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Agarwalla A, Chawla R, Azad SV, Venkatesh P, Vohra R, Kumar V. EVALUATION OF PRONE VERSUS SUPINE POSITIONING IN FRESH RHEGMATOGENOUS RETINAL DETACHMENT TREATED WITH PARS PLANA VITRECTOMY AND GAS. Retina 2024; 44:1150-1156. [PMID: 38470916 DOI: 10.1097/iae.0000000000004075] [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: 03/14/2024]
Abstract
PURPOSE To compare Supine versus Prone positioning in fresh rhegmatogenous retinal detachments treated with vitrectomy and gas tamponade. METHODS This was a prospective randomized controlled trial of 72 eyes with fresh rhegmatogenous retinal detachment that underwent 25-gauge vitrectomy: 37 eyes were allotted supine position and 35 were allotted prone position. Cases were evaluated for single-surgery reattachment rates, best-corrected visual acuity, intraocular pressure, cataract formation, and any complications. The patients were followed up for a period of 3 months. RESULTS Both groups had similar demographics, and no significant difference was found between the two groups in terms of extent of retinal detachment, position, and number of breaks. The anatomical success after single surgery was 97.3% in the Supine group and 94.3% in the Prone group ( P = 0.609). The best-corrected visual acuity at the end of 3 months was 0.44 ± 0.27 in the Supine group and 0.35 ± 0.27 in the Prone group ( P = 0.119) with a significant increase in best-corrected visual acuity preoperatively from 0.11 ± 0.22 and 0.13 ± 0.22 in Supine and Prone groups, respectively ( P = <0.001). The intraocular pressure in the two groups was comparable at each follow-up. The rates of cataract formation were also similar in the two groups-60% and 53.8% in Supine and Prone groups, respectively ( P = 1.00). Complications such as spikes in intraocular pressure, epiretinal membrane formation, and cystoid macular edema were similar in both groups. CONCLUSION Rates of retinal reattachment were comparable in both groups showing that supine position is equally safe and effective for adequate tamponade.
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Affiliation(s)
- Anushka Agarwalla
- Dr. Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Christensen CA, Thompson IA, Nielsen JS. Small-Gauge Vitrectomy for Macular Surgery Using a Systematic Approach to Wound Closure: 27-Gauge vs 25-Gauge. JOURNAL OF VITREORETINAL DISEASES 2024; 8:45-50. [PMID: 38223781 PMCID: PMC10786086 DOI: 10.1177/24741264231209587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Purpose: To evaluate the effectiveness of and to compare vitrectomy performed with 25-gauge or 27-gauge instrumentation for macular surgery by assessing the surgical duration, wound closure, and complication rate using a systematic approach to wound closure. Methods: In this retrospective chart review, 125 25-gauge and 125 27-gauge consecutive small-gauge vitrectomy surgeries for epiretinal membrane, macular hole, vitreomacular adhesion, or a combination were analyzed during and immediately after surgery. Wound closure was performed using a systematic protocol. Results: Baseline characteristics were not statistically different between the 2 groups. The surgical duration was similar with 25-gauge vitrectomy and 27-gauge vitrectomy (P = .07). Although spontaneous wound closure was common in both groups, it was more common in the 27-gauge group (P = .22). Intraoperative and postoperative complications were uncommon in both groups. Conclusions: Findings show that 27-gauge vitrectomy is a safe, effective alternative to the more commonly used 25-gauge vitrectomy for macular surgery. Less manipulation was required to achieve wound closure with 27-gauge vitrectomy using a standardized wound-closure protocol. Smaller 27-gauge vitrectomy did not increase surgical time or complications over 25-gauge vitrectomy for macular surgery.
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Affiliation(s)
- Cory A. Christensen
- Department of Ophthalmology, SUNY Upstate Medical University, Syracuse, NY, USA
| | | | - Jared S. Nielsen
- Vitreoretinal Diseases and Surgery, Wolfe Eye Clinic, West Des Moines, IA, USA
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Cameron NW, Karadaghy A, Mitchell MK, Ajlan RS. Optic inversion of scleral-fixated intraocular lens after vitrectomy with fluid-air exchange: case series and review of the literature. J Surg Case Rep 2023; 2023:rjad600. [PMID: 38026751 PMCID: PMC10640673 DOI: 10.1093/jscr/rjad600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023] Open
Abstract
Lens dislocation is a significant complication after cataract surgery. Scleral fixation of 3-piece intraocular lens provides favorable visual outcome and can spare patients the need for lens exchange. Two patients presented with dislocated 3-piece lenses implanted over 10 years earlier. Both patients underwent pars plana vitrectomy and dropped lens rescue with scleral fixation. Postoperatively, the lens optic was found flipped nearly 90° at the optic-haptic junctions secondary to fluid-air exchange performed during vitrectomy. Both patients underwent intraocular lens exchange with a four point sclera fixated lens. Our study found that air tamponade is better avoided during rescue of old dislocated 3-piece lens implants. Intraocular lens exchange is preferred, when possible, to avoid complications associated with old dislocated lenses. Larger studies are needed to determine the effect of time on dislocated lens implants materials.
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Affiliation(s)
- Nathaniel W Cameron
- Department of Ophthalmology, University of Kansas Medical Center, Kansas City, KS, United States
| | - Amin Karadaghy
- Department of Ophthalmology, University of Kansas Medical Center, Kansas City, KS, United States
| | - Mary K Mitchell
- Department of Ophthalmology, University of Kansas Medical Center, Kansas City, KS, United States
| | - Radwan S Ajlan
- Department of Ophthalmology, University of Kansas Medical Center, Kansas City, KS, United States
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Mohan S, Nadri G, Mohan S. A Rare Complication Causing Another Rare Complication: Corneal Dellen with Infiltration Secondary to Subconjunctival Silicon Oil. BEYOGLU EYE JOURNAL 2023; 8:233-236. [PMID: 37766771 PMCID: PMC10521125 DOI: 10.14744/bej.2023.74508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 04/05/2023] [Accepted: 05/02/2023] [Indexed: 09/29/2023]
Abstract
The usage of silicon oil (SO) in vitreoretinal surgery is associated with potential complications. One such complication is the extravasation of SO into the subconjunctival space through open sclerotomies. Subconjunctival SO (SCSO) can cause irregularities in the ocular surface which predisposes to complications like corneal dellen. This corneal dellen can get infected in rare situations. SCSO needs to be removed to stabilize the ocular surface. We present a case of corneal dellen with infiltration which developed as a consequence of SCSO and its management.
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Affiliation(s)
- Sujatha Mohan
- Department of Cornea, Rajan Eye Care Hospital, Chennai, India
| | - Gauhar Nadri
- Department of Cornea, Rajan Eye Care Hospital, Chennai, India
| | - Sashwanthi Mohan
- Department of Vitreoretina, Rajan Eye Care Hospital, Chennai, India
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Pan Q, Lu S, Li M, Pan H, Wang L, Mao Y, Wu W, Zhang Y. Vitrectomy and ILM peeling in rhesus macaque: pitfalls and tips for success. Eye (Lond) 2023; 37:2257-2264. [PMID: 36443497 PMCID: PMC10366348 DOI: 10.1038/s41433-022-02327-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 10/06/2022] [Accepted: 11/17/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The non-human primate (NHP) model is ideal for pre-clinical testing of novel therapies for human retinal diseases due to its similarity to the human visual system. However, intra-ocular delivery of gene therapy or cell transplantation to the retina gets hampered by the sticky vitreous body and poorly permeable inner limiting membrane (ILM) in primates. Although vitrectomy and ILM peeling are commonly performed in patients, many pitfalls exist in carrying out these procedures in the rhesus macaque, which have not been reported previously. METHODS We summarised common surgical pitfalls after performing vitrectomy and ILM peeling in four eyes of two rhesus macaques (one male and one female). We provided corresponding hands-on technical tips based on our surgical experience and literature search. Orbital CT scans were compared between adult rhesus macaques and humans. High-resolution surgical videos were recorded to demonstrate each critical surgical step. RESULTS Due to size difference, poor post-operative compliance, and high-standard requirements of a controlled experiment, there were eleven common surgical pitfalls during vitrectomy and ILM peeling in rhesus macaque. Falling into these pitfalls may produce discomfort, add fatigue, cause surgical complications, or even lead to the exclusion of the NHP from an experimental group. CONCLUSION Recognition and circumvention of these pitfalls during vitrectomy and ILM peeling in NHP are essential. By focusing on these surgical pitfalls, we can better carry out preclinical tests of novel therapies for retinal diseases in the NHP model.
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Affiliation(s)
- Qintuo Pan
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou, 325027, China
| | - Shengjian Lu
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou, 325027, China
| | - Mengyun Li
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou, 325027, China
- Shaoxing People's Hospital, Shaoxing, 312000, China
| | - Huirong Pan
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou, 325027, China
| | - Lixu Wang
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou, 325027, China
| | - Yiyang Mao
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou, 325027, China
| | - Wencan Wu
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou, 325027, China.
- Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain Health), Wenzhou, 325000, China.
| | - Yikui Zhang
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou, 325027, China.
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Lai JM, Patel V, Watane A, Fils AJ, Pakravan P, Huang CY, Patel N, Sridhar J, Yannuzzi NA. Mechanical Property Comparison of 23-, 25-, and 27-Gauge Vitrectors across Vitrectomy Systems. Ophthalmol Retina 2022; 6:1001-1008. [PMID: 35569764 PMCID: PMC9637701 DOI: 10.1016/j.oret.2022.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/18/2022] [Accepted: 05/09/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate the mechanical properties of 23-, 25-, and 27-gauge vitrectomy vitrectors across 3 different vitrectomy systems to inform surgical techniques. DESIGN An experimental study that did not involve any human subjects. METHODS Nine vitrectors (3 each of 23-, 25-, and 27 gauge) from Alcon, Dutch Ophthalmic Research Center (DORC), and Bausch & Lomb (B/L) were measured. Measurements were performed using electroforce displacement at the tip and 15 mm from the tip. Five measurements were performed at each location, and fully elastic deformation was ensured. MAIN OUTCOME MEASURES The main parameter being measured was the force in grams (gf) necessary to deflect the vitrectors vertically downward by 1 mm, either at the tip of the vitrector or 15 mm from the tip. RESULTS A total of 90 measurements were performed. Across brands, B/L demonstrated the least stiffness at both the tip and at the 15-mm point for 23-gauge (8.0±0.3gf, 67.3±1.0gf), 25-gauge (6.8±0.3gf, 60.5±0.4gf), and 27-gauge (3.3±0.1gf, 33.9±0.5gf) vitrectors. Although there was only a small decrease in the stiffness in the 25-gauge vitrector compared with the 23-gauge vitrector at the 15-mm point, this difference was statistically significant for Alcon (P < 0.001), DORC (P < 0.001), and B/L (P < 0.001). CONCLUSIONS Based on this study, 25-gauge vitrectors, although larger than the 27-gauge vitrectors and less stiff than the 23-gauge vitrectors, may offer favorable compromise between stiffness and gauge size. However, surgeon experience, preference, and the type of surgery being performed should be paramount when making the final vitrector selection. Knowledge of these mechanical properties may aid surgeons in choosing between gauge size and vitrectomy system to optimize their comfort and efficiency.
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Affiliation(s)
- James M Lai
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Veshesh Patel
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Arjun Watane
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; Yale University Eye Center, Yale University, New Haven, Connecticut
| | - Aaron J Fils
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Parastou Pakravan
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Chun-Yuh Huang
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Nimesh Patel
- University of Miami Biomedical Engineering Department, Miami, Florida
| | - Jayanth Sridhar
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Nicolas A Yannuzzi
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
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Affiliation(s)
- Kalpana Nagaraj Badami
- Professor & Head VitreoRetina, Minto Regional Institute of Ophthalmology, Bangalore Medical College & Research Institute, Bengaluru, Karnataka, India
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Mahgoub MM, Roshdy MM, Wahba SS. Dellen formation as a complication of subconjunctival silicone oil following microincision vitrectomy. Clin Ophthalmol 2018; 11:2215-2219. [PMID: 29290680 PMCID: PMC5736360 DOI: 10.2147/opth.s149531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To study the subconjunctival silicone oil (SCSO) parameters associated with dellen formation following microincision vitrectomy (MIV). Patients and methods This was a case-control study of 20 eyes with SCSO following MIV. Ten of them suffered postoperative dellen formation. Dellen occurrence, their sizes, number of loci, and distance between SCSO and the limbus were recorded. The outcome after silicone-oil removal was evaluated. Results The SCSO was at 3.1±1.2 mm from the limbus. All cases with dellen had SCSO within 2 mm of the limbus (P<0.001). No other factors were found to be associated with dellen formation (age, P=0.414; sex, P=0.656; laterality, P=1; indication for pars plana vitrectomy, P=0.655; instrument gauge, P=0.211; circumference involved by SCSO, P=0.252). All the dellen healed after surgical evacuation of SCSO (P<0.001), leaving scars. Conclusion Dellen can be associated with MIV secondary to SCSO near the limbus. Resolution with scarring occurred following SCSO evacuation. Therefore, SCSO should be evacuated as early as possible to avoid long-term peripheral corneal morbidity.
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Affiliation(s)
- Mohamed M Mahgoub
- Ophthalmology Department, Ain Shams University.,Ophthalmology Department, Al Watany Eye Hospital, Cairo, Egypt
| | - Maged M Roshdy
- Ophthalmology Department, Ain Shams University.,Ophthalmology Department, Al Watany Eye Hospital, Cairo, Egypt
| | - Sherine S Wahba
- Ophthalmology Department, Ain Shams University.,Ophthalmology Department, Al Watany Eye Hospital, Cairo, Egypt
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Ghoraba HH, Elgouhary SM, Ellakwa AF. Different techniques of transconjunctival cannulated vitrectomy versus conventional non-cannulated vitrectomy in various vitreoretinal disorders. Clin Ophthalmol 2013; 7:1859-65. [PMID: 24109167 PMCID: PMC3792951 DOI: 10.2147/opth.s38997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the safety and efficacy of different methods of transconjunctival cannulated vitrectomy versus conventional non-cannulated vitrectomy in various vitreoretinal disorders. Methods A prospective randomized study was done from August 2009 to February 2011. The study included 129 eyes of 122 patients, randomly divided into four groups. Group 1 comprised 34 eyes operated on using transconjunctival 20-gauge cannula Claes system. Group 2 comprised 32 eyes operated on using transconjunctival cannulated 23 gauge system. Group 3 comprised 27 eyes operated on using combined 20-gauge non-cannulated and 23-gauge transconjunctival cannulated system. Group 4 comprised 36 eyes operated on using conventional non-cannulated 20-gauge system. Results The four groups were demographically similar. Anatomical outcome was achieved in all cases. Vision was improved in 29 eyes (85.3%) in group 1, 23 eyes (71.9%) in group 2, 19 eyes (70.4%) in group 3, and 26 eyes (72.2%) in group 4. There was no statistical difference between the four groups 1-day postoperative (P=0.405) and 1-week postoperative intraocular pressure (P=0.254). The number of sutureless sclerotomies was 68 (66.6%) in group 1, 78 (81.3%) in group 2, 50 (61.8%) in group 3, and 0 in group 4. Hypotony occurred in one eye (2.9%) in group 1, three eyes (9.4%) in group 2, two eyes (7.4%) in group 3, and no eyes in group 4. Operative endophthalmitis did not occur in any one of the four groups. Conclusion Final anatomical and functional outcomes were not related to the type of sclerotomy used (cannulated or non-cannulated), the gauge used (20 or 23), the route (transconjunctival or transscleral), or type of suture used. The advantages of small-gauge transconjunctival vitrectomy were patient comfort, early ambulation, and preservation of the conjunctiva. This should be weighed against the cost of this cannula system.
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Affiliation(s)
- Hammouda H Ghoraba
- Department of Ophthalmology, Tanta University, Tanta, Egypt ; Vitreoretinal Unit, Magrabi Eye Hospital, Tanta, Egypt
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Cha DM, Woo SJ, Park KH, Chung H. Intraoperative iatrogenic peripheral retinal break in 23-gauge transconjunctival sutureless vitrectomy versus 20-gauge conventional vitrectomy. Graefes Arch Clin Exp Ophthalmol 2013; 251:1469-74. [DOI: 10.1007/s00417-013-2302-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Revised: 02/20/2013] [Accepted: 02/25/2013] [Indexed: 11/24/2022] Open
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Seymenoğlu G, Uzun Ö, Başer E. Surgically Induced Changes in Corneal Viscoelastic Properties After 23-Gauge Pars Plana Vitrectomy Using Ocular Response Analyzer. Curr Eye Res 2012; 38:35-40. [DOI: 10.3109/02713683.2012.707269] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
PURPOSE To determine whether the gauge of vitrectomy instrumentation is associated with the progression of nuclear sclerotic cataract. METHODS A prospective interventional and observational study of patients undergoing vitrectomy surgery for various retinal conditions. Patients had Scheimpflug lens photography in the operated and fellow eye at baseline and at 6 months and 12 months after vitrectomy surgery. RESULTS Of 42 eyes included in the analysis, 11 had 20-gauge surgery, 22 had 23-gauge surgery, and 9 had 25-gauge surgery. In all operated eyes, vitrectomy surgery led to the significant progression of nuclear sclerotic cataract, compared with the fellow, unoperated eye. This small study was unable to detect a difference in nuclear sclerotic progression when comparing small-gauge surgery (23 and 25 gauge) with standard 20-gauge surgery. CONCLUSION Removal of the vitreous gel using any-gauge vitrectomy surgery leads to significant progression of nuclear sclerotic cataract at 6 months and 12 months. The findings are consistent with the hypothesis that the vitreous gel is important in protecting the lens from increased exposure to oxygen that leads to the formation of nuclear sclerotic cataract. This increased exposure to oxygen occurs as a result of removing the vitreous gel and is independent of the gauge of vitrectomy instrumentation.
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Incidence of postoperative hypotony in 25-gauge vitrectomy: oblique versus straight sclerotomies. Can J Ophthalmol 2012; 47:21-3. [DOI: 10.1016/j.jcjo.2011.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 06/09/2011] [Accepted: 08/17/2011] [Indexed: 11/17/2022]
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Mimura T, Nakashizuka T, Mori M. Recent Advances and History of Vitreous Surgery. JOURNAL OF HEALTHCARE ENGINEERING 2011. [DOI: 10.1260/2040-2295.2.4.447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Park DH, Shin JP, Kim SY. Conjunctival pigmentation after 23-gauge microincisional vitrectomy surgery. Eye (Lond) 2011; 25:1465-70. [PMID: 21852803 DOI: 10.1038/eye.2011.199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
AIM To investigate cases with conjunctival pigmentation originating from sclerotomy sites after 23-gauge microincisional vitrectomy surgery (MIVS). METHODS This is a retrospective study comprised of 185 eyes from 185 consecutive patients who underwent 23-gauge MIVS. The authors investigated the incidence and the clinical factors associated with conjunctival pigmentation, including indication of vitrectomy and surgical procedures. RESULTS Eight eyes (4.3%) from 185 eyes showed conjunctival pigmentation after surgery within 7 days postoperatively. Light microscopic examination of excised tissue showed infiltration of abundant dark brownish colored melanophages with surrounding scattered, finely granular, melanin pigments. C3F8 gas tamponade (OR, 9.4; 95% CI, 1.9-44.5; P=0.005) was significantly associated with conjunctival pigmentation. The mean surface area (21.26±2.21 mm(2)) of three eyes with C3F8 tamponade was significantly larger than that of five eyes (2.51±0.73 mm(2)) without tamponade (P=0.025). Neither leakage nor hypotony was found. CONCLUSIONS Intraocular melanin pigments could prolapse through the sclerotomy site and cause conjunctival pigmentation after 23-gauge MIVS. Thus, preoperative warning is necessary in patients with 23-gauge MIVS.
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Affiliation(s)
- D H Park
- Department of Ophthalmology, School of Medicine, Kyungpook National University, Chung-gu, Daegu, South Korea
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Mateo-Montoya A, Mendrinos E, Tabatabay C, Pournaras CJ. 23-gauge transconjunctival sutureless vitrectomy: visual outcomes and complications. Semin Ophthalmol 2011; 26:37-41. [PMID: 21469961 DOI: 10.3109/08820538.2010.544236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To report results and complications of 23-gauge transconjunctival sutureless pars plana vitrectomy for a variety of vitreoretinal diseases. METHODS A prospective consecutive case series study was performed in 66 eyes of 66 patients. Indications for surgery were epiretinal membrane (n = 20), rhegmatogenous retinal detachment (n = 19: 14 pseudophakic, 5 phakic), macular hole (n = 16), vitreous hemorrhage (n = 5), cyclodialysis (n = 1), intraocular lens luxation (n = 1), asteroid hyalosis (n = 1), congenital retinoschisis (n = 1), and endophtalmitis (n = 2). Main outcome measures included visual acuity, intraocular pressure, and intra- and post-operative complications. RESULTS Mean patient age at time of operation was 68 ± 12 years. Overall, visual acuity improved from 1.03 ± 1.00 logMAR preoperatively to 0.32 ± 0.33 logMAR postoperatively (p < 0.01) after a mean follow-up time of 9.3 ± 4.7 months. Mean preoperative intraocular pressure was 13.9 ± 3.5 mmHg, and mean postoperative intraocular pressure was 17.9 ± 9.6 mmHg on day 1 (p < 0.01) and 14.7 ± 2.8 mmHg (p = 0.05) at final visit. Concerning complications, 2 cases of hypotony and 7 of hypertony occurred on day 1, a macular hole reopened some weeks later, and a retinal detachment recurred in one case. CONCLUSION 23-gauge transconjunctival sutureless vitrectomy is an effective and safe technique for a variety of vitreoretinal diseases.
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Affiliation(s)
- Aránzazu Mateo-Montoya
- Ophthalmology Clinic, Department of Clinical Neurosciences, Geneva University Hospital, Geneva, Switzerland
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Bahrani HM, Fazelat AA, Thomas M, Hirose T, Kroll AJ, Lou PL, Ryan EA. Endophthalmitis in the era of small gauge transconjunctival sutureless vitrectomy--meta analysis and review of literature. Semin Ophthalmol 2011; 25:275-82. [PMID: 21091012 DOI: 10.3109/08820538.2010.518109] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The goal of this study was to review, evaluate, and perform a meta-analysis on the current literature that reports rates of postoperative endophthalmitis after small gauge transconjunctival sutureless vitrectomy (TSV) and compare it to 20-gauge pars plana vitrectomy (20G PPV). METHODS We performed an extensive review of the current literature. We included only large comparative institutional reviews. Meta-analysis of these reviews was performed. RESULTS We found six large retrospective comparative cases series on the 25-gauge (25G) TSV as compared to 20G PPV. The test for homogeneity for the meta-analysis indicates that the studies are not homogeneous and therefore the evidence is tentative. CONCLUSION We cannot conclude that 25G TSV has a higher rate of postoperative endophthalmitis compared to the 20G PPV. Future retrospective or prospective trials need to take into consideration multiple factors.
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Affiliation(s)
- Hasan M Bahrani
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA.
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Nam DH, Yoon SC, Lee DY, Sohn HJ. Presumed sclerotomy site bleeding inflowing into the anterior chamber after the removal of a 23-gauge microcannula in 23-gauge sutureless vitrectomy. Indian J Ophthalmol 2010; 58:543-5. [PMID: 20952846 PMCID: PMC2993992 DOI: 10.4103/0301-4738.71709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We experienced two cases of the influx of the sclerotomy site bleeding into the anterior chamber during 23-gauge sutureless vitrectomy for pseudophakic rhegmatogenous retinal detachment. Soon after the removal of a 23-gauge microcannula at the end of the surgery, presumed sclerotomy site hemorrhage was rapidly fluxed into the anterior chamber. The anterior chamber bleeding might come from the sclerotomies rather than from episcleral vessels. The posterior pressure in the gas-filled pseudophakic eye might have pushed the sclerotomy site bleeding into the anterior chamber. We could not find any vitreous hemorrhages. The hemorrhage within the anterior chamber spontaneously absorbed within 14 days.
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Affiliation(s)
- Dong Heun Nam
- Department of Ophthalmology, Gachon University Gil Hospital, Incheon, South Korea
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Singh A, Hosseini M, Hariprasad SM. Polyethylene glycol hydrogel polymer sealant for closure of sutureless sclerotomies: a histologic study. Am J Ophthalmol 2010; 150:346-351.e2. [PMID: 20579628 DOI: 10.1016/j.ajo.2010.04.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 04/05/2010] [Accepted: 04/13/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate a polyethylene glycol-based hydrogel bandage for its ability to secure sutureless pars plana vitrectomy sclerotomies. DESIGN Laboratory investigation. METHODS Twenty-gauge (20-G) and twenty-three gauge (23-G) sclerotomies were constructed in human cadaveric eyes. A total of 24 sclerotomies were constructed in 6 eyes. Four sclerotomies per eye were constructed. Two were straight 20-G incisions, of which 1 was sutured and 1 was covered with the bandage. The other 2 were 23-G beveled incisions, of which 1 was left bare and the other was closed with the hydrogel bandage. India ink was applied over the sclerotomy sites while the intraocular pressure (IOP) was varied. The presence of India ink particles along incisions was evaluated by histologic analysis. RESULTS The hydrogel bandage prevented the entry of ink particles in all covered incisions after IOP modulation and incision manipulation. One 20-G sutured incision showed partial ink ingress. Four uncovered 23-G incisions showed the presence of ink within the inner aspect of the incisions (P = .0455 relative to 23-G sealed incisions). Twenty-two out of 24 incisions were evaluated, as 2 incisions could not be identified on histologic analysis. CONCLUSIONS The use of a hydrogel bandage to close sutureless sclerotomies is a practical alternative to sutures. Closure of sutureless sclerotomies may reduce the entry of ocular surface fluid into these incisions as well as prevent leakage of intraocular fluid in the immediate postoperative period. Incision closure may reduce the incidence of postoperative endophthalmitis and hypotony in sutureless vitreous surgery.
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Chung JH, Chang DJ, Lee WK, Shin CH, Park SC, Ryu JW. A Case of Acute Endophthalmitis After 23-gauge Transconjunctival Sutureless Vitrectomy. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2010. [DOI: 10.3341/jkos.2010.51.6.899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
| | - Dong Jin Chang
- Department of Ophthalmology and Visual Science, The Catholic University of Korea School of Medicine, Seoul, Korea
| | - Won Ki Lee
- Department of Ophthalmology and Visual Science, The Catholic University of Korea School of Medicine, Seoul, Korea
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Shroff CM, Singh AK, Gupta C, Shroff DN. Modified "temporal" sutureless vitrectomy. Indian J Ophthalmol 2009; 58:86-7. [PMID: 20029161 PMCID: PMC2841391 DOI: 10.4103/0301-4738.58489] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Kumar A, Kakkar A, Jindal S, Rajesh R. Combination 20 and 23-gauge transconjunctival vitrectomy: a new approach. Indian J Ophthalmol 2009; 57:459-61. [PMID: 19861749 PMCID: PMC2812766 DOI: 10.4103/0301-4738.57158] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The advent of smaller gauge instrumentation allows for minimally invasive vitreoretinal surgery (MIVS) as compared to conventional pars plana vitrectomy. Sutureless posterior segment surgery has the advantages of faster wound healing, minimal surgical trauma, decreased convalescence period besides reduced postoperative astigmatism; however, slower gel removal and limited peripheral vitreous dissection are disadvantages with smaller gauge systems. We herein describe a new technique combining 23-gauge and 20-gauge vitrectomy to improve the effectiveness and outcomes of vitreoretinal surgery.
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Affiliation(s)
- Atul Kumar
- Department of Vitreous Retina service, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi-11 00 29, India
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[Spontaneous scleral rupture revealed by hypotony maculopathy]. J Fr Ophtalmol 2009; 32:438.e1-6. [PMID: 19515458 DOI: 10.1016/j.jfo.2009.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Accepted: 04/17/2009] [Indexed: 11/20/2022]
Abstract
Cases of a spontaneous scleral rupture are very uncommon. Their diagnosis can be challenging because the scleral lesion might be invisible on clinical examination. We describe herein one case revealed by hypotony maculopathy. A 30-year-old woman presented with severe visual loss in one eye caused by sudden hypotony. Funduscopy revealed a chorioretinal coloboma in the periphery of the retina associated with a hypotony maculopathy. Extensive work-up included optical coherence tomography (OCT), fluoroangiography, ultrasonography, and magnetic resonance imaging examinations. A search for infectious and inflammatory diseases was conducted. Inflammatory and infectious work-ups were not contributive. A surgical exploration was performed, which showed a spontaneous scleral perforation within the coloboma. A patch of polytetrafluoroethylene was sutured on the damaged sclera and air was injected into the vitreous cavity. Vision and ocular pressure were rapidly restored. Spontaneous scleral rupture cases associated with hypotony and visual loss are rare, with only a few cases reported in the literature. Hypotony maculopathy with sclerochoroidal lesion may be the cause of such cases. Excellent outcome can be obtained with surgical diagnosis and repair.
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23-Gauge transconjunctival sutureless pars plana vitrectomy: results of a prospective study. Eye (Lond) 2009; 23:2206-14. [PMID: 19169238 DOI: 10.1038/eye.2008.431] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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