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At least 325 records · Page 18Linked to original sources

PubMed1992

[Chronic uveitis: course after vitrectomy].

Vitrectomy is an acknowledged method in the therapy of chronic uveitis and its complications. We analysed the functional results after vitrectomy of 106 patients (121 eyes). In more than 61% of the patients, the visual acuity improved more than one line. There is less glare, and stereoscopic vision is better. In 10% of the patients, the follow-up was complicated by a retinal detachment; in contrast, a primary retinal detachment was the indication for the vitrectomy in 19%. Our study shows that vitrectomy helps reducing the frequency of recurrence of uveitis and the intensity of drug therapy.

Chronic Disease↗

PubMed2002

Clinical outcomes of pars plana capsulotomy with anterior vitrectomy in pediatric cataract surgery.

PURPOSE: The management of the posterior capsule in pediatric cataract surgery remains challenging. The purpose of our study was to evaluate the role and clinical outcomes of primary pars plana capsulotomy and pars plana anterior vitrectomy during pediatric cataract surgery with intraocular lens (IOL) implantation. METHODS: Consecutive cases of pars plana capsulotomy and anterior vitrectomy during pediatric cataract surgery were retrospectively reviewed. The surgical technique was the same in all patients and involved pars plana capsulotomy with anterior vitrectomy after the IOL was implanted in the capsular bag. RESULTS: Seventy-six pediatric cataract cases in 61 patients performed from 1994 through 1999 used the pars plana posterior capsulotomy technique and were included in this analysis. A posterior chamber IOL was implanted in all cases. There were no intraoperative complications associated with the surgery. Median age at the time of surgery was 21 months. All patients had at least 1 year of follow-up and mean follow-up was 29.4 months. Among patients old enough to read Snellen's letters (53 eyes), final best-corrected visual acuity was 20/40 or better in 32 eyes (60%) and 20/50 to 20/200 in 21 eyes (40%). Poor final visual acuity was associated with deprivation amblyopia or optic nerve dysplasia or hypoplasia. There were no postoperative retinal complications or cases of IOL dislocation during the follow-up period. Seven eyes (9.2%) of five patients with a median age of 2.5 months developed reopacification of the visual axis at a mean of 4.1 months postoperatively. This event occurred in 6 of 28 eyes with an age of 6 months or less (21.4%), versus only 1 of 48 eyes with an age greater than 6 months (2.0%) (P =.006, Fisher exact test). The visual axis was restored by pars plana membranectomy in 6 eyes and 1 eye of one patient underwent neodymium:YAG laser membrane discission. CONCLUSIONS: Pars plana capsulotomy with pars plana anterior vitrectomy is a safe, effective method of managing the posterior capsule in pediatric cataract surgery with IOL implantation. Visual axis reopacification is associated with a very young age at the time of surgery. Continued follow-up of these patients is important to assess the long-term outcomes of this surgical approach.

Acrylic Resins↗

PubMed2004

Pars plana vitrectomy for vitreous opacity associated with ocular sarcoidosis resistant to medical treatment.

OBJECTIVE: To examine the results of pars plana vitrectomy for nonclearing vitreous opacities associated with ocular sarcoidosis that is resistant to corticosteroid treatment. METHODS: Eight consecutive patients (11 eyes) with vitreous opacities and uveitis associated with sarcoidosis were studied. All patients were resistant to or intolerant of corticosteroid therapy. All eyes underwent pars plana vitrectomy, followed by evaluation of visual acuity and recording of the grade of inflammation and complications. RESULTS: Seven eyes had gained two or more lines of Snellen visual acuity six months postoperatively; visual acuity remained unchanged in the other four eyes. Vitreous inflammation was reduced in all cases. Severe postoperative inflammation did not recur in any eyes. Five eyes developed visually significant cataracts and underwent cataract extraction and intraocular lens insertion within 8-30 months. Based on slit-lamp biomicroscopy and fluorescein angiography, preoperative cystoid macular edema in five eyes resolved or improved within six months after vitrectomy. Postoperative complications included elevated intraocular pressure in three eyes, cataract formation in six eyes, epiretinal membrane formation in one eye, and choroidal neovascularization in one eye. None of the patients developed cystoid macular edema postoperatively. Only three patients received systemic corticosteroids after surgery. At the final visit, only one patient required systemic corticosteroid therapy. CONCLUSIONS: Pars plana vitrectomy appears to have beneficial effects on restoring vision, stabilizing vitreous inflammation, and reducing systemic corticosteroid requirements in eyes with thick vitreous opacities associated with sarcoidosis that is resistant to medical treatment.

Adult↗

PubMedDate not supplied

Enzyme-assisted vitrectomy in enucleated pig eyes: a comparison of hyaluronidase, chondroitinase, and plasmin.

PURPOSE: Facilitation of vitrectomy by vitreolytic enzymes may be of great value in complicated or office-procedure vitreo-retinal surgery. In this study, we quantified and compared the effect of hyaluronidase, chondroitinase, and plasmin pre-incubation on vitrectomy rate and explored potential retinal damage. METHODS: Freshly enucleated pigs eyes were incubated (1 or 3 hours) with an intravitreally injected enzyme or control solution. Enzyme doses were 100 and 1000 U for hyaluronidase, 1 and 2 U for chondroitinase, 3 and 30 U for plasmin. The eyes were weighed before and after 10 minutes of one-port vitrectomy, the difference representing the amount of removed vitreous. Light microscopy was used to assess potential damage to the retina. RESULTS: All enzymes significantly increased the amount of removed vitreous at all doses and incubation periods. The highest increase was found with hyaluronidase 1000 U, 3 hours, the lowest with chondroitinase 1 U, 1 hour. Damage occasionally occurred to the internal limiting membrane and very rarely to the nerve fiber layer. No damage at all was seen in the 100 and 1000 U hyaluronidase (1-hour incubation) groups. CONCLUSIONS: Hyaluronidase, chondroitinase, and plasmin are good candidates for enzyme-assisted vitrectomy. Although retinal structural damage was very rarely seen, safety concerns will have to be investigated further.

Animals↗

PubMed2005

Vitrectomy for persistent panuveitis in Behçet's disease.

PURPOSE: To determine whether vitrectomy is safe and effective for the management of vitreoretinal complications in Behçet's patients with persistent panuveitis. METHODS: Patients who had undergone therapeutic vitrectomy for Behçet's panuveitis were reviewed retrospectively. Those patients who had shown persistent uveitis despite maximum medical therapy were included. Surgical outcomes were measured by an improvement in vision of 0.3 logarithm of minimum angle of resolution, acute relapse rates, and postoperative complications. RESULTS: Twenty-one patients with a mean postoperative follow-up of 30 months were identified. For almost all patients visual acuity and inflammatory control were significantly improved after vitrectomy. However, patients with optic disc neovascularization (NVD) showed no improvement in their vision or inflammatory control. The postoperative rise of intraocular pressure was frequently associated with intravitreal triamcinolone acetonide injections. CONCLUSIONS: Our study suggests that vitrectomy may be both safe and effective for the management of vitreoretinal complications in Behçet's patients with persistent uveitis. Patients with NVD, however, may have poor outcomes.

Adult↗

PubMedDate not supplied

Microsurgical instrumentation for vitrectomy: Part II.

The rapid progress in the field of vitrectomy since its recent commencement may be clearly related to the development of microsurgical instrumentation for vitrectomy. In the early 1970s, a number of vitrectomy instruments were introduced in close succession. The experiences gained from this first generation of products were quickly fed back to make modifications and improvements for a second generation of products. Guillotine action cutters and bimanual concepts, for example, became the preferred norm. Concurrently, various instrument systems were developed to satisfy procedures of which vitrectomy is a part. The system concept is still evolving as this new discipline matures.

Equipment Design↗

PubMedDate not supplied

Cataract and uveitis management by pars plana lensectomy and vitrectomy by ultrasonic fragmentation.

Cataract and uveitis occurs usually in young individuals and produces loss of vision from opacification of both the lens and vitreous. The condition does not lend itself to conventional surgery. In the experience of the authors and several other investigators, pars plana lensectomy and vitrectomy by ultrasonic fragmentation not only improves vision but apparently causes a remission of uveitis. A retrospective study of 23 eyes with cataract and uveitis undergoing pars plana lensectomy and vitrectomy by ultrasonic fragmentation (21 eyes) or vitrectomy alone (2 eyes) showed improved vision in 91.3%, no operative complications, and remission of the uveitis in 100% with observation periods of 1-11 years (average, 5 years). Pars plana lensectomy and vitrectomy appears to be the treatment of choice in cataract and chronic uveitis.

Adolescent↗

PubMed1987

Use of high-density fluorosilicone oil in open-sky vitrectomy.

During prolonged open-sky vitrectomy, fluid accumulates in the suprachoroidal and subretinal spaces and the resultant ballooning of the choroid and of the retina interferes with the surgery. Fluorosilicone oil (polymethyl-3,3,3-trifluoropropylsiloxane) with a specific gravity of 1.28 was tested for use as a temporary vitreous substitute during open-sky vitrectomy. After open-sky vitrectomy and bullous retinal detachment in pigmented rabbits, fluorosilicone oil flattened the retina completely in nine of nine eyes, whereas 1% sodium hyaluronate solution flattened the retina completely in only four of nine eyes. The flattening effect of fluorosilicone oil on the retina was also better than that of 1% sodium hyaluronate in an experiment with retinal detachment and giant retinal tear after open-sky vitrectomy.

Animals↗

PubMed1992

Variation of perfluoropropane disappearance after vitrectomy.

In complex cases of retinal detachment, perfluoropropane (C3F8) is frequently used after vitrectomy for tamponade of retinal breaks. Results of previous studies of C3F8 disappearance using 10% C3F8 after vitrectomy in human eyes have differed significantly. A wide variation in the decay rate and half life of C3F8 after vitrectomy was observed in eyes that had similar clinical settings and received the same C3F8 concentration (15%, 20%, or 25%). This occurred even in those eyes where there was no change in the geometric contour of the eye after a repeat vitrectomy.

Eye↗

PubMed1995

Vitrectomy alone for the management of uncomplicated recurrent retinal detachments.

BACKGROUND: The role of vitrectomy for the treatment of uncomplicated recurrent retinal detachments has not been defined clearly. The authors report their experience with vitrectomy alone for the management of such cases. METHODS: Pars plana vitrectomy with internal subretinal fluid drainage and long-term tamponade was performed on nine patients with uncomplicated recurrent retinal detachments after primary scleral buckling surgery. The duration of follow-up was a minimum of 6 months (mean, 39 months). RESULTS: Anatomic success was achieved after the initial reoperation in seven eyes (78%). The overall success rate was 89%. The visual acuity was 20/30 or better in three patients, 20/ 40 to 20/80 in three patients, and 20/200 in two patients. Complications included progressive nuclear sclerosis and macular pucker. CONCLUSION: Vitrectomy is effective and may have advantages over other methods for the management of uncomplicated recurrent retinal detachments.

Adult↗

PubMed1997

Postoperative posterior retinal holes after pars plana vitrectomy for primary retinal detachment.

BACKGROUND: Although retinal breaks occur frequently during vitrectomy, the postoperative occurrence of new retinal holes close to the vascular arcade after vitrectomy for rhegmatogenous retinal detachment rarely has been reported. METHODS: Three patients with rhegmatogenous, retinal detachment were treated by vitrectomy. More than 49 days after vitrectomy, posterior retinal holes with no retinal detachment occurred halfway between the vascular arcade and the chorioretinal scar around the extrusion hole or the primary retinal tear. RESULTS: These new holes were effectively managed with photocoagulation. CONCLUSION: New hole formation could be caused by the technique of the internal drainage, the contraction of the photocoagulation scar, or epiretinal membrane contraction. Another possibility is that new holes occur through two opposite tangential traction contractile forces: one induced by the contraction of the photocoagulation scar, the other caused by the contraction of the premacular cortical vitreous attached to the vascular arcade.

Aged↗

PubMed1998

Vitrectomy for diabetic retinopathy in patients undergoing hemodialysis for associated end-stage renal failure.

PURPOSE: Candidates for diabetic vitrectomy often have concurrent renal dysfunction and have undergone hemodialysis. The influence of hemodialysis on the surgical outcome of vitrectomy was investigated. METHODS: Vitrectomy was performed on 76 eyes with proliferative diabetic retinopathy in 66 patients with end-stage renal failure who had undergone hemodialysis. Follow-up was longer than 1 year. RESULTS: No uncontrollable hemorrhage occurred either during or immediately after the surgery. Final visual acuity after surgery was the same as preoperative visual acuity in 31.5% of the eyes; improvement was seen in 60.5% of the eyes. A final visual acuity of 0.2 or better was observed in 57.6% of the eyes. Major postoperative complications included recurrent vitreous hemorrhage, rhegmatogenous retinal detachment, fibrin clot formation, neovascular glaucoma, flat anterior chamber, and a transient rise in intraocular pressure. CONCLUSION: Renal failure and hemodialysis do not appear to have a deteriorative influence on the outcome of vitrectomy for proliferative diabetic retinopathy. A flat anterior chamber seems to be a rare and perhaps unique postoperative complication of gas-filled eyes in patients who have undergone hemodialysis.

Diabetic Retinopathy↗

PubMed2000

Topical anesthesia in posterior vitrectomy.

PURPOSE: To evaluate the efficacy of topical anesthesia as an alternative to peribulbar or retrobulbar anesthesia in posterior vitrectomy procedures. METHODS: Posterior vitrectomy using topical anesthesia (4% lidocaine drops) was performed prospectively in 134 eyes (134 patients) with various vitreoretinal diseases, including severe proliferative diabetic retinopathy (n = 69), vitreous hemorrhage (n = 12), rhegmatogenous retinal detachments (n = 11), epiretinal membranes (n = 10), macular holes (n = 7), dislocated crystalline lens or intraocular lens (n = 6), giant retinal tears (n = 5), intraocular foreign bodies (n = 3), trauma (n = 3), endophthalmitis (n = 3), subfoveal choroidal neovascular membrane (n = 3), and neovascular glaucoma (n = 2). In 26 (19.4%) eyes, posterior vitrectomy was combined with a scleral buckling procedure, and in 84 (62.6%) eyes, argon laser photocoagulation was performed. Preoperative and intraoperative sedation of varying degrees was necessary. Subjective pain and discomfort were graded from 1 (no pain or discomfort) to 4 (severe pain and discomfort). RESULTS: All patients had grade 1 pain and discomfort during most of the procedure. All patients had grade 2 (mild) pain and discomfort during pars plana sclerotomies, external bipolar cautery, and conjunctival closure. The average amount of 4% lidocaine drops needed during each procedure was 0.5 mL. No patient required additional retrobulbar, peribulbar, or sub-Tenon anesthesia. CONCLUSIONS: This technique avoids the risk of globe perforation, retrobulbar hemorrhage, and prolonged postoperative akinesia of the eye. With appropriate case selection, topical anesthesia is a safe and effective alternative to peribulbar or retrobulbar anesthesia in three-port pars plana vitrectomy procedures.

Adult↗

PubMed2000

Corneal endothelial cell loss in eyes undergoing lensectomy with and without anterior lens capsule removal combined with pars plana vitrectomy and gas tamponade.

PURPOSE: To assess prospectively the comeal endothelial damage associated with pars plana vitrectomy combined with lensectomy and gas tamponade. METHODS: The corneal endothelium was examined with a specular microscope preoperatively and 6 months postoperatively in 42 eyes that underwent pars plana vitrectomy combined with total lensectomy and gas tamponade with SF6 (19 eyes) or C3F8 (23 eyes), and in 12 control eyes that underwent vitrectomy combined with anterior capsule-preserved lensectomy and gas tamponade. RESULTS: The mean +/- SD endothelial cell loss was 17.19+/-7.88% in the SF6 tamponade group, 27.54+/-10.57% in the C3F8 tamponade group, and 3.49+/-2.68% in the control group. Significant differences were found in the mean cell loss among these three groups. The degree of cell loss was significantly related to gas tamponade duration in the eyes with total lensectomy. CONCLUSION: These results suggest that ophthalmic surgeons must try to preserve the lens capsule as much as possible in vitrectomy combined with lensectomy and long-acting gas tamponade in order to prevent corneal endothelial damage.

Adolescent↗

PubMed2003

Anatomic and functional results of vitrectomy and long-term intraocular tamponade for stage 2 macular holes.

PURPOSE: To investigate the results of pars plana vitrectomy combined with long-term intraocular tamponade in patients with a stage 2 macular hole. METHODS: In a retrospective study, 50 consecutive eyes operated on for stage 2 macular hole were reviewed. The surgical technique included pars plana vitrectomy, separation of the posterior hyaloid, and intraocular tamponade with either 12.5% perfluropropane (C(3)F(8)) gas or silicone oil. Patients treated with C(3)F(8) were instructed to keep face-down positioning for 3 or 4 weeks. Removal of silicone oil took place 4 or 5 weeks after the vitrectomy. RESULTS: Closure of the macular hole was achieved in all 50 eyes after one operation. The mean postoperative best-corrected distance visual acuity was 20/32 (range, 20/63-20/20), with 49 eyes (98%) having a postoperative visual acuity of 20/50 or better. Visual acuity improved in all eyes postoperatively, with a mean gain of 4.84 +/- 1.95 ETDRS lines. CONCLUSION: For stage 2 macular holes, vitrectomy combined with long-term intraocular tamponade can result in a very favorable anatomic and functional outcome that is as good as or better than the results described for other modalities. This approach simplifies the surgical technique, and both adjuvant-related complications and potential retinal damage related to internal limiting membrane peeling or use of indocyanine green are avoided.

Adult↗

PubMed2006

Incidence of rhegmatogenous retinal detachment after vitrectomy in eyes of diabetic patients.

PURPOSE: To assess the incidence of rhegmatogenous retinal detachment (RRD) after pars plana vitrectomy (PPV) among diabetic patients with complications of proliferative diabetic retinopathy. METHODS: Ninety-three eyes of diabetic patients-who underwent PPV with or without intraocular gas tamponade for complications of proliferative diabetic retinopathy-were reviewed retrospectively. Indication for vitrectomy was vitreous hemorrhage in 80 patients (86.1%), tractional retinal detachment in 3 (3.2%), and vitreous hemorrhage associated with tractional retinal detachment in 10 (10.7%). RESULTS: Four (4.3%) of 93 eyes developed an RRD after vitrectomy. The primary reason for vitrectomy was recurrent or nonresolving vitreous hemorrhage. The retina was attached with one additional surgical procedure in two of these eyes; the other two had to undergo a third operation before attachment was achieved. CONCLUSION: RRD occurs in a small percentage of patients after PPV with or without gas tamponade for vitreous hemorrhage or tractional retinal detachment caused by proliferative diabetic retinopathy. Thorough postoperative follow-up is important to make early diagnosis and intervention possible.

Cataract Extraction↗

PubMed1996

Optimal management of postoperative endophthalmitis and results of the Endophthalmitis Vitrectomy Study.

The Endophthalmitis Vitrectomy Study was a multicenter randomized clinical trial. A total of 420 patients who had developed acute endophthalmitis after cataract surgery were randomly assigned to undergo vitrectomy or tap and biopsy and to receive either systemic antibiotics (ceftazidime and amikacin) or no systemic antibiotics. At 9 months patients were assessed for final visual acuity and media clarity. There was no difference in final visual acuity or media clarity whether or not systemic antibiotics were used. Patients who presented with hand motion acuity or better did not show a benefit from immediate vitrectomy. However, patients who presented with light-perception-only visual acuity had substantial benefit over immediate vitrectomy, with a threefold (33% vs 11%) increased frequency of achieving 20/40 vision or better, double the frequency of achieving 20/100, and a decrease by half in the frequency of severe visual loss to less than 5/200. These differences were statistically significant.

Aged↗

PubMed2001

Suprachoroidal hemorrhage during pars plana vitrectomy.

Suprachoroidal hemorrhage is an uncommon but serious complication of pars plana vitrectomy that can be associated with a guarded visual prognosis. Risk factors for development of suprachoroidal hemorrhage during pars plana vitrectomy include high myopia, history of previous retinal detachment surgery, rhegmatogenous retinal detachment, use of cryotherapy, scleral buckling at the time of pars plana vitrectomy, external drainage of the subretinal fluid, intraoperative systemic hypertension, and bucking during general anesthesia. In eyes with suprachoroidal hemorrhage during pars plana vitrectomy, the final visual and anatomic outcomes may be compromised by persistent retinal detachment, secondary glaucoma, and ocular hypotony. In most cases, intraoperative drainage of suprachoroidal hemorrhage is not associated with a better outcome. The prognosis is more favorable if the suprachoroidal hemorrhage is localized and does not extend in to the posterior pole.

Choroid Hemorrhage↗