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Quiroz-Reyes MA, Quiroz-Gonzalez EA, Quiroz-Gonzalez MA, Lima-Gomez V. Pneumatic vitreolysis versus vitrectomy for the treatment of vitreomacular traction syndrome and macular holes: complication analysis and systematic review with meta-analysis of functional outcomes. Int J Retina Vitreous 2023; 9:33. [PMID: 37316932 DOI: 10.1186/s40942-023-00472-x] [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: 03/15/2023] [Accepted: 05/10/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND We conducted a systematic review to compare the effects of pneumatic vitreolysis (PV), enzymatic vitreolysis (EVL) with ocriplasmin, and pars plana vitrectomy (PPV) on vitreomacular traction (VMT) syndrome and macular holes (MHs) to assess their efficacy as treatment options. METHODS Databases, including PubMed, ClinicalTrials.gov ( www. CLINICALTRIALS gov ), the Cochrane Central Register of Controlled Trials (CENTRAL)-including the Cochrane Eyes and Vision Group Trials Register (The Cochrane Library 2013, Issue 2)-, Ovid MEDLINE, and EMBASE (January 2000-October 2022), were searched to identify studies comparing the outcomes of PV versus PPV, PPV versus ocriplasmin and ocriplasmin versus PV. RevMan 5.1 was used for the meta-analysis of the studies. RESULTS Among the 89 studies, 79 were considered eligible for qualitative analysis, and 10 quantitative studies were subjected to meta-analysis. PPV resulted in better postoperative visual acuity improvement than ocriplasmin (standardized mean deviation (SMD) = 0.38, 95% CI 0.03-0.73, p = 0.0003). PV resulted in no significant difference in visual improvement compared with PPV (SMD = - 0.15, 95% CI - 0.47 to 0.16, p = 0.35). PPV was significantly more effective in terms of the VMT release rate (risk ratio = 0.48, 95% CI 0.38-0.62, p = 0.00001) and MH closure rate (risk ratio = 0.49, 95% CI 0.30-0.81, p = 0.006) than ocriplasmin. PV was more effective than ocriplasmin in terms of the VMT release rate (risk ratio = 0.49, 95% CI 0.35-0.70, p = 0.0001). Qualitative analysis showed MH closure rates of 46%, 47.8%, and 95% and VMT releases rates of 46%, 68% and 100% after ocriplasmin, PV, and PPV treatments, respectively. Adverse events and postoperative complications occurring after treatment have also been documented in these studies. CONCLUSION PPV appears to be the most promising option for MH closure and VMT release, with fewer serious complications than EVL or PV. However, given the limited number of studies comparing these treatments, further research is needed to establish the superiority of PPV over the other options.
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Affiliation(s)
- Miguel A Quiroz-Reyes
- Retina Department of Oftalmologia Integral ABC (Nonprofit Medical and Surgical Organization), Which is Affiliated with the Postgraduate Studies Division of the National Autonomous University of Mexico, Av. Paseo de las Palmas 735 Suite 303, Lomas de Chapultepec, 11000, Mexico City, Mexico.
| | - Erick A Quiroz-Gonzalez
- Retina Department of Oftalmologia Integral ABC (Nonprofit Medical and Surgical Organization), Which is Affiliated with the Postgraduate Studies Division of the National Autonomous University of Mexico, Av. Paseo de las Palmas 735 Suite 303, Lomas de Chapultepec, 11000, Mexico City, Mexico
- Institute of Ophthalmology, Fundacion Conde de Valenciana, (Nonprofit Organization), Which is Affiliated with the Postgraduate Studies Division of the National Autonomous University of Mexico, Av. Chimalpopoca 14. Col. Obrera, 06800, Mexico City, Mexico
| | - Miguel A Quiroz-Gonzalez
- Retina Department of Oftalmologia Integral ABC (Nonprofit Medical and Surgical Organization), Which is Affiliated with the Postgraduate Studies Division of the National Autonomous University of Mexico, Av. Paseo de las Palmas 735 Suite 303, Lomas de Chapultepec, 11000, Mexico City, Mexico
| | - Virgilio Lima-Gomez
- Juarez Hospital, Public Assistance Institution (Nonprofit Organization), Av. Politecnico Nacional 5160, Colonia Magdalena de las Salinas, 07760, Mexico City, Mexico
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Tarkova A, Jiraskova N, Dusova J, Marak J, Studnicka J. Changes in vascular density in the macula after pars plana vitrectomy for idiopathic macular hole with macular peeling and one type of flap. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2023. [PMID: 37114702 DOI: 10.5507/bp.2023.017] [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: 04/29/2023] Open
Abstract
BACKGROUND AND AIMS The aim of this study was to evaluate changes in vascular density in the macula after pars plana vitrectomy for idiopathic macular hole (IMD) with macular peeling and flap. METHODS A prospective study of 35 eyes in 34 patients who had undergone standard surgery. Evaluated parameters were best-corrected visual acuity (BCVA), intraocular pressure (IOP), central macular thickness (CRT), macular volume (TMV) and vascular density of the superficial and deep capillary plexus. The follow-up period was one year. RESULTS We divided the total group into two: temporal and circular flap and total group. We compared the values after surgery with the preoperative values. In the total group, BCVA increased from 48.38 to 71.44 letters (P≤0.05). IOP changed from 15.24 to 14.76 mmHg (P>0.05). CRT decreased from 432.27 to 323.64 µm (P≤0.05). TMV changed from 0.26 to 0.25 mm3 (P>0.05). The vascular density of the superficial plexus decreased from 32 to 28% (P≤0.05). The intercapillary space of the superficial plexus increased from 68 to 72% (P≤0.05). The vascular density of the deep plexus increased from 17 to 23%. The intercapillary space of the deep vascular plexus decreased from 83 to 77%. Changes in vascular density and intercapillary space of the deep plexus were statistically significant for certain months after operations (P≤0.05). There were no significant differences between subgroups. CONCLUSION The superficial plexus vascular density is almost the same in the temporal flap and in the foveal-sparing flap is decreased, and the deep plexus vascular density increased statistically significantly during the follow-up period after surgery.
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Affiliation(s)
- Anna Tarkova
- Department of Ophthalmology, Faculty Hospital Nitra, Spitalska 6, Nitra, Slovak Republic
- Department of Ophthalmology, University Hospital Hradec Kralove, Sokolska 581, Hradec Kralove, Czech Republic
- Department of Ophthalmology, Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Nada Jiraskova
- Department of Ophthalmology, University Hospital Hradec Kralove, Sokolska 581, Hradec Kralove, Czech Republic
- Department of Ophthalmology, Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Jaroslava Dusova
- Department of Ophthalmology, University Hospital Hradec Kralove, Sokolska 581, Hradec Kralove, Czech Republic
| | - Jan Marak
- Department of Ophthalmology, University Hospital Hradec Kralove, Sokolska 581, Hradec Kralove, Czech Republic
| | - Jan Studnicka
- Department of Ophthalmology, University Hospital Hradec Kralove, Sokolska 581, Hradec Kralove, Czech Republic
- Department of Ophthalmology, Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
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Ruban A, Petrovski BÉ, Petrovski G, Lytvynchuk LM. Internal Limiting Membrane Peeling and Gas Tamponade For Full-Thickness Macular Holes of Different Etiology - Is It Still Relevant? Clin Ophthalmol 2022; 16:3391-3404. [PMID: 36249443 PMCID: PMC9555881 DOI: 10.2147/opth.s373675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/10/2022] [Indexed: 11/23/2022] Open
Abstract
Background Despite the abundance of novel surgical approaches proposed for full thickness macular hole (FTMH) treatment, the choice of the optimal technique remains debatable Vitrectomy with «classic» internal limiting membrane peeling and gas tamponade remains the standard of FTMH surgery in many cases, but there are still very limited recent publications on the outcomes of such surgery. Purpose To investigate the anatomical and functional result and to analyze the significance of outcome-related risk factors of the classic 25-gauge pars plana vitrectomy (PPV) with ILM peeling and gas tamponade (GT) for treatment of FTMH of different etiology. Patients and methods Thirty-eight eyes of thirty-seven patients with FTMH who underwent 25-gauge PPV, ILM peeling and GT were recruited for this retrospective, consecutive, interventional study. Four eyes with persistent holes underwent a re-operation. Outcome-related factors were discussed. Results The primary closure rate was 89.5% (34/38). All eyes that underwent the repeated surgery (4 cases) obtained final closure. A hole size of >500 μm has a statistically significant effect on the primary macular hole closure (F = 0.048; φ = 0.38; p ˂ 0.05). In the general group (N = 38), the duration of symptoms directly correlated with age (ρ = 0.34; p = 0.04), size of the hole (ρ = 0.66; p ˂ 0.001) and BCVA before surgery (ρ = 0.59; p ˂ 0.001), after 1 month (ρ = 0.36; p = 0.03), and after 3 months (ρ = 0.35; p = 0.03). Preoperative BCVA was better in initially closed cases (Group 1) (U = 26.0; p = 0.05). In the Group 2 with primary unclosed holes, 75% of the eyes (3/4) had an axial length (AL) >26 mm, while in Group 1 such eyes were 12.5 times less (2/34) 5.9% (F = 0.004; φ = 0.63; р ˂ 0.01). The ELM recovery rate at 3 months was 92% (35/38 eyes) and the restoration of EZ at 3 months was 47% (18/38 eyes). Best-corrected visual acuity of all individuals improved significantly from 0.72 ± 0.35 (logMAR) (Me = 0.7; IQR: 0.5-0.8) to 0.25±0.14 (logMAR) (Me = 0.2; IQR: 0.2 - 0.3) at 1 month and 0.17 ± 0.13 (logMAR) (Me = 0.2; IQR: 0.1 - 0.2) at 3 months after surgery (P = 0.0001). Conclusion 25G PPV with ILM and GT for FTMH of different etiology provide satisfactory morphologic and functional outcomes. Elongated AL, large diameter of MH and long duration of symptoms are the risk factors for initial closure. Proper second surgery can obtain satisfactory outcomes for persistent holes.
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Affiliation(s)
| | - Beáta Éva Petrovski
- Department of Ophthalmology, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Goran Petrovski
- Department of Ophthalmology, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway,Center for Eye Research, Department of Ophthalmology, Oslo University Hospital, Oslo, Norway,Department of Ophthalmology, University of Split School of Medicine and University Hospital Centre, Split, Croatia
| | - Lyubomyr M Lytvynchuk
- Department of Ophthalmology, Justus-Liebig-University Giessen, Eye Clinic, University Hospital Giessen and Marburg GmbH, Giessen, Germany,Karl Landsteiner Institute for Retinal Research and Imaging, Vienna, Austria,Correspondence: Lyubomyr M Lytvynchuk, Department of Ophthalmology, Justus-Liebig-University Giessen, Eye Clinic, University Hospital Giessen and Marburg GmbH, Campus Giessen, Friedrichstrasse 18, Giessen, 35392, Germany, Tel +49 64198543820, Fax +49 64198543809, Email
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Tao J, Chen H, Chen Y, Yu J, Xu J, Mao J, Lin L, Shen L. EFFICACY OF AIR TAMPONADE TREATMENT OF IDIOPATHIC MACULAR HOLES OF DIFFERENT DIAMETERS AND OF FOLLOW-UP INTRAVITREAL AIR TAMPONADE FOR PERSISTENT HOLES. Retina 2022; 42:877-882. [PMID: 34954776 DOI: 10.1097/iae.0000000000003394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the efficacy of air tamponade in idiopathic macular hole (iMH) surgery and of an additional intravitreal air injection in the treatment of persistent holes. METHODS Retrospective, observational case series. Sixty eyes of 60 patients with an iMH underwent phacoemulsification of cataract (when appropriate), pars plana vitrectomy, and internal limiting membrane peeling, followed by air tamponade. Eyes with persistent holes underwent an additional intravitreal air injection within 1 week after surgery. The iMH closure rate and the best-corrected visual acuity were evaluated. RESULTS In all 30 eyes with an iMH diameter <400 µm, the iMH closed after the primary surgery; however, only 17 of 30 eyes with an iMH diameter of ≥400 µm closed after the primary surgery. For the 13 eyes with persistent holes, an additional intravitreal air injection resulted in successful hole closure. There was no significant difference in the best-corrected visual acuity at the final follow-up between the closed subgroup and the initially unclosed subgroup after closure. CONCLUSION Pars plana vitrectomy combined with air tamponade effectively cured small iMHs. For large iMHs not closed after the primary surgery, an additional intravitreal air injection resulted in hole closure and achieved a good prognosis.
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Affiliation(s)
- Jiwei Tao
- Department of Retina Center, Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang Province, China
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Air versus Sulfur Hexafluoride Gas Tamponade for Small and Medium Sized Macular Holes: a Randomized Noninferiority Trial. Ophthalmol Retina 2022; 6:828-834. [PMID: 35398546 DOI: 10.1016/j.oret.2022.04.003] [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: 02/18/2022] [Revised: 03/25/2022] [Accepted: 04/04/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE To investigate whether air is noninferior to sulfur hexafluoride (SF6) gas tamponade for small (≤250 μm) and medium sized (>250 μm and ≤400 μm) macular holes (MH). DESIGN Multicenter, randomized controlled, noninferiority trial. PARTICIPANTS Patients ≥18 years of age undergoing surgery for primary MH ≤400 μm in diameter. METHODS Both groups underwent conventional pars plana vitrectomy with peeling of the internal limiting membrane. At the end of the surgery, the patients were randomized to receive air or SF6 gas tamponade stratified by MH size. Postoperatively, the patients followed a nonsupine positioning regimen for three days. MAIN OUTCOME MEASURES The primary endpoint was MH closure rate after a single surgery, confirmed by optical coherence tomography after 2-8 weeks. The noninferiority margin was set at a 10 percentage points difference in closure rate. RESULTS A total of 150 patients were included, 75 in each group. In the intention to treat (ITT) analysis, 65 out of 75 patients in the air group achieved primary closure. All 75 MH in the SF6 group closed after a single surgery. Six patients were excluded from the per protocol (PP) analysis. In the PP analysis, 63 out of 70 patients in the air group and all 74 patients in the SF6 group achieved MH closure after a single surgery, resulting in closure rates of 90% (95% confidence interval [CI], 79.9-95.5%) and 100% (95% CI, 93.9-100%), respectively. For the difference in closure rates, the lower bound of a two-sided 95% CI exceeded the noninferiority margin of 10% in both the ITT analysis and the PP analysis. In the subgroup of small MH, all 20 patients in the air group and all 28 patients in SF6 group achieved primary closure. CONCLUSIONS This prospective randomized controlled trial proved that air tamponade is inferior to SF6 tamponade for MH ≤400 μm in diameter.
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Air-Liquid Exchange by Free Hand and One Needle for Unhealed Macular Hole. J Ophthalmol 2022; 2022:3052366. [PMID: 35140986 PMCID: PMC8820866 DOI: 10.1155/2022/3052366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/28/2021] [Indexed: 11/18/2022] Open
Abstract
Aim To report the treatment of 7 cases of unsealed hole after macular hole surgery with air-fluid exchange. Methods Retrospective case series. We collected 7 eyes of 7 patients with unsealed hole an unsealed hole about 2 weeks after macular hole surgery (23G vitrectomy with internal limiting membrane peeling with sterilizing air tamponade) in our hospital from February 2018 to December 2018. All patients underwent “air-liquid exchange by free hand and one needle.” The prone position was taken one week after operation. The macular holes before and after operation were examined by frequency-domain optical coherence tomography (SD-OCT). Results The size of the macular hole before vitrectomy was 481 ± 156 μm (range: 281–609 μm). Two weeks after vitrectomy (before air and liquid exchange), the size of the macular hole was 295 ± 92 μm (range: 210–421 μm). All macular holes were closed within 7–14 days after air-liquid exchange. There was no complaint of discomfort among these patients. Conclusion From this preliminary study, air-liquid exchange by free hand and one needle seems to be safe and effective in the treatment for patients with unsealed and tiny macular hole after vitrectomy as the lack of long effective gas in China. However, the exact efficacy and safety need further large case studies.
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Zhao XY, Meng LH, Zhang WF, Yu WH, Chen YX, Min HY. PUMCH experience and strategy for the management of idiopathic macular hole: a retrospective cohort study. Int Ophthalmol 2021; 42:1133-1145. [PMID: 34743256 DOI: 10.1007/s10792-021-02099-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/21/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To introduce and evaluate a modified therapeutic strategy for idiopathic macular holes (IMH). METHODS A retrospective review of patients with diagnosis of IMH from July 2016 to January 2020 at Peking Union Medical College Hospital. These patients were managed strictly according to our therapeutic strategy. Their comprehensive clinical data were collected and analyzed. RESULTS 209 eyes suffering stage II to IV IMH were identified. For stage II IMH, the spontaneous closure rate was 8.9%, the initial success rate of intravitreal injections (IVI) of expansile gas and pars plana vitrectomy (PPV) + internal limiting membrane peeling (ILMP) + air tamponade was 84.2% and 100%, respectively. The initial success rate of PPV + ILMP + air tamponade for stage III and stage IV IMH was 89.8% and 86.4%, respectively. Following our intervention strategy, stage II IMH achieved a final IMH closure rate of 100%, stage III of 99% and stage IV of 97%. The final best corrected visual acuity was significantly improved (P < 0.05). Sitting position air-fluid (A-F) exchange alone successfully induced IMH closure in 7/19 eyes that did not achieve IMH closure by initial PPV. For three refractory cases that failed additional PPV + ILM stuffing, intraoperative OCT assisted PPV + sub-retinal BSS injection successfully induced the IMH closure. As the remaining three unclosed IMH cases were dry and stable, no more interventions were conducted. CONCLUSION The general IMH closure rate based on our therapeutic strategy was satisfactory with a favorable prognosis. IVI expansile gas and sitting position A-F exchange were effective and highly cost-effective under certain circumstances.
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Affiliation(s)
- Xin-Yu Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
- Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Li-Hui Meng
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
- Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Wen-Fei Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
- Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Wei-Hong Yu
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
- Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - You-Xin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China.
- Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, 100730, China.
| | - Han-Yi Min
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China.
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Zeng Q, Yao Y, Zhao M. Comparison between Fovea-Sparing and Complete Internal Limiting Membrane Peeling for the Treatment of Myopic Traction Maculopathy: A Systemic Review and Meta-Analysis. Ophthalmic Res 2021; 64:916-927. [PMID: 34425571 DOI: 10.1159/000519021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 07/31/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Myopic traction maculopathy (MTM) is a major cause of impaired vision in eyes with high myopia, which is characterized by retinal thickening, retinoschisis, lamellar macular hole (MH), and foveal retinal detachment. Pars plana vitrectomy (PPV) with fovea-sparing internal limiting membrane peeling (ILMP) has been developed to theoretically prevent postoperative MH formation and improve best-corrected visual acuity (BCVA) gain for MTM compared with the complete ILMP. However, in previous studies, the anatomic and visual outcomes still remain uncertain and controversial. OBJECTIVES The aim of this study was to evaluate the anatomic and visual outcomes of vitrectomy with fovea-sparing ILMP for the treatment of MTM compared with complete ILMP. METHODS Articles from PubMed, EMBASE, Web of Science, and Cochrane Library were systematically retrieved. The main outcomes were the rate of a postoperative MH and visual improvement of BCVA (converted to logarithm of the minimum angle of resolution [logMAR]). The secondary outcomes were the proportion of patients with visual improvement, the proportion of anatomic success, preoperative and postoperative BCVA, preoperative and postoperative central fovea thickness, and time to anatomic resolution. RESULTS There was a higher rate of postoperative MH formation (odds ratio [OR] 5.64; 95% confidence interval [CI]: 1.72-18.44; p = 0.004) and less improvement of BCVA in logMAR (mean difference [MD] -0.09; 95% CI: -0.18 to 0.00; p = 0.04) in the complete ILMP group. However, postoperative BCVA (MD 0.14; 95% CI: 0.00-0.27; p = 0.05), the proportion of patients with visual improvement (OR 0.39; 95% CI: 0.15-1.02; p = 0.05), postoperative central foveal thickness (MD -10.02; 95% CI: -24.4 to 4.36; p = 0.17), the rate of anatomic success (MD 0.39; 95% CI: 0.15-1.03; p = 0.06), and time to resolution (MD -1.65; 95% CI: -3.66 to 0.36; p = 0.11) showed no significant differences. CONCLUSION PPV combined with the fovea-sparing ILMP could contribute to a lower MH formation rate and more improvement of BCVA in logMAR than PPV combined with complete ILMP.
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Affiliation(s)
- Qiaozhu Zeng
- Department of Ophthalmology, Eye Diseases and Optometry Institute, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing, China
| | - Yuou Yao
- Department of Ophthalmology, Eye Diseases and Optometry Institute, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing, China
| | - Mingwei Zhao
- Department of Ophthalmology, Eye Diseases and Optometry Institute, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing, China
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Cheng Y, Zou H, Zhang X, Qi S, Sun F, Wang C, Liu Z. Pars plana vitrectomy with air tamponade for the treatment of medium‐large macular holes. Clin Exp Optom 2021; 103:843-846. [PMID: 32944992 DOI: 10.1111/cxo.13145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 07/27/2020] [Accepted: 08/09/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Yan Cheng
- Eye Centre of the Second Hospital, Jilin University, Changchun, China
| | - Hui Zou
- Eye Centre of the Second Hospital, Jilin University, Changchun, China
| | - Xue Zhang
- Department of Ophthalmology, Academy of Chinese Medical Science of Jilin Province, Changchun, China
| | - Shounan Qi
- Eye Centre of the Second Hospital, Jilin University, Changchun, China
| | - Fangge Sun
- Department of Ophthalmology, Luoyang First People's Hospital, Luoyang, China
| | - Chenguang Wang
- Eye Centre of the Second Hospital, Jilin University, Changchun, China
| | - Zaoxia Liu
- Eye Centre of the Second Hospital, Jilin University, Changchun, China
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Moharana B, Dogra M, Singh SR, Ravikumar B, Tigari B, Katoch D, Singh A, Singh R. Outcomes of 25-gauge pars plana vitrectomy with encircling scleral band for acute retinal necrosis-related rhegmatogenous retinal detachment. Indian J Ophthalmol 2021; 69:635-640. [PMID: 33595491 PMCID: PMC7942078 DOI: 10.4103/ijo.ijo_1353_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/21/2020] [Accepted: 08/10/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose The aim of this study was to evaluate the anatomic and functional outcomes of 25-gauge pars plana vitrectomy (25G PPV) with encircling scleral band (ESB) in patients with acute retinal necrosis (ARN)-related rhegmatogenous retinal detachment (RRD). Methods Single-center retrospective interventional case series of patients who underwent 25G PPV with ESB for ARN-related RRD. Complete anatomic success was defined as the complete attachment of retina after primary PPV. Functional success was measured by the final best-corrected visual acuity (BCVA) ≥20/400. Intraoperative and postoperative complications were also noted. Results 14 eyes of 13 patients were included in the study. Six patients (46.1%) were immunocompromised. The mean follow-up was 23.64 ± 9.95 (range 6-42) months. Silicone oil was used as tamponade in 13 eyes and C3F8gas in one eye. After the primary PPV, complete anatomical success was seen in all eyes (100%), however, one eye developed phthisis bulbi after silicone oil removal (SOR). Statistically significant improvement of BCVA was seen, from LogMAR 2.03 ± 0.29 preoperatively to LogMAR 1.57 ± 0.63 postoperatively (p-value 0.014). Six eyes (42.9%) had functional success. Nine eyes (64.3%) had improvement in vision while 4 eyes (28.6%) maintained preoperative vision. 10 eyes (71.4%) underwent cataract surgery, nine eyes (64.3%) underwent SOR while 2 eyes (14.3%) had epiretinal membrane (ERM) under oil during follow-up. Conclusion 25G PPV combines the advantages of minimally invasive vitrectomy surgery while offering improved anatomic outcomes in patients with ARN-related RRD. The functional outcome varies depending on the status of the optic disc and macula.
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Affiliation(s)
- Bruttendu Moharana
- Department of Ophthalmology, Drishti Eye Hospital, Panchkula, Haryana, India
| | - Mohit Dogra
- Department of Ophthalmology, Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Simar Rajan Singh
- Department of Ophthalmology, Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhukya Ravikumar
- Department of Ophthalmology, Dr R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Basavaraj Tigari
- Department of Ophthalmology, Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deeksha Katoch
- Department of Ophthalmology, Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ankur Singh
- Department of Ophthalmology, All India Institute of Medical Sciences, Raebareli, Uttar Pradesh, India
| | - Ramandeep Singh
- Department of Ophthalmology, Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- This Study was Conducted at Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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INTERNAL LIMITING MEMBRANE PEELING AND AIR TAMPONADE FOR STAGE III AND STAGE IV IDIOPATHIC MACULAR HOLE. Retina 2021; 40:66-74. [PMID: 30312258 DOI: 10.1097/iae.0000000000002340] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the effect of internal limiting membrane peeling and air tamponade for idiopathic macular hole, and explore reasons and interventions for persistent holes. METHODS One hundred and thirty-five eyes with Stage III and IV idiopathic macular hole that underwent 23-gauge vitrectomy, internal limiting membrane peeling, and air tamponade were reviewed. Eyes with persistent holes underwent a second surgery. Outcome-related factors and interventions treating persistent holes were discussed. RESULTS The initial closure (Type I) rate was 89.63% (121/135). Eyes that underwent the second surgery all obtained final closure (Type I). Diameter of macular hole was significantly smaller (P < 0.001) and duration of symptoms was significantly shorter (P = 0.017) in initially closed cases than in unclosed ones. Binary logistic regression indicated large diameter of macular hole as a risk factor for initial closure (P = 0.004). A cutoff value of 677 μm was provided by receiver operating characteristic curve to predict initial closure (P < 0.001). Best-corrected visual acuity of all individuals improved significantly (P < 0.001) from 20/154 to 20/40 (mean follow-up: 4.5 months). CONCLUSION Internal limiting membrane peeling and air tamponade for idiopathic macular hole provide satisfactory morphologic and functional outcomes. Large diameter of macular hole and long duration of symptoms are risk factors for initial closure. Proper second surgery can obtain satisfactory outcomes for persistent holes.
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Surgical Treatment of Idiopathic Macular Hole Using Different Types of Tamponades and Different Postoperative Positioning Regimens. J Ophthalmol 2020; 2020:8858317. [PMID: 33552596 PMCID: PMC7847326 DOI: 10.1155/2020/8858317] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 10/26/2020] [Accepted: 11/27/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To compare the effect of different types of intraocular tamponade and different types of postoperative positioning on the closure of idiopathic macular hole (IMH). Methods Prospective randomized clinical trial enrolling 104 eyes of 100 patients (age, 57–87 years) undergoing MH surgery. All patients were operated on by an experienced surgeon using 25-gauge pars plana vitrectomy (PPV) and internal limiting membrane (ILM) peeling. Patients were randomized according to the type of intraocular tamponade and postoperative positioning into the following four groups: SF6 + nonsupine reading position (n = 26) (group 1), air + nonsupine reading position (n = 25) (group 2), air + prone position (n = 26) (group 3), or SF6 + prone position (n = 27) (group 4). The follow-up period was 6 months. Results MH closure was achieved in 87 eyes (83.7 %) in the overall sample after the first surgery, with closure rates of 100%, 56%, 84.6%, and 92.6% in groups 1, 2, 3, and 4, respectively. The group 2 was significantly less successful compared to the other three groups (p < 0.05). MH of sizes ≤400 µm was closed in 97.2% of cases after the first surgery, with no significant differences between groups (p = 0.219). MH with sizes over 400 µm was closed in 70.9% of cases after the first surgery, with both groups with air tamponade being significantly less successful than group 1. The nonsupine reading position was subjected to a better subjective evaluation in terms of postoperative comfort and quality of sleep, with no differences between air and SF6 tamponade tolerance. Conclusion PPV with ILM peeling, intraocular tamponade, and positioning remains the basic surgical approach in the treatment of IMH. For MH ≤ 400 µm, a high closure rate can be achieved by combining air tamponade and nonsupine reading position. For macular holes >400 µm, the greatest anatomical success can be achieved by using the SF6 tamponade in combination with the nonsupine reading position.
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Liao X, Keyal K, Li H, Wang F. One-year outcomes of 27G core-pars plana vitrectomy of idiopathic epiretinal membrane. Exp Ther Med 2020; 20:2721-2729. [PMID: 32765767 PMCID: PMC7401868 DOI: 10.3892/etm.2020.8995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 03/10/2020] [Indexed: 01/31/2023] Open
Abstract
The present study aimed to assess the feasibility and safety of 27G core-pars plana vitrectomy (PPV) for idiopathic epiretinal membrane (IERM). A retrospective analysis was performed on 38 eyes from 38 patients with IERM with a mean age of 62.73±5.61 years. 27G core-PPV was combined with IERM and internal limiting membrane (ILM) peeling. Pre-operative and post-operative best-corrected visual acuity (BCVA) and lens density were measured. Optical coherence tomography (OCT) and OCT angiography were performed to determine the patients' macular area. Ultrasound biomicroscopy and B-mode ultrasound were subsequently performed to observe any complications and the follow-up period ranged from 1 week to 12 months post-operatively. A total of 36 patients achieved visual improvement of ≥2 Snellen lines, of which 33 patients exhibited improvements within 1 week and the lens density remained unchanged. The mean central macular thickness significantly decreased at 12 months post-operatively (P≤0.05); however, it was not observed to be correlated with BCVA (r=0.41; P>0.05). The foveal avascular zone of the affected eye was significantly smaller than that of the healthy fellow eye (P≤0.05) and negatively correlated with post-operative BCVA (r=-0.72; P≤0.05). Superficial retinal capillary density and deep retinal capillary density decreased post-operatively (both P≤0.05) and no complications were observed. Taken together, the results of the present study indicate that application of 27G core-PPV with ILM peeling is minimally invasive for IERM and facilitates rapid post-operative BCVA recovery.
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Affiliation(s)
- Xin Liao
- Department of Ophthalmology, Shanghai 10th People's Hospital affiliated to Tongji University, Shanghai 200072, P.R. China
| | - Khusbu Keyal
- Department of Ophthalmology, Shanghai 10th People's Hospital affiliated to Tongji University, Shanghai 200072, P.R. China
| | - Hui Li
- Department of Ophthalmology, Shanghai 10th People's Hospital affiliated to Tongji University, Shanghai 200072, P.R. China
| | - Fang Wang
- Department of Ophthalmology, Shanghai 10th People's Hospital affiliated to Tongji University, Shanghai 200072, P.R. China
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Qi Y, Yu Y, You Q, Wang Z, Wang J, Liu W. Hole diameter ratio for prediction of anatomical outcomes in stage III or IV idiopathic macular holes. BMC Ophthalmol 2020; 20:351. [PMID: 32859171 PMCID: PMC7456388 DOI: 10.1186/s12886-020-01614-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To determine whether preoperative hole diameter ratio (HDR) is a predictive factor for postoperative anatomical outcome for stage III or IV idiopathic macular holes (IMHs). METHODS One-hundred and one eyes with stage III or IV IMH were included in this retrospective case series study. All cases were treated with vitrectomy combined with internal limiting membrane (ILM) peeling and room air tamponade. The macular hole (MH) minimum and maximum diameter was measured on preoperative optical coherence tomography (OCT) images. The HDR was defined as the minimum to maximum diameter ratio. RESULTS Eighty-one eyes (80.2%) got a Type I closure after surgery (group A). Postoperative unclosed MHs were found in 20 eyes (19.8%) (group B). The preoperative minimal diameter (703.6 ± 116.1 μm vs. 597.6 ± 120.1 μm, P < 0.01) and HDR (0.6 ± 0.1 vs. 0.5 ± 0.1, P = 0.01) were both significantly smaller in postoperative closed eyes. The closure rate of IMHs with HDR < 0.6 was significantly higher than those with HDR ≥ 0.6 (90.2% vs. 65.0%P = 0.002) . CONCLUSIONS Preoperative HDR < 0.6 is predictive for a good postoperative anatomical outcome in stage III or IV IMHs.
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Affiliation(s)
- Yue Qi
- Beijing Tongren Eye Center, Beijing Ophthalmology and Visual Science Key Lab; Beijing Tongren Hospital, Capital Medical University, 1 Dongjiaomminxiang Street, Dongcheng District, Beijing, 100730, China
| | - Yanping Yu
- Beijing Tongren Eye Center, Beijing Ophthalmology and Visual Science Key Lab; Beijing Tongren Hospital, Capital Medical University, 1 Dongjiaomminxiang Street, Dongcheng District, Beijing, 100730, China
| | - Qisheng You
- Casey Eye Institute, Oregon Health Science University, 515 SW Campus Drive, Portland, OR, 97239, USA
| | - Zengyi Wang
- Beijing Tongren Eye Center, Beijing Ophthalmology and Visual Science Key Lab; Beijing Tongren Hospital, Capital Medical University, 1 Dongjiaomminxiang Street, Dongcheng District, Beijing, 100730, China
| | - Jing Wang
- Beijing Tongren Eye Center, Beijing Ophthalmology and Visual Science Key Lab; Beijing Tongren Hospital, Capital Medical University, 1 Dongjiaomminxiang Street, Dongcheng District, Beijing, 100730, China
| | - Wu Liu
- Beijing Tongren Eye Center, Beijing Ophthalmology and Visual Science Key Lab; Beijing Tongren Hospital, Capital Medical University, 1 Dongjiaomminxiang Street, Dongcheng District, Beijing, 100730, China.
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Yu BE, Sheidow T, Sambhi RDS, Hooper P, Malvankar-Mehta MS. The effectiveness of ocriplasmin versus surgery for the treatment of macular holes: A systematic review and meta-analysis. Eur J Ophthalmol 2020; 31:2003-2012. [PMID: 32731755 DOI: 10.1177/1120672120946925] [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: 11/17/2022]
Abstract
OBJECTIVE To conduct a systematic review looking at the effects of ocriplasmin compared to pars plana vitrectomy on macular holes to assess the effectiveness of the treatment options. METHODS Literature was searched through MEDLINE, EMBASE, CINAHL, Clinical Trials.gov, and ProQuest Dissertations and Theses until June 12, 2018. Conferences held through Association for Research in Vision and Ophthalmology, Canadian Society of Ophthalmology, and American Academy of Ophthalmology were searched until June 18, 2018. A total of 208 records were screened leaving 26. One author independently reviewed them for quality and extracted data. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines were followed. The adverse events, MH closure rate, change in MH size, and the extent to which the patients' visual acuity is restored by each treatment option; ocriplasmin and vitrectomy. RESULTS Twenty-six articles were included for qualitative and quantitative analysis. Meta-analysis results showed a 34% closure of macular holes after ocriplasmin treatment compared to 92% after vitrectomy. A significant improvement in visual acuity was seen after vitrectomy (SMD = -1.42; CI: [-1.98, -0.86]) as well as the ocriplasmin treatment (SMD = -0.73; CI: [-0.98, -0.48]). CONCLUSIONS Results suggested 92% macular hole closure after vitrectomy compared to 34% after ocriplasmin. A significant improvement in visual acuity of patients was seen after both treatments. More good quality randomized controlled trials are required to make strong conclusions.
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Affiliation(s)
- Brian Edward Yu
- Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
| | - Tom Sheidow
- Department of Ophthalmology, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
| | - Raman-Deep Singh Sambhi
- Schulich School of Medicine and Dentistry, The University of Western Ontario, Windsor, ON, Canada
| | - Phil Hooper
- Department of Ophthalmology, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
| | - Monali S Malvankar-Mehta
- Department of Ophthalmology, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
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A Comparative Study of Vitrectomy Combined with Internal Limiting Membrane Peeling for the Treatment of Idiopathic Macular Hole with Air or C3F8 Intraocular Tamponade. J Ophthalmol 2018; 2018:1672501. [PMID: 30057803 PMCID: PMC6051092 DOI: 10.1155/2018/1672501] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 04/19/2018] [Indexed: 11/27/2022] Open
Abstract
Purpose The treatment of idiopathic macular holes has been basically modeled, and vitreoretinal surgery is recognized as an effective treatment. However, the postoperative tamponade of gas will still make the patient uncomfortable and may have related complications. The purpose of this study is to investigate whether air as an intraocular tamponade is equivalent to gas and what advantages may exist. Methods A retrospective study was performed in one hundred and ninety-eight patients from 2013 to 2017; 112 received gas tamponade and 86 received air tamponade. After receiving retinal surgery, the outcomes of best corrected visual acuity, intraocular pressure, slit lamp examination, fundus examination, and imaging of the macula by spectral-domain optical coherence tomography were analyzed. Results Before operation, there was no statistically significant difference in age, sex, macular hole diameter, or visual acuity between groups. The median follow-up period for the C3F8 group was 26 months, and the median follow-up for the air group was 25 months. After the operation, the best corrected visual acuity and macular hole closure rate were not significantly different between the two groups. The face-down time after the operation, the incidence of lens opacity on the third postoperative day, the intraocular pressure on the third postoperative day, and the operation time were significantly different between the two groups. Conclusions In idiopathic macular hole surgery, the effect of air as an intraocular tamponade material can be similar to that of C3F8 but has fewer complications. In particular, it is a better choice for patients for whom the face-down position is not suitable.
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Veith M, Stranak Z, Pencak M, Vranova J, Studeny P. 25-gauge vitrectomy and gas for the management of rhegmatogenous retinal detachment. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2018; 163:80-84. [PMID: 29967564 DOI: 10.5507/bp.2018.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 06/07/2018] [Indexed: 11/23/2022] Open
Abstract
AIMS To evaluate the anatomical and functional results in patients with rhegmatogenous retinal detachment (RRD) who underwent 25-gauge pars plana vitrectomy (PPV) with gas tamponade. MATERIALS AND METHODS A retrospective evaluation of 126 eyes of 126 patients (79 men, 47 women) with RRD who underwent 25-gauge PPV with gas tamponade (13% C3F8 in 87 eyes, 20% SF6 in 39 eyes). 113 patients (89.7%), were operated on under local anaesthesia, 13 patients (10.3%) under general anaesthesia. Macula was detached in 85 eyes (67.5%). 53 eyes had pseudophakic RRD, 73 eyes were phakic. Anatomical success of the primary intervention, change in best corrected visual acuity (BCVA) and incidence of complications were assessed. An average follow-up period is 7.2 months (6-15). RESULTS With single operation, retinal attachment was achieved in 125 eyes (99.2%); the final anatomical success was 100%. The initial mean BCVA was 0.89 logMar (2.00 to 0.00); at the end of the follow-up period, it improved to 0.23logMAR (1.00 to -0.10), P < 0,0001. During the first post-intervention day, hypotony of the eye below 10 mmHg was observed in 1 patient (0.8%); on the contrary, intraocular pressure was temporarily increased to 25 mmHg and more in 36 patients (28.6%). CONCLUSION The surgical treatment of RRD using 25-gauge PPV with expansive gas tamponade renders excellent anatomical results and improvement in BCVA. The incidence of complications and necessity of sclerotomy suturing are low.
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Affiliation(s)
- Miroslav Veith
- Department of Ophthalmology, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University in Prague, Czech Republic
| | - Zbynek Stranak
- Department of Ophthalmology, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University in Prague, Czech Republic
| | - Martin Pencak
- Department of Ophthalmology, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University in Prague, Czech Republic
| | - Jana Vranova
- Department of Medical Biophysics and Medical Informatics, Third Faculty of Medicine, Charles University in Prague, Czech Republic
| | - Pavel Studeny
- Department of Ophthalmology, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University in Prague, Czech Republic
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