Clinical outcome of 23g Trans-Conjunctival pars plana vitrectomy - a prospective comparison of Phaco-Vitrectomy with only vitrectomy in phakic eyes

Complications of Silicone Oil as Vitreous Tamponade in Pars Plana Vitrectomy: A Mini Review

PURPOSE

Silicone oil (SO) has been used as a vitreous tamponade for decades. Surgical complications such as glaucoma, cataract, or emulsification are well known. Despite that, increasing case reports of unexplained visual loss after SO removal is concerning because there is no treatment available. This article describes practical complications related to SO use and advantages/disadvantages for consideration regarding the choice of a vitreous substitute in practice.

METHODS

A literature review was conducted for publications related to silicone oil, heavy silicone oil, and vitreous substitutes.

RESULTS

This article summarizes the SO chemical and physical properties including both SO and heavy SO and postoperative complications such as corneal decompensation, glaucoma, hypotony, cataract, optic neuropathy. Surgical complications such as over/underfilling, SO migration/emulsification, sticky SO and proliferative vitreoretinopathy (PVR) simulating epiretinal membranes formation, recurrent retinal detachments, SO unexplained visual loss, and permanent SO, are described. A brief overview on potential vitreous substitutes is presented.

CONCLUSION

The decision to use SO as vitreous substitute in daily practice is based on the severity of retinal diseases and surgeon experience. SO potential complications must not be underestimated. The pursuit of novel safer vitreous substitutes is imperative.

Systematic review of the efficacy and safety of stage I or II IOL implantation in patients with diabetic retinopathy

BACKGROUND

Intraocular lens (IOL) implantation is required after vitrectomy combined with cataract surgery in diabetic retinopathy patients. However, the question of whether an IOL should be implanted in stage I after vitrectomy or stage II during silicone oil filling has been controversial, and there has been no systematic review of this clinical issue.

METHODS

WanFang, SinoMed CNKI, VIP, PubMed, Embase, and Cochrane Library databases were systematically searched for relevant studies. The deadline was May 8, 2021. All studies of stage I or II IOL implantation in patients with diabetes who underwent vitrectomy were included. Revman 5.3 software was used for the meta-analysis.

RESULTS

Four studies, involving 253 eyes, were included. This study analyzed the literature with a common outcome index by meta-analysis and systematically evaluated the literature without a common outcome index. Four studies compared the efficacy and safety of the 2 sequential surgical methods in patients with diabetic retinopathy. The results of the meta-analysis showed that there was no significant difference in the efficacy and safety of stage II IOL implantation when compared with stage I IOL implantation (P > .05). One study showed that stage II cataract surgery with oil extraction resulted in better postoperative visual acuity and fewer complications than stage I cataract surgery with vitrectomy. One study showed that stage II IOL implantation during oil extraction had better postoperative visual acuity than stage I IOL implantation during vitrectomy without increasing surgical complications.

CONCLUSION

Vitrectomy combined with stage II IOL implantation is safer and more effective than stage I in patients with diabetic retinopathy; however, more clinical studies are needed to verify this.

Reopening the severely contracted lens capsular bag post-phacovitrectomy by injecting OVD and removing the fibrous membranous material

Implantation of an intraocular lens (IOL) after combined vitrectomy and cataract surgery is usually required to reduce postoperative refraction errors. However, because of the severe fibrosis of the anterior capsule and the adhesion between the anterior and posterior capsules, it is difficult to reopen the capsular bag to complete the secondary IOL implantation. In this study, a surgical approach is described for reopening the severe adhesion between capsules and removing the significant fibroproliferative membranous material by injecting ophthalmic viscosurgical device into the periphery of the capsular bag to separate the anterior and posterior capsules. The IOL was implanted into the capsular bag without any zonular rupture or posterior capsule tear. The position of the IOL was stable during postoperative follow-up up to 3 months. This procedure to open a severely fibrosis capsule was safe and effective.

Parsplana vitrectomy alone versus parsplana vitrectomy combined with phacoemulsification for the treatment of rhegmatogenous retinal detachment: a randomized study

BACKGROUND

To compare parsplana vitrectomy (PPV) with and without phacoemulsification to treat rhegmatogenous retinal detachment (RRD).

METHODS

Subjects aged 48-65 years with RRD in a phakic eye due to superior retinal tears with an overall extension of retinal breaks < 90° underwent to PPV alone (group A); or PPV plus phacoemulsification (phacovitrectomy, PCV, group B). Post-operative follow-up visits occurred at 1 week, 1 month (m1), 3 months (m3), and 6 months (m6) after surgery. The main outcome was the rate of retinal reattachment. Secondary outcomes included best-corrected visual acuity (BCVA), intraocular pressure (IOP), central macular thickness (CMT), and cataract progression (in the lens-sparing [PPV-alone] group).

RESULTS

In this initial phase of the study a total of 59 patients (mean age: 55 years, 59 eyes) were enrolled: 29 eyes in group A and 30 eyes in group B. Both groups had similar gas tamponade. During the follow-up there were three cases of RRD recurrence in group A and one in group B. The relative risk of recurrence in group A was 3.22 times higher but the difference was not significant (p = 0.3). The two groups were also similar in terms of BCVA and IOP variation. At m3, CMT was significantly higher in group B (p = 0.014). In group A, cataract progression was significant at m6 (p = 0.003).

CONCLUSIONS

In a cohort of RRD patients selected according to their preoperative clinical characteristics, PPV was comparable to PCV in terms of the rate of retinal reattachment after 6 months.

TRIAL REGISTRATION

ISRCTN15940019 . Date registered: 15/01/2021 (retrospectively registered).

Comparative study of combined vitrectomy with phacoemulsification versus vitrectomy alone for primary full-thickness macular hole repair

Background

To assess the effectiveness and safety of 23-gauge pars plana vitrectomy combined with phacoemulsification versus vitrectomy alone in patients over 50 years with primary full-thickness macular holes (FTMH).

Methods

We retrospectively reviewed the medical records related to 406 consecutive vitrectomies performed for primary FTMH. Phacovitrectomy was performed in 294 phakic eyes whereas vitrectomy alone in 112 pseudophakic eyes. The cases were divided into three groups according to the stage of the FTMH: stage 2 (n = 93), stage 3 (n = 270), or stage 4 (n = 43). The primary outcome measure was the closure of the FTMH. The secondary outcome measures were the evolution of visual acuity as well as intraoperative and postoperative complications.

Results

Neither the primary nor the secondary outcomes differed between phacovitrectomy and vitrectomy alone for all three stages. The FTMH were closed in 375 eyes (92.4 %) after a first operation. The closure rate was higher for stage 2 (96.8 %) than for stages 3 (91.1 %) or 4 (90.75 %), but not significantly (P = 0.189). The mean visual acuity increased significantly from preoperatively LogMAR 0.68 (± SD 0.2) to LogMAR 0.43 (± SD 0.24) at the end of the follow-up (p < 0.001).

Conclusions

Combined 23-gauge pars plana vitrectomy with phacoemulsification for primary FTMH repair in patients over 50 years is as efficient and safe when compared with vitrectomy only.

Trial registration

The study was approved on 30^th April 2020 by the local ethics committee (Ethikkommission Ostschweiz, EKOS 20/074; BASEC Nr. 2020-01033).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12886-021-01918-2.

Outcomes of simultaneous vs. sequential pars plana vitrectomy and cataract surgery

The coexistence of cataract and vitreoretinal diseases is common in clinical practice. The technological achievements of the last decade in both types of surgeries, allow simultaneous interventions on lens and retina. This retrospective study assessed the morphofunctional results obtained after performing simultaneous surgeries in a series of 87 patients presenting with both pathologies. The cases were retrospectively reviewed from their clinical records from 2017 to 2019. The patients were divided into two groups: group 1 comprising 41 cases underwent the combined procedure and group 2 comprising 46 patients underwent vitrectomy, followed by cataract surgery after 3-10 months. The functional and anatomical outcomes and the complications were assessed pre- and post-operatively. The statistical analysis was carried out by MaxStat software. The final best corrected visual acuity (BCVA), in group 1 was <0.1 in 4.88% of the cases, 0.1 to 0.3 in 17.07%, 0.3 to 0.5 in 51.22% and >0.5 in 26.83% eyes. In group 2, the final BCVA, after both surgeries were completed was <0.1 in 8.7% cases, 0.1 to 0.3 in 30.43%, 41.3% were 0.3 to 0.5 and 19.57% were >0.5. During the cataract surgery, the most common intraoperative complication was miosis, followed by posterior capsule rupture. Postoperative, 12.2% cases from group 1 developed an immediate inflammatory reaction in the anterior chamber, and 17.07% presented with posterior capsular opacification (PCO). Simultaneous surgery is safe and effective in obtaining a good morphological and functional result and offers the advantage of a clear eye media that allows a safer vitrectomy and thus a quicker rehabilitation of the patient. The analysis of the risks and benefits of each procedure should be taken into account and the cases selected individually for either simultaneous or sequential surgery in order to obtain the best outcomes.