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Qu S, Zhou Q, Shao YT, Lin MY, Shen JQ, Niu GZ, Han WT, Zhang L, Bi YL. Posterior capsular radial sign: a novel method to confirm anterior vitreous cortex resection in phacovitrectomy. BMC Ophthalmol 2024; 24:231. [PMID: 38822280 PMCID: PMC11143691 DOI: 10.1186/s12886-024-03474-x] [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: 09/09/2023] [Accepted: 05/02/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND The main purpose of this paper is to introduce a method that can accurately locate the posterior capsule of the lens to facilitate a relatively complete resection of the anterior vitreous body. METHODS A total of 51 patients in the experimental group and control group were enrolled in this study. Phacoemulsification combined with vitrectomy was performed in all cases. After the cataract procedure was completed in the control group, the surgeon performed a conventional anterior vitrectomy with the operative eye. In the experimental group, anterior vitrectomy was performed according to the threadiness corrugation of the posterior capsule of the lens. During the operation, with the help of triamcinolone, two surgeons confirmed the resection of the anterior vitreous cortex; the best corrected visual acuity and intraocular pressure of all patients were recorded at 1 week, 1 month and 3 months after surgery. RESULTS Fifty patients underwent phacoemulsification combined with vitrectomy, except one patient in the experimental group who was lost to follow-up. After surgery, no significant complications were observed in all patients except two patients in the control group with temporary increases in intraocular pressure. There was no significant difference in preoperative visual acuity between the two groups (t = 0.83, P = 0.25). Both groups had varying degrees of improvement in best corrected visual acuity at 1 week, 1 month and 3 months after surgery. Moreover, there was no significant difference in BCVA between the two groups at the three follow-up time points (t=-1.15, -1.65, -1.09, P = 0.53, 0.21, 0.23). After surgery, no significant complications were observed in all patients except two patients in the control group with temporary increases in intraocular pressure. Incomplete resection of the anterior vitreous cortex was observed in 2 patients in each group, but there was no significant difference (χ2 = 7.81, P > 0.05). CONCLUSION In the process of cataract surgery combined with vitrectomy, thready corrugation appears in the posterior capsule of the lens and is an important sign of its localization. Anterior vitrectomy can be accomplished safely and effectively with the help of thread-like corrugation, and the surgical effect is almost the same as that of traditional surgery. Especially suitable for beginners in vitreous surgery.
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Affiliation(s)
- Shen Qu
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Qi Zhou
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Yu-Ting Shao
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Ming-Yue Lin
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Jia-Qi Shen
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Guo-Zhen Niu
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Wen-Ting Han
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Li Zhang
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Yan-Long Bi
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China.
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Hwang SH, Kim H, Lee DY, Nam DH. Intraoperative challenges and complications of cataract surgery between cataract surgery alone and phacovitrectomy in eyes with diabetic retinopathy: efficacy of illuminated chopper-assisted cataract surgery. BMC Ophthalmol 2023; 23:236. [PMID: 37237351 DOI: 10.1186/s12886-023-02982-6] [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: 04/10/2023] [Accepted: 05/19/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND To compare the intraoperative challenges, complications, and operation time of illuminated chopper-assisted cataract surgery between cataract surgery only and phacovitrectomy in eyes with diabetic retinopathy. METHODS One university hospital, retrospective case series. Two hundred ninety-five eyes of 295 consecutive patients with diabetic retinopathy who underwent cataract surgery only or phacovitrectomy were retrospectively reviewed. Intraoperative challenges and complications of cataract surgery were thoroughly analyzed by 3D viewing of digitally recorded videos. The pupil diameter, operation time, and improved efficacy (100/operation time × pupil diameter) were compared between the cataract surgery only and phacovitrectomy groups. RESULTS Of the 295 eyes, 211 underwent cataract surgery only, and 84 underwent phacovitrectomy. Intraoperative challenges such as small pupil, miosis, or poor red reflex occurred more frequently (46 [21.8%] vs. 28 [33.3%], p = 0.029); pupil diameter was smaller (7.34 ± 0.94 vs. 6.89 ± 0.88 mm, p < 0.001) in the phacovitrectomy group than in the cataract surgery only group; however, rates of posterior capsule rupture and operation time were not different between the two groups (0 [0%] vs. 1 [1.2%], p = 0.285; 16.54 ± 2.65 vs. 16.31 ± 4.30 min, p = 0.434). Improved efficacy was higher in the phacovitrectomy group (0.85 ± 0.18 vs. 0.97 ± 0.28, p = 0.002). CONCLUSIONS The use of an illuminated chopper is a potential solution for diabetic cataract surgery, particularly in phacovitrectomy, by decreasing the use of supplemental devices, operation time, and posterior capsule rupture. TRIAL REGISTRATION Retrospectively registered.
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Affiliation(s)
- Sung Ha Hwang
- Department of Ophthalmology, Gil Medical Center, College of Medicine, Gachon University, 21 Namdong-daero 774-beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea
| | - Haram Kim
- Department of Ophthalmology, Gil Medical Center, College of Medicine, Gachon University, 21 Namdong-daero 774-beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea
| | - Dae Yeong Lee
- Department of Ophthalmology, Gil Medical Center, College of Medicine, Gachon University, 21 Namdong-daero 774-beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea
| | - Dong Heun Nam
- Department of Ophthalmology, Gil Medical Center, College of Medicine, Gachon University, 21 Namdong-daero 774-beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea.
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Awidi AA, Mathews PM, Shekhawat N, Woreta FA, Srikumaran D, Daoud YJ. Comparison of simultaneous vs sequential pars plana vitrectomy and cataract surgery. BMC Ophthalmol 2023; 23:74. [PMID: 36823593 PMCID: PMC9948424 DOI: 10.1186/s12886-023-02801-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 01/30/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND To compare the clinical outcomes of patients undergoing sequential pars plana vitrectomy (PPV) followed by cataract extraction surgery (CE) [PPV/CE], simultaneous PPV and CE (PPV + CE), and sequential CE followed by PPV [CE/PPV]. METHODS A retrospective observational cohort study of 427 eyes of 404 patients who underwent either sequential or simultaneous PPV and CE surgery between March 2016 and May 2021. Pre-operative and post-operative assessments (up to 2 years of follow-up visits) of uncorrected visual acuity (UCVA), corrected distance visual acuity (CDVA), spherical equivalent (SEQ), and refractive prediction error (RPE) was done. Main outcome measures were both visual (UCVA, CDVA) and refractive (RPE, SEQ). RESULTS There was a statistically significant difference in CDVA of the PPV/CE, PPV + CE, CE/PPV groups (logMAR 0.34 ± 0.40, 0.65 ± 0.61, and 0.55 ± 0.60, respectively) at one month postoperatively (POM1) (P < 0.001), and at the POM12 visits (logMAR 0.25 ± 0.34, 0.53 ± 0.68, and 0.44 ± 0.48; P = 0.04). In the subgroup analysis of patients with a diagnosis of either epiretinal membrane or vitreous opacities, there was no statistically significant difference in SEQ (P = 0.09) and RPE (P = 0.13) at the combined 1 month and 3 month visits. CONCLUSION Simultaneous PPV and cataract surgery demonstrated similar improvements in visual acuity and refractive outcomes, as well as comparable intraoperative and postoperative complication profiles to sequential surgery.
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Affiliation(s)
- Abdelhalim A Awidi
- Cornea, Cataract and Anterior Segment Division, The Wilmer Eye Institute, Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, 600 N Wolfe Street, Maumenee 327, Baltimore, MD, 21287, USA
| | - Priya M Mathews
- Cornea, Cataract and Anterior Segment Division, The Wilmer Eye Institute, Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, 600 N Wolfe Street, Maumenee 327, Baltimore, MD, 21287, USA
| | - Nakul Shekhawat
- Cornea, Cataract and Anterior Segment Division, The Wilmer Eye Institute, Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, 600 N Wolfe Street, Maumenee 327, Baltimore, MD, 21287, USA
| | - Fasika A Woreta
- Cornea, Cataract and Anterior Segment Division, The Wilmer Eye Institute, Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, 600 N Wolfe Street, Maumenee 327, Baltimore, MD, 21287, USA
| | - Divya Srikumaran
- Cornea, Cataract and Anterior Segment Division, The Wilmer Eye Institute, Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, 600 N Wolfe Street, Maumenee 327, Baltimore, MD, 21287, USA
| | - Yassine J Daoud
- Cornea, Cataract and Anterior Segment Division, The Wilmer Eye Institute, Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, 600 N Wolfe Street, Maumenee 327, Baltimore, MD, 21287, USA.
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Xia Y. The management of cataract surgery in diabetic patients. J Perioper Pract 2022; 32:361-367. [PMID: 35445624 DOI: 10.1177/17504589221091063] [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: 01/12/2023]
Abstract
A cataract in the eye is a major cause of vision loss in diabetic patients, which occurs earlier and develops faster than non-diabetic patients, and often requires surgery for treatment. However, diabetic patients undergoing cataract surgery have a higher risk of intraoperative and postoperative complications than non-diabetic patients. For diabetic patients undergoing any surgery, careful perioperative assessment and management are required to reduce postoperative complications and improve surgical outcomes. Better understanding of their needs may guide perioperative practitioners to manage their care appropriately. This article presents recent evidence and guidance associated with the preoperative, intraoperative and postoperative management of diabetic patients undergoing cataract surgery and to inform perioperative practitioners of the challenges and potential complications to provide the best care and improve sight.
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Affiliation(s)
- Yu Xia
- Beijing Aerospace General Hospital, Beijing, China
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Limon U, Sezgin Akçay BI. Efficacy of Intravitreal Dexamethasone After Combined Phacoemulsification and Pars Plana Vitrectomy for Diabetic Tractional Retinal Detachments. J Ocul Pharmacol Ther 2021; 38:176-182. [PMID: 34665023 DOI: 10.1089/jop.2021.0072] [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: 11/12/2022] Open
Abstract
Purpose: To evaluate the efficacy and complications of intravitreal dexamethasone with simultaneous silicone tamponade after combined phacoemulsification and pars plana vitrectomy (PPV) in severe diabetic tractional retinal detachments (TRDs). Methods: In this single center, prospective, randomized, and open labeled 2 parallel group study, patients who applied to our clinic due to diabetic TRD involving the macula with grade-3 and 4 cataracts were randomized to receive either simultaneous silicone tamponade and intravitreal dexamethasone (Group-1) or only silicone tamponade (Group-2). Primary outcome measurements were the incidence rate of retinal re-detachment and, proliferative vitreoretinopathy (PVR) at sixth month, and anterior segment inflammation and posterior iris synechia at first and at sixth months. Results: We operated 22 eyes of 22 patients in Group-1 (PPV with dexamethasone implant) and 21 eyes of 21 patients in Group-2 (PPV without dexamethasone implant). The rate of re-detachment and PVR were significantly higher in the Group-2 compared with in Group-1 at sixth month (Group-1, 0/22, Group-2, 6/21 28.6%, P = 0.038). Anterior chamber fibrin exudation at first month was significantly superior in the Group-2 (Group-1, 0/22, Group-2, 8/21 38.0%, P = 0.021). Posterior iris synechia was more observed in the Group-2 at sixth month (Group-1, 0/22, Group-2, 7/21 33.3%, P = 0.029). Conclusions: Dexamethasone implant at the end of combined phacoemulsification and PPV with silicon oil tamponade in patients with diabetic TRD reduces retinal re-detachment, anterior chamber fibrin exudation and posterior iris synechia. This approach can be an alternative option in the treatment of diabetic TRD with coexisting cataracts.
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Affiliation(s)
- Utku Limon
- Eye Clinic, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Betül Ilkay Sezgin Akçay
- Eye Clinic, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Rishi P, Hariprasad SM, Rishi E. Long-Term Outcomes of Combined Phacoemulsification and Pars Plana Vitrectomy Surgery. Ophthalmic Surg Lasers Imaging Retina 2021; 52:470-477. [PMID: 34505807 DOI: 10.3928/23258160-20210824-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Comparative study of combined vitrectomy with phacoemulsification versus vitrectomy alone for primary full-thickness macular hole repair. BMC Ophthalmol 2021; 21:174. [PMID: 33838649 PMCID: PMC8037829 DOI: 10.1186/s12886-021-01918-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 03/19/2021] [Indexed: 11/24/2022] Open
Abstract
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 30th 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.
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Port AD, Nolan JG, Siegel NH, Chen X, Ness SD, Subramanian ML. Combined phaco-vitrectomy provides lower costs and greater area under the curve vision gains than sequential vitrectomy and phacoemulsification. Graefes Arch Clin Exp Ophthalmol 2020; 259:45-52. [PMID: 32813107 DOI: 10.1007/s00417-020-04877-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/24/2020] [Accepted: 07/30/2020] [Indexed: 11/28/2022] Open
Abstract
PURPOSE A majority of phakic patients undergoing pars plana vitrectomy for epiretinal membrane or macular hole require subsequent cataract surgery within 1-2 years. Combined phaco-vitrectomy eliminates the need for a second surgery and may enable patients to attain their best vision sooner. This study aims to compare the visual outcomes, complication rates, and costs of combined phaco-vitrectomy versus sequential vitrectomy followed by cataract surgery. METHODS Records were searched by CPT® codes to identify patients with both cataract and vitrectomy surgery at our institution over a 5-year period (2013-2018). Chart review included medical history, demographics, exam findings, operating room records, visual acuity (VA), and clinical outcomes. Statistical analyses were performed with SPSS v19 (IBM). Area under the curve for visual acuity was calculated as the trapezoidal mean of the change in Early Treatment of Diabetic Retinopathy Study letters. RESULTS After exclusion, 81 eyes of 78 patients underwent both cataract and vitrectomy surgeries at our institution. Thirty-four eyes underwent separate, sequential vitrectomy then phacoemulsification surgery, and 47 eyes had combined phaco-vitrectomy surgery. Total operating room times (120.81 ± 3.41 vs 161.03 ± 5.45 min; p < 0.0001) and associated costs were significantly lower in the combined surgery compared with those in the sequential surgery group. Baseline and final visual acuity were similar between the two groups. Baseline VA was 35.53 letters (~ 20/200) and 32.81 letters (~ 20/220) and increased to final VA of 63.74 (~ 20/53) and 60.91 letters (~ 20/61), in the sequential and combined groups respectively. Area under the curve for vision was greater in the combined surgery group, with subjects gaining an average of + 9.11 ± 3.32 letters from sequential surgery, and + 19.53 ± 3.53 letters in the combined surgery group (p = 0.04). Additionally, patients in the combined group attained their best visual acuity 449 days (15 months) sooner than those receiving sequential surgery. CONCLUSIONS Combined phaco-vitrectomy surgery resulted in greater area under the curve visual acuity benefit and attainment of best visual acuity 15 months sooner compared with conventional sequential surgeries. There were no significant differences in complication rates or clinical outcomes between the groups, but operative times and costs were lower for combined surgery, supporting a favorable cost-benefit ratio. Graphical abstract.
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Affiliation(s)
- Alexander D Port
- Department of Ophthalmology, Boston Medical Center, Boston, MA, USA
| | - John G Nolan
- Department of Ophthalmology, Boston Medical Center, Boston, MA, USA
| | - Nicole H Siegel
- Department of Ophthalmology, Boston Medical Center, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Xuejing Chen
- Department of Ophthalmology, Boston Medical Center, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Steven D Ness
- Department of Ophthalmology, Boston Medical Center, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Manju L Subramanian
- Department of Ophthalmology, Boston Medical Center, Boston, MA, USA.
- Boston University School of Medicine, Boston, MA, USA.
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Iyer SSR, Regan KA, Burnham JM, Chen CJ. Surgical management of diabetic tractional retinal detachments. Surv Ophthalmol 2019; 64:780-809. [PMID: 31077688 DOI: 10.1016/j.survophthal.2019.04.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 04/24/2019] [Accepted: 04/30/2019] [Indexed: 01/06/2023]
Abstract
Tractional retinal detachment is an end-stage form of diabetic retinopathy that occurs when contractile forces in the vitreous and neovascular tissue lead to the detachment of the neurosensory retina. We review the literature related to the management of this disease. Preoperative planning includes appropriate patient selection, diagnostic and prognostic imaging, and medical optimization with reduction of systemic risk factors. Use of antivascular endothelial growth factor for preoperative treatment has had significant benefits for tractional retinal detachment repair in improving surgical efficiency and outcomes. Advances in microsurgical instrumentation are discussed, with attention to small-gauge vitrectomy with improved flow dynamics, viewing strategies, and lighting allowing bimanual surgery. Special emphasis is placed on bimanual surgical technique, choice of tamponade, and the avoidance of iatrogenic damage. Complications and special considerations are further explored. Based on our compilation of relevant literature, we propose a surgical algorithm for the management of these complex patients.
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Affiliation(s)
- Siva S R Iyer
- Department of Ophthalmology, University of Florida College of Medicine, Gainesville, Florida, USA.
| | - Kathleen A Regan
- Department of Ophthalmology, University of Florida College of Medicine, Gainesville, Florida, USA
| | | | - Ching J Chen
- Department of Ophthalmology, University of Mississippi School of Medicine, Jackson, Mississippi, USA
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Outcome and Complications of Combined Phacoemulsification and 23-Gauge Pars Plana Vitrectomy. J Ophthalmol 2019; 2019:7918237. [PMID: 31007952 PMCID: PMC6441543 DOI: 10.1155/2019/7918237] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/10/2019] [Accepted: 02/26/2019] [Indexed: 12/20/2022] Open
Abstract
Background With the advances in surgical tools, simultaneous removal of cataract associated with vitreoretinal disorders is gaining popularity. This combined surgery offers several advantages besides limitations. The aim of this study is to assess the outcome and complications of phacoemulsification combined with pars plana vitrectomy (PPV). Patients and Methods In this retrospective review, medical charts of patients undergoing phacovitrectomy for coexisting cataract and various vitreoretinal disorders were analyzed. Patient demographics, retinal diagnosis, visual acuities (VA) in logMAR, intraocular pressure (IOP), intraoperative and postoperative complications were assessed. Clear corneal phacoemulsification and 23-gauge transconjunctival PPV were administered in all cases. Results Eighty-four eyes of 64 (76.2%) males and 20 (23.8%) females were enrolled. The average age of patients was 59.5 ± 13.8 (18–81). The average period of follow-up was 7.2 ± 7.5 months (1–36). The vitreoretinal diagnoses were as follows: 28 (33.3%) rhegmatogenous retinal detachment, 23 (27.4%) vitreous hemorrhage, 12 (14.3%) intraocular foreign body, 12 (14.3%) epiretinal membrane, 4 (4.8%) macular hole, 4 (4.8%) tractional retinal detachment, and 1 (1.2%) vitreomacular traction. The most common intraoperative complications were miosis and rupture of the posterior capsule (92.9% and 8.3%, respectively). In 8 (9.5%) cases, there was fibrin in the anterior chamber. Posterior synechia developed in 7 (8.3%) of cases. No severe increase in intraocular pressure was evident. Conclusion Phacoemulsification combined with PPV is a safe and efficient way of management in cases where cataract coexists with vitreoretinal pathologies.
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Yoo WS, Seo JS, Jeong JS, Shin MH, Kim SJ, Chung IY. The Changes of Anterior Chamber Depth and Refractive Errors after Phacovitrectomy with Posterior Capsulotomy. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2019. [DOI: 10.3341/jkos.2019.60.10.959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Woong-Sun Yoo
- Department of Ophthalmology, Gyeongsang National University College of Medicine, Jinju, Korea
- Department of Ophthalmology, Gyeongsang National University Hospital, Jinju, Korea
- Health Science Institute, Gyeongsang National University, Jinju, Korea
| | - Jin-Seok Seo
- Department of Ophthalmology, Gyeongsang National University College of Medicine, Jinju, Korea
- Department of Ophthalmology, Gyeongsang National University Hospital, Jinju, Korea
| | - Ji-Sung Jeong
- Department of Ophthalmology, Gyeongsang National University College of Medicine, Jinju, Korea
- Department of Ophthalmology, Gyeongsang National University Hospital, Jinju, Korea
| | - Min-Ho Shin
- Department of Ophthalmology, Chosun University College of Medicine, Gwangju, Korea
| | - Seong-Jae Kim
- Department of Ophthalmology, Gyeongsang National University College of Medicine, Jinju, Korea
- Department of Ophthalmology, Gyeongsang National University Hospital, Jinju, Korea
- Health Science Institute, Gyeongsang National University, Jinju, Korea
| | - In Young Chung
- Department of Ophthalmology, Gyeongsang National University College of Medicine, Jinju, Korea
- Department of Ophthalmology, Gyeongsang National University Hospital, Jinju, Korea
- Health Science Institute, Gyeongsang National University, Jinju, Korea
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INTRAOPERATIVE AND POSTOPERATIVE COMPLICATIONS IN PHACOVITRECTOMY FOR EPIRETINAL MEMBRANE AND MACULAR HOLE. Retina 2018; 38:1865-1872. [DOI: 10.1097/iae.0000000000002034] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Loukovaara S, Haukka J. Repair of primary RRD - comparing pars plana vitrectomy procedure with combined phacovitrectomy with standard foldable intraocular lens implantation. Clin Ophthalmol 2018; 12:1449-1457. [PMID: 30147297 PMCID: PMC6101008 DOI: 10.2147/opth.s171451] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Pars plana vitrectomy (PPV) combined with phacoemulsification and primary intraocular lens implantation can be performed for the repair of primary rhegmatogenous retinal detachment (RRD; PHACOVIT group). The safety and efficacy of this combined ophthalmic procedure on RRD surgery outcomes remain unclear compared with more conventional PPV technique alone (VITRET group). We explored the need for reoperation after primary surgical procedure in these two groups. Methods Retrospective, longitudinal, register-based cohort of RRD patients was operated in University Eye Clinic, Helsinki, Finland, during 2008–2014. The main outcome measure was reoperation rate during a postoperative follow-up period of 1 year due to retinal re-detachment, vitreous rehemorrhage, postoperative endophthalmitis, secondary pucker, macular hole or other reasons. Results We analyzed 1,690 consecutive RRD cases, out of which 1,564 patients were treated in the PPV VITRET group and 126 patients in the PHACOVIT-operated group. Risk for reoperation was 2.67 times higher in the PHACOVIT group compared to the PPV VITRET group (95% CI 1.85–3.85). Conclusion The reoperation rate was higher in RRD eyes operated with combined cataract surgery plus PPV, suggesting that RRD eyes should not primarily undergo combined PHACOVIT surgery.
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Affiliation(s)
- Sirpa Loukovaara
- Unit of Vitreoretinal Surgery, Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland,
| | - Jari Haukka
- Department of Public Health, University of Helsinki, Helsinki, Finland
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Tayyab H, Khan AA, Javaid RMM. Clinical outcome of 23g Trans-Conjunctival pars plana vitrectomy - a prospective comparison of Phaco-Vitrectomy with only vitrectomy in phakic eyes. Pak J Med Sci 2017; 33:1123-1127. [PMID: 29142550 PMCID: PMC5673719 DOI: 10.12669/pjms.335.13430] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To evaluate the effectiveness and safety profile of combined phacoemulsification with 23G pars plana vitrectomy when compared to pars plana vitrectomy alone in phakic patients. Methods This study was performed at Al-Ehsan Eye Hospital (tertiary care eye hospital in Lahore, Pakistan) from January 2016 to August 2016. A total of 40 eyes in two equal groups of 20 eyes each, were enrolled in this prospective study. Group-A underwent combined phaco-vitrectomy, whereas Group-B underwent vitrectomy only for various vitreoretinal pathologies. We evaluated the safety of combined surgery, intra-operative and postoperative complications and short term surgical outcome. Results The most common reason for vitreoretinal intervention was rhegmatogenous retinal detachment followed by vitreous haemorrhage in combined study population. There was statistically significant difference in best corrected visual acuity pre-operatively and post operatively within the groups and between the groups. The most significant immediate post operative observation in Group-A was enhanced anterior chamber inflammation as compared to Group-B, whereas most signification observation in Group-B was development of visually significant cataract (35%) at 6 months follow-up. There was no other significant sequel or complication difference between both groups. Conclusions Combined phaco-vitrectomy is a safe and effective procedure with minimum complication profile and it avoids the need of subsequent cataract surgery.
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Affiliation(s)
- Haroon Tayyab
- Dr. Haroon Tayyab, FCPS (Ophth), FCPS (Vitreoretinal Ophthalmology), FICO, Department of Ophthalmology, King Edwards Medical University - Mayo Hospital, Lahore, Pakistan
| | - Asad Aslam Khan
- Prof. Dr. Asad Aslam Khan, (SI) - MS (Ophth), PhD, Department of Ophthalmology, King Edwards Medical University - Mayo Hospital, Lahore, Pakistan
| | - Rana Muhammad Mohsin Javaid
- Dr. Rana Muhammad Mohsin Javaid, FCPS, Department of Ophthalmology, King Edwards Medical University - Mayo Hospital, Lahore, Pakistan
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COMPLEX RETINAL DETACHMENT IN PHAKIC PATIENTS: Previtrectomy Phacoemulsification Versus Combined Phacovitrectomy. Retina 2017; 37:630-636. [PMID: 27465572 PMCID: PMC5388025 DOI: 10.1097/iae.0000000000001221] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Previtrectomy cataract surgery was associated with less extensive postoperative posterior synechia, however, its final functional and anatomical outcomes were not significantly different from those of combined phacovitrectomy. Both approaches were efficacious. Purpose: To assess the impact of phacoemulsification performed one week before pars plana vitrectomy versus combined phacovitrectomy on postoperative anterior segment status and final functional and anatomical outcomes in phakic patients affected by complex rhegmatogenous retinal detachment. Methods: The authors retrospectively reviewed the records of 59 phakic patients affected by complex rhegmatogenous retinal detachment. Twenty-nine patients underwent cataract surgery 7 days before vitrectomy (preemptive cataract surgery—Group 1), whereas 30 patients underwent combined phacovitrectomy (Group 2). Preoperative, intraoperative, early- and late-postoperative outcomes were measured and compared. Results: Numbers of previous retinal surgical procedures, nuclear sclerosis grade, proliferative vitreoretinopathy grade, eyes with inferior breaks, surgical time, and ratio of silicone oil/gas tamponade were all similar between the two groups. After surgery, there was less extension of posterior synechia in Group 1. There was no significant difference in fibrin, number of patients with posterior synechia, final intraocular pressure, retinal redetachment rate, final retinal status, or final best-corrected visual acuity. Conclusion: Preemptive cataract surgery was associated with less extensive postoperative posterior synechia, however, its final functional and anatomical outcomes were not significantly different from those of phacovitrectomy. Both approaches were efficacious.
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Bikbov MM, Surkova VK. Cornea and its changes in diabetes mellitus: the review. DIABETES MELLITUS 2016. [DOI: 10.14341/dm7972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Diabetes mellitus (DM) is the most common endocrine disease, which makes it a priority among health and social problems. Ocular manifestations in diabetes often lead to patient disability. This review presents an analysis of morphological, experimental and clinical studies of the cornea in patients with diabetes mellitus, including original research, reviews and monographs of Russian and foreign authors from recent years. In addition, modern methods of corneal disease diagnosis are reviewed. Clinical and morphological changes in the diabetic cornea are discussed and early diabetic changes in all structural layers are indicated. The importance of changes to nerve fibres in diabetes is discussed and the correlation between the density of nerve fibres in the cornea and the density of epidermal nerve fibres is shown.
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Arikan Yorgun M, Toklu Y, Mutlu M, Ozen U. Clinical outcomes of 25-gauge vitrectomy surgery for vitreoretinal diseases: comparison of vitrectomy alone and phaco-vitrectomy. Int J Ophthalmol 2016; 9:1163-9. [PMID: 27588272 DOI: 10.18240/ijo.2016.08.13] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 11/09/2015] [Indexed: 11/23/2022] Open
Abstract
AIM To compare the clinical outcomes of combined 25-gauge pars plana vitrectomy (PPV) and phacoemulsification/posterior chamber intraocular lens (PC-IOL) implantation with vitrectomy alone surgery in patients with various vitreoretinal diseases. METHODS A total of 306 eyes (145 with PPV alone and 161 with phaco-vitrectomy) were enrolled in this retrospective analysis. The surgical approach was 25-gauge PPV combined with phacoemulsification and PC-IOL implantation at the same time in eyes in phaco-vitrectomy group and only PPV in eyes in vitrectomy alone surgery group. The main outcome measures were postoperative clinical outcomes included anterior chamber inflammation, changes in intraocular pressure (IOP) and best corrected visual acuity (BCVA). RESULTS The most common postoperative complication was anterior chamber reaction which has higher incidence in phaco-vitrectomy group (P<0.001). The mean postoperative 1(st) day IOP of vitrectomy alone group was significantly lower than that of phaco-vitrectomy group (16.3±5.8 mm Hg vs 17.8±8.1 mm Hg, respectively, P=0.02). Hypotony (IOP≤8 mm Hg) was not different between groups in the postoperative 1(st) day (P>0.05). The mean preoperative visual acuity was not different between groups (1.6±0.9 logMAR vs 1.8±0.9 logMAR, respectively, P>0.05). However, the mean visual acuity was decreased in vitrectomy alone group at the final visit compared to phaco-vitrectomy group (1.2±0.8 logMAR, 0.9±0.7 logMAR, respectively P<0.05). CONCLUSION Twenty-five gauge PPV combined with phacoemulsification surgery is a safe and efficient procedure, which can be preferred in phacic patients with a variety of vitreoretinal diseases compared to vitrectomy alone. Despite improved outcomes, this approach is not free of limitations as anterior chamber complications especially with combined surgery.
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Affiliation(s)
- Mucella Arikan Yorgun
- Department of Ophthalmology, Ankara Ataturk Education and Research Hospital, Yildirim Beyazit University, Ankara 06800, Turkey
| | - Yasin Toklu
- Department of Ophthalmology, Ankara Ataturk Education and Research Hospital, Yildirim Beyazit University, Ankara 06800, Turkey
| | - Melek Mutlu
- Department of Ophthalmology, Ankara Ataturk Education and Research Hospital, Yildirim Beyazit University, Ankara 06800, Turkey
| | - Umut Ozen
- Department of Ophthalmology, Ankara Ataturk Education and Research Hospital, Yildirim Beyazit University, Ankara 06800, Turkey
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Abstract
PURPOSE To evaluate and compare the cost of combined pars plana vitrectomy and phacoemulsification/intraocular lens implantation (phacovitrectomy) to a sequential approach to the surgical procedures for patients with an indication for vitrectomy and a visually significant cataract. METHODS The total cost of both the combined and sequential approaches to surgery were calculated by combining the surgeon, ambulatory surgical center, and anesthesiology fees as reimbursed by Medicare. A univariate sensitivity analysis was also performed to examine the sensitivity of our estimations to changes in surgical duration. RESULTS Phacovitrectomy afforded a 17% to 20% per-patient cost savings to Medicare (depending on the type of vitrectomy) compared with vitrectomy with sequential phacoemulsification. The conclusion that phacovitrectomy was less expensive than sequential surgery was robust in sensitivity analysis. CONCLUSION Phacovitrectomy seems to be significantly less costly to Medicare than a sequential approach to surgery for patients with an indication for vitrectomy and a visually significant cataract.
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Moya Romero JO, Arroyo González JM, Iniesta Sánchez LD, Ochoa Máynez GA, Gómez Cortes CA, Heras Bautista JA. Vitrectomía y facovitrectomía con anestesia tópica/intracameral. REVISTA MEXICANA DE OFTALMOLOGÍA 2015. [DOI: 10.1016/j.mexoft.2014.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Haddad NMN, Sun JK, Abujaber S, Schlossman DK, Silva PS. Cataract Surgery and its Complications in Diabetic Patients. Semin Ophthalmol 2014; 29:329-37. [DOI: 10.3109/08820538.2014.959197] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Reasons for Early Ocular Hypertension after Uneventful Cataract Surgery. Eur J Ophthalmol 2014; 24:712-7. [PMID: 24557756 DOI: 10.5301/ejo.5000441] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2014] [Indexed: 01/26/2023]
Abstract
Purpose To discuss the reasons for and measurements of early ocular hypertension after uneventful phacoemulsification and intraocular lens (IOL) implantation. Methods This was a retrospective review of patients who had early ocular hypertension after cataract surgery from a single-surgeon practice that medications failed to control or required additional surgery from September 2011 to January 2013. Results Of the 1270 eyes that had cataract surgery by one surgeon in our department in 16 months, 12 (9.4‰) eyes of 12 patients met the inclusion criteria. The mean postoperative intraocular pressure (IOP) peak was 41 (range 32-62) mm Hg. The median time of initial onset after cataract surgery was 3.5 days (range 1-60 days). Six eyes had antiglaucoma surgery history. Ahmed valve implantation with mitomycin C (MMC) was applied to 4 eyes. Two eyes underwent 5-fluorouracil needling revision with MMC. The IOP dropped in 3 eyes only in the case that the conventional topical corticosteroid agent was stopped, diagnosed as steroid responders. One eye of a patient with diabetes mellitus (DM) developed pseudophakic pupillary block angle-closure glaucoma due to the plasma glucose fluctuations. The IOP was controlled after Nd:YAG laser iridotomies. Residual cortex caused ocular hypertension in 2 eyes and surgical aspirations were performed. Following monitoring of IOP for 6 to 24 months, all eyes were within the normal range. Conclusions Patients with history of glaucoma surgery; high myopia, especially in young age; and DM merit particular observation and treatment for possible IOP elevation following cataract surgery.
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