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At least 289 records · Page 16Linked to original sources

PubMed2002

Total en bloc excision: a modified vitrectomy technique for proliferative diabetic retinopathy.

PURPOSE: To report a modified vitrectomy technique for proliferative diabetic retinopathy. DESIGN: Interventional case series. METHODS: In the modified vitrectomy technique for proliferative diabetic retinopathy, core vitrectomy is performed, followed by separation of the glial ring from the optic disk using a hook or forceps. The posterior hyaloid membrane, including proliferative tissues, is lifted and peeled from the posterior to the peripheral retina without creating a window in the posterior hyaloid membrane. At any strong vitreoretinal adhesion site, the posterior hyaloid is partially removed, followed by membrane delamination. RESULTS: In the 18 eyes that underwent the modified technique, iatrogenic retinal breaks occurred less often compared with the 48 eyes that underwent the conventional technique. The difference was not statistically significant (P =.14), but the surgical time was significantly reduced (P =.0003). The glial ring and proliferative tissue arising from the optic disk can be readily separated, and other adhesion sites can be satisfactorily peeled after separating the posterior hyaloid membrane around the optic disk. CONCLUSIONS: This modified vitrectomy technique for proliferative diabetic retinopathy may be an alternative surgical technique to the conventional technique.

Diabetic Retinopathy↗

PubMed2003

Vitrectomy with internal limiting membrane peeling for macular retinoschisis and retinal detachment without macular hole in highly myopic eyes.

PURPOSE: To report anatomic and visual improvement following vitrectomy with internal limiting membrane (ILM) peeling for two highly myopic patients with retinoschisis and/or retinal detachment without a macular hole. DESIGN: Two interventional case reports. METHODS: Two highly myopic patients who had retinoschisis and/or retinal detachment without a full-thickness 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 coherent tomography finding. RESULTS: Vitrectomy with ILM peeling results in biomicroscopic, functional, and tomographic improvement in both patients, for follow-up periods of 12 months and 8 months, respectively. CONCLUSIONS: Vitrectomy with ILM peeling and gas tamponade is an effective method for retinoschisis and/or retinal detachment without a macular hole in highly myopic patients.

Aged↗

PubMed1997

Management of condensation on a foldable acrylic intraocular lens after vitrectomy and fluid-air exchange.

PURPOSE: To describe the management of condensation on the posterior surface of a foldable acrylic intraocular lens during vitrectomy and fluid-air exchange. METHODS: A 70-year-old pseudophakic man with a foldable acrylic intraocular lens and open posterior capsule underwent vitrectomy and fluid-air exchange for repair of rhegmatogenous retinal detachment. RESULTS: During pars plana vitrectomy and fluid-air exchange, condensation immediately formed on the posterior surface of the foldable acrylic intraocular lens. This condensation, which prevented a view of the retina, was eliminated by wiping the posterior surface of the intraocular lens with a soft-tipped cannula. CONCLUSION: Although condensation may rapidly form on acrylic intraocular lenses during vitrectomy and fluid-air exchange, it can be managed readily by wiping with a soft-tipped cannula.

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PubMed1995

Pars plana vitrectomy for chronic pseudophakic cystoid macular edema.

PURPOSE: We determined the efficacy of pars plana vitrectomy in a series of patients with chronic pseudophakic cystoid macular edema. METHODS: Clinical records were reviewed on 24 consecutive patients who underwent pars plana vitrectomy in one eye for chronic pseudophakic cystoid macular edema. All 24 patients had failed to improve on medical therapy and had preoperative evidence of either vitreous adhesions to anterior segment structures (23 eyes) or iris capture of the intraocular lens (one eye). RESULTS: The mean, best-corrected Snellen visual acuity was 20/190 preoperatively (median, 20/200; range, 20/50 to 3/200) and 20/52 postoperatively (median, 20/40; range, 20/20 to 20/400 [P < .0001]). Visual acuity improved postoperatively in all 24 eyes, with a mean improvement of 4.7 Snellen lines (range, one to eight lines). There was no highly significant difference in preoperative visual acuity (P = .41) or postoperative visual improvement (P = .17) between patients with anterior as opposed to posterior chamber intraocular lenses. Longer time interval from cataract surgery to vitrectomy did not correlate with less postoperative visual improvement. CONCLUSIONS: In pseudophakic eyes with chronic cystoid macular edema, vitreous adhesions to anterior segment structures, and visual loss that is unresponsive to medical therapy, pars plana vitrectomy with removal of these vitreous adhesions may lead to improved visual acuity.

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PubMed1992

Intraocular fluid cultures after primary pars plana vitrectomy.

To determine what organisms enter the eye and remain in the eye after pars plana vitrectomy, vitreous cavity aspirates were cultured postoperatively. Two of 33 (6%) consecutive eyes undergoing primary pars plana vitrectomy had positive cultures. One sample grew a single colony of Staphylococcus epidermidis, the second grew two colonies of Acinetobacter lwoffi. Neither of these eyes developed endophthalmitis. This study demonstrates that bacteria enter the eye at a low rate during pars plana vitrectomy and that the eye on which a vitrectomy has been performed is capable of clearing a low inoculum of bacteria.

Acinetobacter↗

PubMed1992

Vitrectomy for perforating eye injuries from shotgun pellets.

Pars plana vitrectomy and scleral buckling were performed on 22 eyes of 19 patients for treatment of perforating eye injuries from shotgun pellets. We reviewed the intraoperative findings at the time of vitrectomy to determine what factors might influence final visual acuity. The presence of a total retinal detachment at vitrectomy portended a poor prognosis when compared with eyes without total retinal detachment, as only one of ten eyes with total retinal detachment obtained useful vision (P = .002). Preoperative separation of the posterior vitreous was associated with a favorable outcome when compared with the absence of posterior vitreous detachment (P = .035), as ten of 16 eyes with posterior vitreous detachment at the time of vitrectomy ultimately achieved functional vision. The locations of the exit wounds did not affect visual success in the overall series of patients. However, in the patients who achieved visual success, exit wounds outside the vascular arcades were more likely to be associated with final visual acuities of, or better than, 20/70 than were those within the arcades (P = .022). Other prognostic factors, such as the number of perforations and the use of cryotherapy, were also examined for their effects on final visual outcome. However, these factors did not appear to affect visual outcome statistically.

Adolescent↗

PubMed1998

Vitrectomy in patients with decreased visual acuity secondary to asteroid hyalosis.

PURPOSE: To evaluate the role of vitrectomy in patients with decreased visual acuity solely attributable to asteroid hyalosis. METHOD: We retrospectively reviewed the records of patients with asteroid hyalosis and identified those who underwent vitrectomy for symptomatic asteroid hyalosis alone. RESULTS: After vitrectomy, nine of 10 eyes (10 patients) had at least 1 line of improvement in nonstandardized best-corrected visual acuity. In one eye, vision was unchanged postoperatively. The average gain was 3.44 lines. CONCLUSIONS: A small percentage of patients with asteroid hyalosis have decreased visual acuity caused solely or primarily by the asteroid hyalosis. Vitrectomy in these patients may alleviate symptoms and improve visual acuity.

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PubMed1999

Vitrectomy for chronic pseudophakic cystoid macular edema.

PURPOSE: We report the results of pars plana vitrectomy for chronic pseudophakic cystoid macular edema unresponsive to medical treatment. METHODS: Retrospective analysis of 23 consecutive eyes of 23 patients with chronic pseudophakic cystoid macular edema was performed. Eyes with vitreous incarceration into the cataract wound or vitreous-cornea contact were excluded from the study. Preoperatively, all eyes had cystoid macular edema confirmed on fluorescein angiography and were unresponsive to medical treatment. Pars plana vitrectomy was performed using standard techniques and vitreous adhesions to the iris, intraocular lens, or both were lysed if present. RESULTS: The mean interval between cataract surgery and vitrectomy was 32.3+/-30.9 months (median, 20 months; range, 3 to 110 months). The vitreous was adherent to the iris or intraocular lens in 12 eyes (52.2%) and was present in the anterior chamber with no evidence of adhesions in seven eyes (30.4%). In four eyes (17.4%) the vitreous was posterior to the iris plane with no adhesions to anterior segment structures. The median preoperative best-corrected visual acuity was 20/200, and the median final postoperative best-corrected visual acuity was 20/60 (P<.0001) after a mean follow-up of 30.2+/-31.2 months (median, 14 months; range, 2 to 109 months). Final best-corrected visual acuity improved by a mean of 3.3+/-2.6 Snellen lines, with a median percent change of 70% (mean, 57.3%; range, 0% to 99%). In all 23 eyes the cystoid macular edema resolved postoperatively by biomicroscopic examination in a mean period of 3.3 months (median, 2 months; range, 1 to 12 months). CONCLUSIONS: In pseudophakic eyes with chronic cystoid macular edema unresponsive to medical treatment, vitrectomy resulted in resolution of the cystoid macular edema with improved visual acuity in some cases. Clinical improvement may occur in eyes with no apparent vitreous disturbance.

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PubMed2000

Pars plana vitrectomy during cataract surgery for prevention of aqueous misdirection in high-risk fellow eyes.

PURPOSE: To report the use of pars plana vitrectomy as a prophylactic measure during cataract surgery for prevention of aqueous misdirection in high-risk fellow eyes. METHODS: Chart review of two patients with severe aqueous misdirection in their first eye at the time of cataract surgery that only responded to pars plana vitrectomy. RESULTS: In both patients, cataract extraction with posterior chamber intraocular lens implantation was initially performed after pars plana vitrectomy, with the creation of hyaloido-capsulo-iridotomy to establish a communication between the vitreous cavity and the anterior chamber. CONCLUSION: Pars plana vitrectomy as a prophylactic measure during cataract surgery may have a beneficial role in fellow eyes at high risk for developing aqueous misdirection.

Aged↗

PubMedDate not supplied

Factors contributing to corneal complications after vitrectomy in diabetic patients.

PURPOSE: To elucidate factors contributing to corneal complications after vitrectomy in diabetic patients. METHODS: The records of a series of 129 diabetic patients (202 eyes) who underwent pars plana vitrectomy performed by a single surgeon between March 1997 and February 1999 were analyzed retrospectively. Logistic regression analysis was performed to determine possible factors contributing to corneal complications. RESULTS: Of the 202 eyes, 102 (50.5%) developed corneal complications after surgery; 90 (44.6%) had epithelial disturbance; and 48 (23.8%) had corneal edema. The degree of surgical invasion during vitrectomy was significantly correlated with the occurrence of epithelial disturbance and corneal edema. CONCLUSION: Surgical invasion is a risk factor for corneal complications after vitrectomy in diabetic patients.

Corneal Diseases↗

PubMedDate not supplied

Core vitrectomy preceding triple corneal procedure in patients at high risk for increased posterior chamber pressure.

We evaluated the effectiveness of performing a core vitrectomy to prevent intraoperative posterior chamber pressure evaluation in eyes at high risk for development of this complication, prior to penetrating keratoplasty, extracapsular cataract extraction and posterior chamber lens (IOL) implantation. Results in 10 cases with core vitrectomy were compared with 10 cases without (controls); in all eyes with vitrectomy, a posterior chamber IOL was easily implanted but four eyes of the control group developed vitreous complications. Our results indicate that core vitrectomy does facilitate IOL implantation during a triple corneal procedure in eyes at increased risk of elevated posterior chamber pressure.

Aged↗

PubMedDate not supplied

Survey of surgical indications and results of primary pars plana vitrectomy for rhegmatogenous retinal detachments.

BACKGROUND: Several surgical techniques to repair rhegmatogenous retinal detachment have been developed. Recently, both the method of reattaching the retina and of obtaining an early visual recovery are considered important factors when determining which surgical techniques to perform to treat retinal detachment. CASES: The surgical outcome in a series of 63 consecutive patients, who were treated at Osaka Rosai Hospital between 1993 and 1996, was reviewed retrospectively to evaluate the efficacy of primary vitrectomy to treat uncomplicated rhegmatogenous retinal detachment associated with posterior hyaloid separation. The criteria for vitrectomy included the presence of not only posterior retinal breaks, but also of multiple peripheral retinal breaks. OBSERVATIONS: The reattachment rate after the first surgery was 92.1% (58 eyes), and by the final examination it increased to 100%. Of the 46 eyes with macular detachment, good visual rehabilitation and a visual acuity improvement of 5 or more lines was obtained in 33 eyes (71.7%) by 1 month postoperatively. No statistically significant difference in the reattachment rate was found when eyes that underwent an encircling procedure were compared with those that did not. In eyes with lens opacity, cataract surgery was also performed and intraocular lenses were implanted uneventfully in all but one case with myopia. There was a high incidence (53.8%) of cataract progression in phakic eyes. However, no other serious complications, such as proliferative vitreoretinopathy, were found throughout the follow-up period. CONCLUSIONS: The results indicate that vitrectomy performed to alleviate peripheral vitreoretinal traction is an effective surgical technique to treat primary rhegmatogenous retinal detachment. Vitrectomy combined with cataract surgery may also be a valuable surgical option in selected cases to maintain long-standing visual rehabilitation.

Adult↗

PubMedDate not supplied

Vitrectomy for vitreous bleeding and tractional retinal detachment in a case of Evans syndrome.

PURPOSE: To evaluate the effect of vitrectomy to treat Evans syndrome with vitreous bleeding followed by tractional retinal detachment. CASE: Vitrectomy was performed on a 21-year-old man with Evans syndrome who developed tractional retinal detachment in the left eye after experiencing vitreous bleeding and tissue proliferation related to the bleeding. OBSERVATIONS: After the proliferative tissue was removed and tractional retinal detachment corrected, the patient's visual acuity improved from 6/20 to 10/20. A small amount of residual proliferative tissue remained after the vitrectomy. CONCLUSIONS: Vitrectomy may be beneficial in patients with serious vitreous complications induced by hematological diseases such as Evans syndrome.

Adult↗

PubMedDate not supplied

Vitrectomy in the management of diabetic retinopathy.

According to the Early Treatment Diabetic Retinopathy Study, at least 5% of eyes receiving optimal medical treatment will still have progressive retinopathy that requires laser treatment and pars plana vitrectomy. During the past decade, improvements in instrumentation and surgical techniques have allowed more difficult cases of diabetic retinopathy to be candidates for vitrectomy. However, although the thresholds for performing surgery within established indicated situations have been lowered, only a few additional indications have been established. Although vitrectomy improves the prognosis for a favorable visual outcome, preventive measures, such as improved control of glucose levels and timely application of panretinal photocoagulation, produce better results. The authors review the indications, techniques, and results of vitrectomy in the management of diabetic retinopathy.

Diabetic Retinopathy↗

PubMed2001

Vitrectomy for retained lens material after cataract extraction: the relationship between histopathologic findings and the time of vitreous surgery.

PURPOSE: To report the histopathologic features of vitreous specimens obtained after vitrectomy for retained lens material and to correlate these findings with the time after cataract surgery at which vitreous surgery was performed. DESIGN: Observational case series. PARTICIPANTS: All 135 patients who had vitreous specimens submitted to the pathology laboratory after vitreous surgery for retained lens material after elective senile cataract surgery. METHODS: A review of histopathologic reports of 135 consecutive vitreous specimens that were obtained during vitreous surgery for retained lens material after surgery for senile cataract. MAIN OUTCOME MEASURES: Identification of lens material, macrophages, phacolytic cells, and giant cells in the vitrectomy specimens. RESULTS: Lens material was observed in 100% of cases. Macrophages without ingested lens material were present in 48% (65 of 135), phacolytic cells in 24% (32 of 135), and a mixture of neutrophils and multinucleated giant cells in 8% (11 of 135). No cells were discovered in eyes in which vitrectomy was performed within 3 days of cataract extraction. The percentages of eyes with macrophages increased from 35% when vitrectomy was performed 4 to 7 days after cataract surgery to 80% when this time interval was 61 to 90 days. CONCLUSION: Lens-induced inflammatory reaction seems to increase with time that retained lens material remains in the eye.

Adult↗

PubMed2002

Diagnostic yield of vitrectomy in eyes with suspected posterior segment infection or malignancy.

PURPOSE: To determine the yield of diagnostic pars plana vitrectomy in eyes with suspected posterior segment inflammation or malignancy when clinical examination and systemic laboratory testing did not yield a specific diagnosis. DESIGN: Non-comparative interventional case series PARTICIPANTS: Eighty-seven consecutive patients (90 eyes) who underwent diagnostic pars plana vitrectomy from 1989 through 1999. INTERVENTIONS: Vitreous samples were analyzed in a directed manner based on the preoperative clinical examination and systemic laboratory testing. MAIN OUTCOME MEASURES: Diagnosis from each test performed on the vitreous samples. RESULTS: Diagnostic vitrectomy was performed alone in 6 eyes (7%) and as part of a therapeutic procedure in the remaining 84 eyes. The diagnostic tests performed most frequently included cytopathology (83%), microbiologic culture and sensitivity (43%), polymerase chain reaction (PCR) (36%), and intraocular antibody levels for T. canis (14%). Of these, intraocular antibody testing and PCR had the highest positive yield, 46% and 39%, respectively. Overall, directed vitreous analysis identified a specific cause in 35 eyes (39%). Of the 65 cases in which an underlying infection was suspected preoperatively, the procedure yielded a specific diagnosis in 27 (42%). When intraocular malignancy was considered preoperatively (71 eyes), a diagnosis of intraocular lymphoma was obtained in seven (10%). This difference between these diagnostic yields was significant (P = 0.02, Fisher's exact test). CONCLUSIONS: Diagnostic vitrectomy with directed vitreous fluid analysis yields a specific cause and guides subsequent therapy in a high percentage of cases. This procedure is a valuable adjunct in cases that cannot be diagnosed by less invasive methods.

Adolescent↗

PubMed2002

Vitrectomy for diabetic traction retinal detachment using the multiport illumination system.

OBJECTIVE: To examine the visual and anatomic results of bimanual vitrectomy surgery with the multiport illumination system (MIS) in eyes with advanced diabetic traction retinal detachment. DESIGN: Retrospective, noncomparative interventional case series. PARTICIPANTS: Sixty-seven consecutive eyes in 62 patients having vitrectomy with the MIS. METHODS: During surgery, the vitreous, the posterior hyaloid membrane, and fibrovascular proliferative tissue were removed by using bimanual dissection made possible by the MIS. MAIN OUTCOME MEASURES: Retinal reattachment rate, visual function, and postoperative complications were compared with previously published series of vitrectomy for diabetic traction retinal detachment. RESULTS: With a minimum of 6 months of follow-up, complete retinal reattachment was achieved in 62 eyes (93%), and macular attachment was achieved in all 67 eyes. Vision was stabilized or improved in 51 eyes (72%), and 5/200 vision was achieved in 47 eyes (70%). No unique complications, such as incision-related retinal tears, occurred. CONCLUSION: MIS allows bimanual surgery during vitrectomy for diabetic traction retinal detachment, with good visual and anatomic results.

Adult↗

PubMed2003

Combining phacoemulsification with pars plana vitrectomy in patients with proliferative diabetic retinopathy: a series of 223 cases.

PURPOSE: To describe the results of combined phacoemulsification, insertion of posterior chamber intraocular lens (PCIOL), and pars plana vitrectomy for patients with retinal disorders resulting from diabetic retinopathy. DESIGN: Retrospective, consecutive, noncomparative, interventional case series. PARTICIPANTS: Two hundred twenty-three patients with vitreoretinal disorders secondary to diabetic retinopathy. METHODS: A case series of 223 consecutive patients with retinal disorders resulting from diabetic retinopathy who underwent combined phacoemulsification, insertion of PCIOL, and pars plana vitrectomy. MAIN OUTCOME MEASURES: Vision, number of secondary procedures, and complications. RESULTS: Two hundred twenty-three patients (153 with vitreous hemorrhage, 58 with traction retinal detachment, and 12 with macular traction) underwent combined surgery. The average increase in vision was 4.3 Snellen lines. The average follow-up was 10 months. Retinal detachment occurred in 5% of patients who underwent surgery. Diabetic macular edema was found in 12% after combined surgery. Cystoid macular edema was found in 3%. Vitreous hemorrhage requiring another procedure occurred in 11%. Twenty-two patients (10%) required a repeat vitrectomy (12 for vitreous hemorrhage and 10 for retinal detachment). CONCLUSIONS: Combined phacoemulsification, insertion of PCIOL, posterior capsulectomy, and pars plana vitrectomy can be used to treat patients with complications resulting from proliferative diabetic retinopathy. Combined surgery may prevent a second operation for postvitrectomy cataract, allowing earlier visual rehabilitation.

Cataract↗