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Bai A, Sharma A, Chiang M, Lee L. Aetiology and epidemiology of surgical vitreoretinal presentations in an Australian paediatric population: A seven-year retrospective study. Clin Exp Ophthalmol 2024. [PMID: 38937978 DOI: 10.1111/ceo.14413] [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: 02/04/2024] [Revised: 06/02/2024] [Accepted: 06/13/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Paediatric vitreoretinal pathology is distinct from adult cases in both presentation and surgical planning. Here we aim to report the aetiology and epidemiology in children 0-18 years requiring vitreoretinal surgery at a major tertiary paediatric hospital in Queensland, Australia. METHODS Retrospective review of cases requiring vitreoretinal surgery between May 2015 and October 2022 was conducted. Demographics, ocular and medical history, surgical pathology, procedures performed, and epidemiology data were retrieved. Patients were grouped into three main aetiologies: traumatic, syndromic, or secondary. RESULTS A total of 124 patients, the majority male (87, 70.2%) with a mean age of 10.3 years underwent vitreoretinal surgery. Trauma accounted for 32.3% of cases requiring surgery of which 47% were due to a penetrating eye injury. 35.5% were associated with a syndromic cause with common aetiology including coats, congenital cataract, sticklers, and retinopathy of prematurity. 32.3% developed secondary pathology and retinal detachment was the primary cause for surgery (55%). The average time from symptom onset to presentation was 30 days (SD 56.88) with patients living an average of 306.2 km (SD 558.9) away from the Queensland Children's Hospital. Older age was significantly associated with increased days to presentation in the traumatic group (p < 0.05). CONCLUSIONS This study provides an insight into the aetiology and epidemiology of paediatric vitreoretinal presentations in Queensland, Australia.
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Affiliation(s)
- Amelia Bai
- Department of Ophthalmology, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Abhishek Sharma
- Department of Ophthalmology, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Mark Chiang
- Department of Ophthalmology, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Lawrence Lee
- Department of Ophthalmology, Queensland Children's Hospital, South Brisbane, Queensland, Australia
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WenTao D, SanMei L, Jie L, Jie Z. Wound healing and postoperative management in paediatric patients following 27-Gauge Transconjunctival Sutureless Vitrectomy for vitreoretinal conditions. Int Wound J 2024; 21:e14611. [PMID: 38156741 PMCID: PMC10961879 DOI: 10.1111/iwj.14611] [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: 12/03/2023] [Revised: 12/06/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024] Open
Abstract
The utilization of 27-G TSV, or 27-Gauge Transconjunctival Sutureless Vitrectomy, poses distinct difficulties in the context of paediatric patients, particularly those younger than 14 years old, on account of the dearth of exhaustive documentation concerning the efficacy and results of these operations. Therefore, this retrospective study was to evaluate the safety and efficacy of 27-G TSV in paediatric patients, with emphasis on management of intraoperative and postoperative complications and postoperative wound healing. A total of 54 eyes of 52 paediatric patients who underwent 27-G TSV at Sichuan Provincial People's Hospital were included in the study. The average duration of follow-up was 9.32 ± 3.35 months. The complication with the highest incidence rate was Rhegmatogenous Retinal Detachment (RRD), which was detected in 27.8% cases. Familial Exudative Vitreoretinopathy (FEVR) and Persistent Fetal Vasculature (PFV) each accounted for 16.7% of the cases. Retinopathy of Prematurity (ROP) and Vitreous Haemorrhage (VH) constituted 11.1% and 14.8%, respectively, of the reported cases. Lens injury (1.9%), cannula slippage (7.4%) and wound leakage (5.6%) were intraoperative complications. Iatrogenic retinal detachment occurred at 3.7%. Hypotony (10.8% of patients), vitreous haemorrhage (9.3%), cataract formation (9.3%), ocular hypertension (8.1%) and retinal detachment (5.6%) were postoperative complications. Effective management strategies were executed, such as performing in situ trocar puncture to address cannula slippage and promptly suturing to address wound leakage. 27-G TSV exhibited promise as the therapeutic alternative for range of vitreoretinal disorders in paediatric patients, accompanied by complications that were controllable during and after the procedure. Strict preoperative planning and precise surgical technique are indispensable in order to maximize patient outcomes and guarantee effective wound healing and recovery within this particular demographic.
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Affiliation(s)
- Dong WenTao
- Department of Ophthalmology, Sichuan Provincial People's Hospital, School of MedicineUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Liu SanMei
- Department of Ophthalmology, Sichuan Provincial People's Hospital, School of MedicineUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Li Jie
- Department of Ophthalmology, Sichuan Provincial People's Hospital, School of MedicineUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Zhong Jie
- Department of Ophthalmology, Sichuan Provincial People's Hospital, School of MedicineUniversity of Electronic Science and Technology of ChinaChengduChina
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Tang Y, Yao S, Chu Y, Han Q. Vitreous management in Yamane's technique for crystalline lens dislocation: anterior vitrectomy or PPV? BMC Ophthalmol 2023; 23:466. [PMID: 37978463 PMCID: PMC10655444 DOI: 10.1186/s12886-023-03204-9] [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: 04/23/2023] [Accepted: 11/06/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE To study the postoperative visual outcomes and surgical complications of anterior/pars plana vitrectomy and concurrent Yamane's IOL fixation for crystalline lens dislocation. METHODS Fifty-three patients (56 eyes) with crystalline lens subluxation/dislocation were enrolled in this retrospective interventional study. Patients received anterior/pars plana vitrectomy and concurrent Yamane's IOL fixation. Main outcome measures were postoperative BCVA and surgical complications. Proportion of spontaneous PVD and preoperative undetected retinal holes/degeneration (PURH/D) were recorded. RESULTS Twenty-four eyes were treated with anterior vitrectomy (Group AnV) and 32 eyes with pars plana vitrectomy (Group PPV). Overall incidence of PURH/D was 10.7% (6/56). Spontaneous PVD occurred in 68.8% (24/32) in Group PPV. During six months follow-up, one case of postoperative RRD and one case of choroidal detachment occurred in Group AnV. There was no significant difference between anterior vitrectomy and PPV in the final BCVA and postoperative complications. CONCLUSION Anterior or pars plana vitrectomy, which are both applicable in YAMANE technique for crystalline lens dislocation, exhibit similar surgical outcomes. Patient's age, PVD status and PURH helps to determine the route of vitrectomy. Pediatric patients might be potential candidates for transcorneal vitreolensectomy. For adult, PURH managed with total vitrectomy and intraoperative lase retinopexy might be beneficial to decrease the incidence of postoperative RRD.
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Affiliation(s)
- Yong Tang
- Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology, Tianjin Medical University, Gansu Road 4, Heping District, Tianjin, 300020, China
| | - Shiqi Yao
- Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology, Tianjin Medical University, Gansu Road 4, Heping District, Tianjin, 300020, China
| | - Yanhua Chu
- Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology, Tianjin Medical University, Gansu Road 4, Heping District, Tianjin, 300020, China
| | - Quanhong Han
- Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology, Tianjin Medical University, Gansu Road 4, Heping District, Tianjin, 300020, China.
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Di-Luciano A, Gómez-Nuñez R, Acosta F, Rivas-Vega L, Morales-Cantón V, Trujillo-Alvarez M, Cernichiaro-Espinosa L. Trocar shortening for pediatric vitreoretinal surgery with a 3D printed trocar spacer: Report of two cases. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2022; 97:473-476. [PMID: 35914891 DOI: 10.1016/j.oftale.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/07/2021] [Indexed: 06/15/2023]
Abstract
PURPOSE To show the results of a trocar spacer for pediatric vitreoretinal surgery with a 3D printed trocar spacer in 2 cases. METHODS We used standard 27 gauge (ga) and 25 ga trocars and cannulae, and prototyped 1.5 mm × 3 mm spacers with a Prusa MK3 3D printer (0.4 mm nozzle) with Fuse deposition melting (FDM) technology. Parts were printed with a 50 μm layer height in polylactic acid or polylactide (PLA). The spacer was placed in two places: between the blade's base and the trocar, and between the trocar and the sclera depending on the desired amount of shortening. This prototype was used in 2 vitrectomy cases in pediatric patients. RESULTS We used this trocar spacer in 2 cases with positive results. CONCLUSIONS This 3D printed spacer has proved to effectively shorten the introduced trocar into two different small eyes. More studies are needed to validate the efficacy and safety of this spacer in clinical practice.
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Affiliation(s)
- A Di-Luciano
- Pediatric Retina Unit, Retina and Vitreous Department, Asociación para Evitar la Ceguera en México, IAP, Mexico City, Mexico
| | - R Gómez-Nuñez
- Biomedical engineer, private practice, Mexico City, Mexico
| | - F Acosta
- CEO, Custom Surgical, Munich, Germany
| | - L Rivas-Vega
- Anesthesiology department, Pediatric Retina Unit, Retina and Vitreous Department, Asociación para Evitar la Ceguera en México, IAP, Mexico City, Mexico
| | - V Morales-Cantón
- Pediatric Retina Unit, Retina and Vitreous Department, Asociación para Evitar la Ceguera en México, IAP, Mexico City, Mexico
| | - M Trujillo-Alvarez
- Pediatric Retina Unit, Retina and Vitreous Department, Asociación para Evitar la Ceguera en México, IAP, Mexico City, Mexico
| | - L Cernichiaro-Espinosa
- Pediatric Retina Unit, Retina and Vitreous Department, Asociación para Evitar la Ceguera en México, IAP, Mexico City, Mexico.
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Ahmed SB, Higham A, Mulvihill A, Chan TKJ, Adams G, Patel CK. The UK practice of Anti-VEGF therapy for treatment of retinopathy of prematurity. Eye (Lond) 2021; 35:2451-2453. [PMID: 33879853 PMCID: PMC8377112 DOI: 10.1038/s41433-021-01543-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 02/18/2021] [Accepted: 04/06/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
- Shahanaz B Ahmed
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | - Aisling Higham
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Alan Mulvihill
- Royal Hospital for Children and Young People, NHS Lothian, Edinburgh, UK
- The Princess Alexandra Eye Pavilion, NHS Lothian, Edinburgh, UK
| | - T K J Chan
- Royal Hospital for Children and Young People, NHS Lothian, Edinburgh, UK
- The Princess Alexandra Eye Pavilion, NHS Lothian, Edinburgh, UK
| | - Gill Adams
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Chetan K Patel
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- University of Oxford, Oxford, UK
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Fischer MD, Bartz-Schmidt KU, Dimopoulos S, Herrmann P, Gerhardt M, Holz FG, Priglinger S. Surgical Aspects in Gene Therapy for Inherited Retinal Diseases. Klin Monbl Augenheilkd 2021; 238:267-271. [PMID: 33618387 DOI: 10.1055/a-1315-1331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Inherited retinal dystrophies (IRD) have been studied since their recognition by Franz Donders and Albrecht von Graefe. It nevertheless took 100 years for a causal therapy to take shape in the form of gene therapy: The approval of Voretigen Neparvovec (VN) for the treatment of hereditary retinal dystrophies due to RPE65 mutations was thus a significant milestone - for the era of personalised medicine in general and ophthalmology in particular. The clinical management around gene therapy applications is complex and requires the cooperation of various experts as a multidisciplinary team. This article describes the requirements, challenges, approaches, and open questions regarding the surgical aspects of gene therapy for retinal dystrophies. The first part outlines the standard surgical treatment. Based on this standard, alternative approaches are indicated for each individual step and their value discussed. Knowledge gaps are defined and in the outlook we speculate on future developments.
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Affiliation(s)
- M Dominik Fischer
- Department für Augenheilkunde, Universitäts-Augenklinik, Universitätsklinikum Tübingen, Deutschland.,Nuffield Laboratory of Ophthalmology, University of Oxford, United Kingdom of Great Britain and Northern Ireland
| | | | - Spyridon Dimopoulos
- Department für Augenheilkunde, Universitäts-Augenklinik, Universitätsklinikum Tübingen, Deutschland
| | | | | | - Frank G Holz
- Augenklinik, Universitätsklinikum Bonn, Deutschland
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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.
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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
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Dogra M, Singh SR, Dogra MR. Commentary: Vitrectomy for stage 4 and 5 retinopathy of prematurity - Selecting the right approach to the vitreous cavity. Indian J Ophthalmol 2019; 67:938-939. [PMID: 31124520 PMCID: PMC6552591 DOI: 10.4103/ijo.ijo_848_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Mohit Dogra
- Advanced Eye Centre, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Simar Rajan Singh
- Advanced Eye Centre, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Mangat Ram Dogra
- Advanced Eye Centre, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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