Search

The purpose of this cross-sectional retrospective study was to determine the relationship between the retinal displacements and the retinal thickness in eyes with epiretinal membrane (ERM) after vitrectomy with internal limiting membrane (ILM) peeling. To accomplish this, we measured the retinal thickness using optical coherence tomography (OCT) and the retinal displacement using OCT angiography to obtain 3 mm × 3 mm en face images before, and 2, 4, and 8 weeks following the surgery from 20 eyes of 20 patients. The distance between the retinal vessel bifurcations and the fovea was significantly displaced centrifugally and asymmetrically in the 4 quadrants postoperatively (P < 0.001). The foveal avascular zone (FAZ) was significantly enlarged, and the central foveal thickness (CFT) and the inner nuclear layer (INL) thickness were significantly thinner postoperatively. The displacements were significantly correlated with the changes in the FAZ area (r = 0.717, P < 0.001), the CFT (r = − 0.702, P < 0.001), and the INL thickness (r = − 0.702, P < 0.001). In conclusion, the distance between the retinal bifurcations and the fovea was asymmetrically expanded after the surgery and was significantly correlated with the morphological changes. These results indicate that a horizontal macular contraction is correlated with vertical retinal contraction in the eyes with an ERM. [ABSTRACT FROM AUTHOR]

Emerging evidence has suggested that the entoptic phenomena associated with vitreous opacities (i.e. vitreous floaters) are more bothersome than previously believed. In addition, the prevalence of vitreous floaters is likely increasing due to the evolving global pandemic of myopia. The use of YAG laser vitreolysis for the treatment of annoying vitreous floaters has attracted significant attention in recent years as the technique offers a number of potential advantages. Unfortunately, the currently available evidence that is needed to guide clinical practice is both very limited and contradictory. As a consequence, the technique remains highly controversial. A review of the existing literature sheds light on patient- and treatment-related factors that may significantly affect both the effectiveness and the safety of the procedure. The current article discusses important aspects of key publications on the topic, offers suggestions for clinical practice, and highlights unmet needs that should be addressed by future research. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study is to identify the effect of Nd: YAG laser posterior capsulotomy using an anterior chamber morphology.Methods: This study included 42 eyes of 33 pseudophakic patients with visually significant PCO after uncomplicated cataract surgery. Exclusion criteria were complications related to cataract surgery, corneal pathology, pseudoexfoliation, glaucoma, uveitis, previous ocular surgery or trauma, and posterior segment pathology. All patients underwent routine ophthalmic examinations. The AS-OCT measurements were performed using NIDEK RS-3000 Lite retinal scan with anterior segment module. The anterior chamber depth (ACD) was measured by Monitor A&B Scan biometer. Nd: YAG laser posterior capsulotomy was done in a single session by the circular pattern with rupture of vitreous strands. Anterior chamber depth (ACD), central corneal thickness (CCT), and intraocular pressure (IOP) were measured. Anterior chamber angle (ACA), angle opening distances (AOD) at 500 mm (AOD500), AOD at 750 mm (AOD750), trabecular-iris space area at 500 (TISA 500), and TISA at 750 (TISA 750) were measured both nasally and temporally.Results: The mean patient age was 55.56 ± 6.33 years. There were non-significant changes in IOP, ACD, and CCT with P values 0.395, 0.153, and 0.541, respectively. ACA, AOD500, AOD750, TISA 500, and TISA 750 highly significantly increased with P value < 0.001 for all.Conclusion: Nd: YAG laser posterior capsulotomy with the circular pattern with vitreous strand cut technique is a safe technique for laser posterior capsulotomy. [ABSTRACT FROM AUTHOR]

Purpose: LR11 (also called SorLA or SORL1) is a migration regulator of adherent cells with the immature proliferative phenotype. The present study investigated the clinical and pathological involvement of the soluble form of LR11 (sLR11) in the idiopathic epiretinal membrane (iERM). Methods: The subjects were 51 patients with iERM (24 cellophane macular reflex (CMR) and 27 preretinal macular fibrosis (PMF)) and 45 patients with macular holes as age and sex-matched controls. Vitreous sLR11 and transforming growth factor (TGF)β2 levels were measured by ELISA. Results: The sLR11 levels in the vitreous fluids of patients with iERM (20.2 ± 8.1 ng/mL) were significantly higher than those in controls (11.4 ± 4.7 ng/mL). Among the patients with iERM, the vitreous sLR11 levels were significantly higher in PMF (23.6 ± 8.2 ng/mL), than those in CMR (16.5 ± 5.9 ng/mL). Multivariate regression analysis of the studied factors showed that sLR11 was a unique factor independently contributing to the discrimination of the iERM patients against the control subjects (odds ratio [OR] 1.35 per 1-ng/mL increase, 95% CI 1.09-1.67; P = 0.004). ROC analysis showed that the sensitivity and the specificity of sLR11, but not of other studied factors, categorized into the rank of moderate accuracy. Finally, there was a positive correlation (R = 0.588; P = 0.003) between the vitreous levels of sLR11 and TGFβ2 using the available samples. Conclusions: sLR11 levels in vitreous fluids were specifically increased in patients with iERM, suggesting the involvement in the pathology of proliferative and migrating cells for the development of iERM. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate long-term success of the Ahmed glaucoma valve (AGV) for refractory glaucoma after vitreoretinal surgery with silicone oil insertion. Methods: Prospective non-comparative evaluation of patients who underwent AGV insertion for management of post-vitreoretinal surgery glaucoma, post-silicone oil removal. Intraocular pressure (IOP), visual acuity, and glaucomatous neuropathy status were evaluated preoperatively and at multiple follow-up visits postoperatively. Success, using Kaplan-Meier analysis, was determined at the 12-month follow-up visit and at the last follow-up. Factors associated with failure were analysed. Results: Twenty-seven eyes of 27 patients with a mean age of 28.3 ± 15.2 years underwent a superior AGV implantation. The average follow-up after AGV implantation was 17.11 ± 8.36 months (range: 9-60 months). Kaplan-Meier survival analysis revealed a 62 % success at 12 months and 37 % at 5 years. A 48 % rate of complications was noted, 22 % of which were vision-threatening. Factors analysed, including patient age, interval between vitreoretinal surgery and silicone oil removal, interval between vitreoretinal surgery and AGV implantation, and phakic status, were not found to be associated with higher failure rates. Conclusion: Long-term success of AGV implantation for glaucoma after vitreoretinal surgery with silicone oil insertion is better than that reported for trabeculectomy, though complication rates remain high. [ABSTRACT FROM AUTHOR]

Title: Minimally fibrotic Stage 5: A clinical prognostic factor in eyes undergoing vitrectomy for stage 5 retinopathy of prematurity (ROP). Purpose: To define minimally fibrotic stage 5 ROP and to demonstrate better surgical outcomes in this subgroup. Methods: A cohort of eligible eyes with stage 5 ROP undergoing vitrectomy were further divided into those with minimally fibrotic stage 5 and others. Minimally fibrotic stage 5 ROP was defined as those stage 5 eyes having a translucent retrolental membrane with visibility of the underlying retinal vessels and absence of anteriorly rotated ciliary processes. We reported on anatomic and visual outcomes in eyes with defined characteristics of this subgroup identified before surgery and then observing them post vitrectomy over a period of time as compared to others. Results: Minimally fibrotic stage 5 eyes had better visual ( p = .0068) and anatomical outcomes ( p = .0001). Conclusion: Minimally fibrotic stage 5 ROP shows ridge to ridge traction that has resulted in a traction retinal detachment with a retrolental membrane, but fibrotic change has just begun. This stage 5 ROP with limited fibrosis represents a subset of this stage 5 ROP with a positive anatomic and visual prognosis. [ABSTRACT FROM AUTHOR]

PurposeTo evaluate the outcomes and complications of 25-gauge (G) pars plana vitrectomy (PPV) for repair of diabetic tractional retinal detachment (TRD).MethodsRetrospective review of consecutive, single-surgeon 25-G PPV cases between July 2007 and July 2014. Seventy eyes from 55 patients were operated on for diabetic TRD; all eyes were tamponaded with sulfur hexafluoride, octofluoropropane, silicone oil, or balanced salt solution. Mean age at surgery was 47.7 years (range 23-76 years), and mean length of follow-up was 713 days (range 90-2368 days; median 671 days). Primary outcomes included best-corrected visual acuity (BCVA), intraocular pressure (IOP), anatomic success, redetachment, and endophthalmitis.ResultsPreoperatively, 49 eyes (70%) had a concurrent rhegmatogenous component (8 of which also had proliferative vitreoretinopathy (PVR)). Mean BCVA improved from logarithm of the minimal angle of resolution 1.59 (20/800, SD 0.88) to 0.68 postoperatively (20/100, 0.77), P-value<0.001. Mean IOP increased from 15.9 to 20 mm Hg 1 day after surgery. Elevated postoperative IOP (≥22 mm Hg) occurred in 25 eyes, and low IOP (≤5 mm Hg) occurred in 2 eyes. Primary reattachment was achieved in 63 eyes (90%), and final anatomical success occurred in 69 eyes (99%). There were no cases of endophthalmitis.ConclusionsTwenty-five-G PPV repair was safe and effective in the repair of diabetic TRD, including eyes with a combined rhegmatogenous detachment or PVR. Gas, silicone oil, and balanced salt solution tamponading agents all proved to be efficacious in this surgical population. [ABSTRACT FROM AUTHOR]

PurposeTo analyse the postoperative anatomic and functional outcomes in addition to complications after vitreoretinal surgery for patients with shotgun eye injuries related to hunting accidents.MaterialsRetrospective review of the clinical records of all cases of shotgun eye injuries presented between January 2000 and January 2011 and with a minimum follow-up of 1 year. Collection of demographics, type of injury, choice of management, complications and final surgical success with final visual acuity is reported.ResultsTwenty eyes of 19 patients (all male) with a mean age of 36.1 years (range 16−60 years) were included in the study. Mean postoperative follow-up was 47.5 months (range 15−118 months). Best corrected visual acuity (BCVA) at presentation ranged from perception of light to 20/200. Ten eyes had a penetrating injury and 10 others had a perforating injury. All the eyes underwent an initial vitrectomy and the intraocular pellet was removed in all the 10 penetrating injuries. Concurrent cataract surgery was performed in 12 cases, internal tamponade was used in 15 cases and a supplemental encircling scleral buckle was inserted in 12 cases. One additional vitreoretinal surgery was required in seven cases (35%) and two additional surgeries required in two other cases (10%). At last follow-up BCVA ranged from NPL to 20/20 and was 20/100 or better in 10 eyes (50%). All patients had a flat retina except for two cases (10%) that developed severe proliferative vitreoretinopathy.ConclusionThese results suggest that vitreoretinal surgery can offer good visual rehabilitation in patients with shotgun eye injuries. [ABSTRACT FROM AUTHOR]

BackgroundGlobe-sparing treatments such as plaque brachytherapy, local or endoresection, and proton beam therapy (PBT) are the treatments of choice for posterior uveal melanoma. However, both early and late complications can arise from these techniques, including vitreous haemorrhage (VH) and retinal detachment (RD). Choroidal melanomas in Scotland are managed by a single unit, the Scottish Ocular Oncology Service (SOOS).MethodsIndications and outcomes from surgery were analysed for patients undergoing vitrectomy following treatment for uveal melanoma in the SOOS between 1998 and 2013.ResultsSeventeen from 715 cases (2.4%) required vitrectomy, of which 8/445 (1.8%) followed plaque brachytherapy, 7/43 (16.3%) combined local resection and brachytherapy, and 2/227 (0.9%) PBT. Casenotes were reviewed for 16/17 cases, with surgery indicated for VH in 10 (63%), RD in 5 (31%), and combined VH/RD in 1 (6%). The median interval from initial tumour treatment to vitrectomy was 5.8 months (range 10 days to 8.8 years). Ten (63%) required early vitrectomy (within 6 months), of which the majority (70%) followed combined resection/brachytherapy. Six (37%) required late vitrectomy (after 6 months), of which all were non-clearing VH following plaque brachytherapy, with proliferative retinopathy in 4/6 (67%), and tumour recurrence in 2/6 (33%). Overall vision improved in 8 eyes (50%), remained the same in 2 (12.5%), and deteriorated in 6 (37.5%).ConclusionsEarly vitrectomy was most commonly indicated for RD following local resection, and late vitrectomy for VH due to radiation retinopathy. The majority of patients undergoing vitrectomy gained or maintained vision. [ABSTRACT FROM AUTHOR]

PurposeTo evaluate the morphological changes before and after the formation of a full-thickness macular hole (MH) in highly myopic eyes.Patients and methodsRetrospective observational case series. From 2006 to 2013, clinical records of patients with MH and high myopia who had optical coherence tomography (OCT) before the development of MH were reviewed. All patients had been followed for more than 1 year since MH formation to observe the morphological changes.ResultsTwenty-six eyes of 24 patients were enrolled. The initial OCT images could be classified into four types: (1) normal foveal depression with abnormal vitreo-retinal relationship (eight cases), (2) macular schisis without detachment (six cases), (3) macular schisis with concomitant/subsequent detachment (nine cases), and (4) macular atrophy with underlying/adjacent scar (three cases). After MH formation, one case in type 1 and one case in type 4 group developed retinal detachment (RD). In type 2 group, four cases developed RD at the same time of MH formation. The preexisting detachment in type 3 group extended in eight cases and improved in one case. Among all the cases, 14 eyes received vitrectomy and 7 eyes received gas injection. MH sealed in nine eyes after vitrectomy and four eyes by gas injection.ConclusionThe study revealed four pathways of MH formation in highly myopic eyes. MH from macular schisis tended to be associated with detachment. However, the evolution and the results of surgical intervention were not always predictable. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to investigate and present the results of a new vitrectomy technique to preserve the foveolar internal limiting membrane (ILM) during ILM peeling in early stage 2 macular holes (MH). Methods: The medical records of 28 consecutive patients (28 eyes) with early stage 2 MH were retrospectively reviewed and randomly divided into two groups by the extent of ILM peeing. Group 1: foveolar ILM nonpeeling group (14 eyes), and group 2: total peeling of foveal ILM group (14 eyes). A donut-shaped ILM was peeled off, leaving a 400-μm-diameter ILM over foveola in group 1. Results: Smooth and symmetric umbo foveolar contour was restored without inner retinal dimpling in all eyes in group 1, but not in group 2. The final vision was better in group 1 ( P = 0.011). All eyes in group 1 (100 %) and seven of 14 eyes in group 2 (50 %)regained the inner segment/outer segment (IS/OS) line. Restoration of the umbo light reflex was found in 12 of 14 eyes in group 1 (86 %) but none in group 2 (0 %). Conclusions: Nonpeeling of the foveolar ILM in early stage 2 idiopathic MH surgery prevented inner retinal damages, restored umbo light reflex, achieved better foveolar microstructures, and led to better final visual acuity. [ABSTRACT FROM AUTHOR]

Over the past 25 years, vitreoretinal surgery has undergone considerable change in technology, techniques, and professional organisation. Many conditions that were considered untreatable in 1988 are now treated routinely by vitreoretinal surgeons. Over the same period, vitreoretinal surgery has become a separate subspecialty with its own scientific meetings and professional organisation. This article describes a noncomprehensive selection of some of the highlights of the past 25 years, including the establishment and growth of BEAVRS (British and Eire Association of Vitreoretinal Surgeons), the revolution in the management of macular holes, the development of submacular surgery, and the introduction of sutureless vitrectomy. [ABSTRACT FROM AUTHOR]

Vitreomacular traction (VMT) and VMT with macular hole (MH) are serious conditions, being associated with visual disturbance, for example, metamorphopsia, and diminished visual acuity (VA). Pars plana vitrectomy is the routine treatment for symptomatic VMT and VMT+MH. However, ocriplasmin has demonstrated favourable efficacy and safety in specific patient groups with VMT/MH and is now recommended as a treatment option for certain patients by the National Institute of Health and Care Excellence. This means that services for managing patients with VMT/MH may need to be revised, as patients can now potentially receive treatment earlier in the course of the disease. VMT triage clinics could provide a more efficient way of managing VMT/MH patients. Patient assessment should always include high-definition optical coherence tomography, as this is the most accurate means of assessing abnormalities in the vitreoretinal (VR) interface, and an accurate measurement of best-corrected VA. It has been proposed that patients with VMT+MH be managed as a routine 6-week referral, with the complete patient journey-from initial referral to treatment-taking no longer than 6 months. It is important that patients are entered onto VR surgical lists so that there is no delay if ocriplasmin treatment is unsuccessful. Patients will need appropriate counselling about the expected outcomes and possible side effects of ocriplasmin treatment. One-year follow-up data should be collected by treatment centres in order to evaluate the new VMT service. [ABSTRACT FROM AUTHOR]

AimsTo determine the predictive factors of visual outcomes in children with open globe injury and to give guidance to reduce the incidence of open globe injury.MethodsOne hundred and forty eyes of 137 consecutive open globe injury patients, who were treated at the Eye Center of Second Bethune Hospital affiliated with Jilin University between August 2005 and August 2012, were retrospectively analyzed. Data recorded included demographic characteristics, causes of injury, location and extent of injury, presenting visual acuity, detailed ocular anterior and posterior segment evaluations, details of primary and subsequent surgeries, and postoperative complications and outcomes. The follow-up data included the most recent best-corrected visual acuity, complications, and the duration of follow-up.ResultsOf the 137 patients, there were 116 (84.7%) boys and 21 (15.3%) girls. Their ages ranged between 3 and 17 years old (mean=11.57±4.19 years old). Sixty (43.8%) children had a right eye injury, whereas 74 (54.0%) had a left eye injury. Only three (2.2%) children suffered bilateral eye injury. Living utensils, industrial tools, and fireworks contributed to the most common causes of open globe injury. Eighty-one (59.1%) had sharp force injuries, 23 (16.8%) had blunt injuries, and 33 (24.1%) had missile injuries.ConclusionsUnfavorable visual outcomes were related to a younger age at presentation, poor presenting visual acuity, injuries caused by blunt or missile objects, posterior wound location, hyphema, vitreous hemorrhage, and surgical intervention of pars plana vitrectomy. [ABSTRACT FROM AUTHOR]

PurposeTo evaluate the long-term visual outcomes of pars plana vitrectomy (PPV) for polypoidal choroidal vasculopathy (PCV)-associated vitreous haemorrhage (VH).MethodWe retrospectively reviewed the records of patients with PCV-related VH who underwent PPV. The main outcome measures were best-corrected visual acuity (BCVA) and fundus findings at 3 months postoperatively and final visit.ResultsSeventeen eyes of 17 patients with massive subretinal haemorrhage (16.7±7.1 disc size of mean subretinal haemorrhage area) were enrolled. The mean postoperative follow-up period was 25.2 months. Four eyes received intravitreal bevacizumab injections, and three eyes underwent photodynamic therapy before the onset of VH. The mean BCVA improved from logarithm of the minimum angle of resolution (LogMAR) of 2.63±0.57 preoperatively to 1.43±0.82 at final visit (P<0.001). Among the eyes with initial polyps at subfoveal or juxtafoveal area, 16.70% achieved final BCVA ≥20/400 (LogMAR 1.3), whereas 87.50% of eyes with initial polyps at extrafoveal area had final BCVA ≥20/400 (Fisher's exact test, P=0.026).ConclusionsPCV with massive subretinal haemorrhage is at risk for breakthrough VH. The visual prognosis in eyes with PCV-related breakthrough VH is variable after vitrectomy. Initial polyps at the extrafoveal area led to better functional outcomes. Early vitrectomy may be beneficial for visual recovery after PCV-related VH. [ABSTRACT FROM AUTHOR]

PurposeTo study retrospectively the characteristics of residual indocyanine green (ICG) fluorescence after ICG-assisted vitrectomy and the association with spectral-domain optical coherence tomography (SD-OCT) findings in diabetic macular oedema (DMO).MethodsThirteen consecutive eyes of 12 patients for whom fundus near-infrared fluorescence and 20° retinal sectional images were obtained using HRA2 and Spectralis OCT, respectively, 5 days after vitrectomy combined with ICG-assisted inner limiting membrane peeling for DMO. The relationship between the characteristics of the ICG hyperfluorescence and the cystoid spaces in the outer plexiform layer (OPL) on SD-OCT images was evaluated.ResultsA total of 390 well-demarcated areas of ICG hyperfluorescence were delineated on 20° radial OCT scans dissecting the fovea 5 days after vitrectomy. The areas of ICG hyperfluorescence in the parafovea or perifovea were significantly smaller than those at the fovea. Most areas of hyperfluorescence were irregularly shaped in the parafovea and perifovea, whereas 18 of 38 areas of hyperfluorescence were round or oval at the fovea (P<0.001). SD-OCT delineated the cystoid spaces in the OPL in 73 areas of hyperfluorescence that were round or oval and accompanied by dark spots more frequently than that without cystoid spaces on OCT images (P<0.001 and P=0.002). Of the 123 cystoid spaces in the OPL on OCT images, 44 did not have ICG hyperfluorescence, had lower OCT reflectivity, and contained fewer hyperreflective foci than those with ICG hyperfluorescence (P<0.001 and P=0.020).ConclusionThe results provided novel interpretations of the ICG hyperfluorescence and its association with OCT characteristics of the cystoid spaces in DMO. [ABSTRACT FROM AUTHOR]

PurposeTo establish whether early vitrectomy for epiretinal membrane (ERM) is preferable to delayed surgery.MethodsWe carried out a retrospective study of 120 eyes from 120 patients with pre-operative visual acuity (VA) of 6/60 or better. Pre-operative logMAR score was considered to act as an appropriate proxy measure for time of surgical procedure, with scores of 0.3 or less considered to represent early surgery, scores of 0.4 or 0.5 considered to represent medium surgery, and scores of 0.6 or more considered to represent late surgery for ERM. Patients were either pseudophakic at the time of vitrectomy or underwent combined phaco-vitrectomy for symptomatic ERM.ResultsEvaluation of parameter coefficients indicated that controlling for other factors, a delay of the surgical procedure from a state of early to medium corresponded to an increase (ie, disbenefit) of 0.074 units in post-operative logMAR score (95% confidence interval −0.001-0.15). A delay of the surgical procedure from a state of early to late corresponded to an increase (ie, disbenefit) of 0.21 units in post-operative logMAR score (95% confidence interval 0.13-0.29). Mean post-operative VA for early surgery was 0.16, out of which 36.2% of patients had a LogMAR score of 0.1 or better. This is in comparison to 17.2% in late ERM (those with a pre-operative logMAR score of 0.6 or more).ConclusionWe conclude that early surgery is associated with a lower (ie, better) post-operative logMAR score. Vitrectomy for early symptomatic ERM, in carefully selected patients, is beneficial in preserving excellent vision and allows quicker visual rehabilitation. [ABSTRACT FROM AUTHOR]

AimThe objective of this study was to present the results of combined phacovitrectomy using 1.8 mm microincision cataract surgery (MICS) with special emphasis on the anterior segment complications in this group.MethodsRetrospective, single-centre case series involving consecutive patients undergoing phacovitrectomy in a single centre in the United Kingdom during a 6-month period.ResultsA total of 52 eyes underwent combined MICS and pars plana vitrectomy. Intraoperative complications included posterior capsule rupture (n=2), minor iris trauma during phacoemulsification (n=1), iatrogenic retinal tears (n=2), and entry site break (n=1). Postoperatively two cases had significant inflammation, one of which resulted in 360° posterior synaechiea, iris bombe, and raised intraocular pressure. Other complications included mild posterior synaechiae (n=2), posterior capsular opacification (n=3), cystoid macular oedema (n=1), and hyphaema (n=1), which spontaneously resolved. There were no cases of intraocular lens decentration. Two patients who underwent surgery for retinal detachment repair subsequently redetached. Among those having surgery for macular hole, non-closure was seen in one patient and one patient developed a retinal detachment.ConclusionIn conclusion, sub-2 mm MICS is a safe and effective technique in dealing with vitreoretinal disorders necessitating cataract surgery at the same time. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the clinical, histopathological, and surgical features of the epiretinal membrane (ERM) after diabetic vitrectomy (DV). Methods: From August 2007 to January 2010, clinical charts of consecutive proliferative diabetic retinopathy (PDR) cases with significant post-DV ERM, defined as thickened membrane causing macular distortion and vision decrease, were enrolled as the study group; PDR cases without post-DV ERM in 24 months follow-up served as the control group. Factors associated with post-DV ERM formation, morphological and visual changes before and after ERM surgery, and histopathological features were analyzed. Results: Sixteen eyes were in the ERM group, while 60 eyes were in the control group. Active PDR ( p < 0.001), fibrovascular proliferation (FVP) grade ( p = 0.001), post-DV hemorrhage ( p = 0.012), and residual fibrovascular stump ( p = 0.002) were factors significantly associated with post-DV ERM. Most membranes (87.5 %) developed within 12 months, were widespread beyond the arcade (81.3 %), and connected with retinal vessels (87.5 %). After surgery, significant VA improvement was achieved. ERM recurrence was noted in six eyes (37.5 %). Histopathological examinations of ERMs in six cases showed abundant collagen fibers with epithelial cells. Immunohistochemical staining with CD 34 demonstrated the presence of vascular endothelium in two of the six specimens. Conclusion: The post-DV ERM is a complex tissue with variable vascularity that often presents with widespread distribution, rapid progression, and causes macular distortion. Associated risk factors include active PDR, high FVP grade, post-DV hemorrhage, and residual fibrovascular stumps. Membrane removal surgery may be beneficial in selected cases, but recurrence is not uncommon. [ABSTRACT FROM AUTHOR]

Posterior vitreous detachment (PVD) is a common phenomenon in the aging eye. However, this may be complicated by persistent symptomatic vitreomacular adhesions that exert tractional forces on the macula (vitreomacular traction; VMT). VMT itself may be associated with epiretinal membrane formation and the development of idiopathic macular holes (IMH). Such pathologies may cause visual disturbances, including metamorphopsia, photopsia, blurred vision, and decreased visual acuity, which impact an individual's quality of life. Technologies such as optical coherence tomography allow an increasingly more accurate visualisation of the macular anatomy, including quantification of macular hole characteristics, and this facilitates treatment decision-making. Pars plana vitrectomy remains the primary treatment option for many patients with VMT or IMH; for the latter, peeling of the inner limiting membrane (ILM) of the retina has shown improved outcomes when compared with no ILM peeling. The development of narrow-gauge transconjunctival vitrectomy systems has improved the rate of visual recovery following surgery. Ocriplasmin, by degrading laminin and fibronectin at the vitreoretinal interface, may allow induction of PVD in a non-invasive manner. Indeed, clinical studies have supported its use as an alternative to surgery in certain patient populations. However, further research is still needed with respect to greater understanding of the pathophysiology underlying the development of VMT and IMH. [ABSTRACT FROM AUTHOR]

Purpose: We produced a simulated eye for vitreous surgery training by using Japanese quail eggs, and verified its utility. Methods: We used a special cutter to cut off the sharp end of a Japanese quail egg, fitted a silicone simulated sclerocorneal cap to the exposed area, and fixed the egg to a base. Trocars were placed in the simulated sclera according to the usual procedure for vitreous surgery, and the yolk and albumen were treated as the vitreous body, and resected by using a vitreous cutter. Membrane peeling was performed on the inner eggshell membrane as if it were the internal limiting membrane. Results: The yolk and albumen could be resected with a vitreous cutter in the same way as the vitreous body. The inner eggshell membrane could be visualized under staining with Brilliant Blue G and other stains, enabling peeling to be performed with vitreous forceps in the same way as is normally performed for the human internal limiting membrane. Conclusion: This model can be used for simulating the spatial recognition of the vitreous chamber during vitreous surgery. This model proved useful for initial training in port creation, central vitreous body resection, and membrane manipulation in the macular area. [ABSTRACT FROM AUTHOR]

Background: Primary vitreous floaters can be highly bothersome in some patients. In the case of persistently bothersome floaters, pars plana vitrectomy may be the most effective treatment. The aim of this study is to evaluate the incidence of complications, and patient satisfaction, after pars plana vitrectomy for disabling primary vitreous opacities. Methods: We included a total of 110 eyes that underwent pars plana vitrectomy between February 1998 and August 2010. Fifty-seven eyes (51.8 %) underwent 20-gauge vitrectomy, whereas 53 eyes (48.2 %) underwent 23-gauge vitrectomy. In a retrospective manner, we assessed intraoperative and postoperative complications. There was a considerable range of time between surgery and questionnaire (range: 4-136 months). Patient satisfaction was assessed by a questionnaire based on a modified NEI VFQ-25 questionnaire. Results: A retinal detachment occurred in 10.9 % of cases, and the incidence did not differ significantly between the 20-gauge and 23-gauge vitrectomy groups. In 4.5 % of the eyes, a retinal detachment developed within the first 3 months, and 6.4 % occurred later in the postoperative period. Cystoid macular edema occurred in 5.5 %, and an epiretinal membrane was seen postoperatively in 3.6 % of cases. Development of glaucoma requiring glaucoma surgery, a macular hole, and postoperative scotoma, each occurred in 0.9 % of cases. No cases of endophthalmitis occurred. Eighty-five percent of patients were satisfied or very satisfied with the results of the vitrectomy. Eighty-four percent of all patients were completely cured from their troublesome vitreous floaters, and an additional 9.3 % of patients were less troubled by vitreous floaters. Ten patients (9.3 %) were dissatisfied, and six of these patients (5.6 %) had a serious complication that resulted in permanent visual loss. Conclusions: Pars plana vitrectomy is an effective approach to treat primary vitreous floaters, resulting in a high rate of patient satisfaction. Postoperative complications may be more frequent than previously reported, so patients should be well-informed about the complication rate before reaching informed consent about this surgical intervention. Additional preventive measures should be considered to reduce this complication rate. [ABSTRACT FROM AUTHOR]

Purpose: To compare the thickness of each retinal layer in the parafoveal and perifoveal regions of eyes after successful closure of a macular hole (MH) by pars plana vitrectomy with internal limiting membrane (ILM) peeling to the corresponding areas of the normal fellow eyes. Methods: Twenty-two eyes of 22 patients with an idiopathic MH who underwent PPV with ILM peeling at the Matsumoto Dental University Hospital were studied. The retinal thickness was measured manually with the volume scan mode of the Spectralis HRA + OCT (Heidelberg Engineering, Germany). Results: The average postoperative parafoveal thickness of the temporal sector was 314.8 μm, and that of the corresponding area of the fellow eyes was 325.0 μm ( P = 0.01). The parafoveal thickness of the nasal sector was 360.7 μm, and that of the fellow eyes was 339.6 μm ( P < 0.0001). Changes in the inner retinal layer thicknesses contributed to the decreased temporal and increased nasal sectors. The perifoveal retinal thickness was significantly increased in all sectors after PPV, probably due to an increase in the outer nuclear layer thickness. Conclusions: PPV with ILM peeling for MHs can cause microstructural changes in wide areas of the macula region, suggesting a loss of longitudinal support of the Müller cells. [ABSTRACT FROM AUTHOR]

Purpose: We developed a new artificial image enhancement system and evaluated its usefulness in controlling intraoperative reflection and enhancing of Brilliant Blue G (BBG) staining. Methods: The system was composed of three kinds of filters (a polarizing filter, a blue-enhancing filter, and a sharp-cut filter Y) and attached to the inferior surface of the operating microscope. Twenty-seven post-mortem extracted porcine eyes were used for a series of examinations. We performed surgery using the 23G-vitrectomy system with a halogen light and xenon lights and compared the reduction of intraoperative reflection under air condition and visibility and BBG contrast with and without this system. The evaluation of images was calculated in CIE 1976 ( L*, a*, b*) color space (CIELAB) carried out by ImageJ software. The transmission of each filter and absorbance of BBG was measured by a spectrophotometer. We measured spectral irradiance at each wavelength about each filter from each light source with a spectroradiometer. Results: Under both light sources, intraoperative reflection was controlled using a polarizing (PL) filter or combination of filters under air condition. Evaluation of the value of L* within the cutter surface was changed by 37.8 % under the halogen light, and 61.6 % (averaged) under the xenon light with inserted filters versus no filter. The BBG intensity difference was obtained with sharp-cut Y filter under both light source and PL with blue enhancing filter under the halogen light using each L*, a*, b* parameter with statistically significant ( p < 0.01, 0.05). However, there was a relative decrease in the observation illuminance when the filter inserted according to the attenuation total spectral irradiance. Conclusions: This system can reduce intraoperative reflections under the air condition and obtain an excellent BBG staining intensity induced by various light sources. [ABSTRACT FROM AUTHOR]

PurposeVitreous biopsy for the cytological assessment of suspected intraocular lymphoma and vitritis of uncertain aetiology is a standard investigation. The types of specimens generated and the diagnostic rate are variable within and between centres. There are many reasons for this but one observation that has not been considered previously is the differential distribution of cells in the vitreous gel. To test this possibility, five consecutive patients with suspected vitreous involvement by lymphoma or vitritis of uncertain aetiology underwent a core vitreous biopsy immediately before a planned full pars plana vitrectomy (PPV) and the cellularity of the two sampling techniques compared.MethodsA prospective study of five consecutive patients requiring vitreous sampling to secure a firm diagnosis. For each of five patients, the core vitreous biopsy specimen was received in a universal tube and the PPV specimen was received in a vitreous cassette. Fluid (0.25 ml) was removed from both specimens, centrifuged and haematoxylin and eosin (H&E) stained slides prepared per sampling method. The slides were examined with a light microscope, the most cellular field selected and the number of cells per mm2 counted and compared between sampling techniques.ResultsPPV specimen's, revealed a cellularity range that was 7.4 to 78 × (average 31 ×) greater than a core vitreous biopsy. In the two cases of a final diagnosis of intraocular lymphoma, the vitreous core biopsy was non-diagnostic. Furthermore, the PPV specimen generated additional cellular material for numerous ancillary investigations to permit a secure diagnosis.ConclusionsThe results of this differential vitreous sampling study has strengthened our anecdotal slit lamp clinical observations that inflammatory cells and lymphoma cells are concentrated more in the cortical vitreous. Therefore, vitreous cells have less chance to be sampled if a single core vitreous biopsy is performed. Indeed, the two cases of confirmed lymphoma generated a non-diagnostic core vitreous biopsy. In our centre, this study has lead to PPV being performed as a gold standard on all patients with suspected intraocular lymphoma or vitritis of uncertain aetiology. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the relationship between compliance with ophthalmic examinations before vitrectomy for proliferative diabetic retinopathy (PDR) and postoperative vision. Methods: The clinical findings and visual acuity in 128 eyes of 94 patients who had undergone vitrectomy for PDR were reviewed. The patients were divided into the never-examined group with no previous ophthalmic examination until the first visit when vitrectomy was prescribed, the noncompliant group with a history of missing ophthalmic examinations over a 1-year period, and the compliant group with ophthalmic examinations at least once a year before the vitrectomy. Results: Compliance with general medical examinations in the never-examined group (19 %) and in the noncompliant group (26 %) was significantly lower than that in the compliant group (100 %; P < 0.001 and P < 0.001, respectively). The mean glycosylated hemoglobin in the never-examined group (8.9 %) was significantly higher than that in the compliant group (7.6 %; P = 0.047). The postoperative visual acuities at 6 months and at the final visit were significantly better in the compliant group than in the never-examined group ( P = 0.017). Conclusions: Compliance with preoperative examinations significantly affects vision after vitrectomy for PDR. Low compliance with ophthalmic examinations was significantly associated with low compliance with general medical examinations and high blood glucose levels. [ABSTRACT FROM AUTHOR]

Background: Intravitreal injection of bevacizumab in retinopathy of prematurity has shown satisfactory results without any systemic complications. However, increased fibrosis and tissue contraction are reported as adverse effects in some cases. Case: A premature girl, born at 29 weeks + 4 days of gestation, had bilateral aggressive posterior retinopathy of prematurity (APROP) on her first screening at 3 weeks of age. She received extensive, near confluent, laser ablation of the avascular retina and off-label intravitreal bevacizumab (0.75 mg) injection OU. The right eye showed a slight regression, but a localized tractional membrane was noted OS. After another intravitreal bevacizumab injection in each eye, the left eye underwent lens-sparing vitrectomy (LSV) because of contraction of the proliferative membrane leading to a dome-shaped tractional retinal detachment (TRD). Observations: At 6-week follow-up, the left eye showed complete retinal reattachment. Both eyes showed prompt resolution of vascular engorgement with anterior progression of the peripheral retinal vasculature. Conclusions: Intravitreal bevacizumab is safe and effective as a treatment of APROP. In some cases tissue contraction may occur, but because TRD is localized to the posterior pole, effective LSV can be performed. [ABSTRACT FROM AUTHOR]

Purpose: We investigated the effects on corneal shape of suturing the scleral wound during 23-gauge vitreous surgery. Methods: We used a corneal topographic modeling system to measure the corneal shape in 39 eyes of 39 patients before and at 1 week, 1 month, and 3 months after performing 23-gauge vitreous surgery. We investigated the immediate postoperative changes and the postoperative changes over time according to whether suturing was performed. Suturing of the scleral wound was required in 20 eyes of 20 patients (suture group) and was not performed in 19 eyes of 19 patients (no-suture group). Spherical equivalent, regular astigmatism, asymmetry, and higher order irregularity components were investigated separately using Fourier analysis of corneal shape data obtained from the topographic modeling system. Results: The no-suture group showed no significant change in any component at any point after surgery. In the suture group, spherical equivalent, regular astigmatism, asymmetry, and higher order irregularities were all increased 1 week postoperatively, but by 1 month postoperatively, these had all returned to their preoperative states. Conclusions: If suturing is required during 23-gauge vitreous surgery, patients should be monitored with the understanding that changes in refractive value may occur during the month after surgery owing to changes in corneal shape. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the prognostic risk factors for failure of trabeculectomy with mitomycin C (MMC) in vitrectomized eyes. Methods: Retrospective cohort study. We reviewed the medical records of 116 patients (116 eyes) treated at Kumamoto University Hospital. The primary endpoints were persistent intraocular pressure of >21 mmHg, deterioration of visual acuity to no light perception, or additional glaucoma procedures. Multivariable analysis was performed with the Cox proportional hazards model. Results: The mean follow-up period was 36.5 months (range, 0.5-134.1 months). The probability of success 1 year after trabeculectomy was 55.1 %, 2 years after was 45.3 %, and 3 years after was 43.1 %. The multivariable model showed that higher preoperative intraocular pressure (IOP) [relative risk (RR), 1.05/mmHg; P = 0.0077] and neovascular glaucoma (NVG) (RR, 1.88; P = 0.049) were prognostic factors for surgical failure. Conclusions: The prognostic factors for surgical failure of trabeculectomy with MMC in vitrectomized eyes are a higher preoperative IOP and NVG. [ABSTRACT FROM AUTHOR]

PurposeTo evaluate the visual and anatomical results of surgery for macular hole-related retinal detachment (MHRD) after phacoemulsification cataract extraction.MethodsData for all patients who underwent surgery for MHRD after phacoemulsification cataract extraction from 1 December 1998 to 30 September 2008 in one hospital were evaluated. Patient characteristics, best-corrected visual acuity (VA) preoperatively and at last examination, surgical technique, anatomical success, and follow-up period were extracted and analysed statistically.ResultsA total of 13 625 eyes of 10 076 patients who had phacoemulsification cataract surgery were included. In the follow-up period, 10 cases of MHRD in nine patients were observed, of which seven eyes had high myopia. The mean axial length was 30.97±1.36 mm (29.19, 32.97) and mean myopia was−19.35±1.93 (−7.5,−3.5) dioptres. Overall anatomical success was achieved in 90% (9 out of 10 eyes). There was no statistically significant difference (P=0.240) between the logarithm of the MAR VA before the phacoemulsification cataract extraction and after MHRD surgical repair. VA increased in three eyes but decreased in the other seven after MHRD surgery.ConclusionsAs a primary procedure, vitreous surgery combined with other necessary adjunct procedures such as membrane peeling and retinal tamponade seems to be successful in achieving anatomical success. However, VA improvement is dependent on the type of macular lesion and not the surgical procedure. [ABSTRACT FROM AUTHOR]

PurposeA growing body of evidence points to a role for inflammation mediated by lymphocyte function-associated antigen-1 (LFA-1) and its ligand intercellular adhesion molecule-1 in the pathogenesis of diabetic macular oedema. This phase 1b clinical trial assessed the safety, tolerability, and pharmacokinetics of topically administered SAR 1118, a novel LFA-1 antagonist, in human subjects.MethodsIn this prospective, randomized, double-masked trial, 13 subjects scheduled for vitrectomy received one of three concentrations of topical SAR 1118 (0.1, 1.0, or 5.0%) twice daily for 1 week before surgery. Undiluted aqueous and vitreous samples were collected at surgery and analysed for the concentration of the medication.ResultsAll subjects completed the entire course of medication. The only adverse events reported were instillation site irritation (4/13, 31%) and dysgeusia (3/13, 23%). These were mild and transient, occurring at the highest dose. Mean concentrations (ng/ml) of SAR 1118 in the aqueous humour were 0.25, 37.2, and 101.1 for the 0.1%, 1.0%, and 5.0% dose groups, respectively. SAR 1118 was below the level of detection (0.5 ng/ml) for all vitreous samples except in a single subject who had a history of prior vitrectomy and a dislocated intraocular lens.ConclusionsTopical SAR 1118 was safe and well tolerated, and dose-dependent levels of drug were detected in aqueous. However, vitreous levels were below the threshold of detection with the concentrations tested. Further investigation of this medication for posterior segment applications would require intravitreal delivery or chemical modification of the drug. [ABSTRACT FROM AUTHOR]

AimTo propose a new mechanism for the development of idiopathic macular hole in the setting of pre-existing posterior vitreous detachment (PVD).MethodsPatients were examined clinically with fundus contact lens biomicroscopy and high-definition optical coherence tomography (OCT) was used to characterize the structural changes in the fovea following PVD.ResultsTwo patients presented with vitreofoveal separation and were found by high-definition OCT to have subtle foveal disruption and irregularity of the foveal contour with no evidence of a full thickness macular hole. Sequential examination of these patients demonstrated delayed formation of idiopathic macular hole.ConclusionTraction-induced inner foveal damage occurring before or coincident with spontaneous vitreofoveal separation destabilizes the fovea and predisposes some eyes to delayed macular hole formation. [ABSTRACT FROM AUTHOR]

Background: To investigate blood flow velocity (BFV) in the perifoveal capillaries before and after vitreous surgery for patients with epiretinal membrane (ERM). Methods: Twenty-one eyes in patients with ERM and 16 eyes in healthy subjects were involved in this study. Fluorescein angiography was performed using a scanning laser ophthalmoscope and BFV was analyzed by the tracing method. Foveal thickness (FT) was measured by optical coherence tomography. Results: BFV was significantly slower in the ERM patients (1.04 ± 0.10 mm/s) than in the healthy subjects (1.49 ± 0.11 mm/s ) ( p = 0.0010). BFV in the ERM patients 6 months after vitreous surgery (6 M) (1.21 ± 0.02 mm/s) significantly increased compared with BFV before surgery (0 M) (1.04 ± 0.10 mm/s) ( p = 0.0061). BFV 1 year after vitreous surgery (1 Y) significantly increased (1.38 ± 0.02 mm/s) compared with BFV(6 M) (1.21 ± 0.02 mm/s) ( p = 0.0235). FT was significantly greater in the ERM patients (351.7 ± 87.1 μm) than in the healthy subjects (158.9 ± 16.9 μm) ( p = 0.0011). FT (6 M) significantly decreased (285.3 ± 36.9 μm) compared with FT before surgery (0 M) (351.7 ± 87.1 μm) ( p = 0.0212). FT did not show significant differences between (6 M) and (1 Y). No significant correlation was found between BFV and FT before surgery. Conclusions: Perifoveal capillary BFV in patients with ERM was slower than that in the healthy subjects, and significantly improved after vitreous surgery as time progressed. It can be said that perifoveal capillary BFV is related to the development and improvement of ERM in the long term. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to determine the incidence of and risk factors for intraocular pressure (IOP) elevation within 24 h following vitrectomy for rhegmatogenous retinal detachment (RD). Methods: We assessed 34 eyes of 34 consecutive patients with RD undergoing vitrectomy and 12 eyes of 12 patients with macular hole as controls. IOP was measured using Tonopen XL before surgery, at the end of surgery, and at 5 h and 1 day postoperatively. IOP at the end of surgery was adjusted to 15.0 ± 2.0 mmHg. Results: IOP elevation was found in five RD eyes at 5 h and in 13 1 day postoperatively. IOP in patients with RD at both 5 h and 1 day postoperatively was significantly higher than that of controls. Circumferential dimension of retinal tears and disease duration were significantly associated with IOP elevation at both 5 h and 1 day postoperatively. Conclusions: IOP elevation in the early postoperative period following vitrectomy for RD is common. The risk factors for IOP elevation include the extent of retinal tears and duration of detachment. Prophylactic treatment may be useful in eyes with higher risks of IOP elevation. [ABSTRACT FROM AUTHOR]

Purpose: To report clinicopathologic and ultrastructural feature of one opacified hydrophilic acrylic intraocular lens (IOL) explanted from a diabetic patient. Methods: A 48-year-old man underwent trans pars plana vitrectomy and phacoemulsification with implantation of a hydrophilic acrylic lens OS in November 2008. The patient complained of a marked decrease in visual acuity in May 2009 as a result of a milky opalescence of the IOL. Intraocular lens explantation and exchange were performed in August 2009, and the explanted IOL was submitted to our center for detailed pathologic, histochemical and ultrastructural evaluation. It was stained by the von Kossa method for calcium, and also underwent scanning electron microscopy and energy dispersive radiograph spectroscopy to ascertain the nature of the deposits leading to opacification. Results: Opacification of the IOL was found to be the cause of the decreased visual acuity. The opacification involved only the IOL optic, and the haptics was clear. Histochemical and ultrastructural analyses revealed that the opacity was caused by deposition of calcium and phosphate within the lens optic. Conclusion: We believe this report of calcification of the Akreos MI-60 IOL is of clinicopathological importance. Long-term follow-up of diabetic patients implanted with this IOL should be maintained by surgeons and manufacturers. [ABSTRACT FROM AUTHOR]

PurposeTo compare the effectiveness and safety of 25- and 23-gauge sutureless microincision vitrectomy surgery (MIVS) in the management of various vitreoretinal diseases.MethodsEighty-five consecutive patients undergoing sutureless vitrectomy during January to April 2008 were randomized to either 25- or 23-gauge MIVS. Data collected prospectively included best-corrected visual acuity (BCVA), operation time, postoperative visual recovery, postoperative anterior segment change, and complications.ResultsThe most common indications for MIVS were macular hole, macular pucker, vitreous haemorrhage, and diabetic traction retinal detachment. Mean operation times of the 25-gauge (n=38) and 23-gauge groups (n=47) were 33.68 and 34.47 min, respectively (P=0.942). Mean BCVA improved significantly in both the 25- and 23-gauge groups when measured 3-month postoperatively. There was no between-group difference in either the degree or the rate of postoperative visual recovery. Seven patients in the 23-gauge group, compared with three in the 25-gauge group, required suturing of sclerotomy at the end of the surgery. No patients in either group developed postoperative wound leakage or endophthalmitis.ConclusionOur prospective study suggests that, within the limited indications, both 25- and 23-gauge MIVS are equally effective, with similar safety profiles. Gauge selection thus may be made according to a surgeon's preference and the availability of appropriate instruments. [ABSTRACT FROM AUTHOR]

To present the visual results and the complications of primary intraocular lens (IOL) implantation in infants aged 6 to 12 months between January 2002 and July 2007. A total of 26 consecutive eyes, of 16 infants with cataract aged 6 to 12 months, were reviewed in the study. All patients had cataract extraction with anterior and posterior capsulorrhexis combined with anterior vitrectomy and primary hydrophobic acrylic IOL implantation. Six infants (six eyes) had unilateral congenital cataract and ten (20 eyes), bilateral cataract. Visual acuity and complications were recorded throughout the 46.4-month mean follow-up (range 22 to 79 months). All eyes had primary IOL implantation. The mean best-corrected visual acuity (logMAR) was 0.98 ± 0.18,0.50 ± 0.14 and 0.61 ± 0.25 for unilateral, bilateral and all eyes respectively at the last follow-up. IOLs were implanted in the capsular bag of 25 eyes (96.2%) and in the sulcus of the remaining one eye (3.8%). Seven eyes (26.9%) developed visual axis opacification (VAO), and four eyes required secondary pars plana vitrectomy (PPV). IOL opacification occurred in one eye 54 months after implantation. Late onset open-angle glaucoma developed in one eye, and required trabeculectomy surgery. The predictors of good best-corrected visual acuity (BCVA) included partial cataract, bilateral cataract, absence of strabismus or nystagmus, and good amblyopic treatment. The greatest annual myopic change (5.15 ± 2.08 D) was observed during the first 12 months after surgery. In unilateral cases, there was no significant difference in the axial length between the cataractous eye and the fellow normal eye both at the time of surgery ( P = 0.891) and final follow-up ( P = 0.693). Primary IOL implantation was safe and effective for infantile cataract surgery. Total or unilateral cataract, nystagmus or strabismus, and inadequate amblyopic therapy were predictors of poor BCVA. Significant myopic shifts occurred especially in infants in the first year of surgery. The pseudophakic eye had a similar growth rate, as measured by axial length, to that of the fellow normal eye, in unilateral cases. [ABSTRACT FROM AUTHOR]

Abstract  Saccadic eye rotations induce a flow in the vitreous humor of the eye. Any such flow is likely to have a significant influence on the dispersion of drugs injected into the vitreous chamber. The shape of this chamber deviates from a perfect sphere by up to 10–20% of the radius, which is predominantly due to an indentation caused by the lens. In this paper we investigate theoretically the effect of the domain shape upon the flow field generated by saccades by considering an idealized model. The posterior chamber geometry is assumed to be a sphere with a small indentation, undergoing prescribed small-amplitude sinusoidal torsional oscillations, and, as an initial step towards understanding the problem, we treat the vitreous humor as a Newtonian fluid filling the chamber. The latter assumption applies best in the case of a liquefied vitreous or a tamponade fluid introduced in the vitreous chamber after vitrectomy. We find the flow field in terms of vector spherical harmonics, focusing on the deviation from the flow that would be obtained in a perfect sphere. The flow induced by the departure of the domain geometry from the spherical shape has an oscillating component at leading order and a smaller-amplitude steady streaming flow. The oscillating component includes a circulation cell formed every half-period, which migrates from the indentation towards the center of the domain where it disappears. The steady component has two counter-rotating circulations in the anterior part of the domain. These findings are in good qualitative agreement with the experimental results of Stocchino et al. (Phys Med Biol 52:2021–2034, 2007). Our results predict a significant reduction in the expected time for drug dispersal across the eye compared with the situation in which there is no fluid flow present. [ABSTRACT FROM AUTHOR]

PurposeTo evaluate results of 23-gauge transconjunctival sutureless vitrectomy in various indications of vitreoretinal diseases.DesignProspective, non-comparative study.Materials and methodsFifty-seven consecutive eyes of 57 patients underwent vitreoretinal surgery by one surgeon using the 23-gauge, two-step instrumentation developed by Dutch Ophthalmic Research Center Inc., for epiretinal membranes (n=24), macular holes (n=10), diabetic retinopathy (n=4), rhegmatogenous retinal detachment (n=3), silicone oil removal (n=10), and other procedures (n=4). Mean operative time and intraoperative and postoperative complications were recorded. At 1 month, postoperative visual acuity, anatomical results, and induced astigmatism measured by Orbscan (BAUSCH and LOMB laboratories Inc., Rochester, NY, USA) were analysed.ResultsMean operative time was 32.6±21.5 min. At 1 month, mean visual acuity improved from 1.09±0.82 to 0.80±0.79 logMar. Transient postoperative hypotony was the most common complication (21.1%), resolving without treatment. There was no choroidal effusion; and no postoperative endophthalmitis was observed. There were no significant changes in mean keratometry (P=0.957), mean axis (P=0.818), and power of astigmatism (P=0.860) at 1 month.ConclusionsA 23-gauge vitrectomy seems to be safe and effective for a wide range of indications for vitreoretinal surgery. Further studies are needed to compare it with 25-gauge and 20-gauge vitrectomy in larger series. [ABSTRACT FROM AUTHOR]

The Stokes–Einstein equation predicts that diffusion is inversely correlated with viscosity of the medium. This predicts that diffusion fluxes should be lower in vitreous humour than in saline solution with lower viscosity. We test this hypothesis, which has implications for vitrectomy. Diffusion cells were used, with a middle chamber filled with saline solution with different concentrations of hyaluronic acid (0 µg/ml, 30 µg/ml, 90 µg/ml and 180 µg/ml) or porcine vitreous humour, between cellophane membranes. HPLC was used to measure the concentration of the diffusing molecule, dexamethasone, and calculate the flux through the chamber filled with the various media. The diffusion coefficients were calculated, using Fick's law. Viscosity was measured with a Brookfield digital DV-I+viscometer. The diffusion coefficient for dexamethasone in vitreous humour is 0.065 ± 0.022 cm2/hour, 0.26 ± 0.12 cm2/hour for saline alone, 0.17 ± 0.04 cm2/hour for saline with 30 µg/ml hyaluronan, 0.076 ± 0.009 cm2/hour with 90 µg/ml hyaluronan, and with 180 µg/ml hyaluronan 0.072 ± 0.0018 cm2/hour ( p < 0.001). The viscosity of liquid vitreous is 6.29 ± 2.3 cp, and the viscosity of saline alone is 1.01 ± 0.008 cp. For saline with 30 µg/ml of hyaluronan the viscosity is 1.04 ± 0.015, with 90 µg/ml hyaluronan is 1.06 ± 0.01, and with 180 µg/ml hyaluronan is 1.08 ± 0.014 ( p < 0.001). Dexamethasone diffuses four times faster through saline solution than vitreous humour. Liquid vitreous humour is about six times more viscous than saline. The results indicate that diffusion is faster in saline solution than in vitreous humour, in accordance to the Stokes–Einstein equation. This finding can help explain some of the physiological, pharmacological and clinical consequences of vitrectomy. [ABSTRACT FROM AUTHOR]

Histopathologic and morphometric analysis of the internal limiting membrane (ILM) in diabetic eyes was performed. The thickness of the ILM was correlated with the level of glykosylated hemoglobin (HbA1C) and other clinical factors. The prospective study involved 56 eyes of 52 diabetic patients with a mean age of 63 ± 7.6 years. Vitrectomy with trypan blue-assisted ILM peeling was performed in the standard way. The mean follow-up period was 8.7 months (range 3–19 months). The ILM was fixed immediately after peeling in 2.5% glutaraldehyde and submitted for electron microscopic evaluation. The ILM was photographed at standard magnification (×5,000) with the scale of 1 µm in the shot. Morphometric analysis demonstrated a significant thickening of the ILM in all eyes, with a mean thickness of the ILM of 3.61 ± 1.22 µm. It was found that a higher thickness of the ILM is related to elevated HbA1C in both types of diabetes mellitus (DM) ( p = 0.040). We also found significant dependence of ILM thickness in relation to duration of DM by comparison of men and women ( p = 0.026), and a significant correlation between ILM thickness and the age of diabetic patients related to their gender ( p = 0.029). We confirmed increased thickness of the surgically peeled ILM and statistically significant correlations to elevated HbA1C in both types of DM, and to further clinical characteristics of case series. Morphometric and histopathologic analyses of the ILM contribute to more objective evaluation of the ultrastructure of the vitreomacular interface. [ABSTRACT FROM AUTHOR]

In this pilot study the effects of vitrectomy on PO2 in the vitreous cavity in CRVO were investigated. Prospective, controlled, interventional study. Six patients with ischaemic CRVO in one eye (undergoing vitrectomy for radial optic neurotomy, RON) and six with either macula hole or membrane were included. An oxygen probe was inserted before removal of the vitreous (pre-vitrectomy) and after removal of the vitreous (post-vitrectomy). In the patients with CRVO, measurements were taken before RON was performed. Oxygenation recordings (PO2) were taken in the mid-vitreous cavity and the preretinal vitreous. Mean age was 65 years. In controls, pre-vitrectomy, the mean PO2 adjacent to the retina (15.0 mmHg S.D.5.7) was significantly less than mid-cavity (33.7 mmHg S.D.12.8). Similarly in CRVO, the pre-vitrectomy pre-retinal PO2 (8.1 mmHg S.D. 3.5), was significantly less than mid-cavity (19.8 mmHg S.D.7.3). The mean PO2 was significantly less in the eyes with CRVO than in control eyes. Post-vitrectomy, the PO2 was significantly greater than pre-vitrectomy at both recording sites in the controls mid-cavity (61.5 mmHg S.D.13.9) and pre-retinal (75.8 mmHg S.D. 9.1), and CRVO eyes mid-cavity (53.7 mmHg S.D. 17.9) and pre-retinal (59.8 mmHg S.D. 15.8). PO2 is reduced in the vitreous cavity in CRVO. Vitrectomy may be a method of increasing oxygen availability to the retina. [ABSTRACT FROM AUTHOR]

Abstract Background  To investigate the clinical benefit of internal limiting membrane (ILM) peeling at the macula for the prevention of epimacular membrane formation following vitreous surgery using silicone oil for the treatment of complicated retinal detachment. Methods  This was a non-randomized, retrospective, interventional study of a case series. Patient charts were reviewed retrospectively for 20 consecutively recruited patients who underwent successful primary vitrectomy with ILM peeling at the macula using silicone oil (group 1) and 22 consecutively recruited patients who underwent successful primary vitrectomy using silicone oil without ILM peeling at the macula for complicated rhegmatogenous retinal detachment (group 2). The main outcome measures were distant visual acuity and epimacular membrane formation. The data were analyzed and compared using Fisher’s Exact test, Pearson Chi-square test, independent t-test, Mann–Whitney U-test, and a repeated ANOVA. Results  The mean age of patients was 52.7 ± 12.6 years in group 1 and 53.2 ± 13.3 years in group 2 (p = 0.89). The mean follow-up time was 24.6 ± 7.6 weeks in group 1 and 34.1 ± 12.6 weeks in group 2 (p = 0.01). Preoperatively, ten eyes in group 1 and 10 eyes in group 2 were pseudophakic; the macula was detached in all cases. Silicone oil had been removed from all eyes of both groups at least 3 months before the final examination. There were no significant differences between the two groups with regard to sex (p = 0.44), mean duration of retinal detachment (p = 0.12), mean preoperative visual acuity (logMAR), mean number of retinal breaks (p = 0.43), and grade of proliferative vitreoretinopathy (p = 0.35). The final visual acuity (logMAR) was 0.60 ± 0.30 in group 1 and 0.72 ± 0.35 in group 2 (p = 0.49). Four eyes in group 1 and two eyes in group 2 underwent cataract surgery during silicone oil removal. Epimacular membrane formation was observed in two eyes before silicone oil removal and in four eyes within 8 weeks after silicone oil removal in group 2. No epimacular membrane formation was seen in group 1 (p = 0.02). Conclusion  ILM peeling at the macula during vitreous surgery with silicone oil for the treatment of complicated retinal detachment may prevent epimacular membrane formation without negatively affecting distant visual acuity. [ABSTRACT FROM AUTHOR]

Abstract Purpose  Results of vitreous surgery alone in patients with diabetic macular edema (Vit group) were compared with results of surgery combined with peeling of the internal limiting membrane (ILM group), and surgery combined with removal of the residual vitreous cortex after its visualization using triamcinolone acetonide (TA) and a postoperative intravitreal TA injection (TA group). Visual acuities after the operation, degree of improvement in visual acuity (VA), and intra- and postoperative complications were evaluated. Methods  The study included 141 consecutive patients (168 eyes) who could be followed up for at least 12 months after the operation. The Vit group consisted of 66 eyes, the ILM group of 62 eyes, and the TA group of 40 eyes. Patient background factors, and visual acuities 6 and 12 months after operation were evaluated first, and at the final examination, the degree of improvement in VA, the incidences of intra- and postoperative complications, and the incidence of intraocular pressure ≥25 mmHg were studied. Results  Preoperative VA was compared with the 6- and 12-month postoperative VA and the VA at the final examination. The preoperative to 6 months postoperative improvements and those between the 12-month postoperative and final examination did not differ among the three groups. However, the degree of improvement in VA between 6 and 12 months after the operation was significantly smaller in the TA group than in the other two groups. The incidences of intra- and postoperative complications did not differ among the three groups, but the incidence of intraocular pressure ≥25 mmHg was slightly higher in the TA group. Conclusion  Surgical results did not differ among the three operative techniques examined in this study. [ABSTRACT FROM AUTHOR]

Abstract  Vitreous surgery has various physiological and clinical consequences, both beneficial and harmful. Vitrectomy reduces the risk of retinal neovascularization, while increasing the risk of iris neovascularization, reduces macular edema and stimulates cataract formation. These clinical consequences may be understood with the help of classical laws of physics and physiology. The laws of Fick, Stokes-Einstein and Hagen-Poiseuille state that molecular transport by diffusion or convection is inversely related to the viscosity of the medium. When the vitreous gel is replaced with less viscous saline, the transport of all molecules, including oxygen and cytokines, is facilitated. Oxygen transport to ischemic retinal areas is improved, as is clearance of VEGF and other cytokines from these areas, thus reducing edema and neovascularization. At the same time, oxygen is transported faster down a concentration gradient from the anterior to the posterior segment, while VEGF moves in the opposite direction, making the anterior segment less oxygenated and with more VEGF, stimulating iris neovascularization. Silicone oil is the exception that proves the rule: it is more viscous than vitreous humour, re-establishes the transport barrier to oxygen and VEGF, and reduces the risk for iris neovascularization in the vitrectomized-lentectomized eye. Modern vitreous surgery involves a variety of treatment options in addition to vitrectomy itself, such as photocoagulation, anti-VEGF drugs, intravitreal steroids and release of vitreoretinal traction. A full understanding of these treatment modalities allows sensible combination of treatment options. Retinal photocoagulation has repeatedly been shown to improve retinal oxygenation, as does vitrectomy. Oxygen naturally reduces VEGF production and improves retinal hemodynamics. The VEGF-lowering effect of photocoagulation and vitrectomy can be augmented with anti-VEGF drugs and the permeability effect of VEGF reduced with corticosteroids. Starling’s law explains vasogenic edema, which is controlled by osmotic and hydrostatic gradients between vessel and tissue. It explains the effect of VEGF-induced vascular permeability changes on plasma protein leakage and the osmotic gradient between vessel and tissue. At the same time, it takes into account hemodynamic changes that affect the hydrostatic gradient. This includes the influence of arterial blood pressure, and the effect oxygen (laser treatment) has in constricting retinal arterioles, increasing their resistance, and thus reducing the hydrostatic pressure in the microcirculation. Reduced capillary hydrostatic pressure and increased osmotic gradient reduce water fluxes from vessel to tissue and reduce edema. Finally, Newton’s third law explains that vitreoretinal traction decreases hydrostatic tissue pressure in the retina, increases the pressure gradient between vessel and tissue, and stimulates water fluxes from vessel into tissue, leading to edema. [ABSTRACT FROM AUTHOR]

AimTo describe our experience in surgical management of stages 4 and 5 retinopathy of prematurity (ROP) and assess its anatomical and visual outcome.Materials and methodsThis study is a retrospective, interventional, consecutive case series. It involved 33 eyes of 29 infants. The data were retrieved retrospectively for each case from their medical records. All the eyes underwent primary vitrectomy with additional procedures like scleral buckling (two eyes), lensectomy (14 eyes), subretinal fluid drainage (two eyes), and one case of corneal transplant (open sky vitrectomy). The anatomical and visual outcome was reviewed at the final follow-up.ResultsThe mean gestational age was 29.7 weeks (range 25–34 weeks) and mean birth weight was 1332 g (range 650–2050 g). Anatomical success for stage 4A was defined as complete retinal attachment with undistorted or minimally distorted posterior pole. For stage 4B, partial residual retinal detachment and for stage 5 at least posterior pole attachment. Visual acuity was measured in anatomically successful eyes that were cooperative. The anatomical outcome was 90% (9/10 eyes) for stage 4A, 44.4% (4/9 eyes) for stage 4B, and 14.3% (2/14) for stage 5. The mean follow-up was 19.1 months. Posterior retinotomy was the commonest complication for stage 4B (66.7%).ConclusionAnatomical and visual success was the best for stage 4A ROP. Surgery for stage 4A can halt progression to stages 4B or 5 ROP. Aggressive peeling of posterior membranes should be avoided for stage 4B. Anatomical and visual outcome is very poor for stage 5.Eye (2009) 23, 176–180; doi:10.1038/sj.eye.6702939; published online 3 August 2007 [ABSTRACT FROM AUTHOR]

PurposeTo evaluate the safety and efficacy of intravitreal injection of bevacizumab advanced to vitrectomy for severe proliferative diabetic retinopathy.MethodsEight eyes of six patients (33–64 years old, all male patients) with severe proliferative diabetic retinopathy were investigated. An intravitreal injection of 1.25 mg bevacizumab was performed 3–30 days prior to planned vitrectomy.ResultsAll cases showed minimum bleeding during surgical dissection of fibrovascular membrane. Two cases receiving bevacizumab 7 days before the surgery showed strong fibrosis and adhesion of fibrovascular membrane, resulted in some surgical complications. The cases having intravitreal bevacizumab for shorter time did not show extensive fibrosis.ConclusionsThe pretreatment of bevacizumab is likely effective in the vitrectomy for severe PDR. The appropriate timing of vitrectomy after bevacizumab injection should be further evaluated.Eye (2009) 23, 108–111; doi:10.1038/sj.eye.6702983; published online 21 September 2007 [ABSTRACT FROM AUTHOR]

Abstract Purpose  To report three cases of early-onset macular hole secondary to a ruptured retinal arterial macroaneurysm. Methods  Case reports. Results  The patients were diagnosed with a subretinal hemorrhage with macular involvement. A macular hole was confirmed during the first fundus examination in two cases, and after vitreous surgery to remove a sub-internal limiting membrane (ILM) hemorrhage overlying the macula in the third case. All cases were probably complicated with a macular hole immediately after the rupture of a macroaneurysm. The distance from the macroaneurysm to the fovea was 2250 µm or less. All cases had a submacular hemorrhage and retinal detachment around the macular hole. In cases 2 and 3, vitrectomy with peeling of the ILM and SF6 gas tamponade led to closure of the macular hole; the macular hole remained open in case 1 without vitrectomy. Independent of anatomic repair of macular holes, the final best-corrected visual acuity (VA) was less than 20/67 in all cases. Conclusions  Early-onset macular hole formation secondary to a ruptured retinal arterial macroaneurysm occurs mechanically due to the proximity between the macroaneurysm and the fovea. Current and previous reports have suggested that any VA improvement was likely to be limited, at least in older patients. [ABSTRACT FROM AUTHOR]

PurposeTo report the clinical features of the eye of young patients with an idiopathic macular epiretinal membrane (ERM), and the visual outcomes after the surgical removal of the ERM.MethodsA retrospective review of the medical records of eight young patients (age, 23–39 years; mean, 32.5 years) with an idiopathic macular ERM was performed. The patients underwent vitrectomy and removal of the ERM with peeling of the internal limiting membrane (ILM). The pre- and postoperative visual acuity and intra- and postoperative complications were investigated.ResultsOphthalmoscopically, the ERMs in seven eyes were white, opaque, and dense, while one was grayish-white and less dense. A posterior vitreous detachment was not present and the ERM adhered strongly to the underlying retina in all eight eyes. The mean best-corrected visual acuity (BCVA) preoperatively was 20/140 (Snellen; range: 20/250–20/63), and the BCVA improved significantly to 20/30 (range: 20/40–20/20) postoperatively with an average follow-up of 14.6 months (range: 6–42 months; Wilcoxon sign-rank test, P<0.001). An improvement of >7 lines was observed in seven of eight eyes. A recurrence of an ERM without involving the macula was detected in one eye (12.5%).ConclusionsThe clinical features of the ERMs in young patients are different from those in elderly patients, eg, thicker, more adherent to the retina, and still attached to the vitreous. Vitrectomy and removal of ERM with ILM peeling are effective and safe surgical procedures. Removal of the ILM may minimize the recurrence of an ERM.Eye (2008) 22, 1430–1435; doi:10.1038/sj.eye.6702963; published online 31 August 2007 [ABSTRACT FROM AUTHOR]

PurposeTo discuss the evolution and current status of 25-, 23-, and 20-gauge vitrectomy instrumentation.MethodsLiterature review.ResultsThere are multiple small case series describing the surgical techniques, clinical outcomes, and complications associated with 25- and 23-gauge vitrectomy. These studies suggest that small-gauge vitrectomy may shorten operating time, improve patient comfort, and speed visual recovery. However, increased complication rates involving hypotony and endophthalmitis have been reported. There are no level 1 evidence-based studies comparing the efficacy and safety of 25-, 23-, and 20-gauge vitrectomy.Conclusion25- and 23-gauge vitrectomy techniques may shorten operating time, improve patient comfort, and speed visual recovery. However, larger and better designed evidence-based studies are required to better understand relative values of 25-, 23-, and 20-gauge vitrectomy.Eye (2008) 22, 1263–1266; doi:10.1038/eye.2008.20; published online 22 February 2008 [ABSTRACT FROM AUTHOR]