Comparison of the 20-gauge conventional vitrectomy technique with the 23-gauge releasable suture vitrectomy technique

PURPOSE

To compare the efficacy of the transconjunctival releasable suture technique for pars plana vitrectomy using 23-gauge (23G) instruments versus the conventional 20-gauge (20G) technique.

METHODS

A retrospective and interventional case series was consecutively performed for 199 eyes of the 192 patients that were a part of this study. Clinical data were reviewed retrospectively regarding the operation time, preoperative and postoperative intraocular pressure, visual acuity and astigmatism for 54 consecutive patients who received a 23G releasable suture vitrectomy and for 98 consecutive patients who received a 20G conventional vitrectomy during the period between April 2007 and September 2010.

RESULTS

Mean operation time based on the operation record was 88.5 ± 20.1 minutes in the 23G releasable suture vitrectomy group and 102.1 ± 23.1 minutes in the 20G conventional vitrectomy group, respectively (p = 0.01). The last best-corrected visual acuity (BCVA) was significantly better than the preoperative BCVA in both patient groups (p = 0.01, p = 0.01). The 23G releasable suture group showed less surgically induced astigmatism than the 20G conventional vitrectomy group. Vitreous bleeding was observed to be in 6 eyes (5.9%) in the 23G group, and in 8 eyes (8.2%) in the 20G group. In addition, ocular hypertension was noted to be in 3 eyes (3.0%) in the 23G group, and 6 eyes (6.1%) in the 20G group. No serious complications such as postoperative hypotony or endophthalmitis were observed in either group.

CONCLUSIONS

The 23G releasable suture technique is as effective as the 20G conventional technique and offers several advantages.

Rhegmatogenous retinal detachment after LASIK for myopia of up to -10 diopters: 10 years of follow-up

BACKGROUND

The aim of this work was to characterize rhegmatogenous retinal detachment (RRD) in over 22,000 eyes after laser-assisted in situ keratomileusis (LASIK) for the correction of myopia ≤ -10.00 diopters (D), its characteristics, and its frequency at 10 years of follow-up.

METHODS

This is a retrospective single-center interventional non-comparative case series. A total of 22,296 myopic eyes that underwent surgical correction of myopia ≤ -10.00 D were included. LASIK for the correction of myopia was performed in all eyes. Patients were followed for 10 years after LASIK. The clinical charts of patients that developed rhegmatogenous retinal detachment (RRD) after LASIK were reviewed.

RESULTS

A total of 11,594 (52%) eyes came back for follow-up after LASIK at 10 years. Twenty-two eyes (19 patients) developed a RRD after LASIK at 10 years. Rhegmatogenous retinal detachments occurred between 1 month and 10 years (mean: 31.6 ± 39.3 months) after LASIK. Eyes that developed a RRD had from -1.50 to -9.75 D of myopia (mean: -4.81 ± 2.2 D) before LASIK. The frequency of RRD after LASIK determined in our study was 0.05% (11/22,296) at 1 year, 0.15% (18/11,371) at 5 years, and 0.19% (22/11,594) at 10 years.

CONCLUSIONS

Rhegmatogenous retinal detachment after LASIK for the correction of myopia ≤ -10.00 D is infrequent. The risk of RRD after LASIK is very low if you screen patients, and do prophylactic treatment as performed in this study. RRD, if managed promptly, will result in good vision. We recommend that patients scheduled for refractive surgery undergo a very thorough dilated indirect funduscopy with scleral depression and treatment of any retinal lesion predisposing to the development of a RRD before LASIK surgery should be performed.

Combined 23-gauge microincisonal vitrectomy surgery and phacoemulsification with AcrySof toric intraocular lens implantation: a comparative study

AIM

To compare AcrySof toric intraocular lens (IOL) and non-toric IOL in patients who had combined 23-gauge microincisional vitrectomy surgery (MIVS) and phacoemulsification for vitreoretinal diseases and cataract with pre-existing corneal astigmatism.

METHODS

This is a prospective comparative study comprised of 30 patients (30 eyes) who had combined 23-gauge MIVS and phacoemulsification for vitreoretinal diseases and cataract with pre-existing regular corneal astigmatism greater than 1 diopters (D). In all, 15 eyes had AcrySof toric IOL (Alcon Laboratories) and 15 eyes had non-toric IOL (Akreos AO MI60; Bausch & Lomb) implantation. Main outcome measures were uncorrected visual acuity (UCVA), refractive cylinder, surgically induced astigmatism (SIA), and IOL misalignment during 6 months.

RESULTS

The mean UCVA of the toric IOL group was better than the non-toric IOL group at postoperative months 1, 3, and 6 (P<0.001, respectively). The mean absolute residual refractive cylinder of the toric IOL group at postoperative week 1, and months 1, 3, and 6 was less than the non-toric IOL group (P=0.008, <0.001, <0.001, and <0.001, respectively). There was no difference in the mean SIA between the two groups (P>0.05, respectively). The mean toric IOL axis rotation was 3.52 ± 2.75°, which was within 5° in 66.7% of the toric IOL group and within 10° in 100%.

CONCLUSIONS

Combined 23-gauge MIVS and phacoemulsification with AcrySof toric IOL implantation is an effective method of correcting vitreoretinal diseases and cataract and pre-existing corneal astigmatism, and the toric IOL showed good rotational stability, even in vitrectomized eyes for 6 months.

Ocular surface influences on corneal topography

The shape of a cornea, as measured by corneal topography, can be influenced by a variety of factors. Direct and obvious influences on corneal shape include corneal pathology, corneal surgery, and contact lenses. With the modern and widespread use of computerized videokeratoscopy, subtle topographic changes from other external and systemic influences can now be detailed. The purpose of this review is to examine ocular surface influences and indirect surgical, pathological, and pharmacological factors that affect the corneal shape and acquired topographic maps. The clinical consequences of altered corneal topography will be highlighted throughout.

A phacovitrectomy with a clear corneal incision for a full-thickness macular hole

PURPOSE

To describe the results of a pars plana vitrectomy, combined with phacoemulsification, using a sutureless, superotemporal, clear corneal incision for patients with a macular hole.

METHODS

This study reviewed the records of 22 patients (22 eyes) who underwent a phacoemulsification with the insertion of an acrylic intraocular lens, using a 3.2 mm superotemporal clear corneal incision and a pars plana vitrectomy with an internal limiting membrane peeling in one session, for the treatment of a macular hole.

RESULTS

All 22 patients had their macular holes closed using the combined surgical procedures. The mean preoperative visual acuity was 0.086, and the mean postoperative visual acuity was 0.173. This improvement was statistically significant (paired Student's t-test, p < 0.05). No patients developed posterior capsular opacity, retinal detachment, or a cystoid macular edema. The surgically induced astigmatism (SIA) was 0.808 diopters (0.808 +/- 0.761) two months after surgery.

CONCLUSIONS

Combining cataract surgery with vitrectomy can achieve visual rehabilitation in the early postoperative period without requiring post-vitrectomy cataract surgery. A sutureless clear corneal incision, used in this procedure, can minimize the SIA and promote postoperative wound healing. If sutureless, transconjunctival, pars plana vitrectomy can be used more widely in the future, then the simplified, combined cataract surgery using a small clear corneal incision will also become more common, hence decreasing operation time, and hastening postoperative recovery.

Retinal Detachment in Myopic Eyes After Laser in situ Keratomileusis

PURPOSE

To report the characteristics and surgical outcomes of rhegmatogenous retinal detachments in myopic eyes after laser in situ keratomileusis (LASIK).

METHODS

Clinical charts of patients that developed rhegmatogenous retinal detachment after LASIK were reviewed. Surgery to repair rhegmatogenous retinal detachment was performed in 31 eyes (mean follow-up of 14 months after vitreoretinal surgery).

RESULTS

A total of 38,823 eyes underwent surgical correction of myopia from -0.75 to -29.00 D (mean -6.00 D). Thirty-three eyes (27 patients; frequency .08%) developed rhegmatogenous retinal detachment after LASIK; detachments occurred between 12 days and 60 months (mean 16.3 mo) after LASIK. Eyes that developed a rhegmatogenous retinal detachment had a mean -8.75 D before LASIK. Most rhegmatogenous retinal detachment and retinal breaks occurred in the temporal quadrants (71.1%). Final best spectacle-corrected visual acuity (BSCVA) of 20/40 or better was obtained in 38.7% of the 31 eyes (two patients refused surgery). Poor final visual acuity (20/200 or worse) occurred in 22.6% of eyes. Information regarding visual acuity after LASIK and before the development of rhegmatogenous retinal detachment was available in 24 eyes; 45.8% (11/24 eyes) lost two or more lines of visual acuity after vitreo-retinal surgery. Reasons for poor visual acuity included the development of proliferative vitreo-retinopathy (n=5), epiretinal membrane (n=1), chronicity of rhegmatogenous retinal detachment (n=1), new breaks (n=1), displaced corneal flap (n=1), and cataract.

CONCLUSIONS

Rhegmatogenous retinal detachment after LASIK for myopia is a serious complication. Final visual acuity may be limited by myopic degeneration, amblyopia, or delayed surgical repair.

Rhegmatogenous retinal detachment in myopic eyes after laser in situ keratomileusis

PURPOSE

To report the characteristics and frequency of rhegmatogenous retinal detachment (RRD) after laser in situ keratomileusis (LASIK) for the correction of myopia in a large case series.

SETTING

Private practices, Caracas, Venezuela.

METHODS

Five refractive surgeons and 31 739 myopic eyes that had surgical correction of a mean myopia of -6.01 diopters (D) (range -0.75 to -29.00 D) participated in this study. Laser in situ keratomileusis was performed in all eyes. Patients were followed for a mean of 36 months (range 6 to 48 months). The clinical charts of patients who developed RRD after LASIK were reviewed.

RESULTS

Twenty eyes (17 patients) developed RRD after LASIK. Rhegmatogenous retinal detachments occurred a mean of 13.9 months (range 1 to 36 months) after LASIK. The mean pre-LASIK myopia in eyes that developed an RRD was -7.02 D (range -1.50 to -16.00 D). Most RRDs and retinal breaks occurred in the temporal quadrants (71.4%). Rhegmatogenous retinal detachments were managed with vitrectomy, cryoretinopexy, scleral buckling, argon laser retinopexy, or pneumatic retinopexy techniques. The frequency of RRD after LASIK was 0.06%.

CONCLUSIONS

Rhegmatogenous retinal detachment after LASIK for the correction of myopia is infrequent. If managed promptly, RRD will result in good vision. Before LASIK is performed, patients should have a thorough dilated indirect fundoscopy with scleral depression and treatment of any retinal lesion predisposing to the development of an RRD.