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At least 343 records · Page 19Linked to original sources

PubMed2007

Long-term outcomes of vitrectomy with or without arteriovenous sheathotomy in branch retinal vein occlusion.

PURPOSE: To evaluate the long-term effect of vitrectomy with or without arteriovenous sheathotomy for macular edema secondary to branch retinal vein occlusion (BRVO). METHODS: The study was a prospective, randomized, comparative, interventional case series of 36 patients (36 eyes) who underwent pars plana vitrectomy with or without arteriovenous sheathotomy for macular edema due to BRVO of <or=8 weeks' duration of symptoms. Eighteen eyes with arteriovenous sheathotomy (sheathotomy group) were compared with 18 eyes without sheathotomy (vitrectomy group). Main outcomes measures were best-corrected visual acuity and central foveal thickness as evaluated by optical coherence tomography. RESULTS: Baseline demographic characteristics of the groups were similar. Postoperative follow-up period ranged from 12 months to 45 months (31 months). Median best-corrected visual acuity significantly improved from 0.4 at baseline to 1.0 at the final visit in both groups, and there was no significant difference in best-corrected visual acuity at any postoperative period between the groups. Of 16 patients with duration of symptoms of <4 weeks, those with arteriovenous sheathotomy had a tendency toward better visual outcomes than those without arteriovenous sheathotomy (P = 0.064). The central foveal thickness also significantly decreased after surgery in both groups, but the differences were not significant for the two groups at each time point. No patients had severe intraoperative and/or postoperative complications. CONCLUSIONS: Our findings suggest that vitrectomy with or without arteriovenous sheathotomy may improve the long-term functional and tomographic outcomes for patients with macular edema secondary to BRVO. Although additional arteriovenous sheathotomy did not lead to a distinct functional benefit in this series, early surgical intervention may result in better visual outcomes.

Adult↗

PubMed2004

Combining phacoemulsification and vitrectomy in patients with proliferative diabetic retinopathy.

PURPOSE OF REVIEW: Modern vitrectomy and cataract extraction techniques have reached levels not imagined 20 years ago. Combining pars plana vitrectomy with phacoemulsification and posterior capsulectomy now has the potential to condense three separate procedures: pars plana vitrectomy, phacoemulsification, and YAG capsulotomy into one procedure. Interest in combined surgery is increasing as reports in the literature documenting its safety and efficacy continue to be published. The purpose of this article is to review the recent trends in combined surgery. RECENT FINDINGS: Studies have shown that when comparing sequential surgery to combined surgery, there is no significant difference in visual outcome. Multiple reports confirm the safety of combined surgery in patients with proliferative diabetic retinopathy. SUMMARY: In select patients with diabetes, combining vitrectomy with phacoemulsification and posterior capsulectomy allows patients who often have bilateral vitreoretinal disease to come to a stable postoperative vision in the eye requiring vitreous surgery much earlier than three separate procedures spread out over months or years.

Cataract↗

PubMed2004

Auckland proliferative diabetic vitrectomy fellow eye study.

BACKGROUND: To review medical and ophthalmic findings of primary diabetic vitrectomy patients to examine indices important in progression to fellow eye surgery. METHODS: A retrospective analysis was undertaken of all diabetic patients undergoing vitreoretinal surgery at Auckland Public Hospital between January 1992 and July 1996. Kaplan-Meier survival analysis was performed along with univariate and multivariate (Cox Proportional Hazards) data analysis. RESULTS: One hundred and fourteen primary diabetic vitrectomy cases were reviewed with mean follow-up duration of 4 years. Thirty-eight per cent (n = 43) of the study group underwent fellow eye surgery at a mean time of 1.6 years after first eye surgery. Fourteen patients were already blind in the fellow eye at baseline, and five patients refused second eye surgery on intention to treat. Thus there were 62 (54%) patients with severe (surgical threshold) fellow eye disease diagnosed within the follow-up period. The presence of either tractional retinal detachment or combined rhegmatogenous/tractional retinal detachment but without vitreous haemorrhage in the presenting eye was, in this series, a risk factor for fellow eye surgery (OR 5.56; 95% CI 1.96-15.8). Maori and Pacific Islander ethnicity was significantly associated with traction retinal detachment (OR 2.23; 95% CI 1.05-4.7). At data analysis 57% (n = 60) of the study patients had died. The mean time to death was 4.3 years, with 84% of these patients having evidence of renal disease at the time of their first eye surgery. Good visual function in at least one eye was maintained in many patients. CONCLUSIONS: A substantial proportion of diabetic vitrectomy patients require fellow eye surgery. Absence of vitreous haemorrhage in the presenting eye (i.e. tractional or combined rhegmatogenous/tractional retinal detachments but without vitreous haemorrhage) was predictive of need for fellow eye surgery. The need for diabetic vitrectomy correlates with poor survival in this study population.

Adult↗

PubMed2005

Effects of pars plana vitrectomy on retrobulbar haemodynamics in diabetic retinopathy.

BACKGROUND: The purpose of the present study was to determine the effects of pars plana vitrectomy on retrobulbar haemodynamics in patients with proliferative diabetic retinopathy (PDR). METHODS: Colour Doppler imaging was used for measurement of blood flow velocities and resistive index of the ophthalmic artery (OA), posterior ciliary arteries (PCA) and central retinal artery (CRA) in 14 eyes of 14 patients with PDR before pars plana vitrectomy and at the 1 and 6 months after operation. The patients were also treated by laser photocoagulation before or during surgery. Twenty age- and sex-matched healthy subjects were used as control group. RESULTS: Mean peak systolic velocity and the end diastolic velocity of the CRA in the patients with PDR were lower and the mean resistive index was higher than in those of the control group (P < 0.05). The mean end diastolic velocity of OA in the patients was lower and the mean resistive index was higher than in the control group (P < 0.05). The peak systolic velocity of the OA and the end diastolic velocity of the CRA were significantly increased (P = 0.043 and P = 0.018, respectively) and the mean resistive index of the CRA was significantly decreased after pars plana vitrectomy (P = 0.043). No significant changes were detected among preoperative and postoperative values of peak systolic velocity, end diastolic velocity, and resistive index of the PCA and the mean velocity of the central retinal vein (P > 0.05). CONCLUSIONS: The blood flow velocities of OA and CRA are decreased but the resistive index is increased significantly in patients with PDR. Pars plana vitrectomy in patients with PDR may decrease resistive index and improve blood flow in the CRA.

Adult↗

PubMed2006

Tilt and decentration of the intraocular lens following combined vitrectomy and pars plana lensectomy.

PURPOSE: To investigate intraocular lens (IOL) tilt and decentration following combined vitrectomy and pars plana lensectomy (PPL) with IOL implantation in patients with proliferative diabetic retinopathy. METHODS: We followed 25 patients with proliferative diabetic retinopathy who underwent PPL and IOL (MA60BM) implantation at the time of pars plana vitrectomy (PPL group), and 25 patients who underwent phacoemulsification and IOL (MA60BM) implantation without vitrectomy (PE group). Intraocular lens tilt and decentration were evaluated quantitatively, using the anterior eye segment analysis system, approximately 12 months after surgery. RESULTS: There was no significant difference in IOL tilt (p = 0.47) or decentration (p = 0.26) between the PPL and PE groups. CONCLUSIONS: The present study suggests that tilt and decentration of the IOL are acceptable in combined vitrectomy and pars plana lensectomy.

Aged↗

PubMed2006

Vitrectomy for non-ischaemic macular oedema in retinal vein occlusion.

PURPOSE: To evaluate the effect of vitrectomy in eyes with non-ischaemic macular oedema secondary to hemi and central retinal vein occlusion. METHODS: This retrospective study analysed the outcome of eight patients with non-ischaemic macular oedema without posterior vitreous detachment. Six patients had a central retinal vein occlusion and two had a hemi retinal vein occlusion. A standard three-port vitrectomy was performed in all patients. Retinal mapping by optical coherence tomography and visual acuity (VA) testing were performed before vitrectomy and at 1, 2 and 12 months postoperatively. RESULTS: At the 1-month follow-up there was a statistically significant reduction in retinal thickness (Wilcoxon; p = 0.04) that persisted at 2 months (Wilcoxon; p = 0.04). However, at 12 months there was no difference compared with baseline. LogMAR VA was significantly improved at 1 month (Wilcoxon p = 0.04), but at 2 and 12 months there was no difference compared with baseline. CONCLUSIONS: Vitrectomy in hemi and central retinal vein occlusion has the potential to reduce macular oedema and improve VA in the early postoperative phase but does not seem to improve the longterm outcome of the disease.

Adult↗

PubMed1983

Prognostic parameters in pars plana vitrectomy.

Based on a period of introduction with the vitrectomy technic the visual acuity results in 143 consecutive cases performed between 1976 and 1980 are related to the anamnestic information, the pre-, per- and post-operative findings. In this introductional period the patients referred had longstanding retinovitreal changes, and, because of lack of prognostic parameters, all patients were offered surgery regardless of the observed pathology. All vitrectomies were carried out with the Klöti macrostripper and diathermy unit, without any additional instrumentation. From the results of these early cases, we have changed our surgical method to a three-port entrance with a separate infusion canula, a separate fiberoptic illumination and an interchange between vitrector, automatic scissors, hook, stilleto, vacuo needle, forceps and intravitreous photocoagulation through a third port. Diabetics should be offered vitrectomy if vitreous haemorrhages last for more than 3 months. Vitrectomy is considered useless or contraindicated in diabetics with lack of light perception or light projection, neovascular glaucoma, extinguished visual evoked potential. Only an improvement in the peripheral vision can be expected in diabetics with macular detachment. In rhegmatogenous detachment cases with intravitreal traction, vitreous operations should be performed only where intraretinal or retroretinal changes do not prevent mobilization or unfolding of the retina. Traumatic vitreoretinal disorders should be operated upon early.

Adolescent↗

PubMed1985

Some experimental data concerning the safety of vitrectomy.

Several reasons why vitrectomy does not compromise retinal functions are shown, based on closed and open-sky vitrectomy on the rabbit eye. We observed that ERG b- and c-waves were stable during and after open-sky vitrectomy. The c-wave disappeared when the retina was detached. Function of the retinal ganglion cells after vitrectomy was shown to be almost normal by electrophysiological studies and by measured amounts of axonally transported radioactive proteins.

Animals↗

PubMed2006

The effect of pars plana vitrectomy on cystoid macular oedema associated with chronic uveitis: a randomised, controlled pilot study.

AIM: To evaluate the efficacy of pars plana vitrectomy (PPV) in the management of chronic uveitic cystoid macular oedema (CMO). METHODS: A prospective, interventional, randomised, controlled, pilot study. 23 eyes of 23 patients with CMO secondary to chronic intermediate or posterior uveitis unresponsive to medical treatment were randomised into a surgical (group S) or medical group (group M). 12 patients in group S underwent PPV as opposed to 11 patients in group M who received systemic corticosteroid and/or immunosuppressive treatment during the study period. The primary outcome measures of the study were change in visual acuity and angiographic appearance of CMO at 6 months. RESULTS: Mean visual acuity in group S improved significantly from 1.0 (0.62) at baseline to 0.55 (0.29) at 6 months following vitrectomy (p = 0.011), with five (42%) eyes reaching vision of 20/40 or better. Conversely, mean visual acuity in group M improved only marginally by 0.03 (0.27) (p = 0.785). CMO after vitrectomy was angiographically improved in four (33%) eyes, remained unchanged in seven (58%) eyes, and deteriorated in one (8%) eye. In the medical group, fluorescein leakage decreased in one eye, did not alter in four eyes, and deteriorated in two eyes. CONCLUSION: PPV for macular oedema secondary to chronic uveitis despite angiographic improvement in only one third of the patients, seems to have a significant beneficial effect on visual function. This study provides enough evidence to justify a large scale trial which would define the role of vitrectomy in uveitic macular oedema.

Adult↗

PubMed1994

Long-term results of pars plana vitrectomy in the management of complicated uveitis.

This retrospective study evaluates the long term efficacy of pars plana vitrectomy on the preservation of vision in complicated chronic uveitis, including endogenous intermediate uveitis and other entities. Combined vitrectomy-lensectomy was performed in 10 eyes with complicated cataracts, and 18 vitrectomies were done without lensectomies. The mean follow up was 45 months. Additional retinal surgery (for example, scleral buckling) was performed in five eyes. Visual acuity improved in 23 eyes (82.8%) following surgery, with 16 eyes (57%) achieving a vision better than 6/24. The main causes for vision less than 6/24 were persistent cystoid macular oedema (three eyes), macular puckers (one eye), retinal vascular obliterations (four eyes), optic atrophy (five eyes), and chorioretinal scars (seven eyes). Postoperative complications were cataract formation (seven eyes), cystoid macular oedema (one eye), and tractional retinal detachments (three eyes). The surgical intervention resulted in a remarkable reduction of the severity of inflammation or frequency of exacerbations, and allowed significant tapering (11 eyes) or withdrawal (11 eyes) of the topical steroids, or oral corticosteroids (10 cases). Pre-existent cystoid macular oedema resolved in three eyes. Pars plana vitrectomy, eventually combined with lensectomy, may visually rehabilitate eyes with chronic uveitis and media opacities, and may reduce the activity of disease postoperatively.

Adolescent↗

PubMed2001

Results of vitrectomy performed at the time of phacoemulsification complicated by intravitreal lens fragments.

AIM: To evaluate outcome of vitrectomy performed at the time of phacoemulsification complicated by intravitreal lens material. METHODS: Clinical records associated with consecutive 8536 phacoemulsification procedures were reviewed retrospectively. RESULTS: 17 (0.20%) eyes had a posterior capsule rupture with retained lens material in the vitreous cavity that required vitrectomy. Final visual acuity was 0.5 or better in 14 eyes (82%) and 0.4 to 0.1 in three eyes (18%). Retinal detachment occurred in one eye during vitrectomy and two after the surgery. Cystoid macular oedema was observed in two eyes and none developed glaucoma. The corneal endothelial cell loss was 5.7% (SD 6.8 %) (n=15) at 3-6 months postoperatively. CONCLUSIONS: Combined vitrectomy and intraocular lens implantation at the time of phacoemulsification complicated by intravitreal lens material is an option to be considered to reduce the risk of postoperative complications including secondary glaucoma and corneal endothelial cell damage.

Aged↗

PubMed2003

Use of perfluorocarbon liquid during vitrectomy for severe proliferative diabetic retinopathy.

AIM: To evaluate the value of using perfluorocarbon liquid (PFCL) during vitrectomy in eyes with proliferative diabetic retinopathy (PDR). METHODS: The surgical records of eyes with PDR (291 eyes of 228 patients) that underwent vitrectomy in the vitreoretinal service of Osaka Medical College (April 1999 to October 2001) were reviewed. From these, 18 eyes of 15 patients had PFCL used during vitrectomy, and the preoperative and postoperative findings of these eyes were analysed. RESULTS: All of the 18 eyes had advanced PDR with tractional and/or rhegmatogenous retinal detachment. PFCL enabled easier flattening of the retinal folds and effective endophotocoagulation. In two cases, PFCL was used to flatten a bullous retinal detachment that developed when a tight vitreoretinal adhesion was loosened. In two other cases with combined traction/rhegmatogenous retinal detachment, PFCL was used to tamponade the detached retina which then allowed successful membrane dissection. Anatomical success was obtained in 16 of the 18 cases (mean follow up time 13.3 months) with visual acuity of 20/200 or better in nine eyes (50%). CONCLUSIONS: PFCL is considered to be a useful adjunct during vitrectomy for the treatment of severe PDR.

Adult↗

PubMedDate not supplied

Vitrectomy for diabetic macular edema with and without internal limiting membrane removal.

PURPOSE: To compare the efficacy of surgically removing or not removing the internal limiting membrane (ILM) during pars plana vitrectomy on the visual acuity and retinal thickness in eyes with diabetic macular edema. METHODS: A prospective, case-control study was carried out on 30 eyes of 29 patients undergoing pars plana vitrectomy for diabetic macular edema. Fifteen eyes underwent pars plana vitrectomy with ILM removal and 15 eyes without ILM removal. RESULTS: In 7 of 15 eyes (47%) in the ILM-removed group, the visual acuity improved by 0.2 or more log of the minimum angle of resolution (log MAR) units and remained unchanged in 8 eyes (53%). In the ILM-preserved group, the final visual acuity improved in 9 of 15 eyes (60%) and remained unchanged in 6 eyes (40%). The difference in visual acuity between the two groups after 11 months the surgery was not significant (Fisher's exact test, p=0.4938). In the ILM-removed group, the final retinal thickness decreased by more than 20% of the preoperative retinal thickness in 12 of 15 eyes (80%), remained unchanged in 2 of 15 eyes (13%), and increased in 1 of 15 eyes (7%). In the ILM-preserved group, the final retinal thickness decreased in 13 of 15 eyes (87%) and remained unchanged in 2 of 15 eyes (23%). The differences in the changes in the retinal thickness between the two groups were not statistically significant (Fisher's exact test, p=0.5945). CONCLUSION: Vitrectomy in eyes with diabetic macular edema without ILM removal was as effective in reducing the retinal thickness and improving the visual acuity as eyes with ILM removal. We conclude that ILM need not be removed to treat eyes with diabetic macular edema.

Adult↗

PubMed2006

Long-term outcome after vitrectomy for diabetic macular edema.

BACKGROUND: To determine the benefit of vitrectomy on eyes with diabetic macular edema. METHODS: A retrospective institutional case series was used including 66 patients (69 eyes) who had undergone pars plana vitrectomy for diabetic macular edema between 1992 and 2000. Prior to surgery, the patients had been treated with laser coagulation as recommended by the Early Treatment Diabetic Retinopathy Study. In the case of persistent macular edema, vitrectomy with removal of the posterior hyaloid in all cases and the inner limiting mem brane in 51 (74%) of all cases was performed. RESULTS: The mean preoperative best-corrected visual acuity improved from 20/320 to 20/80 at the time of best postoperative best-corrected visual acuity (p < 0.0001). The mean increase in Snellen lines was 2.7 +/- 7.9. In 90% of eyes, the macular edema improved. A persistence of the edema was observed in 10%. All eyes had at least 12 months of follow-up with a mean of 55 months and a maximum of 120 months. CONCLUSIONS: Our findings confirm that vitrectomy might represent a therapeutic alternative in the case of persisting diabetic macular edema after laser photocoagulation.

Adult↗

PubMed2006

Scleral resection technique combined with vitrectomy for a macular hole retinal detachment in highly myopic eyes.

PURPOSE: To evaluate scleral resection technique combined with vitrectomy for macular hole retinal detachment of highly myopic eyes. MATERIALS AND METHODS: Seventeencases (17 eyes) of macular hole retinal detachment in highly myopic eyes, in which the patient underwent vitrectomy combined with scleral resection technique formacular hole retinal detachment between January 1996 and December 2003 at Fukuoka University Chikushi Hospital, were studied. Following pars plana vitrectomy, as much as possible of the residual vitreous and/or epiretinal membrane was removed. A scleral resection was performed in 2 quadrants of the equatorial region of the temporal sclera. Finally, a fluid-air exchange with SF(6) gas injection was performed to achieve retinal attachment. Pre- and postoperative axial length of the eyeballs were measured by B-scan ultrasonography. RESULTS: All cases had the retina reattached at the initial surgery, and visual acuities were stabilized or improved after the surgery. The posterior staphyloma became obscure in 13 out of 17 eyes (76.8%). The macular hole closed in 14 of 17 eyes (82.4%) ophthalmoscopically. There were no cases in which retinal redetachment occurred during follow-up periods of more than 6 months. CONCLUSION: In cases of macular hole retinal detachment of a highly myopic eye, scleral resection technique combined with vitrectomy changed the shape of the eyeballs and allowed successful retinal reattachment at the initial surgery.

Aged↗

PubMed1992

Intraocular irrigating solutions and vitrectomy-related changes (in protein, lactic and ascorbic acid) in rabbit vitreous.

Vitrectomy and the subsequent vitreous fluid exchange alter the chemical and physical properties of the vitreous. This study assessed the time course alterations of total protein, ascorbic acid and lactic acid in the rabbit vitreous cavity following vitrectomy. Normal values were 2.2 +/- 1.2 mg/ml, 8.5 +/- 1.0 mg/100 ml and 16.8 +/- 3.5 mumol/ml, respectively. Nine groups of 5-10 adult albino rabbits underwent closed vitrectomy using physiologic saline, Ringer's lactate and BSS plus solutions. Samples were withdrawn at 3 and 24 h and 7 days after vitrectomy. Total protein levels increased in all groups at 3 and 24 h (20-30 mg/ml). Ascorbic acid measurements at 24 h rose only with saline and BSS plus. At 24 h the BSS plus group was the only one demonstrating an increased lactic acid concentration.

Animals↗

PubMed1989

[Vitrectomy in florid proliferative diabetic retinopathy].

In 11 eyes out of 7 patients, vitrectomy was performed for progressive proliferative diabetic retinopathy. The indication for vitrectomy was as follows: (1) macular traction with fibrovascular proliferation on the disk; (2) progressive proliferation with vitreous hemorrhage; (3) fibrovascular proliferation on the disk in spite of intensified scattered photocoagulation. 3 eyes were operated a second time, 1 needed a third vitrectomy after nonresolving hemorrhage. Visual acuity increased after vitrectomy in 9 eyes. In 4 eyes new proliferations on the disk occurred. After an observation period of 1 year, 7 eyes show a stable course.

Adolescent↗

PubMed2003

Changes in focal macular electroretinograms and foveal thickness after vitrectomy for diabetic macular edema.

PURPOSE: To evaluate the changes in the focal macular electroretinogram (FMERG) and foveal retinal thickness after vitrectomy for diabetic macular edema (DME). METHODS: FMERGs were elicited from 25 eyes of 21 patients (ages 29-75 years) who underwent vitrectomy for DME by a 15 degrees stimulus. A posterior vitreous detachment (PVD) was created during surgery in 19 eyes (group 1), and 4 eyes had a PVD before surgery (group 2). In the remaining 2 eyes, a PVD could not be created (group 3). FMERGs were recorded before and 3, 6, and 12 months after vitrectomy. The foveal thickness, determined by optical coherence tomography (OCT), and visual acuity were measured on the same day as the FMERG recordings. RESULTS: The postoperative visual acuity (logarithm of the minimum angle of resolution [logMAR]) improved gradually after the surgery and was significantly better at 12 months in eyes in group 1 (P = 0.0393). The postoperative mean foveal thickness was significantly less at 3 months after surgery in group 1 eyes (P = 0.0006), and there was a further decrease thereafter. In the 2 eyes in group 3, the decreased foveal thickness 3 and 6 months after surgery became thicker at 12 months. The mean b-wave amplitude of the FMERGs increased significantly at 12 months in group 1 eyes (P = 0.0297). The mean implicit time of a- and b-waves was more delayed at 3 months, and the change in a-wave was statistically significant in group 1 eyes (P = 0.0474). There was a wide range of changes in the b-wave amplitude at 12 months, however, the increase in the b-wave was correlated with the decrease in foveal thickness (r =.49, P = 0.012). CONCLUSIONS: A disparity in the time course and degree of recovery of the foveal thickness and macular retinal function was found in eyes with DME after vitrectomy. Part of the functional recovery could be attributed to decreased retinal thickness and the absorption of the subretinal fluid.

Adult↗