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Marco Mura,1– 3 Wendy Martin,4 K Keven Williams,4 Dina Joy K Abulon5 1Department of Translational Medicine, University of Ferrara, Ferrara, Italy; 2Department of Ophthalmology, University of Illinois, Chicago, IL, USA; 3Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; 4Preclinical Development, Alcon Vision LLC, Fort Worth, TX, USA; 5Global Medical Affairs, Alcon Vision LLC, Irvine, CA, USACorrespondence: Marco MuraDepartment of Translational Medicine, University of Ferrara, Via Luigi Borsari 46, Ferrara, 44121, ItalyTel +390532455845Fax +390532207351Email marco.mura@unife.itPurpose: Novel 3D digital display systems, such as NGENUITY 3D digitally assisted visualization system (DAVS), can provide enhanced illumination, depth of field, and digital filtering. This study compared vitreous removal using NGENUITY 3D DAVS with a standard surgical microscope.Methods: This was an in vivo, 2-arm laboratory study in 15 Yorkshire pig eyes. The LuxOR LX3 microscope with NGENUITY 3D DAVS (arm 1) and the LuxOR LX3 microscope alone (arm 2) were used with 5× optical magnification and Oculus BIOM 200 mm optics. Standard core and peripheral vitrectomy without scleral depression was performed using the CONSTELLATION Vision System. Residual vitreous weight was assessed in enucleated eyes by a masked observer. Axial length and vitreous weight of contralateral eyes were compared from an additional 14 Yorkshire pigs to confirm that eyes from a single animal were essentially identical.Results: After vitrectomy, mean ± SD residual vitreous was significantly smaller with NGENUITY versus standard microscope (0.143 ± 0.146 versus 0.580 ± 0.269 g, respectively; P < 0.0001). Based on a mean initial vitreous weight of 2.5 g, as determined by assessment in contralateral eyes from an additional 14 Yorkshire pigs, the mean percentage vitreous removal was 94% ± 6% versus 77% ± 11%, respectively. Further, vitreous weight and axial length for contralateral eyes from any single animal in these additional 14 animals were essentially identical, as mean differences were 0.046 ± 0.035 g and 0.11 ± 0.08 mm, respectively.Conclusion: Vitrectomy with NGENUITY 3D DAVS resulted in significantly less residual vitreous in pig eyes compared with standard microscopy. NGENUITY may improve vitreous removal during vitreoretinal surgery by enhancing visualization.Keywords: 3D digital display systems, NGENUITY, vitrectomy

INTRODUCTION[|]To evaluate the outcomes of vitreoretinal surgery in patients with recurrent retinal detachment (RD) and compare whether these outcomes differ regarding the surgeon who carried out the first surgery.[¤]METHODS[|]The medical records of the recurrent RD patients who underwent vitrectomy between January 2014 and December 2016 were reviewed for this retrospective single-surgeon study. The included patients had a postoperative follow-up period of at least 12 months. If the first surgery was carried out by the same surgeon, then the patients were included in group A, and if the patient was a referral patient and the first surgery was carried out by another surgeon, then the patient was included in group B. Primary outcome measure was the anatomical success at month 12.[¤]RESULTS[|]There were 12 eyes (20.7%) in group A and 46 eyes (79.3%) in group B. The anatomical success after a single secondary operation was 67.2% in the whole group. It was 75.0% and 65.2% in groups A and B, respectively (p=0.4). Final anatomical success after multiple surgeries was achieved in 46 of the 58 patients (77.6%) in the whole group. The final anatomical success was 91.7% and 73.9% in group A and B, respectively (p=0.1).[¤]DISCUSSION AND CONCLUSION[|]In conclusion, we detected a positive trend in anatomical outcomes after vitrectomy surgery in the subgroup recurrent RD patients that were operated by the same surgeon who carried out the first operation.[¤]

OBJECTIVE: The present study aims to describe a novel, low-cost, transconjunctival sutureless bimanual vitrectomy illumination approach and evaluate its surgical outcome. METHODS: Thirty-six eyes of 36 patients who underwent pars plana vitrectomy with the above-mentioned technique were included in this study. Four trocars were placed in superotemporal, inferotemporal, inferonasal and superonasal quadrants. A piece (23 mm) was cut from 30G intravenous cannula and a 30 mm endoillumination probe was placed inside this sleeve. This design limited the entry of the light probe into the vitreous cavity to 7 mm and provided a safe illumination by the assistant without the risk of damaging the retinal tissue. RESULTS: Thirty-six eyes of 36 patients were included (24 male, 12 female, mean age: 58.4+-14.3 years) in this study. Thirty patients had rhegmatogenous retinal detachment (six of these patients with coexisting choroidal detachment), four patients had diabetic tractional retinal detachment, one patient had a nucleus drop and one patient had an intraocular foreign body. The mean follow-up time after pars plana vitrectomy (PPV) was 5.05+-4.4 months. LogMAR best-corrected visual acuity improved significantly after PPV (p

Firecracker induced open globe injury is a big challenge for ophthalmic surgeons. Its association with the intraocular foreign body makes the diagnosis and treatment even more difficult resulting in poor anatomical and visual outcomes. We report a case of a 35-year-old male who presented with bilateral, multiple corneal and intraocular foreign body due to firecracker explosion. His vision was limited to hand movement in both eyes. Combined penetrating keratoplasty and cataract surgery were done in both eyes followed by pars plana vitrectomy for intraocular foreign body removal. The final best-corrected visual acuity of the patient stood to be 6/6 and 6/9 in the right and left eye respectively. The encouraging result in our case prompts ophthalmologists for a timely stepwise multidisciplinary approach in all open globe injuries with intraocular foreign body cases having poor initial acuity.

Mohamed M Mahgoub,1,2 Maged M Roshdy,1,2 Sherine S Wahba1,2 1Ophthalmology Department, Ain Shams University, 2Ophthalmology Department, Al Watany Eye Hospital, Cairo, Egypt Purpose: To study the subconjunctival silicone oil (SCSO) parameters associated with dellen formation following microincision vitrectomy (MIV).Patients and methods: This was a case–control study of 20 eyes with SCSO following MIV. Ten of them suffered postoperative dellen formation. Dellen occurrence, their sizes, number of loci, and distance between SCSO and the limbus were recorded. The outcome after silicone-oil removal was evaluated.Results: The SCSO was at 3.1±1.2 mm from the limbus. All cases with dellen had SCSO within 2 mm of the limbus (P

This report is a description of a surgical technique for optic disc maculopathy (OPM). Pars plana vitrectomy combined with internal limiting membrane (ILM) peeling, reverse ILM flap insertion into optic pit, and gas tamponade surgery was performed on 5 patients with OPM. Preliminary outcomes of the technique were promising.

In this surgical technique report, the advantages of use of vitreous cutters with smaller diameters as vitreoretinal surgical instruments and choroid-RPE patch transplantation that was performed with combination of 23- and 25-gauge vitrectomy systems are described.

Objective: To determine the mean endothelial cell change in patients undergoing vitrectomy with silicon oil replacement and to compare the corneal endothelial cell loss frequency of phakic, pseudophakic, and aphakic Vitrectomized Silicone Oil-filled eyes. Study Design: Cross-sectional Study. Place and Duration of Study: Retina Department, Al-Shifa Trust Eye Hospital, Rawalpindi Pakistan, from Aug 2020 to Jan 2021. Methodology: A total of one hundred patients of either gender, aged 50-80 years, who underwent vitrectomy with silicon oil replacement were enrolled in the study. Patients were assigned to one of the three groups based on their lens status, phakic, pseudophakic and aphakic. Mean endothelial count density before and three months after vitrectomy was estimated in all the patients. Results: Cell loss was higher in the pseudophakic and aphakic groups than in the phakic groups. More than 5% cell loss at three months was observed in 11.8%, 21.2% and 33.3% in the phakic, pseudophakic, and aphakic groups, respectively (p-value 0.102). Conclusions: Mean endothelial cell loss was higher in the pseudophakic and aphakic groups than in the phakic groups. [ABSTRACT FROM AUTHOR]

Introduction Retinal phototoxicity caused by light from the endoilluminator used in vitrectomy has been described. Xenon light, as its radiation is near ultraviolet spectrum, can be one of the most harmful to the retina if adequate filters are not used. Case Reports Case 1 was a 71 year-old Caucasian male who underwent 20-gauge three-port pars plana vitrectomy (PPV) due to a Macular Hole (MH). Case 2 was a 64 year-old Caucasian women underwent 23-gauge PPV due also to a MH, and Case 3 was a 68-year old Caucasian women who underwent also 23-gauge PPV due to same reason. In all cases we performed internal limiting membrane (ILM) peeling and fluid-gas exchange (C3F8). In all of them we used a Xenon light during surgery with an intensity power ranging between 50 and 75%. Full clinical examination, with determined Best Corrected Visual Acuity (BCVA), fundus examination, retinography and Optical Coherence Tomography (OCT), were performed prior and after surgery. Fluorescein angiography (FA) was also performed in all cases after surgery. One week after surgery, the macular hole was closed in all cases and it remained stable during follow-up. One month later, BCVA was lower than before surgery and we observed changes in retinal pigment epithelium at the posterior pole, which remained stable two years after light exposure, with a final BCVA less than 10/100 in all cases. Conclusion Macular phototoxic damage with foveal involvement remains a factual danger during vitrectomy using Xenon light as endoilluminator with inadequate filters.

Background: In a prospective randomized double-blind study, the analgesic effect produced by sub-Tenon infiltration was compared with classic analgesic drugs in patients scheduled for posterior segment surgery under general anaesthesia. Methods: One hundred patients were randomized into two groups of 50. One group received sub-Tenon infiltration (group 1) with 3 mL of bupivacaine 0.50% by the surgeon before the end of the surgery and the other (group 2) received only classical analgesic drugs postoperatively. A visual analogue scale (VAS) (graded from 1 to 10) was used to assess pain. For both groups, when VAS was between 1 and 3 paracetamol (3 g/24 h) associated with ketoprofen (200 mg/24 h) was given; between 3 and 6 nalbuphine (0.2 mg/kg slowly intravenously repeated every 4 h if necessary) was given; and over 6 morphine was given. Morphine 1 mg was injected every 2 min until VAS below 3 was obtained. Results: All patients in group 2 (control) experienced pain in the recovery room period; however, no patient in group 1 required analgesic drugs in the first 6 h after the sub-Tenon infiltration. In the recovery room period, the VAS pain score in patients who received sub-Tenon infiltration (group 1) was 0.6 ± 1.3 (mean ± SD) compared to 3.4 ± 2.2 in group 2. The difference was statistically significant (P = 0.000001). All patients in group 2 asked for analgesic drugs in the recovery room, some of whom required morphine. Despite the administration of drugs the pain score was statistically higher in group 2. Between the end of the recovery room period and the 6th hour, the VAS pain score in group 1 was statistically lower. From the 6th until the 24th hour, the pain score was not statistically significantly different between the groups. Regarding consumption of analgesic drugs from the recovery room until the 24th hour, the consumption of level 1 analgesic drugs (paracetamol, ketoprofen) and level 3 (morphine) was statistically lower in group 1 ( P = 0.0009). The difference was not significant for level 2, probably because the number of patients was not sufficient. Conclusion: Sub-Tenon infiltration with 3 mL of bupivacaine 0.50% offers excellent postoperative analgesia for about 6 h and is an excellent alternative to classical drugs. Furthermore, it is highly reliable and safe. [ABSTRACT FROM AUTHOR]

We report successful surgical management of a circumscribed choroidal hemangioma with exudative retinal detachment refractory to transpupillary thermotherapy (TTT). A 33-year-old man with symptomatic serous macular detachment in the left eye (Snellen acuity: 20/200) secondary to a paramacular choroidal hemangioma was treated with TTT. The nonresponsive detachment was subsequently managed by vitrectomy, endophotocoagulation and silicon-oil tamponade. It resulted in complete resolution of the tumor and the detachment. Silicon oil was removed at four months. Visual acuity improved to 20/80 by the last follow-up visit at 10 months without any recurrence.

Silicone oil was used in combination with vitrectomy to treat 127 cases of complicated retinal detachments. An initial anatomic success in 120 cases (94%) was reduced to 68 (54%) after an average follow-up of 32 months and was attributable to ongoing proliferative vitreo-retinopathy (PVR). The indications for the use of silicone oil were: 1. Retinal detachment complicated by PVR (107 cases), 20 of which required multiple operations. Anatomic success was achieved in 59 (55%) and of these 23 (40%) had visual acuity of 6/60. 2. Giant retinal tears (GRT) (7 cases). Four (57%) of these remained attached, three (75%) having final vision of 6/36. 3. GRTs complicated by PVR (8 cases). Four (50%) were anatomically successful and two had final vision of 6/60. 4. Proliferative diabetic retinopathy (5 cases). Two (40%) remained attached and one of these (50%) had hand movements vision. The silicone oil was removed electively in 23 eyes, 16 (70%) of these being anatomically successful. Oil was removed in 43 eyes because of complications, and in 20 (46%) of these, the retina remained attached at the end of follow-up. Complications included cataract in all 14 phakic eyes; rubeosis in 19 eyes (15%); corneal opacification in 52 eyes (41%), there being no clear cut difference between those eyes with an inferior iridectomy (35 of 85 eyes - 41%) and those without (12 of 29 eyes - 41%); and raised intraocular pressure in 55 eyes (43%). We conclude that although far from being ideal, silicone oil appears to have played some part in achieving the successful results reported in this study. [ABSTRACT FROM AUTHOR]

A series of 13 cases of globe perforation following local ocular anaesthesia are reported. All cases were associated with cataract surgery. Perforation occurred with the retrobulbar approach in nine cases and with the peribulbar approach in two cases. In two cases the approach for local anaesthesia was not recorded. In 12 of the 13 cases, perforating wound was found in the inferotemporal quadrant. All cases were found to have vitreous haemorrhage. All cases had significant posterior segment injury. Vitrectomy was carried out in nine of the 13 cases. At final review the retina was attached in 12 of the 13 cases. A final visual acuity of between 6/9 and 6/12 was achieved in six cases, four cases had acuity of between 6/18 and 6/24 and three cases had visual result of less than 6/60. [ABSTRACT FROM AUTHOR]

A review was made of 58 cases of suspected endophthalmitis presenting to Auckland Public Hospital between January 1983 and July 1991 (103 months). Thirty culture positive cases were found comprising 13 early onset postoperative, six delayed onset postoperative, five bleb-associated, four post-traumatic and two endogenous cases. The most frequent organism grown in postoperative endophthalmitis was Staphylococcus epidermidis. No conclusion could be reached as to the effectiveness of early versus delayed vitrectomy. Endophthalmitis due to S. epidermidis usually had a good prognosis while streptococcal endophthalmitis had a poor prognosis. Delayed-onset postoperative endophthalmitis most often had a good prognosis while bleb-associated endophthalmitis had a uniformly poor visual outcome. Two isolates responsible for cases of delayed-onset postoperative endophthalmitis, Propionibacterium acnes and Rhodococcus species, did not grow on agar plates until the seventh day of culture. Significant bacterial resistance to cephazolin was identified with 33% of Gram-positive and 75% of Gram-negative isolates resistant. Prevention of postoperative endophthalmitis is discussed. [ABSTRACT FROM AUTHOR]

Sodium hyaluronate can be used to manipulate a hypermature dislocated cataract from the posterior pole of the eye and stabilise it in the retropupillary area prior to its removal, intact, through a lirnbal incision. [ABSTRACT FROM AUTHOR]

Retinopathy of prematurity (ROP) is a vaso-proliferative disease with infiltration of the vitreous gel. Contraction of the infiltrate results in traction detachment with typical peripheral trough formation. Cryotherapy inhibits proliferation in the active stages of the disease (Stage 3, 'plus'). With development of traction detachment involving the macula (Stage 48) encircling buckling procedures should first be tried. Closed vitrectomy is considered when high retinal detachment and opacification by vitreous strands occur. The surgical technique is described. Anatomical (64%) and functional (43%) successes are reasonably high for Stage 4 cases, but disappointing (anatomical 40%, functional 16%) for Stage 5 ROP. Open funnels of detached retina fare better than closed ones. It is probably best to perform surgery not before the cicatricial stage, i.e. six months after birth. [ABSTRACT FROM AUTHOR]

We review 12 consecutive cases of pre-macular fibrosis (PMF) treated by vitreous surgical techniques. The causes of PMF included retinal detachment surgery in four patients, idiopathic in three patients, laser treatment in three patients, pars planitis in one patient and diabetic retinopathy in one patient. The membrane was successfully removed in all the patients. One patient developed a retinal detachment that was repaired successfully. All patients had improved visual acuity (VA) of two Snellen lines or more and six patients achieved VA of 6/12 or better. Patients with PMF following retinal detachment had poorer final VA. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study was to compare cytokine levels in the vitreous body of patients with proliferative diabetic retinopathy (PDR) undergoing posterior vitrectomy., Patients and Methods: The study included 39 patients (39 eyes) undergoing pars plana vitrectomy (PPV). Patients were divided into three groups: patients with proliferative diabetic retinopathy (PDR) without aflibercept injection prior to the surgery, PDR patients administered aflibercept injection prior to the surgery, and patients without diabetes mellitus (control group). All patients underwent a comprehensive eye examination one day before and 3 weeks after the surgery, including measurements of: best-corrected visual acuity (BVCA) and intraocular pressure (IOP), slit-lamp examination and spectral domain optical coherence tomography (SOCT). Concentrations of cytokines: IL-6, IL-8, IL-12p70, TNF, IL-10, IL-1β were measured in the vitreous body of patients with BD™ Cytometric Bead Array (CBA) Human Inflammatory Cytokines Kit., Results: PDR patients who received pretreatment with aflibercept injection showed significantly lower concentrations of IL-12p70, TNF, IL-10 and IL-1β in the vitreous body compared to the control group. Meanwhile, patients without prior aflibercept injection had a significantly higher concentration of IL-8. There was also a significant positive correlation between IOP before PPV and IL-8 concentration in both PDR patients' groups., Conclusion: Findings of our study suggest an important role of IL-8 in the development of severe PDR. Aflibercept administration on the day before elective vitrectomy facilitated the surgery., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.)