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Objective To report on the incidence and outcome of rhegmatogenous retinal detachment after transscleral local resection of choroidal melanoma. Design Prospective, noncomparative, interventional case series. Participants One hundred fifty-six patients with choroidal melanoma treated by transscleral local resection between January 1993 and June 2000. Intervention Transscleral choroidectomy or cyclochoroidectomy for uveal melanoma, with ocular decompression by single-port pars plana vitrectomy and, in most patients, adjunctive ruthenium plaque radiotherapy. Main outcome measures Incidence of rhegmatogenous retinal detachment according to predictive factors and outcomes reported in terms of anatomic success, visual acuity, and ocular conservation. Results Rhegmatogenous retinal detachment occurred in 28 (18%) eyes and was significantly more common in patients with thick tumors (Cox univariate analysis, P = 0.001) and in males (Cox univariate analysis, P = 0.013), with posterior tumor extension being of borderline significance (Cox univariate analysis, P = 0.069). Surgical treatment of the retinal detachment was performed in 25 patients; it was undertaken at our center in 22 patients and at the referring hospital in 3 patients. Anatomic success was achieved in 21 (84%) of these 25 patients, with 7 eyes retaining counting fingers vision, and 3 eyes seeing 6/60 or better. Ten eyes treated for retinal detachment were enucleated because of recurrent tumor (four eyes), retinal detachment (three eyes), wound dehiscence (one eye), phthisis (one eye), and poor visual acuity (one eye). Eleven eyes known to have a retinal tear underwent prophylactic vitreoretinal surgery at the end of the local resection, with only one (9%) of these subsequently developing retinal detachment. Conclusions Rhegmatogenous retinal detachment after transscleral choroidectomy or cyclochoroidectomy for uveal melanoma is a serious complication requiring early vitreoretinal surgery.

Objective To determine the outcomes of vitreoretinal surgery after choroidal tumor biopsy. Design Retrospective, single-center, consecutive case series. Participants A total of 739 consecutive patients undergoing choroidal tumor biopsy. Methods All subjects who underwent transretinal or transscleral choroidal tumor biopsy for diagnostic or prognostic purposes between May 1993 and May 2013 were identified in our database. We then reviewed patients who subsequently required secondary vitreoretinal surgery for complications arising from such biopsies. Main Outcome Measures Reason for vitreoretinal surgery, association with biopsy procedure, best-corrected visual acuity (BCVA; logarithm of the minimum angle of resolution [logMAR]), intraocular or extrascleral tumor dissemination, resolution of vitreous hemorrhage, reattachment of the retina with a single vitreoretinal procedure, number of additional vitrectomies undertaken, and number of enucleations. Results A total of 20 of 739 eyes (2.7%) underwent vitreoretinal surgery for complications arising from choroidal tumor biopsy. The tumors consisted of choroidal melanoma in all 20 eyes. The reasons for the secondary surgery included persistent vitreous hemorrhage in 1.9% (14/739), rhegmatogenous retinal detachment in 0.7% (5/739), and endophthalmitis in 0.14% (1/739). Median BCVA improved from 2.0 logMAR (mean, 1.92 logMAR; range, 0.8–2.7 logMAR) before vitrectomy to 0.72 logMAR (mean, 0.88 logMAR; range, −0.14 to 2.7 logMAR) after vitrectomy and 0.76 logMAR (mean, 1.14 logMAR; range, 0.1–3.0 logMAR) at the final visit ( P t test). Permanent resolution of vitreous hemorrhage was achieved in 6 of 14 patients, and reattachment of the retina was achieved in 2 of 5 patients after the first vitrectomy. A median of 1 (mean, 1.5; range, 1–3) additional vitrectomy was performed. Enucleation was necessary in 3 of 20 eyes (15%). There were no cases of intraocular invasion or extrascleral extension after vitrectomy. Conclusions Vitrectomy for complications of choroidal tumor biopsy is rare. Such corrective surgery is complex and is best undertaken by specialized ocular oncologists or vitreoretinal surgeons with experience in managing this problem.

Objective To describe and evaluate transretinal biopsy of choroidal tumors using 25-gauge vitrectomy instrumentation. Design Retrospective, consecutive, noncomparative case series. Participants Fourteen patients undergoing choroidal tumor biopsy at an ocular oncology center. Methods The biopsies were performed under local or general anesthesia, alone or in combination with ruthenium plaque or tantalum marker insertion. Immunohistochemistry was performed on all samples, and some melanomas were also analyzed cytogenetically. Results Surgery was uneventful in all cases. A positive tissue diagnosis was made in 13 of 14 patients, albeit at the second attempt in 1 patient. The only failure occurred because the tumor was calcified. Conclusion Transretinal choroidal biopsy with 25-gauge instrumentation yields a larger sample than fine-needle aspiration biopsy, usually producing sufficient tissue for cytogenetic studies. We did not identify safety concerns in this series of patients. Insufficient samples can occur in some patients, and further studies are needed to understand the reason for such failure.

Objective To determine the efficacy of a combination of 5-fluorouracil and low-molecular-weight heparin (LMWH) to improve the outcome of surgery for established proliferative vitreoretinopathy (PVR). Design Double-masked, prospective, randomized, placebo-controlled clinical trial. Setting Three tertiary-referral teaching hospital vitreoretinal surgical units. Patients One hundred fifty-seven patients with established PVR (grade C, anterior or posterior) undergoing vitrectomy surgery. Intervention All patients underwent vitreoretinal surgery and silicone oil exchange with or without membrane peeling and/or retinectomy. Patients were randomly allocated to perioperative infusion with or without 5-fluorouracil (200 μg/ml) and LMWH (5 IU/ml) in Hartmann's solution for 1 hour. Outcome measures The primary outcome measure was defined as posterior retinal reattachment after removal of silicone oil without any reoperations at 6 months. Secondary outcome measures recorded were posterior retinal reattachment, localized/tractional retinal detachment, visual acuity, macular pucker, hypotony, glaucoma, keratopathy, and cataract. Removal of silicone oil and reoperations were also recorded. Results Overall, at 6 months 84% of patients had full retinal reattachment and 94% had stable posterior retinal reattachment. There was no significant difference in success in the primary outcome measure (56%, treatment group; 51%, placebo group; P = 0.59) or in secondary outcome measures or rates of complications. Secondary macular pucker occurred less often in the treatment group (6% vs. 17% at 6 months, P = 0.068). Conclusions A perioperative infusion of combined 5-fluorouracil and LMWH does not significantly increase the success rate of vitreoretinal surgery for established PVR.

Purpose To describe a new surgical approach in the management of pseudophakic malignant glaucoma. Design Noncomparative case series. Participants Five consecutive patients with pseudophakic malignant glaucoma. Methods All patients underwent zonulo-hyaloido-vitrectomy. The procedure involves the performance of zonulectomy, hyaloidectomy, and anterior vitrectomy (zonulo-hyaloido-vitrectomy) through a peripheral iridectomy or iridotomy via the anterior chamber. Main outcome measures Medications, visual acuity, intraocular pressure, and anterior and posterior segment findings were recorded before and after surgery. Results Resolution of the malignant glaucoma was achieved in all cases. No recurrences were observed after a median follow-up of 5.5 months (range, 1–9 months). In one patient with extensive anterior synechiae, bleb failure occurred after the resolution of the malignant glaucoma. This patient was treated successfully with a guarded filtration procedure supplemented with 5-fluorouracil. No other complications were observed. Conclusions Zonulo-hyaloido-vitrectomy via the anterior segment appears to be an alternative option in the treatment of patients with pseudophakic malignant glaucoma.