- Flaum Eye Institute, University of Rochester Medical Center, Rochester, New York, USA
| | - Nancy J Philp
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ajay E Kuriyan
- Mid Atlantic Retina, Retina Service of Wills Eye Hospital
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| |
Collapse
|
4
|
Lai FHP, Wong EWN, Lam WC, Lee TC, Wong SC, Nagiel A, Lam RF. Endoscopic vitreoretinal surgery: Review of current applications and future trends. Surv Ophthalmol 2020; 66:198-212. [PMID: 33278403 DOI: 10.1016/j.survophthal.2020.11.004] [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: 07/07/2020] [Revised: 11/20/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
Endoscopy provides unique optical properties to circumvent anterior segment opacities and visualize difficult-to-access anatomical regions, including retroirideal, retrolental, ciliary body, and anterior retinal structures. We summarize the basic principles and utilization of endoscopic vitreoretinal surgery, along with recent technological advances in the field base on a structured literature search in Pubmed, Embase, and Google Scholar database up to February, 2020. Endoscopy has been used in the management of retinal detachment, ischemic retinopathies with neovascular glaucoma, severe ocular trauma, endophthalmitis, lens-related disorders in the posterior segment, pediatric vitreoretinal diseases, and implantation of retinal prostheses. Ongoing development of endoscopic technology aims to provide higher resolution images with endoscopes of smaller diameter. New surgical techniques supported by the adoption of endoscopy are available to manage challenging surgical scenarios. Endoscopy can be a useful adjunct to microscope wide-angle viewing systems in the management of complex vitreoretinal diseases.
Collapse
Affiliation(s)
| | | | - Wai Ching Lam
- Department of Ophthalmology, The University of Hong Kong, Hong Kong; Department of Ophthalmology and Vision Science, University of Toronto, Ontario, Canada
| | - Thomas C Lee
- The Vision Center, Department of Surgery, Children's Hospital Los Angeles, Los Angeles, California, USA; USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Sui Chien Wong
- Great Ormond Street Hospital for Children, London, England; National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital & UCL Institute of Ophthalmology, London, England; Royal Free Hospital, London, England
| | - Aaron Nagiel
- The Vision Center, Department of Surgery, Children's Hospital Los Angeles, Los Angeles, California, USA; USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Robert Fung Lam
- Department of Ophthalmology, Caritas Medical Centre, Hong Kong
| |
Collapse
|
5
|
Abdullatif AM, Nabih MH. Endodiathermy assisted vitreous base and anterior hyaloid visualization during vitrectomy for rhegmatogenous retinal detachment. Eur J Ophthalmol 2020; 31:2606-2611. [PMID: 32985268 DOI: 10.1177/1120672120960329] [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: 11/17/2022]
Abstract
PURPOSE To describe a novel technique to visualize vitreous base and the anterior hyaloid during vitrectomy for Rhegmatogenous Retinal Detachment (RRD). METHODS Retrospective, single-center study enrolling all patients who underwent vitrectomy for RRD between June 2015 and June 2018. After core vitrectomy and the necessary additional procedures, endodiathermy was activated near the edge of the peripheral vitreous. This created a heat-induced bubble stream and the bubbles were entangled in the vitreous base and anterior hyaloid. As a result, the vitreous base and anterior hyaloid were visualized and removed. RESULTS Between June 2015 and June 2018, a total of 210 cases of rhegmatogenous retinal detachment were treated with vitrectomy. Endodiathermy assisted vitreous base shaving and anterior hyaloid removal was used in those cases with a very low incidence of iatrogenic peripheral retinal breaks during vitreous base shaving (2%), and with no case of lens injury related to the technique. We achieved a final anatomical success of 95.2% in the study period after mean number of operations of 1.3 ± 0.2. Endodiathermy near the peripheral vitreous was not associated with any intraoperative or postoperative complications. CONCLUSION Endodiathermy assisted vitreous base and anterior hyaloid visualization is a safe adjuvant method that could help in achieving complete and rapid vitreous base shaving and anterior hyaloid removal.
Collapse
Affiliation(s)
| | - Mostafa H Nabih
- Department of Ophthalmology, Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt
| |
Collapse
|
6
|
New era in endoscopic vitreoretinal surgery. Graefes Arch Clin Exp Ophthalmol 2019; 257:2797-2798. [PMID: 31650273 DOI: 10.1007/s00417-019-04468-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 07/06/2019] [Accepted: 09/05/2019] [Indexed: 10/25/2022] Open
|
7
|
Ajlan RS, Desai AA, Mainster MA. Endoscopic vitreoretinal surgery: principles, applications and new directions. Int J Retina Vitreous 2019; 5:15. [PMID: 31236288 PMCID: PMC6580629 DOI: 10.1186/s40942-019-0165-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 04/30/2019] [Indexed: 12/30/2022] Open
Abstract
Purpose To analyze endoscopic vitreoretinal surgery principles, applications, challenges and potential technological advances. Background Microendoscopic imaging permits vitreoretinal surgery for tissues that are not visible using operating microscopy ophthalmoscopy. Evolving instrumentation may overcome some limitations of current endoscopic technology. Analysis Transfer of the fine detail in endoscopic vitreoretinal images to extraocular video cameras is constrained currently by the caliber limitations of intraocular probes in ophthalmic surgery. Gradient index and Hopkins rod lenses provide high resolution ophthalmoscopy but restrict surgical manipulation. Fiberoptic coherent image guides offer surgical maneuverability but reduce imaging resolution. Coaxial endoscopic illumination can highlight delicate vitreoretinal structures difficult to image in chandelier or endoilluminator diffuse, side-scattered lighting. Microendoscopy’s ultra-high magnification video monitor images can reveal microscopic tissue details blurred partly by ocular media aberrations in contemporary surgical microscope ophthalmoscopy, thereby providing a lower resolution, invasive alternative to confocal fundus imaging. Endoscopic surgery is particularly useful when ocular media opacities or small pupils restrict or prevent transpupillary ophthalmoscopy. It has a growing spectrum of surgical uses that include the management of proliferative vitreoretinopathy and epiretinal membranes as well as the implantation of posterior chamber intraocular lenses and electrode arrays for intraretinal stimulation in retinitis pigmentosa. Microendoscopy’s range of applications will continue to grow with technological developments that include video microchip sensors, stereoscopic visualization, chromovitrectomy, digital image enhancement and operating room heads-up displays. Conclusion Microendoscopy is a robust platform for vitreoretinal surgery. Continuing clinical and technological innovation will help integrate it into the modern ophthalmic operating room of interconnected surgical microscopy, microendoscopy, vitrectomy machine and heads-up display instrumentation.
Collapse
Affiliation(s)
- Radwan S Ajlan
- 1Department of Ophthalmology, University of Kansas School of Medicine, 7400 State Line Road, Prairie Village, KS 66208-3444 USA
| | - Aarsh A Desai
- 2School of Medicine, University of Missouri-Kansas City, Kansas City, MO USA
| | - Martin A Mainster
- 1Department of Ophthalmology, University of Kansas School of Medicine, 7400 State Line Road, Prairie Village, KS 66208-3444 USA
| |
Collapse
|
8
|
Abstract
Proliferative vitreoretinopathy (PVR) is the most common cause for failure of rhegmatogenous retinal detachment repair and is characterized by the growth and contraction of cellular membranes within the vitreous cavity and on both sides of the retinal surface as well as intraretinal fibrosis. Currently, PVR is thought to be an abnormal wound healing response that is primarily driven by inflammatory, retinal, and RPE cells. At this time, surgery is the only management option for PVR as there is no proven pharmacologic agent for the treatment or prevention of PVR. Laboratory research to better understand PVR pathophysiology and clinical trials of various agents to prevent PVR formation are ongoing.
Collapse
Affiliation(s)
- Sana Idrees
- Flaum Eye Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Jayanth Sridhar
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Ajay E. Kuriyan
- Flaum Eye Institute, University of Rochester Medical Center, Rochester, NY, USA
| |
Collapse
|
9
|
Yu YZ, Zou YP, Zou XL. Endoscopy-assisted vitrectomy in the anterior vitreous. Int J Ophthalmol 2018; 11:506-511. [PMID: 29600187 DOI: 10.18240/ijo.2018.03.23] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 01/12/2018] [Indexed: 11/23/2022] Open
Abstract
Endoscopy-assisted ocular surgery is a relatively old technique that is increasingly being recognized for its application in cases of vitreoretinal disease. This technique is especially useful when both the vitreous and retina are difficult to access because of media opacity, a small pupil, or a microcornea. In this context, the anterior vitreous is often difficult to dissect because of its complex pathological changes. This article reviews the common anatomical features and pathologies that are observed in the anterior vitreous, as well as the applications and indications of endoscopy-assisted vitrectomy in the anterior vitreous.
Collapse
Affiliation(s)
- Yong-Zhen Yu
- Department of Ophthalmology, Guangzhou General Hospital of Guangzhou Military Command of PLA, Guangzhou 510000, Guangdong Province, China
| | - Yu-Ping Zou
- Department of Ophthalmology, Guangzhou General Hospital of Guangzhou Military Command of PLA, Guangzhou 510000, Guangdong Province, China
| | - Xiu-Lan Zou
- Department of Ophthalmology, Guangzhou General Hospital of Guangzhou Military Command of PLA, Guangzhou 510000, Guangdong Province, China
| |
Collapse
|
10
|
Kuhn F, Schrader W. Prophylactic chorioretinectomy for eye injuries with high proliferative-vitreoretinopathy risk. Clin Anat 2017. [DOI: 10.1002/ca.22906] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Ferenc Kuhn
- Helen Keller Foundation for Research and Education; Birmingham Alabama
| | | |
Collapse
|
11
|
Martiano D, L’helgoualc’h G, Cochener B. Vitrectomie endoscopique 20Ga dans les endophtalmies sévères : série de 18 cas et revue de la littérature. J Fr Ophtalmol 2015; 38:941-9. [DOI: 10.1016/j.jfo.2015.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Revised: 07/01/2015] [Accepted: 07/02/2015] [Indexed: 11/17/2022]
|
12
|
Jusufbegovic D, Tamiya S, Kaplan HJ. Risk factors and prevention of proliferative vitreoretinopathy. EXPERT REVIEW OF OPHTHALMOLOGY 2015. [DOI: 10.1586/17469899.2015.1090875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
13
|
Combined pars plana vitrectomy-scleral buckle versus pars plana vitrectomy for proliferative vitreoretinopathy. Int Ophthalmol 2015; 36:217-24. [PMID: 26260357 DOI: 10.1007/s10792-015-0104-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 07/21/2015] [Indexed: 10/23/2022]
Abstract
The purpose of the study is to evaluate the surgical outcomes of combined pars plana vitrectomy-scleral buckle (PPV-SB) versus pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment complicated with proliferative vitreoretinopathy (PVR). One thousand one hundred and seventy four patients with rhegmatogenous retinal detachment surgery between January 2002 and December 2013 were retrospectively reviewed. Patients with grade C PVR treated with either combined PPV-SB or PPV alone were included in the study. Study outcomes included single surgery anatomic success rate and postoperative visual outcome at 12 months postoperatively. Seventy-seven patients with grade C PVR were identified for analysis. At the end of 12-month follow-up, 80.5 % eyes (33/41) in the PPV-SB group and 58.3 % eyes (21/36) in the PPV group achieved single surgery anatomical success. In a multiple logistic regression model, none of the baseline variables (age, gender, macula status, grade of PVR, extent of detachment, presence of vitreous hemorrhage, lens status, status of high myopia) nor types of retinal detachment surgery (use of scleral buckle, barrier endolaser, 360 degree endolaser, cryopexy, retinectomy, tamponade agent, phacoemulsification) had significant effect on single surgery anatomical success. The post-treatment mean logMAR visual acuity of the PPV-SB group was 1.58 ± 0.58 and the PPV group was 1.57 ± 0.61. There was no significant difference in the postoperative visual acuity between the two groups (P = 0.849). For patients with grade C PVR, PPV-SB did not demonstrate a superiority over PPV alone in achieving single surgery anatomical success.
Collapse
|
14
|
Kaplowitz K, Kuei A, Klenofsky B, Abazari A, Honkanen R. The use of endoscopic cyclophotocoagulation for moderate to advanced glaucoma. Acta Ophthalmol 2015; 93:395-401. [PMID: 25123160 DOI: 10.1111/aos.12529] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 07/10/2014] [Indexed: 11/30/2022]
Abstract
Endoscopic Cyclophotocoagulation (ECP) is a glaucoma surgery designed to reduce the intraocular pressure (IOP) by partially ablating the ciliary processes to decrease aqueous humour production and secretion. The aim of this paper is to review the literature regarding the background, indications and results of the surgery. Although there are case reports of visually devastating complications, including persistent hypotony and phthisis, the use of ECP is often reported in eyes with advanced diseases. When compared with both trabeculectomy and aqueous shunt implantation, the visual outcomes were better with ECP while the IOP outcomes were very similar. The evidence supports ECP as a very effective surgical option in recalcitrant glaucoma while some evidence supports its safety for use as a primary procedure.
Collapse
Affiliation(s)
- Kevin Kaplowitz
- Department of Ophthalmology; Stony Brook University Medical Center; Stony Brook New York USA
| | - Andrew Kuei
- Department of Ophthalmology; Stony Brook University Medical Center; Stony Brook New York USA
| | - Britany Klenofsky
- Department of Ophthalmology; Stony Brook University Medical Center; Stony Brook New York USA
| | - Azin Abazari
- Department of Ophthalmology; Stony Brook University Medical Center; Stony Brook New York USA
| | - Robert Honkanen
- Department of Ophthalmology; Stony Brook University Medical Center; Stony Brook New York USA
| |
Collapse
|
15
|
Boscher C, Kuhn F. Endoscopic Evaluation and Dissection of the Anterior Vitreous Base. Ophthalmic Res 2015; 53:90-9. [DOI: 10.1159/000370032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 11/17/2014] [Indexed: 11/19/2022]
|