Search

Purpose: To determine the retinal thickness (RT), after vitrectomy with internal limiting membrane (ILM) peeling, for an idiopathic macular hole (MH) or an epiretinal membrane (ERM). Also, to investigate the effect of a dissociated optic nerve fiber layer (DONFL) appearance on RT. Methods: A non-randomized, retrospective chart review was performed for 159 patients who had successful closure of a MH, with (n = 148), or without (n = 11), ILM peeling. Also studied were 117 patients who had successful removal of an ERM, with (n = 104), or without (n = 13), ILM peeling. The RT of the nine Early Treatment Diabetic Retinopathy Study areas was measured by spectral domain optical coherence tomography (SD-OCT). In the MH-with- ILM peeling and ERM-with-ILM peeling groups, the RT of the operated eyes was compared to the corresponding areas of normal fellow eyes. The inner temporal/inner nasal ratio (TNR) was used to assess the effect of ILM peeling on RT. The effects of DONFL appearance on RT were evaluated in only the MH-with-ILM peeling group. Results: In the MH-with-ILM peeling group, the central, inner nasal, and outer nasal areas of the retina of operated eyes were significantly thicker than the corresponding areas of normal fellow eyes. In addition, the inner temporal, outer temporal, and inner superior retina was significantly thinner than in the corresponding areas of normal fellow eyes. Similar findings were observed regardless of the presence of a DONFL appearance. In the ERM-with-ILM peeling group, the retina of operated eyes was significantly thicker in all areas, except the inner and outer temporal areas. In the MH-with-ILM peeling group, the TNR was 0.86 in operated eyes, and 0.96 in fellow eyes (P < 0.001). In the ERM-with-ILM peeling group, the TNR was 0.84 in operated eyes, and 0.95 in fellow eyes (P < 0.001). TNR in operated eyes of the MH-without-ILM peeling group was 0.98, which was significantly greater than that of the MH-with-ILM peeling group (P < 0.001). TNR in the operated eyes of the ERM-without-ILM peeling group was 0.98, which was significantly greater than that of ERM-with-ILM peeling group (P<, 0.001). Conclusion: The thinning of the temporal retina and thickening of the nasal retina after ILM peeling does not appear to be disease-specific. In addition, changes in RT after ILM peeling are not related to the presence of a DONFL appearance. [ABSTRACT FROM AUTHOR]

This article gives an overview of the vitreal anatomy and its changes in ageing, which have a significant impact on the two main retinal complications after damage of the vitreolenticular barrier, namely retinal detachment and cystoid macular edema. The possible reasons and pathomechanisms for this entity of retinal diseases in the context of anterior segment interaction are highlighted, and a summary of references is provided showing the epidemiology and consequences of such interventions. Copyright © 2011 S. Karger AG, Basel [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]

Objective: To evaluate the outcome of primary pars plana vitrectomy with silicon oil tamponade versus scleral buckling procedureas a treatment for rhegmatogenous retinal detachment. Methodology: This prospective, comparative, interventional study was conducted from July 2008 to June 2009. Patients were selected and divided into two groups. Pars plana vitrectomy (group I) or scleral buckling (group II) was performed as primary procedure. Patients were followed for 06 months after surgery. Results: Anatomical outcome in pars plana vitrectomy procedure was 96.2% as compared to scleral buckling procedure 87.0%. Functional outcome in pars planavitrectomy, best corrected visual acuity of 6/6 - 6/18 was attained in 34.6%, in sclera buckling procedure 65.2% at 06 months. Conclusion: Anatomical outcome in pars plana vitrectomy is better as compared to scleral buckling. Visual outcome and visual rehabilitation is earlier and better in scleral buckling as compared to pars plana vitrectomy. [ABSTRACT FROM AUTHOR]

Purpose: To determine the incidence of difficulty in inserting a 25- and 23-gauge trocar cannula (DITC) during 25- or 23-gauge micro-incision vitrectomy surgery (MIVS). Methods: Retrospective, consecutive, interventional case series performed by a single surgeon at a single centre. We defined a DITC as the condition where at least 1 trocar cannula could not be inserted into the vitreous at the beginning of MIVS. The incidence of DITC was calculated from 1,525 eyes, and the pre-operative demographics of the DITC cases were compared to those of the non-DITC cases. Results: The incidence of DITC for all cases was 0.6% (9 of 1,525 eyes). Overall, there were 242 eyes with a retinal detachment (RD), and 8 of the 9 eyes with DITC had an RD with an incidence of 3.3% (8 of 242 RD eyes). Seven of these 8 eyes had a total RD, 4 also had a choroidal detachment, 4 eyes were also myopic (>-8.0 dpt, high myopia), and 6 of the 8 eyes were hypotonic (<8 mm Hg). The DITC cases had larger RDs (p < 0.0001), a higher incidence of choroidal detachment (p < 0.0001), higher myopia (p = 0.0204) and hypotony (p = 0.0003) than the non-DITC eyes with an RD. Conclusions: A large RD, a choroidal detachment, high myopia and hypotony are significant risk factors for DITC. We recommend that MIVS should be performed cautiously for eyes with these risk factors. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Aims: Posttraumatic endophthalmitis (PTE) managed with pars plana vitrectomy (PPV) and a variety of other methods often resulted in retinal detachment (RD), which deteriorates postoperative visual acuity (VA). We investigated initial ocular conditions, surgical management and outcomes of PTE patients and analyzed their relationship in order to find the necessary management for different patients' conditions. Methods: Retrospective study. Medical records of 62 consecutive patients who were diagnosed with PTE and managed with PPV were retrospectively analyzed. The included patients were divided into two groups depending on their initial VA, with light perception (LP) as borderline: group A (12 cases; VA = LP) and group B (50 cases; VA > LP). Specific variables related to surgical outcomes were analyzed, including: initial VA; intraocular foreign body; location and length of the wound; microbiologic test; cataract extraction; scleral buckling; silicon oil tamponade; gas tamponade, and retinal restoration. Data were statistically analyzed by the χ2 test, by univariate analysis for predictors and by multivariate logistic regression analysis. Results: RD happened in 19 (30.6%) of the 62 cases included. There were 6 cases (50%) in group A and 13 cases (26%) in group B which resulted in RD. Statistical analysis demonstrated that none of the related factors were correlated to the occurrence of RD (all factors: p > 0.05) in group A, but in group B, scleral buckling (with: 2/22, 9%; without: 11/28, 39%; p < 0.05) and silicone oil tamponade (with: 0/6; without: 13/44, 30%; p < 0.05) were statistically significantly correlated to the occurrence of RD. Conclusions: Preventive scleral buckling and silicone oil tamponade are important for patients with good initial VA (VA > LP) to be successfully managed by PPV. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The article focuses on closed eye pars plana vitrectomy pioneered by Robert Machemer. It mentions that recent advances have been made on pars plana vitrectomy with the three-port, 20 gauge system. It reveals that retina surgeons today prefer to use transconjunctival microincision vitrectomy surgery (MIVS) with 23-g or 25-g instrumentation on simple vitreoretinal pathologies and complex cases. The theoretical advantages of transconjunctival MIVS for diabetic retinopathy are also examined.

Purpose: To compare the postoperative ocular surface problems and patient comfort of 23 gauge (g) transconjunctival vitrectomy with the conventional 20 g pars plana vitrectomy in macular surgery. Materials and Methods: Sixty-one consecutive patients undergoing vitrectomy for idiopathic epiretinal membrane and macular hole were recruited to either 20 or 23 g vitrectomy groups and prospectively evaluated. The postoperative ocular surface reaction was qualitatively graded by slit-lamp examination. On postoperative month 1, the patients' postoperative degree of pain, discomfort, lacrimation and photophobia were assessed in a questionnaire. Results: Mean ocular surface score significantly lower in 23 g group at all postoperative visits compared with 20 g group values (p=0.001). In early as well as late postoperative period, mean ocular surface scores of 23 g group were significantly lower compared with the scores of 20 g group. One month postoperatively, the mean score of the patient comfort questionnaire was 4.0 in 20 g group and 1.5 in 23 g group. The patients in 23 g group reported significantly higher postoperative comfort than the patients in 20 g group (p=0.001). Conclusion: By comparison with conventional 20 g vitrectomy, 23 g transconjunctival vitrectomy system provided higher postoperative patient comfort and a faster postoperative recovery and less conjunctival scarring. [ABSTRACT FROM AUTHOR]

Abstract: Retinal trauma is a serious concern for patients undergoing inner limiting membrane (ILM) peeling to correct for various vitreoretinal interface conditions. This mechanical trauma can be prevented by modifying the surface of surgical instruments to increase adhesion to the ILM. To this effect, we have studied the effects of roughness and surface charge on the adhesive properties of ILMs by utilizing layer-by-layer (LbL) films with embedded gold nanoparticles (LbL-AuNP films). LbL films were assembled on atomic force microscopy (AFM) tipless cantilevers. Topographical analysis of these films, with and without nanoparticles, showed that LbL films with nanoparticles had a higher rms roughness compared to films alone or unmodified cantilevers. Nanoparticle-modified LbL films significantly increased the adhesion forces at the cantilever–ILM interface, compared to LbL films without particles. Surprisingly, adsorption of gold nanoparticles onto the AFM cantilevers caused increases in adhesion forces greater than those measured with LbL-AuNP films. These results have important implications for the design of surface modifications for vitreoretinal surgical instruments. [Copyright &y& Elsevier]

Copyright of Arquivos Brasileiros de Oftalmologia is the property of Arquivos Brasileiros de Oftalmologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The goal of all vitreous surgery is to perform the desired intraoperative intervention with minimum collateral damage in the most efficient way possible. An understanding of the principles of fluidics is of importance to all vitreoretinal surgeons to achieve these aims. Advances in technology mean that surgeons are being given increasing choice in the settings they are able to select for surgery. Manufacturers are marketing systems with aspiration driven by peristaltic, Venturi and hybrid pumps. Increasingly fast cut rates are offered with optimised, and in some cases surgeon-controlled, duty cycles. Function-specific cutters are becoming available and narrow-gauge instrumentation is evolving to meet surgeon demands with higher achievable flow rates. In parallel with the developments in outflow technology, infusion systems are advancing with lowering flow resistance and intraocular pressure control to improve fluidic stability during surgery. This review discusses the important aspects of fluidic technology so that surgeons can select the optimum machine parameters to carry out safe and effective surgery. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Purpose: To investigate the feasibility and efficacy of 25-gauge vitrectomy in the treatment of proliferative diabetic retinopathy (PDR). Methods: All patients underwent primary 25-gauge vitrectomy for simple vitreous hemorrhage (VH), fibrovascular proliferation (FVP), or tractional retinal detachment (TD), and were followed for more than 1 month. Final visual outcomes and intraoperative and postoperative complications were evaluated. Results: 167 eyes (138 patients) were used in this study, 65 eyes (39%) with VH, 66 eyes (40%) with FVP, and 36 eyes (21%) with TD. Measured using the mean logarithm of the minimum angle of resolution (logMAR), visual acuity (VA) significantly improved (p < 0.0001). Intraoperative iatrogenic retinal breaks developed in 19 eyes (11%). Concerning postoperative complications, VH in 36 eyes (22%), retinal detachment in 2 eyes (1%), and neovascular glaucoma 12 eyes (7%) were observed. No endophthalmitis developed. Conclusions: Twenty-five-gauge vitrectomy can successfully treat PDR. Clinical outcomes and complications are comparable to those of 20-gauge vitrectomy. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Aims: To describe 2 cases of diffuse diabetic macular edema (DME) after diabetic vitrectomy caused by a taut internal limiting membrane (ILM), with clinicopathological correlation. Methods: Interventional case series with immunohistochemical analysis. Results: Two patients were referred for unresponsive diffuse DME after pars plana vitrectomy with removal of the posterior hyaloid. Clinically, a taut ILM was noted over the fovea, and its removal resulted in rapid and long-term resolution of the edema, confirmed by optical coherence tomography with visual acuity improvement. Histopathology with immunostaining revealed a segment of ILM with an inner monolayer of cytokeratin-positive (retinal pigment epithelial cells) and/or glial fibrillary acidic protein-positive cells with smooth muscle actin immunoreactivity. Conclusions: A taut ILM can cause diffuse DME after vitrectomy, and its removal can restore the normal foveal contour and improve visual acuity. Tangential tractional forces from contractile cells propagated across the fovea via the ILM appear to be the etiology. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background/Aims: To evaluate the correlation between visual acuity (VA) and photoreceptor integrity in eyes with resolved diabetic macular edema (DME) after pars plana vitrectomy (PPV). Methods: Eleven eyes with resolved macular edema following PPV with internal limiting membrane removal for DME were included in this retrospective study. The integrity of the external limiting membrane (ELM) and inner and outer segments (IS/OS) of the photoreceptor junction was evaluated by spectral domain optical coherence tomography. The main outcome measures were percentage of disrupted ELM and IS/OS lines, and correlation between VA and photoreceptor integrity. Results: The mean time after PPV was 78 ± 17 months. The mean lengths of the disrupted ELM and IS/OS lines were 223 ± 167 μm (63%) and 189 ± 175 μm (54%) in the foveola, and 900 ± 522 μm (60%) and 835 ± 582 μm (55%) in the fovea, respectively. Intact ELM and IS/OS lines were positively correlated with VA in both the fovea (p = 0.09 and p = 0.02, respectively) and foveola (p = 0.004 and p = 0.03, respectively). Linear regression analysis showed a statistically significant association of intact ELM and IS/OS lines with VA in the fovea. Disrupted ELM and IS/OS lines had a strong correlation with each other in both the fovea (r = -0.71, p = 0.013) and foveola (r = 0.81, p = 0.02). Conclusions: The integrity of the ELM and IS/OS lines was positively correlated with VA in eyes with resolved DME after PPV. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Purpose: To evaluate preoperative and intraoperative parameters in patients who underwent pars plana vitrectomy (PPV) for epiretinal membrane (ERM) removal and identify prognostic factors for visual recovery and complications. Furthermore, eyes with and without additional vision-limiting ocular disease were compared. Methods: Ninety eyes of 90 patients who underwent PPV and ERM peeling were included in this retrospective study. Patients were divided according to the presence of additional vision-limiting conditions. Results: The mean visual acuity (VA) improvement was -0.156 logMAR. No parameter was found to correlate with the final VA or postoperative complications. Thirty-four patients (37.8%) had concurrent vision-limiting ocular conditions. Although these eyes had lower initial and final VA, there was no significant difference in VA improvement between them and eyes without concurrent disease. Conclusions: PPV and membrane peeling is an effective treatment for patients with ERM, even in the presence of concurrent vision-limiting ocular disease. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Abstract: Vitreoretinal disorders constitute a significant portion of treatable ocular disease. Advances in vitreoretinal surgery have included the development and characterization of suitable substitutes for the vitreous. Air, balanced salt solutions, perfluorocarbons, expansile gases, and silicone oil serve integral roles in modern vitreoretinal surgery. Vitreous substitutes vary widely in their properties, serve different clinical functions, and present different shortcomings. Permanent vitreous replacement has been attempted with collagen, hyaluronic acid, hydroxypropylmethylcellulose, and natural hydrogel polymers. None, however, have proven to be clinically viable. A long-term vitreous substitute remains to be found, and recent research suggests promise in the area of synthetic polymers. Here we review the currently available vitreous substitutes, as well those in the experimental phase. We classify these compounds based on their functionality, composition, and properties. We also discuss the clinical use, advantages, and shortcomings of the various substitutes. In addition we define the ideal vitreous substitute and highlight the need for a permanent substitute with long-term viability and compatibility. Finally, we attempt to define the future role of biomaterials research and the various functions they may serve in the area of vitreous substitutes. [Copyright &y& Elsevier]

The article discusses the preoperative, intraoperative, and postoperative aspects of transconjunctival vitrectomy surgery techniques. It describes the complications involved in the technique and presents strategies for the risks' mitigation. It details the considerations involved in the entire procedure to help surgeons minimize the risks associated with transconjunctival/smaller-gauge vitrectomy surgery.

PURPOSE: To evaluate the effect of previous vitrectomy on the incidence of macular oedema (MO) after cataract surgery in diabetic eyes. METHODS: Ninety phakic eyes of 70 patients with diabetes undergoing non-emergent vitrectomy surgery were reviewed for rates of postvitrectomy MO, cataract formation and postcataract surgery MO. Preoperative and final best-corrected visual acuity were recorded. Baseline risk characteristics were analysed. RESULTS: Postvitrectomy MO increases initially but then levels off at 28% by 4 years. Cumulative proportion of eyes requiring cataract surgery after vitrectomy climbs steadily, reaching 40% at 4 years and 60% at 8 years. Of those eyes which underwent vitrectomy and then subsequent cataract surgery, the incidence of postvitrectomy MO was 6% at 6 months, and that of postcataract surgery MO was 30% at 6 months (p<0.02). Previous clinically significant macular oedema (CSMO) predicted development of postcataract surgery MO (p<0.04). CONCLUSIONS: Previous vitrectomy does not appear to lessen rates of postcataract surgery MO. Cataract formation is common after vitrectomy in diabetic eyes, and risk of postcataract surgery MO is substantial and more likely in eyes with prior CSMO. Cataract formation and risk of postcataract surgery MO should be considered when assessing the long-term benefits of vitrectomy surgery in patients with diabetes. [ABSTRACT FROM AUTHOR]

The article provides clinical reviews of papers studying the vitreous, choroid, and retina. Featured articles include "Pars plana anterior vitrectomy, hyaloidozonulectomy, and iridectomy for aqueous humor misdirection," by E. Bitrian and J. Caprioli, in the "American Journal of Ophthalmology" and "Patients with an acute zonal occult outer retinopathy-like illness rapidly improve with valacyclovir treatment," by V. B. Mahajan and E. M. Stone in the "American Journal of Ophthalmology".

PURPOSE: To assess the selectivity of brilliant blue G (BBG) staining by analysing the morphological components of unstained and stained tissue obtained during epiretinal membrane (ERM) removal with internal limiting membrane (ILM) peeling in BBG-assisted macular surgery. METHODS: Twenty-six surgical specimens were removed from 13 eyes with epiretinal gliosis during vitrectomy using BBG for ERM and ILM peeling. We included eyes with idiopathic macular pucker, idiopathic macular hole and vitreomacular traction syndrome. The dye was injected into the fluid-filled globe. Unstained and stained epiretinal tissue was harvested consecutively and placed into separate containers. All specimens were processed for conventional transmission electron microscopy. RESULTS: The first surgical specimen of all eyes showed no intraoperative staining with BBG and corresponded to masses of cells and collagen. The second surgical specimen demonstrated good staining characteristics and corresponded to the ILM in all patients included. In seven eyes, the ILM specimens were seen with minor cell proliferations such as single cells or a monolayer of cells. Myofibroblasts, fibroblasts and astrocytes were present. In five cases, native vitreous collagen fibrils were found at the ILM. In six of the eyes, ILM specimens were blank. CONCLUSION: Our clinicopathological correlation underlines the selective staining properties of BBG. The residual ILM is selectively stained by BBG even when a small amount of cells and collagen adheres to its vitreal side. To reduce the retinal exposure to the dye, the surgeon might choose to remove the ERM without using the dye, followed by a BBG injection to identify residual ILM. [ABSTRACT FROM AUTHOR]

Abstract: Cataract surgery is routinely performed under local anaesthesia. With modern surgical techniques, adequate operating conditions can often be provided by topical anaesthesia alone. For more complex procedures and for prolonged operations such as vitreo-retinal surgery a local block is required. Historically, the sharp needle techniques of retrobulbar and peribulbar eye block have been used. However, the occurrence of rare but sight-threatening complications such as retrobulbar haemorrhage and globe perforation have led to the adoption of the technique of sub-Tenon’s block, which avoids the use of sharp needles. A thorough knowledge of ocular anatomy is essential before proceeding with any eye block technique. Patients who receive local anaesthesia for ocular surgery require careful preoperative assessment and stabilization of concomitant medical conditions. The intended procedure should be explained to the patient to ensure their cooperation and reduce anxiety. [ABSTRACT FROM AUTHOR]

Summary: Many patients presenting for V-R surgery are elderly with a high incidence of associated medical conditions. Thorough preoperative assessment is essential especially for those scheduled for general anaesthesia. Patients on anticoagulants and antiplatelet drugs scheduled for V-R surgery should continue their routine medication. However, where there are specific concerns, the anaesthetist, surgeon and patient should discuss the risks and benefits of continuing their routine medication to agree an acceptable approach. Local anaesthetic techniques are now far more commonly used than general anaesthesia for V-R surgery. Clinicians must recognize the limitations and contraindications of both approaches. Whenever local anaesthetic techniques are used, attention to small details can make a huge difference to patient comfort. This often entails meticulous patient positioning and clear lines of communication between patient and the theatre team. Sometimes, sedative drugs are beneficial to patient care. Careful patient monitoring is recommended during V-R surgery because of the darkened theatre environment, the age and associated medical conditions of many of these patients, and the risk of precipitating abnormal cardiac rhythms from drugs and the oculocardiac reflex. [Copyright &y& Elsevier]

Purpose: To assess the prognosis and complications after pars plana vitrectomy (PPV) combined with lensectomy as a primary procedure for visual correction of complicated cataract. Setting: Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA. Methods: This retrospective study reviewed the preoperative, intraoperative, and postoperative clinical features in eyes that had PPV combined with lensectomy as a primary procedure for complicated cataract without severe posterior segment pathology (study group). The corrected distance visual acuity (CDVA), reoperations, retinal detachment (RD), and cystoid macular edema (CME) were ascertained. Results were compared with those in a control group of eyes having combined PPV and lensectomy for uncomplicated cataract. Results: In the study group (40 patients), 23 eyes had traumatic lens dislocation, 12 had Marfan syndrome, 7 had idiopathic lens dislocation, and 4 had pseudoexfoliation syndrome. The median corrected distance visual acuity improved from 20/185 (range 20/20 to hand motions) preoperatively to 20/30 (range 20/20 to hand motions) 3 months postoperatively (P<.001). The postoperative CDVA was poorer in cases with an etiology of trauma (P = .018). Complications included RD (6.5%), transient vitreous hemorrhage (13.0%), choroidal detachment (4.3%) and CME (13.0%), which occurred more frequently in eyes with a history of trauma (P = .022). The control group (43 eyes; 42 patients) had 1 (2.3%) RD. Conclusions: Pars plana vitrectomy with lensectomy yielded favorable visual outcomes in eyes with complicated cataract in which standard anterior segment techniques were prohibitive or risky. However, preexisting conditions and postoperative complications may limit visual outcomes. Financial Disclosure: Neither author has a financial or proprietary interest in any material or method mentioned. [Copyright &y& Elsevier]

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]

The article discusses research studies on vitreous, choroid and retina. A study of medicare beneficiaries showed the adverse events among them after a pars plana vitrectomy. In the control group of patients with progressive high myopia, a study showed that posterior pole buckles can be safe and effective. Among the eyes of patients with severe acute postoperative endophthalmitis, analyzing the diluted vitreous samples from the vitrectomy were proven useful.

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]

Objective: To analyze the reasons for postvitrectomy vitreous hemorrhage in proliferative diabetic retinopathy (PDR), and to evaluate the effects of retreatment. Design: Retrospective, nonrandomized, observational case series. Methods: Three hundred and fifteen eyes of 302 consecutive patients underwent primary standard three-port vitrectomy with 20-gauge instruments for complications of PDR from 2000 to 2006. One hundred and forty-two patients were male, and 160 were female. The age ranged from 38 to 72 years with a mean of 56 years. There were 32 eyes which developed postvitrectomy vitreous hemorrhage during follow-up. The mean follow-up was 12 months with a range from 3 to 48 months. Results: Of 315 eyes with PDR and receiving pars plana vitrectomy, 32 eyes had postvitrectomy vitreous hemorrhage. The onset of recurrent vitreous hemorrhage ranged from 1 to 210 days with an average of 51 days. The reasons for postvitrectomy vitreous hemorrhage in PDR mainly included fibrovascular ingrowth at sclerotomy sites (9 eyes), residual or recurrent neovascular membrane on the optic nerve (6 eyes), insufficient retinal photocoagulation (7 eyes), residual and recurrent epiretinal proliferative membrane (3 eyes), retinal vein occlusion (2 eyes), postoperative low intraocular pressure (2 eyes), and ocular trauma (3 eyes). The visual acuity increased in 31 eyes (96.88%), and decreased in 1 eye (3.12%) after retreatment. The postoperative complications following the treatment of recurrent vitreous hemorrhage mainly included posterior synechia of the iris (3 eyes), nucleus sclerosis (18 eyes), and delayed healing of corneal epithelium (3 eyes). Conclusion: Vitrectomy is a safe and effective method for treating PDR. Appropriate and complete analysis of postvitrectomy vitreous hemorrhage can significantly improve the primary treatment effects for PDR. [ABSTRACT FROM AUTHOR]

The article presents a case study on a branch retinal artery occlusion with pars plana vitrectomy and removal of the retinal arterial embolus. A 70-year old diabetic and hypertensive woman was presented with retinal artery occlusion and laboratory evaluations revealed an acute lacunar infarcts. The case illustrated an experience with vitreous surgical techniques of embolus extraction with a branch retinal artery occlusion and ophthalmoscopically visible embolus.

The article presents a case study on the association of toxoplasmosis gondii in focal retinochoditis and vitritis in large B-cell and primary intraocular lymphoma. A 79-year old woman was presented for treatment of persistent vitritis and recurrent ocular toxoplasmosis through vitrectomy. The study found that T. gondii caused the lymphoproliferation and development of primary intraocular lymphoma.

Abstract: Background: Vitreous substitutes presently in use for intraoperative tamponade are perfluorocarbon liquids (PFCL) and for post operative tamponade are silicon oil (SO), sulphur hexafluoride (SF6) and perfluorocarbon gas (PFC). Several factors are important for a thorough understanding of each of these vitreous substitutes. The absorption or necessity for removal, indications for use (including clinical studies and special surgical methods), additives and complications of use have to be considered. Methods: Three port standard pars plana vitrectomy was performed in 60 consecutive cases requiring intra-vitreal intervention. PFCL was used intra-operatively in 30 cases (PFCL group and X group). The eyes were implanted with SO (silicon oil subgroup), PFC (C3F8 sub-group) and SF6 (SF6 sub-group) in twenty cases each. Apart from best corrected visual acuity (BCVA), the retinal status and the longevity of gas when used, changes and reaction in both the anterior and posterior segments were noted. Result: The difference of postoperative BCVA in the PFCL and non-PFCL groups was statistically significant with p<0.001. In both the PFCL and non-PFCL groups the difference between preoperative and postoperative BCVA was statistically significant with p<0.0001. All three vitreous substitutes studied are effective given the case where they had been utilised. Conclusion: PFCL is invaluable in the management of complicated retinal detachment (RD). Where a vitreous microsurgery is indicated, the visual outcome is good. SF6 is useful for short-term tamponade. Silicon oil and C3F8 are useful for longer tamponade. [Copyright &y& Elsevier]

Purpose: To evaluate the safety and efficacy of pars plana vitrectomy (PPV) for pseudophakic retinal detachment with unseen retinal breaks. Material and Method: In this single-centre, non-comparative study, 17 eyes of 17 patients who underwent PPV for pseudophakic retinal detachment with unseen retinal breaks between December 2003 and November 2008 were evaluated retrospectively. Eyes with exudative and tractional retinal detachment, and with media opacities due to vitreous hemorrhage or dense cataract were not included in the study. All eyes underwent PPV with contact wide-angle viewing system, identification of retinal break(s) with liquid perfluorocarbon, internal drainage of subretinal fluid, 360° peripheral retinal endolaser photocoagulation and injection of silicone oil. Main outcome measures were anatomic success and visual outcome. Results: The mean follow-up time was 10.4 months (6-24 months). Primary anatomic success was achieved in 15 of 17 eyes (88.2%) with single operation. Final reattachment was attained in all of the eyes. The mean visual acuity was 2.15±0.27 logMAR preoperatively and 0.86±0.48 logMAR postoperatively (p<0.001). Visual acuity increased postoperatively in all eyes (100%). No major intraoperative complication was observed in any of the eyes. Postoperative complications were transient hypertension in 2 eyes (%11.8), macular pucker in 1 eye (%5.9) and cystoid macular oedema in 1 eye (%5.9). Discussion: PPV was observed to be safe and effective in the treatment of pseudophakic retinal detachment with unseen retinal breaks. Prospective studies with more number of patients and comparing PPV with other surgical procedures are required. [ABSTRACT FROM AUTHOR]

Purpose: To determine the intravitreal IL-8, TNF-α and VEGF levels in patients with proliferative vitreoretinopathy (PVR) due to rhegmatogenous retinal detachment (RD) and to compare them with those in a control group. Material and Method: Vitreous samples were collected from 27 eyes of 27 patients who underwent vitrectomy procedure for PVR due to RD and from 20 eyes of 20 patients, the control group, with macular hole during pars plana vitrectomy. All PVR patients were stage A and stage B PVR (according to the criteria of the Retina Society Terminology Committee, 1983). Before intraocular infusion, the vitreous core was cut and 0.5 cc was aspirated via the pars plana under fluid-air exchange, and collected undiluted. The vitreous samples were immediately frozen at -70°C until assayed. Enzyme-linked immunosorbent assay of the samples was performed using human VEGF assay kit and human IL-8 assay kit obeying the manufacturer's instructions. Results: The vitreous concentrations of VEGF were significantly elevated in the samples from patients with retinal detachment (872.2±312.2 pg/ml [95.55-1991.38]), when compared with the samples from control patients (21.9±32.5 pg/ml [0.09-36.23] (p<0.05). The vitreous concentrations of IL-8 were also significantly elevated in patients with macular oedema (95.3 ±109.5 pg/ml [13.27-202.58]), when compared with the control patients (8.3±21.7 pg/ml [1.98-20.59]) (p<0.05). Discussions: The increase in IL-8, as an inflammatory and angiogenic mediator and VEGF, as a regulatory mediator of cellular proliferation and permeability in the vitreous humor may play a role in the formation of PVR, an inflammatory process, due to RD. [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]

Purpose: To evaluate the role of preoperative macular hole (MH) diameter, cataract surgery, and cystoid macular edema (CME) in the reopening of idiopathic macular hole (IMH) after initially successful surgery. Design: Multicenter, retrospective, comparative case series. Methods: One hundred and thirty patients (135 eyes) with stage 2, 3, or 4 IMH were included after successful IMH repair at Dijon University Hospital or Nancy University Hospital. The eyes were separated into 4 groups according to the lens status: group 1, vitrectomy in pseudophakic eyes; group 2, vitrectomy and cataract extraction as a combined procedure; group 3, vitrectomy followed by cataract extraction; group 4, vitrectomy on eyes that remained phakic. All patients underwent a complete vitrectomy with retinal inner limiting membrane peeling and intraocular gas tamponade. The main outcome measures were IMH closure rate and best-corrected visual acuity. Results: Mean duration of symptoms was 8.6 ± 7.6 months. The follow-up was 37 ± 8.6 months (range, 30 to 67 months). The mean preoperative IMH diameter was 454 ± 191 μm. No MH reopened during the follow-up after the initial vitreous surgery. Seven cases of CME were observed (1 in groups 1 and 2; 5 in group 3), and cataract surgery was performed in the 53 patients in group 3 with a mean delay of 11.6 months. Conclusions: Cataract extraction, CME, or preoperative MH diameter measured by optical coherence tomography were not identified as risk factors for IMH reopening. [Copyright &y& Elsevier]

Purpose: The purpose of this paper will suggest best practice guidelines that should be implemented in ambulatory surgery centers for review of cataract complications. The paper will also assess and compare a physician's rate of posterior capsule rupture (PCR) with published literature. Methods: A retrospective chart review encompassing 2010-2015 which evaluated 4,028 consecutive patients who underwent a routine cataract procedure with one physician at three locations. Results: Over the five year period, 4,028 cases experienced no PCR, for an incidence rate of 0%. Surgeon volume showed no signs of correlation with the rate of PCR. Conclusions: Posterior capsule rupture remains a huge concern for patients undergoing cataract procedures. The results of this study include a lower incidence of previously published literature. Suggested guidelines found in the article will only add to the growing body of literature to inform future policy. [ABSTRACT FROM AUTHOR]

The article evaluates a 27-gauge vitrectomy instrument used for microincision vitrectomy surgery (MIVS) aiding faster visual recovery and reduced postoperative inflammation form medical companies Alcon and Dutch Ophthalmic.

Background/aims While the Endophthalmitis Vitrectomy Study (EVS) included only post-cataract surgery patients, the methods and data from that study are widely applied in the management of endophthalmitis of all types. We sought to examine how our experience with in-office vitreous aspiration differed from the EVS in two ways: first, by reviewing microbiological culture yields from vitreous aspirates obtained using 30-gauge needles versus 25-27-gauge needles and second, by reviewing culture yields in cases of endogenous versus non-endogenous endophthalmitis. Methods Cases of endophthalmitis over a 14-year period were reviewed when vitreous tap was the initial diagnostic procedure. The data included infection source, needle size used to obtain a vitreous aspirate, organism cultured and rates of unsuccessful attempts at vitreous aspiration or dry taps. Results 10 cases were endogenous endophthalmitis, while 36 cases were a mix of postoperative, posttraumatic, post-intravitreal injection and miscellaneous patients. A positive microbiological culture was obtained in 11/36 (31%) of vitreous taps using a 25-27-gauge needle and in 8/10 (80%) taps using a 30-gauge needle ( p<0.01). A positive vitreous culture was obtained in 18/36 (50%) of all non-endogenous cases, while a positive result was obtained in 0/10 (0%) cases of endogenous endophthalmitis ( p<0.01). Conclusions The use of a smaller needle in obtaining vitreous samples in endophthalmitis did not lower the microbiological yield. A positive microbiological yield was significantly less likely in cases of endogenous endophthalmitis compared with non-endogenous cases. Vitreous tap as a method for identifying the causative organism in endogenous endophthalmitis was of limited utility. [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]

Objective: To assess the effect of early vitrectomy for aggressive posterior retinopathy of prematurity (APROP) using fundus fluorescein angiography. Design: Retrospective, observational case series. Participants: Eleven eyes of 7 patients with APROP that underwent early vitreous surgery. Methods: All eyes underwent vitrectomy with lensectomy that removed the vitreous gel around the fibrovascular proliferative tissue, but not the proliferative tissue when fibrovascular proliferation and retinal detachment occurred despite retinal photocoagulation. Fundus fluorescein angiography was performed before and after the early vitreous surgery. Main Outcome Measures: Dye leakage from the fibrovascular tissue, dilation and tortuosity of the retinal vasculature, and shunt vessels were evaluated by fundus fluorescein angiography. The status of the retinal reattachment was assessed postoperatively. Results: Nine eyes had severe dye leakage from the fibrovascular tissue and 2 eyes had moderate leakage seen by preoperative fluorescein angiography. Severe dilation and tortuosity of the retinal vessels were detected in 10 eyes and shunt vessels in 7 eyes. Six to 12 days after successful surgery, the retina reattached and dilation and tortuosity of the retinal vessels decreased substantially. Dye leakage diminished markedly in all eyes, resolved completely in 7 eyes, and was still apparent slightly in 4. At the final examination, fibrovascular proliferation and retinal detachment did not progress in any eyes; however, 2 eyes had a dragged or folded retina. Follow-up ranged from 6 to 19 months (mean, 9.2). Conclusions: Early vitrectomy that removes vitreous gel from around the proliferative tissue promptly reduces vascular activity and may limit progression of retinal detachment in APROP. Financial Disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article. [Copyright &y& Elsevier]

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]

Purpose: To determine vascular endothelial growth factor (VEGF) and hypoxia-inducible factor 1a (HIF-1a) in the vitreous fluid of patients with proliferative diabetic retinopathy (PDR). Design: Observational case-control study. Methods: Serum and vitreous fluid samples were obtained during vitrectomy from 42 eyes of diabetic patients with PDR (17 type I and 25 type II diabetes mellitus) and from 23 eyes of nondiabetic patients. Retinopathy of 19 diabetic patients was graded as active and the other 23 graded as quiescent according to retinal neovascularization. VEGF and HIF-1a of serum and vitreous fluid samples were measured by enzyme-linked immunosorbent assay. Results: Both intravitreous VEGF and HIF-1a were higher in diabetic patients with PDR than in control subjects (P < .01 and P < .01, respectively). After adjusting for total intravitreous protein (TP) concentration, intravitreous VEGF/TP and HIF-1a/TP in diabetic patients remained significantly higher too. Correlations between intravitreous VEGF and HIF-1a and intravitreous VEGF/TP and HIF-1a/TP were observed in diabetic patients with PDR (r = 0.730; P < .01; r = 0.531; P < .01, respectively) but not in control subjects. Both intravitreous VEGF and HIF-1a were higher in diabetic patients with active PDR than in those with quiescent PDR (P < .01 and P < .05, respectively). Intravitreous VEGF/TP in patients with active PDR remained higher (P < .05). Correlation between intravitreous VEGF and HIF-1a, as well as correlation between intravitreous VEGF/TP and HIF-1a/TP, were observed in diabetic patients with active PDR and those with quiescent PDR but not observed in control subjects. Conclusions: Intravitreous VEGF and HIF-1a in diabetic patients with PDR are increased and related mutually. VEGF and HIF-1a, especially VEGF, are associated with the angiogenesis of PDR. [Copyright &y& Elsevier]

Copyright of Arquivos Brasileiros de Oftalmologia is the property of Arquivos Brasileiros de Oftalmologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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]

Background: While lens-sacrificing vitrectomy is the standard approach to manage Stage 5 retinopathy of prematurity (ROP), scleral buckling has been used to manage some cases of Stage 4. Lens-sparing vitrectomy was popularized by Maguire and Trese in selected cases of Stage 4 disease. Purpose: To assess the functional and visual outcomes aft er primary lens-sparing pars plana vitrectomy for Stage 4 ROP. Materials and Methods: In a retrospective, interventional, consecutive case series, the records of 39 eyes of 31 patients presenting with Stage 4 retinal detachment secondary to ROP who underwent primary two or three-port lens-sparing vitrectomy from January 2000 to October 2006 were evaluated. The outcomes studied at the final follow-up visit were the retinal status, lens and medial clarity and visual acuity. Favorable anatomical outcome was defined as the retinal reattachment of the posterior pole at two months aft er the surgery; and favorable functional outcome was defined as a central, steady and maintained fixation, with the child following light. Results: At mean follow-up of 15 months, 74% of the eyes had a favorable anatomical outcome with single procedure. The visual status was favorable in 63%. The lens remained clear in all the eyes at the last follow-up, and the media clarity was maintained in 87%. Intraoperative complications included vitreous hemorrhage, pre-retinal hemorrhage and retinal break formation. Conclusions: Lens-sparing vitrectomy helps to achieve a favorable anatomical and functional outcome in selected cases of Stage 4 ROP. [ABSTRACT FROM AUTHOR]

Purpose: To compare the measurements of anterior chamber depth (ACD), lens thickness (LT), and central corneal thickness (CCT) in eyes undergoing vitreoretinal surgery in the early postoperative period. Materials and Methods: The study included 19 eyes of 19 patients. There was retinal detachment in 10 eyes, vitreous hemorrhage in 8 eyes, and a macular hole in 1 eye. The patients that had undergone previous ocular surgery, or had uveitis, or glaucoma or corneal disorders were not included. The patients were grouped according to vitrectomy technique (20 gauge(g) or 23 gauge) and internal tamponade agent (silicone oil (SO) or gas tamponade). None of the eyes underwent any surgical intervention for anterior segment or cataract surgery. ACD, LT, and CCT were measured one day before the operation and one month after the operation. The Wilcoxon test was used for the statistical analysis. Results: Eleven eyes underwent 20 g vitrectomy and SO was used in 8 eyes and C3F8 in 3 eyes. Eight eyes underwent 23 g vitrectomy and SO was used in 4 eyes and C3F8 in 4 eyes. All eyes were phakic. There was no statistically significant difference between 20 and 23 g vitrectomy with respect to ACD, LT, or CCT (p>0.05). No significant difference was found when ACD, LT, and CCT were compared between eyes with SO and those with gas tamponade (p>0.05). Conclusion: The prominent effects on ACD, LT, and CCT of the vitreoretinal surgical technique or internal tamponade agents may not appear in the early postoperative period. [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]

The article discusses the results of diabetic retinopathy treatment and associated complications using small incision vitrectomy techniques. It presents the 25 gauge vitrectomy techniques for non proliferative diabetic retinopathy and proliferative diabetic retinopathy. Also discussed are postdiabetic vitrectomy complications such as increased intraocular pressure, corneal epithelial defects, intraocular fibrin formation, and cataract formation or progression.

The article gives advice on how ophthalmologists make a decision about whether and when to adopt a novel idea or technique in ophthalmology. It relates the previous concern of ophthalmologists regarding the use of vitrectomy. It presents issues that ophthalmologists should keep in mind when they contemplate novel practices.

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]

The article presents information on diabetic traction retinal detachment. Its pathophysiology and pathoanatomy are discussed. The categories of diabetic traction retinal detachment are described, including traction detachment recently involving the macula and extramacular traction retinal detachment. Also discussed is the use of 25-gauge vitrectomy surgery for the disease.