SEARCH · PubMed Health

Results for “Vitrectomy”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 271 records · Page 15Linked to original sources

PubMed2004

Optical coherence tomography in optic pit maculopathy managed with vitrectomy-laser-gas.

BACKGROUND: Optic disc pit (ODP) maculopathy has a poor visual prognosis if left to its natural course. Several therapeutic approaches have been attempted. The cases of 11 patients evaluated with optical coherence tomography (OCT) and treated with vitrectomy-laser-gas and their functional and anatomical outcomes are presented. METHODS: Retrospective interventional consecutive case series, including 11 eyes with ODP maculopathy. Pre- and postoperative best-corrected visual acuity (BCVA), OCT and angiography were recorded. All patients underwent pars plana vitrectomy, posterior hyaloid dissection peripapillary diode laser prior to retinal reapplication and C(3)F(8) 15% injection. RESULTS: Mean preoperative BCVA was 20/126. Median preoperative BCVA was 1.0 LogMAR (range 1.3-0.4) . Eighty-two per cent of patients gained 2 or more Snellen lines of vision (mean 4.4 lines gained). Mean final BCVA was 20/32, and median final BCVA was 20/30 in Snellen VA and 0.2 in LogMAR (range 0.7-0) Preoperative OCT in all but one case confirmed the bilaminar structure of the macular detachment. Postoperative OCT helped in monitoring reabsorption of the macular detachment, which was achieved in all cases after an average of 6.5 months post-surgery. BCVA increased progressively as the subretinal fluid was reabsorbed (P=0.006). Mean duration of postoperative follow-up was 15 months. Recurrence was observed in two cases. CONCLUSIONS: In our series, the vitrectomy-laser-gas procedure for ODP maculopathy improved vision and achieved satisfactory anatomic results in all 11 cases. OCT was useful in the diagnosis and follow-up of this pathology. However, the low incidence of this entity makes it difficult to obtain series large enough to determine the efficacy of the vitrectomy-laser-gas procedure and other treatment modalities and be able to suggest a procedure of choice.

Adult↗

PubMed2005

A prospective, open-label, dose-escalating study of low molecular weight heparin during repeat vitrectomy for PVR and severe diabetic retinopathy.

BACKGROUND: To determine the maximum tolerated dose (MTD) of enoxaparin, a low molecular weight heparin (LMWH) was used during repeat vitrectomy for rhegmatogenous retinal detachment with proliferative vitreoretinopathy (PVR) and severe diabetic retinopathy. METHODS: From 25 patients, 29 eyes undergoing repeat vitrectomy for PVR (CP3 or greater) or severe diabetic retinopathy were included in the study. Patients had previously undergone an average of 2.1 previous vitrectomies (range 1-5). Enoxaparin was added to the infusion fluid in an escalating dose from 0.1 IU/ml to 6.0 IU/ml as tolerated. Intraoperative bleeding, postoperative fibrin, hyphema and vitreous hemorrhage were graded in an unmasked fashion using previously described grading scales. RESULTS: All patients completed the study, and the study was able to achieve the 6.0 IU/ml maximum dose on the dose escalation schedule. No patient experienced dose-limiting toxicity. Analysis showed no increase in intraoperative bleeding complications between low dose ( 1.0 IU/ml) enoxaparin (Mann-Whitney Test, P=0.029). CONCLUSIONS: Enoxaparin dose escalation did not result in a dose-dependent increase in acute side effects. The establishment of a well-tolerated dose of enoxaparin during repeat vitrectomy for PVR and severe diabetic retinopathy (6.0 IU/ml) provides a foundation for future studies.

Diabetic Retinopathy↗

PubMed2005

Trans-Tenon's retrobulbar triamcinolone acetonide infusion for refractory diabetic macular edema after vitrectomy.

PURPOSE: To evaluate the efficacy and safety of trans-Tenon's retrobulbar triamcinolone acetonide (TA) infusion for the treatment of refractory diabetic macular edema (DME) after vitrectomy. METHODS: After topical anesthesia, 20 eyes from 20 patients with persistent DME after pars plana vitrectomy were treated with trans-Tenon's retrobulbar infusion of 40 mg TA through an inferotemporal approach. The mean duration (+/-SD) between vitrectomy and trans-Tenon's retrobulbar TA infusion was 11.4+/-7.9 months. The mean follow-up period (+/-SD) after trans-Tenon's retrobulbar TA infusion was 13.3+/-2.8 months. RESULTS: At 1 week after trans-Tenon's retrobulbar TA infusion, the mean central retinal thickness (+/-SD) measured by optical coherence tomography was 381+/-99 mum, which was a statistically significant decrease in comparison with the preoperative thickness (555+/-112 mum) (P<0.001). Additional trans-Tenon's retrobulbar TA infusions were performed in ten eyes (50%), due to the recurrence of DME at 6.6+/-3.0 months after the first TA infusion. At the final examination, macular edema resolved in 13 (65%), improved in four (20%), and remained unchanged in three (15%) of the 20 eyes. At 1 month after trans-Tenon's retrobulbar TA infusion, the mean laser flare value (+/-SD) was 9.6+/-3.0 photon/ms, which was a statistically significant decrease in comparison with the preoperative value (15.5+/-5.9 photon/ms) (P<0.01). Furthermore, in ten eyes (50%) with recurrent DME, re-elevated laser flare values were observed prior to the recurrence of DME. The final best-corrected Snellen visual acuity improved by two or more lines in nine eyes (45%), and remained unchanged in 11 eyes (55.0%). IOP elevation equal to or higher than 21 mmHg was observed in three (15%) of the 20 eyes with TA infusion, and was controlled by topical medications. No other injection-related complications were observed. CONCLUSION: Trans-Tenon's retrobulbar TA infusion is an effective and safe method for the treatment of refractory DME, which is present even after vitrectomy.

Adult↗

PubMed2005

Vitreous collagen metabolism before and after vitrectomy.

PURPOSE: To assess vitreous metabolism by measuring C-propeptide levels of type II procollagen (pCOL-II-C) and hyaluronan levels in the vitreous and in the vitreous fluid after vitrectomy for macular hole. METHODS: We obtained 1-ml vitreous samples during vitrectomy from 34 patients (34 eyes) with a macular hole (age range 50-77 years, mean 64 years). After vitrectomy, we performed fluid-air exchange in six eyes because of unresolved macular holes and collected 4-ml fluid samples. Gel-filtration high-performance liquid chromatography (HPLC) was used to determine the molecular weight of pCOL-II-C in the samples. The pCOL-II-C level was measured by sandwich enzyme immunoassay and hyaluronan by sandwich binding protein assay. RESULTS: HPLC showed that pCOL-II-C in the vitreous samples corresponded to purified pCOL-II-C from cartilage. The vitreous pCOL-II-C level (4.7+/-0.3 ng/ml) was similar to reported synovial fluid levels. In six eyes that underwent fluid-air exchange, pCOL-II-C in the fluid samples remained at a level similar to that in the vitreous samples, while hyaluronan levels in the fluid samples were significantly lower than in the vitreous samples. CONCLUSIONS: The molecular weight and concentrations of pCOL-II-C in the vitreous are similar to those in joint fluid. In patients with a macular hole, type II procollagen may be secreted persistently into the vitreous cavity before and after vitrectomy.

Aged↗

PubMed2006

Pars plana vitrectomy and panretinal photocoagulation combined with trabeculectomy for successful treatment of neovascular glaucoma.

BACKGROUND: Treatment of neovascular glaucoma (NVG) must be focused on the reduction of intraocular pressure (IOP) and prompt application of pan retinal photocoagulation (PRP). A combination of complete PRP during vitrectomy with trabeculectomy should theoretically be a better method to lower the IOP rapidly in eyes with NVG. The purpose of our study is to assess the efficacy of combining pars plana vitrectomy and PRP with trabeculectomy assisted by mitomycin C (MMC) on NVG eyes secondary to diabetic retinopathy. METHODS: Twenty-five eyes with NVG associated with diabetic retinopathy had pars plana vitrectomy, followed by PRP and trabeculectomy with MMC. The eyes were divided into two groups: nine eyes with vitreous hemorrhage, fibrovascular membrane and/ or retinal detachment were placed in the Proliferation group; and 16 eyes without vitreous hemorrhage, fibrovascular membrane, or retinal detachment were placed in the PC (photocoagulation) group. These eyes had vitrectomy performed so that PRP could be safely performed from ora to ora. The surgical outcome in the two groups was assessed by Kaplan-Meier survival analysis. The criteria for success were a postoperative intraocular pressure (IOP) < or =21 mmHg and a preservation of light perception. RESULTS: In the Proliferation group, Kaplan-Meier life-table analysis showed that the success rate was 55.6% after 1 year and 18.5% after 2 years. The success rate in the PC group was 81.2% from 1 to 3 years after surgery. The surgical outcome was significantly better in the PC group than in the Proliferation group (P=0.009). In the Proliferation group, four eyes had preoperative vitreous hemorrhage, three eyes had a fibrovascular membrane, and two eyes had a retinal detachment. Three of four eyes with vitreous hemorrhage achieved good IOP control. On the other hand, the IOP of all eyes with retinal detachment and fibrovascular membrane were not lowered significantly. CONCLUSIONS: Complete PRP combined with trabeculectomy with MMC can effectively reduce the elevated IOP in eyes with NVG. However, this combined treatment is not effective in eyes with proliferative membranes and retinal detachments.

Adult↗

PubMed1998

Electroretinographic alterations during vitrectomy in human eyes.

BACKGROUND: We previously reported a new system of electroretinographic monitoring of the retinal function during vitrectomy in human eyes, and found that lowering the intravitreal temperature by applying an infusion solution kept at room temperature (used routinely for vitrectomy throughout the world) can alter the electroretinogram (ERG). This time we attempted to study the effect upon the ERG of replacing the intraocular medium and acutely elevating the intraocular pressure during vitrectomy. METHODS: Using a special contact lens with a built-in light-emitting diode light source, 30-Hz flicker ERG was quickly recorded under aseptic conditions. RESULTS: Acute, reversible reduction in amplitude was observed upon replacing the intraocular medium with air or silicon oil and during periods of acutely elevated intraocular pressure. Infusions of gentamicin or miconazole did not affect the ERG when intravitreal temperature and intraocular pressure were constant. CONCLUSION: The ERG monitor can reveal changes of the retinal function during vitrectomy, particularly when the infusion temperature, intraocular medium and intraocular pressure are kept constant.

Antifungal Agents↗

PubMed2001

Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment (SPR Study): design issues and implications. SPR Study report no. 1.

BACKGROUND: In patients with more complex rhegmatogenous retinal detachments (RRD) not complicated by proliferative vitreoretinopathy (PVR), the most appropriate operating method is controversial, and different surgeons use different techniques. The Scleral Buckling Versus Primary Vitrectomy in Rhegmatogenous Retinal Detachments Study (SPR Study) is designed to compare primary vitrectomy and scleral buckling techniques in these patients. METHODS: The SPR Study is a multicentre, randomised, controlled clinical trial stratified by lens status. Patients with RRD which is not complicated by PVR grade B or C and which cannot be treated with a single meridional sponge are randomised to either scleral buckling or pars plana vitrectomy as first surgical intervention. Four hundred consecutive patients are to be recruited per subtrial (phakic and aphakic/pseudophakic patients), and followed up for 1 year. The primary endpoint (functional outcome) is the change in visual acuity. Secondary endpoints (anatomical outcome) include postoperative PVR, retinal reattachment and the number of reoperations necessary to achieve retinal reattachment. Twenty-seven institutions (49 surgeons) in six European countries have been recruited for participation in the study. CONCLUSION: The SPR Study is the first randomised prospective clinical trial to compare scleral buckling and primary vitrectomy in patients with RRD. The results of this study should enable vitreoretinal surgeons to improve the surgical therapy of patients with the more complicated manifestations of RRD.

Humans↗

PubMedDate not supplied

Twenty-gauge Transconjunctival Vitrectomy.

PURPOSE: To describe a new 20-gauge transconjunctival vitrectomy procedure that we designed, to evaluate its usefulness, and to compare two different methods of use. METHODS: The records of 431 patients (433 eyes) who underwent 20-gauge transconjunctival vitrectomy at the Surugadai Hospital of Nihon University between March 2003 and January 2004 were studied retrospectively. In surgical method 1, 20-gauge wounds were made through the conjunctiva and sclera together. In surgical method 2, 20-gauge conjunctival openings were made 2 mm posterior to the sclerotomies. Absorbable sutures were used to stitch the scleral and conjunctival openings simultaneously in both methods. RESULTS: A 20-gauge transconjunctival vitrectomy has various benefits and is indicated for nearly all ocular diseases. Moreover, it is not limited by the intraocular instruments required. However, since cannulas were not placed in all ports, conjunctival edema occurred more easily with surgical method 2 owing to the leakage of perfusion fluid. CONCLUSIONS: This new 20-gauge transconjunctival vitrectomy procedure has various benefits and is indicated for nearly all ocular diseases. It is not limited by the intraocular instruments required.

Adult↗

PubMed2006

Vitrectomy seems to be beneficial for advanced diffuse diabetic macular oedema not responding to laser treatment.

BACKGROUND: To evaluate the surgical efficacy of vitrectomy, with optical coherence tomography, in patients with non-ischemic and ischemic diffuse diabetic macular oedema not responding to laser treatment. METHODS: Ten eyes from nine patients (aged 46.0 +/- 20 years, diabetes duration 12.4 +/- 4 years) operated with vitrectomy for diabetic macular oedema not responding to laser treatment were evaluated before and 6 months postoperatively. Retinal thickness was assessed with optical coherence tomography, OCT, measuring the mean values of the centre of fovea and the second and third concentric rings from foveola. Four patients with type 1 diabetes had ischemic and five patients (6 eyes) with type 2 diabetes had non-ischemic diffuse macular oedema diagnosed on fluorescein angiography (FA). All eyes had an attached vitreous diagnosed on OCT. RESULTS: Mean foveal thickness for the three concentric rings from centre and out was significantly less 6 months postoperatively 437 +/- 125 vs. 286 +/- 67 microm; p = 0.027, 426 +/- 105 vs. 308 +/- 35 microm; p = 0.019 and 404 +/- 69 microm vs. 318 +/- 29 microm; p = 0.011 respectively. The decrease in foveal thickness was similar for eyes with and without signs of ischemic maculopathy. There was a trend toward improved visual acuity (VA) 6 months after surgery 0.4; range 0.2-0.6 compared to 0.3; range 0.1-0.5 before vitrectomy; p = 0.107). CONCLUSION: Vitrectomy seems to be a beneficial treatment for both ischemic and non-ischemic advanced diffuse diabetic macular oedema not responding to laser treatment.

Diabetic Retinopathy↗

PubMed2004

The role of patient age and intraocular gas use in cataract progression after vitrectomy for macular holes and epiretinal membranes.

PURPOSE: To evaluate the rate of increase in nuclear sclerosis and posterior subcapsular cataracts in eyes as a function of patient age and use of intravitreal gas at the time of vitrectomy. DESIGN: Observational case series. METHODS: Nuclear sclerosis and posterior subcapsular cataracts were evaluated as a function of patient age and use of intravitreal gas at vitrectomy. SETTING: A clinical practice. STUDY POPULATION: The study population consisted of 301 consecutive eyes. OBSERVATIONAL PROCEDURE: Nuclear sclerotic cataracts and posterior subcapsular cataracts were graded on a scale from 0 to 4.0 before and after vitrectomy. MAIN OUTCOME MEASURE: Linear regression analysis was performed to measure and compare the rate of change in cataract score over time based on patient age and use of intraocular gas. RESULTS: Nuclear sclerotic cataracts showed minimal increase in patients younger than 50 years of age after vitrectomy (0.13 grades/year). Nuclear sclerotic cataracts increased at a rate of 0.7 to 0.9 grades/year (mean, 0.812) in patients aged 50 to 60 years, 60 to 70 years, 70 to 80 years, and 80+ years, even though the baseline nuclear sclerosis scores were progressively greater for each decade. The increase in nuclear sclerotic cataracts in patients younger than 50 years of age was significantly less (P <.001) than in patients aged 50 years or older. Eyes with intraocular gas use had a higher rate of nuclear sclerosis progression (0.8 grades/year) compared with eyes without intraocular gas bubbles (0.5 grades/year; P <.001). Posterior subcapsular cataract scores showed minimal or no increases in all groups. CONCLUSIONS: Patients older than 50 years of age have a similar rate of increase in nuclear sclerotic cataracts, independent of age. The rate is approximately sixfold greater than in patients younger than 50 years of age. Intravitreal gas bubbles are associated with a nuclear sclerosis increase of approximately 60% compared with eyes without use of a gas bubble.

Adolescent↗

PubMed2004

Vitrectomy as a treatment for elevated intraocular pressure following intravitreal injection of triamcinolone acetonide.

PURPOSE: To report control of intravitreal triamcinolone acetonide-induced elevated intraocular pressure (IOP) by vitrectomy-assisted corticosteroid removal. DESIGN: Interventional case series. METHODS: Of the 26 eyes that had intravitreal injection of triamcinolone acetonide for various causes, 11 eyes (42.5%) developed elevated IOP. In nine eyes IOP was controlled by antiglaucoma medication. Two eyes of two patients developed uncontrolled IOP despite maximal antiglaucoma medication. These eyes underwent vitrectomy and removal of triamcinolone acetonide. RESULTS: IOP returned to normal in 3 weeks and 1 week, respectively, after vitrectomy. CONCLUSIONS: Elevated IOP associated with intravitreal injection of triamcinolone acetonide that is not controlled by maximal antiglaucoma medication can be effectively treated by vitrectomy-assisted removal of triamcinolone acetonide.

Drainage↗

PubMed2005

Vitrectomy for persistent diffuse diabetic macular edema.

PURPOSE: To evaluate the potential benefit of vitrectomy in eyes with persistent diffuse macular edema. DESIGN: Prospective randomized comparative clinical trial. METHODS: Eyes with diffuse diabetic macular edema for 6 to 18 months, an attached posterior hyaloid, and grid laser photocoagulation performed at least 4 months before were included. Patients were randomized either to a vitrectomy group or to a control group. MAIN OUTCOME MEASURES: Evaluations of Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity, reading vision, and retinal thickness were carried out at baseline and 1, 3, and 6 months after enrollment. RESULTS: Fifty-six eyes (100%) were enrolled in this study. Twenty-five eyes (44.6%) were randomized into Gr I (vitrectomy group) and 31 eyes (55.4%) into Gr II (controls). Both groups were comparable in mean age (62.7 years and 63.9 years) and distribution of gender (one third male, two thirds female). ETDRS visual acuity showed a statistical significance in favor of Gr I at all time points (P = .035 to .005 Fisher's exact test). With Jaeger charts a significance for Gr I was found only at the 6-month examination (P = .01). With optical coherence tomography, the different behavior of retinal thickness changes in both groups during follow-up was statistically significant; P values were <.0001 for month 1, 3, and 6, preferring Gr I. CONCLUSIONS: We provide evidence that vitrectomy with internal limiting membrane peeling is superior to observation alone in eyes with persistent diffuse diabetic macular edema for 6 to 18 months. Longer follow-up periods and larger series might be needed to confirm these results and gain additional information.

Adult↗

PubMed2005

Diagnostic testing of vitrectomy specimens.

PURPOSE: To assess the usefulness of diagnostic tests that are performed on vitrectomy specimens from patients with suspected lymphoma or infection. DESIGN: Noncomparative, retrospective, interventional case series. METHODS: Seventy-eight consecutive patients (84 eyes) underwent pars plana vitrectomy for diagnostic purposes. Vitrectomy with cytologic, cytofluorographic, or microbiologic analysis of vitreous samples was performed. The main outcome measures were the efficiency of diagnostic procedure and positive and negative predictive values (PPV and NPV). RESULTS: There were 28 patients (33 eyes) with suspected intraocular lymphoma and 50 patients (51 eyes) with suspected infection, which was subdivided into chronic endogenous endophthalmitis, atypical chorioretinitis, or chronic postoperative inflammation. Vitreous testing led to a diagnosis in 48 of 78 patients (61.5%); 14 patients with a final diagnosis of lymphoma/leukemia, and 34 patients with a final diagnosis of infection. When preoperative indication was compared with final clinical diagnosis, the efficiency of the diagnostic procedure of cytologic evaluation, flow cytometry, and bacterial/fungal culture was 67%, 79%, and 96%, respectively. For lymphoma, the PPV of cytologic evaluation was 100% and the NPV 60.9%. For infection, the PPV of bacterial/fungal culture was 100% and the NPV 94.9%. CD22+ B lymphocytes >or=20% of total cells on cytofluorographic analysis had a PPV of 88% for lymphoma. A cytofluorographic CD4:CD8 T-lymphocyte ratio >or=4 had a PPV of 70% for immunologically mediated uveitis. Surgical complications were rare and manageable. CONCLUSION: Diagnostic vitrectomy in selected patients with carefully planned testing is an effective means of supporting diagnoses in intraocular lymphoma, chronic intraocular infections, and atypical chorioretinitis. Flow cytometry quantitates the percentages and ratios of various cell types and is helpful in contrasting intraocular lymphoma with immunologically mediated uveitis.

Adult↗

PubMed2005

Pars plana vitrectomy with gas tamponade for lamellar macular holes.

PURPOSE: To report anatomic and visual improvement after pars plana vitrectomy with gas tamponade for a lamellar macular hole with poor central visual acuity. DESIGN: Two interventional case reports. METHODS: Two patients with a lamellar macular hole underwent vitrectomy, internal limiting membrane peeling, and long-acting gas injection. Main outcome measures included best-corrected visual acuity, biomicroscopic appearance, and optical coherence tomography findings. RESULTS: Vitrectomy with gas tamponade resulted in biomicroscopic, functional, and tomographic improvement in both patients for follow-up periods of 12 months. CONCLUSIONS: Vitrectomy with gas tamponade may be an effective method for a lamellar macular hole with poor visual acuity.

Aged↗

PubMed2004

Ultrastructure of internal limiting membrane removed during plasmin-assisted vitrectomy from eyes with diabetic macular edema.

PURPOSE: To study the effect of autologous plasmin enzyme (APE) on the adhesion of the vitreous cortex to the internal limiting membrane (ILM) in eyes with diabetic macular edema. DESIGN: Nonrandomized, comparative, interventional case series. PARTICIPANTS: Ten eyes of 10 patients with diabetic macular edema without a posterior vitreous detachment (PVD), which were treated with APE as an adjunct to conventional pars plana vitrectomy, and 10 eyes of 9 patients without a PVD, which underwent pars plana vitrectomy without APE, were studied. METHODS: In the APE group, 0.4 IU of APE was injected into the midvitreous cavity in 9 eyes, and 0.8 IU of APE in 1 eye. Thirty minutes after plasmin injection, the eyes underwent pars plana vitrectomy with ILM peeling. All eyes in the control group had conventional vitreous surgery with ILM peeling. The removed ILMs were investigated for the presence of vitreous and for ultrastructural differences by transmission and scanning electron microscopy. MAIN OUTCOME MEASURES: The status of the vitreous and induction of a PVD during surgery, and the presence of vitreous and ultrastructural differences of the removed ILM by transmission and scanning electron microscopy. RESULTS: In APE-treated eyes, the degree of liquefaction of the vitreous was graded as high in 4 eyes. Spontaneous PVD occurred in 2 eyes, whereas core vitrectomy with a maximum vacuum of 100 mmHg induced a PVD in 2 additional eyes. In the control group, 8 eyes required suction with a maximum of 200 mmHg to induce the PVD. Scanning electron micrography of the removed ILM in the APE-treated eyes showed a smooth surface on the vitreous side in 8 eyes and only sparse collagen fibers in 2 eyes. Conversely, in the control group, dense vitreous fibers were found in 4 eyes, sparse collagen fibrils in 3 eyes, and a smooth retinal surface in 3 eyes. CONCLUSIONS: These findings indicate that APE helps separate the vitreous hyaloid from the ILM surface and may be a useful adjunct to conventional vitreous surgery for diabetic macular edema.

Adult↗

PubMed2000

Vitrectomy for diffuse diabetic macular edema associated with a taut premacular posterior hyaloid.

PURPOSE: To evaluate the role of vitrectomy in eyes with diffuse diabetic macular edema associated with a taut posterior hyaloid. METHODS: Records of 55 eyes of 50 patients with diabetic retinopathy and diffuse clinically significant diabetic macular edema who underwent vitrectomy with stripping of the premacular posterior hyaloid were reviewed. In all 55 eyes, diffuse diabetic macular edema was present on contact lens examination and confirmed with fluorescein angiography. On fundus examination, the premacular posterior hyaloid was attached and appeared taut. RESULTS: The mean preoperative best-corrected visual acuity was 20/160, and the mean final best-corrected visual acuity was 20/80 (P <.0001, Wilcoxon signed rank test), with 27 (49.1%) of the 55 eyes demonstrating improvement in best-corrected visual acuity of 2 or more lines. Fifty-two (94.5%) of the 55 vitrectomized eyes showed improvement in clinically significant macular edema and in 45 eyes (81.8%) the macular edema resolved completely during a mean period of 4.5 months (range, 1 to 13 months). Eyes with macular ischemia and preoperative best-corrected visual acuity of 20/200 or less tended to respond less favorably to vitrectomy than eyes lacking these characteristics. All eyes had at least 6 months of follow-up after surgery, with a mean follow-up of 23.2 months. CONCLUSION: In eyes with persistent diffuse diabetic macular edema with a taut premacular posterior hyaloid face unresponsive to laser therapy, vitrectomy with removal of the posterior hyaloid appears to be beneficial in some cases. Careful selection of eyes with favorable preoperative clinical characteristics may improve surgical outcomes.

Adult↗

PubMed2002

A new high-speed pneumatic vitrectomy cutter.

PURPOSE: To describe a new high-speed pneumatic vitrectomy instrument capable of 2000 cuts/minute. DESIGN: Observational report. METHODS: A high-speed guillotine vitrector, developed to perform vitrectomy, with the ability to adjust from 1 to 2000 cuts/minute, was used in 80 consecutive vitreoretinal cases with a variety of diagnoses in a hospital setting. RESULTS: The performance was almost vibration-free. The instrument performed efficiently up to 1500 cuts/minute during vitrectomy, maintaining a constant flow rate. Higher cutting rates were used successfully for special indications. No complications were linked to the use of the instrument. CONCLUSION: The instrument was used successfully in 80 consecutive vitrectomies for a variety of diagnoses, performing efficiently up to 1500 cuts/minute, with a constant flow rate without complications. Higher cutting rates (2000 cuts/minute) were used successfully for special indications.

Equipment Design↗

PubMed2002

A controlled study of vitrectomy for diabetic macular edema.

PURPOSE: To compare eyes that underwent surgery with untreated fellow eyes to assess the efficacy of vitrectomy for diabetic macular edema. METHODS: In a nonrandomized clinical trial, seven adult patients with mean age of 53 years (range 42 to 64) and the same degree and duration of diabetic macular edema in both eyes were followed up for more than 5 months after unilateral vitrectomy. The treated eye was selected at random, but if visual disparity between the both eyes was more than 3 lines, we operated on the worse side. We compared the preoperative and postoperative foveal thicknesses (the distance between the inner retinal surface and retinal pigment epithelium) and the best-corrected visual acuity by a certified examiner with those of the untreated fellow eye. RESULTS: In the seven eyes that underwent surgery, the foveal thickness decreased by an average of 622 to 269 microm (P =.027, Wilcoxon signed-rank test). In the fellow eyes, the average decrease in foveal thickness was from 617 to 546 microm (P =.176, Wilcoxon signed-rank test). The best-corrected postoperative visual acuity in the eyes that underwent surgery improved more than 2 lines in four eyes (57%) and remained the same in three eyes (43%). In the fellow eyes, it improved more than 2 lines in one eye (14%), remained the same in three eyes (43%), and decreased more than 2 lines in three eyes (43%). CONCLUSION: In eyes with diabetic macular edema that underwent surgery, the foveal thickness significantly decreased after vitrectomy. Vitrectomy may be effective for treating diabetic macular edema.

Adult↗