Primary vitrectomy for the treatment of retinal detachment in highly myopic eyes with axial length over 30 mm

Vitreous Wiping, a new technique for removal of vitreous cortex remnants during vitrectomy

PURPOSE

Unremoved vitreoschisis-induced vitreous cortex remnants (VCR) are associated with macular pathology. When present on the retinal periphery, they may play a role in proliferative vitreoretinopathy and retinal detachment after vitrectomy. Existing instruments for their removal involve substantial risk of iatrogenic retinal damage. Purpose of this study was to evaluate the use of a new technique, Vitreous Wiping, for removal of VCR during vitrectomy.

METHODS

Proof-of-concept case series of six eyes (six patients) treated with vitrectomy for various pathologies (macula-on and macula-off retinal detachment, macular hole, macular pucker and vitreous floaters). Vitreous cortex remnants on the surface of the retina were visualized with triamcinolone and removed by Vitreous Wiping with a rectangular piece of polyvinyl alcohol (PVA) held with intra-ocular forceps. Visual acuity and clinical course were assessed during a follow-up of 6 months. All eyes underwent postoperative macular optical coherence tomography. Eyes without preoperative macular pathology, underwent retinal sensitivity testing and eyes without paracentral pathology underwent visual field analysis.

RESULTS

Vitreous cortex remnants could be removed completely in all eyes. There were no intra- or postoperative complications. We observed that PVA is soft like a sponge and vitreous sticks to it, making Vitreous Wiping easier and safer, compared to alternative instruments. Visual acuity improved in all eyes. Microperimetry and visual field analysis revealed no abnormalities related to Vitreous Wiping.

CONCLUSION

Vitreoschisis-induced VCR can be removed effectively and safely from the retinal surface by Vitreous Wiping. Larger studies are needed to confirm this promising finding and its potential impact.

Retinal detachment due to paravascular abnormalities-associated breaks in highly myopic eyes

PURPOSE

To describe the characteristics of a novel type of retinal detachment (RD) due to paravascular abnormalities (PVAs) associated breaks in highly myopic eyes.

METHODS

We retrospective recruited eight eyes with RD due to PVA-associated breaks. The clinical features and surgical results were evaluated.

RESULTS

All eyes were highly myopic with a mean axial length of 31.31 ± 2.86 mm (27.51-36.52 mm). Two of the eight eyes had multiple paravascular retinal breaks associated with PVAs, four had a single paravascular break with PVAs nearby, and two had multiple paravascular breaks along the same vessels. All breaks were round or oval-shaped, and only three eyes (37.5%) had their breaks located over patchy chorioretinal atrophy. Two of the eight eyes had the breaks outside the arcades, five had their breaks within the arcades, and one had a break within the arcade as well as breaks outside the arcade. Vitrectomy and epiretinal and internal limiting membrane peeling were performed in all cases, with inverted or free internal limiting membrane flap insertions for the perifoveal breaks and endolaser for the more peripheral breaks. All eyes had retinal reattachment after one single operation.

CONCLUSION

RD due to PVA-associated breaks represented a distinct entity. PVAs and the associated breaks should be searched in RD without macular hole or obvious breaks in highly myopic eyes. It may be treated as RD caused by peripheral breaks or as macular hole associated RD depending on the location of the breaks.

Anatomical success rate of pars plana vitrectomy for treatment of complex rhegmatogenous retinal detachment

Background

Pars plana vitrectomy (PPV) is preferred surgical procedure for the management of complex rhegmatogenous retinal detachment (RRD). The purpose of this study was to evaluate the anatomical results of primary PPV for the treatment of primary complex RRD and to determine the influence of lens status, tamponading agent, preoperative proliferative vitreoretinopathy (PVR) and axial length (AL) of the eye upon the anatomical outcome.

Methods

A retrospective consecutive chart analysis was performed on 117 eyes from 117 patients with complex RRD managed with PPV. Fifty-nine eyes were phakic and 58 pseudophakic eyes. All patients had a minimum follow-up period of 12 months. Eyes were classified into groups using independent variables (first classification based upon lens status and tamponade used, second classification based upon lens and PVR status and third classification based upon AL of the eye). The groups were compared for anatomical outcomes (dependent variables) using nonparametric- or, in case of normally distributed data, parametric- statistical tests.

Results

Retinal reattachment rate in phakic eyes was 94.9% compared to 93.1% in pseudophakic, with no statistically significant difference between the two. The overall retinal reattachment rate with single surgery was 94.0%. Final reattachment rate was 97.4%. In case of established PVR ≥ C1, the reattachment rate was not statistically different (92.6%) from eyes with no PVR (91.1%) irrespective of lens status. A statistically significant difference was found between redetachment rates only between phakic eyes with gas tamponade compared to silicon oil (SO) (p = 0.001). Reattachment rate proved to be similar in both AL groups (≤24 mm and > 24 mm).

Conclusions

High anatomical success rate of primary vitrectomy for complex RRD with either gas or SO tamponade was achieved in phakic as well as pseudophakic eyes irrespective of AL of the eye.

Tamponade or filling effect: changes of forces in myopic eyes

Myopia is the most common ocular abnormality. Its high and growing prevalence has contributed to a recent surge in surgical interest in the disorder, since retinal detachment in eyes with high myopia differs from that in emmetropic eyes or eyes with low myopia. The myopic eye, because of its specific anatomy, poses special challenges that need to be overcome to ensure the appropriate use of vitreous substitutes. However, intraocular tamponades have shown great potential for revolutionizing retinal detachment surgery and vitreomacular surgery in general in myopic eyes. We provide an updated review of the clinical use of vitreous substitutes in the myopic eye, paying particular attention to analyzing the ideal function of endotamponade agents and comparing the effects of these agents on the physical and biological properties of the eye.