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A multi-purpose titanium forceps has been developed for small-gauge pars plana vitrectomy surgery. These forceps were designed to provide the vitreoretinal surgeon with a single tool for the extraocular manipulations that are necessary for the placement and removal of 23- and 25-gauge trochars for small-incision, sutureless pars plana vitrectomy surgery. The forceps has been designed to allow for the atraumatic manipulation of the conjunctiva, measurement of distance from the limbus, and a strong purchase of the trochar for both its fixation and removal., (Copyright 2012, SLACK Incorporated.)

Background and Objective: To assess anatomic and visual outcomes after pars plana vitrectomy for vitreomacular traction syndrome., Patients and Methods: Charts of 746 patients who had vitrectomy surgery with membrane peel between January 2002 and December 2007 were reviewed. Vitreomacular traction syndrome (VMT) was diagnosed based on optical coherence tomography (OCT) appearance. Twenty eyes of 20 patients were found to have had vitrectomy surgery for VMT and were included in the study., Results: Mean visual acuity was 20/122 preoperatively and 20/68 postoperatively (P = .005). Mean foveal thickness was 404.00 microm preoperatively and 250.55 microm postoperatively (P = .001). A subgroup analysis was performed based on preoperative OCT appearance. Improvement in vision was not significant in eyes with lamellar separation between the inner and outer fovea (P = .379), but was significant in eyes with cystoid macular edema (P = .045) or perifoveal traction (P = .040)., Conclusion: Overall, there was a significant improvement in visual acuity and central foveal thickness postoperatively. Eyes with lamellar separation of the inner and outer foveal layers preoperatively had worse visual results, whereas eyes with cystoid macular edema or perifoveal VMT had better visual results.

Background and Objective: To assess anatomic and visual outcomes after pars plana vitrectomy for lamellar macular holes., Patients and Methods: Charts of 746 patients who had vitrectomy surgery with membrane peel were reviewed. Preoperative diagnosis of lamellar macular hole was based on optical coherence tomography (OCT) appearance; 16 eyes of 16 patients met the inclusion criteria., Results: Mean acuity was 20/158 preoperatively and 20/118 postoperatively (P = .408). Central macular thickness was 377.06 µm preoperatively and 245.7 µm postoperatively (P = .002). Two eyes (13%) developed full-thickness macular holes postoperatively. Six eyes (38%) continued to have a lamellar macular defect on OCT postoperatively., Conclusion: Despite postoperative anatomic improvement in many patients and an overall decrease in foveal thickness on OCT, this retrospective series suggests that vitrectomy for lamellar holes may not improve visual acuity.

The authors describe a recently developed system for use in vitreoretinal surgery. The system is compatible with a variety of lens choices, including wide-field, equatorial, and high-magnification direct viewing lenses, allowing for visualization of the far peripheral retina and detailed imaging of the macula. Used with autoclavable lenses, the system achieves high-resolution image quality at a cost-effective price., (Copyright 2009, SLACK Incorporated.)

Background and Objective: This study evaluates the effectiveness of Akten (Akorn, Inc., Buffalo Grove, IL), a novel ophthalmic gel anesthetic agent for complete ocular anesthesia., Patients and Methods: This study was conducted as a prospective, randomized, double-blinded, multicenter Phase III clinical trial to evaluate Akten gel. The study had four cohorts of subjects who received sham gel, Akten 1.5%, Akten 2.5%, and Akten 3.5%, respectively. Subjects were assessed for achievement of anesthesia at defined time intervals and questioned for "pain" or "no pain" following pinching of the conjunctiva with 0.3-mm forceps at predetermined intervals., Results: A total of 209 subjects were entered into the study. The percentages of patients achieving the primary endpoint (ie, anesthesia within 5 minutes) were as follows: 22% for sham, 88% for Akten 1.5%, 89% for Akten 2.5%, and 92% for Akten 3.5%, respectively. Safety measures including corneal staining, conjunctival hyperemia, and eye pain with administra-tion were low and comparable in all cohorts., Conclusion: Akten gel appears to be an effective and safe ocular anesthetic. All doses were well tolerated and no dose-related corneal toxicity was observed.

Background and Objective: To describe a series of patients with decreased vision secondary to stage 1 macular hole confirmed by optical coherence tomography (OCT) that failed to spontaneously resolve with observation. To determine whether current surgical techniques can prevent progression to a full-thickness macular hole and lead to improved visual acuity., Patients and Methods: Retrospective, comparative case series presenting patient demographics, duration of symptoms, timing of surgery, preoperative and postoperative vision, and clinical outcome based on examination and OCT., Results: Five eyes of five patients with stage 1 macular holes identified on OCT required surgical repair. All eyes showed anatomic closure and lack of progression to a full-thickness hole confirmed by OCT after one procedure. Mean preoperative visual acuity was 20/102 (range, 20/50 to 20/200) and mean postoperative visual acuity was 20/52 (range, 20/25 to 20/200). Average improvement for all five eyes was 3 Snellen lines, with four of the five (80%) improving 5 lines each., Conclusion: In symptomatic eyes with stage 1 macular holes that fail to spontaneously resolve with observation, vitrectomy with intraocular gas tamponade may prevent progression to a full-thickness hole and lead to improved visual acuity.

Background and Objective: Diode laser transpupillary thermotherapy can be used for the treatment and choroidal tumors. A large spot endolaser probe was developed for endophotocoagulation and transvitreal thermotherapy. The aim of this study was to assess the probe's clinical performance for photocoagulation and transvitreal thermotherapy combined with macular elevation., Materials and Methods: Endolaser with a divergent beam giving a 3 mm spot size on the retina was developed. Vitrectomy was performed on ten eyes of five Dutch Belted rabbits. Threshold for photocoagulation was determined for the diode (810 nm) laser in four eyes. In another six eyes, the retina was detached with balanced salt solution prior to laser irradiation. The tissue effects were monitored clinically and with photography and microscopy., Results: Threshold photocoagulation was induced with 150 mW power, for 1 minute, in attached retina. Following retinal detachment, no coagulation occurred at 200 mW (suprathreshold) power for 1 minute., Conclusions: A large spot endolaser probe may be useful for endophotocoagulation. It generates more gradual photocoagulation than standard endolaser probes, giving a more controllable reaction over a larger area. This may be useful for treatment of large areas of the retina when treating retinal detachments or ischemic retinopathies. When detached retina was irradiated, no retinal damage occurred at suprathreshold power. This development may allow for intraoperative transvitreal thermotherapy of choroidal neovascularization while protecting the retina with intentional intraoperative detachment of the retina.

A novel technique for localizing subthreshold infrared (810 nm) laser treatment and its use in three patients is described. Two patients were treated for choroidal neovascularization with transpupillary thermotherapy or focal subthreshold photocoagulation, and the third patient was treated with grid laser photocoagulation for diabetic macular edema using the 810-nm laser after undergoing indocyanine green angiography for diagnostic purposes. Postoperative indocyanine green images, obtained without reinjection of indocyanine green, revealed areas of hypofluorescence that corresponded to the laser treatment spots. This technique, named subthreshold infrared footprinting, can precisely localize subthreshold infrared laser photocoagulation sites and is potentially useful for evaluating treatment postoperatively and planning additional therapy if necessary.

A new inverted-image ophthalmoscopic contact lens provides 2X laser spot magnification and a 117 degrees degree instantaneous field of view. It has three times the resolution of very wide-field, inverted-image ophthalmoscopic contact lenses to permit effective use of higher slit-lamp magnifications. The lens was designed for transpupillary thermotherapy with large lesions and panretinal photocoagulation with hazy ocular media.