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At least 37 records · Page 2Linked to original sources

PubMed2000

[Air endotamponade in 52 vitrectomies due to proliferative diabetic retinopathy--retrospective comparison with 40 vitrectomies without endotamponade].

BACKGROUND: In patients with proliferative diabetic retinopathy rebleeding after pars plana vitrectomy is one of the most common complications. We tried to reduce the rate of that complication by using an air endotamponade. PATIENTS AND METHODS: The following study is a retrospective comparison of 2 patient groups both after pars plana vitrectomy due to proliferative diabetic retinopathy. Group 1 was managed with air as endotamponade (n = 52, mean age 61.2 years), group 2 without any endotamponade (n = 40, mean age 59.4 years). Classification of the proliferative diabetic retinopathy as described by Kroll et al. [5] in both groups: 23 and 29 patients with stage A resp., 24 and 10 patients with stage B resp., 5 and 1 patient with stage C respectively. RESULTS: 77% of group 1 patients had an increase os vision by mean of 4.8 vision steps, in 70% of the group 2 patients vision increased by mean of 7.2 vision steps. Complications in both groups as follows: Rebleeding within 14 days 15% vs. 33%, development of secondary glaucoma in 9.6% and 17.5% resp., revitrectomy within 14 days were necessary in 3.8% resp. 2.5% of the patients, later revitrectomy in 13.5% vs. 42.5% of all patients. SUMMARY: Air endotamponade turned out to be appropriate to reduce the rate of postoperative vitreous rebleeding after pars plana vitrectomy due to proliferative diabetic retinopathy. We found no increase of secondary glaucoma or cataract.

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PubMed1998

[Vitrectomy for treatment of ocular complications in diabetes. III. Factors influencing results of vitrectomy].

UNLABELLED: The aim of this study was to find factors influencing results of pars plana vitrectomy for proliferative diabetic retinopathy. MATERIAL AND METHODS: 25 general and local factors which could influence results of pars plana vitrectomy (ppV) were selected and compared with functional results of surgery of 168 eyes with diabetic retinopathy. RESULTS: The most significant general factor was the age during ppV and the age at diagnosis of diabetes. Glycosylated hemoglobin blood level had little influence on ppV results. The most important local factor was the morphological state of the retina before the surgery. Better functional results were also achieved in eyes treated with panretinal photocoagulation before ppV and treated with vitrectomy without silicone oil tamponade when visual acuity was better than 5/50. CONCLUSIONS: General state of patients before ppV has little influence on functional results of ppV. Local factors are the main factors influencing this results.

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PubMed2004

Surgery for idiopathic full-thickness macular hole: two-year results of a randomized clinical trial comparing natural history, vitrectomy, and vitrectomy plus autologous serum: Morfields Macular Hole Study Group RAeport no. 1.

OBJECTIVES: To determine the benefits of idiopathic full-thickness macular hole (FTMH) surgery compared with observation and to evaluate the use of autologous serum as an intraoperative adjunct. METHODS: A randomized clinical trial was performed to evaluate the anatomic and visual benefits of FTMH surgery for lesions of 9 months or less symptom duration and visual acuity of 20/60 or less. We compared surgery with natural history and determined whether use of intraoperative adjunctive autologous serum improves the surgical outcome. Eyes were randomized to (1). observation, (2). vitrectomy, or (3). vitrectomy plus serum and were followed for 24 months to assess anatomic status and visual function. RESULTS: In total, 185 eyes of 174 patients were enrolled. In the observation group, spontaneous closure of the FTMH occurred in 7 (11.5%) of 61 patients, with little or no change in overall acuity levels in 24 months. In contrast, the surgical groups had an overall closure rate of 80.6% (100/124) at 24 months, with 45% of eyes achieving Snellen acuity of 20/40 or greater. Surgical eyes had better median near acuity than observation eyes by 6 lines (N5 vs N14). Use of autologous serum did not seem to affect anatomic or visual results. At 24 months, 72 (58.1%) of 124 surgical eyes had undergone cataract extraction. CONCLUSIONS: Surgery for FTMH is safe and effective and is associated with significant visual improvement compared with the natural history. Autologous serum application does not enhance the results of surgery.

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PubMed1997

Vitrectomy for the treatment of full-thickness stage 3 or 4 macular holes. Results of a multicentered randomized clinical trial. The Vitrectomy for Treatment of Macular Hole Study Group.

OBJECTIVE: To prospectively assess the risks and benefits of vitrectomy surgery for eyes with stage 3 or 4 macular holes. DESIGN: A multicentered, controlled, randomized clinical trial. SETTING: Community- and university-based ophthalmology clinics. PATIENTS: One hundred twenty patients (129 eyes) with stage 3 or 4 macular holes. INTERVENTIONS: Standardized macular hole surgery vs observation alone. MAIN OUTCOME MEASURES: Four measures of best-corrected visual function, standardized photographic evaluation of the extent of hole closure, evaluation of lens opacification, and determination of adverse events. Outcomes were determined at 6 months after randomization. RESULTS: Compared with observation alone, a significant benefit due to surgery was found in the rate of hole closure (4% vs 69%, P < .001). After adjusting for baseline visual acuity, hole duration, and maximum hole diameter, a significant benefit due to surgery was found in visual acuity for the Bailey-Lovie Word Reading (P = .02) and the Potential Acuity Meter (P < .01) tests; a marginally significant benefit due to surgery was found in visual acuity for the Early Treatment Diabetic Retinopathy Study chart (P = .05). Although the proportion of eyes achieving a change in visual acuity of 2 or more lines on the Early Treatment Diabetic Retinopathy Study chart was significantly greater for the surgery group vs the observed group (11 [19%] of 59 eyes vs 3 [5%] of 58 eyes, adjusted P = .05), 20 (34%) of 59 eyes randomized to surgery had a loss in visual acuity of 1 or more lines. Compared with the observation group, eyes randomized to surgery had higher nuclear sclerosis scores (2.4 vs 1.3, P < .001). Fourteen adverse events were noted in the surgery group; none were noted in the observed group. CONCLUSIONS: Some visual benefit of vitrectomy surgery for macular holes exists, despite a notable incidence of adverse events. The large variability in visual acuity outcome in the surgical group may be because of complications or progressive cataract. A study of the long-term outcome after macular hole surgery is needed.

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PubMed2006

Pars plana vitrectomy versus combined pars plana vitrectomy-scleral buckle for primary repair of pseudophakic retinal detachment.

PURPOSE: To evaluate pars plana vitrectomy (PPV) versus a combined PPV and scleral buckle (PPV/SB) for repair of noncomplex, pseudophakic retinal detachment. DESIGN: Retrospective, nonrandomized, comparative interventional study. PARTICIPANTS: One hundred fifty-two eyes of 152 patients followed up for a mean of 10 months. The case series included 68 consecutive patients who underwent PPV and 84 consecutive patients who underwent a PPV/SB for primary repair of primary pseudophakic retinal detachment at Wills Eye Hospital between 2002 and 2004. METHODS: All primary PPV cases were performed by 2 surgeons who perform primary vitrectomy without regard to location of detachment, number and location of break(s), refractive error, or macula status. All primary PPV/SB were performed by a group of surgeons who solely perform PPV/SB on pseudophakic retinal detachments. All eyes underwent a standard 3-port 20-gauge PPV under wide-field viewing and scleral depression. Endolaser photocoagulation was applied either around the retinal tears or 360 degrees to the vitreous base region followed by gas tamponade. Patients with proliferative vitreoretinopathy grade C or worse were excluded from the study. MAIN OUTCOME MEASURES: (1) Single surgery anatomic success rates, (2) preoperative and postoperative visual acuity, and (3) complications. RESULTS: The single surgery anatomic success rate in the primary PPV group was 63 of 68 eyes (92.6%; 95% confidence interval [CI], 84%-98%) and in the primary PPV/SB group was 79 of 84 eyes (94.0%; 95% CI, 87%-98%). Both groups obtained 100% final reattachment rate. There was no statistically significant difference between the success rates (P = 0.75, Fisher exact test). The PPV group's best-corrected postoperative visual acuity demonstrated a +0.10 logarithm of the minimum angle of resolution improvement over the PPV/SB group (P = 0.07). The PPV group had a smaller incidence of postoperative complications (13/68 patients [19.1%] vs. 27/84 patients [32.1%]; P = 0.10, Fisher exact test). CONCLUSIONS: Primary PPV and PPV/SB seem to have similar efficacy in the repair of a matched group of patients with primary noncomplex pseudophakic retinal detachment. There was no statistically significant difference in complication rate between the 2 groups.

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PubMed1996

Prospective randomized trial of vitrectomy or observation for stage 2 macular holes. Vitrectomy for Macular Hole Study Group.

PURPOSE: To determine the risks and benefits of vitrectomy surgery in eyes with stage 2 macular holes. METHODS: A multicentered, controlled, randomized clinical trial was performed with participation of 16 community and university-based ophthalmology clinics. Thirty-six eyes with stage 2 macular holes and 12 months of follow-up were studied. Pars plana vitrectomy with separation of the posterior hyaloid membrane and intraocular injection of perfluoropropane (C3F8) was followed by postoperative face-down positioning for two weeks. This protocol was compared with observation alone. Outcome variables included anatomic closure of the macular hole, macular hole size, and four standardized measures of vision. RESULTS: At 12 months, 15 (71%) of 21 eyes randomly assigned to observation progressed to stages 3 or 4, compared with three (20%) of 15 eyes randomly assigned to surgery (P < .006). Compared with eyes randomly assigned to observation, eyes randomly assigned to surgery had significantly smaller hole diameters (P < .01) and significantly better visual acuity outcomes, as measured by the Word Reading (P = .02) and Potential Acuity Meter (P = .002) charts. No significant differences were found for the Early Treatment Diabetic Retinopathy Study chart and Contrast Sensitivity test. CONCLUSION: Compared with observation alone, surgical intervention in stage 2 macular holes resulted in a significantly lower incidence of hole enlargement and appeared to be associated with better outcome in some measures of visual acuity.

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PubMed1994

Vitrectomy for prevention of macular holes. Results of a randomized multicenter clinical trial. Vitrectomy for Prevention of Macular Hole Study Group.

PURPOSE: The purpose of this study is to assess the benefit of vitreous surgery in preventing full-thickness macular holes in patients with impending (stage 1) macular holes. METHODS: A prospective randomized multicenter clinical trial was conducted on patients with full-thickness macular holes in their first eye (stage 3 or 4) and signs and symptoms of stage 1 macular holes in their fellow eye (study eye). The study eye was randomized to vitreous surgery or observation. Outcome was assessed by standardized measurement of visual acuity, detailed clinical examination, fundus photographs, and fluorescein angiography. RESULTS: A full-thickness macular hole developed in 10 (37%) of 27 patients in the vitrectomy group compared with 14 (40%) of 35 patients randomized to observation (P = 0.81). This difference of 3% has a 95% confidence interval of (-21%, 27%). CONCLUSION: The study was terminated because of low recruitment. The authors were unable to prove (or disprove) the benefit of vitreous surgery in patients with stage 1 macular holes. The authors can state, however, that should a beneficial effect from vitrectomy exist, it would probably be minimal. Considering the cost and morbidity of vitreous surgery, a conservative approach for stage 1 macular hole might be appropriate.

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PubMed1998

Additional procedures after the initial vitrectomy or tap-biopsy in the Endophthalmitis Vitrectomy Study.

OBJECTIVE: The study aimed to assess the frequency, indications, and outcome of additional ocular procedures after initial treatment of vitrectomy (VIT) or tap-biopsy (TAP) for patients with endophthalmitis after cataract extraction. DESIGN: The study design was an analysis of observational data collected as part of a multicenter, randomized clinical trial. PARTICIPANTS: Of the 420 patients enrolled in the Endophthalmitis Vitrectomy Study, the 148 who had additional procedures were compared with the 272 who did not. MAIN OUTCOME MEASURES: The types, indications, and number of additional ocular procedures were assessed. A masked examiner measured visual acuity 9 to 12 months after study entry. RESULTS: Within 1 week of study entry, 8% of VIT eyes and 13% of TAP eyes underwent additional procedures, 14% for complications of the initial procedure and 86% for worsening ocular inflammation or infection. Cultures were obtained in 33 of the 38 eyes operated on for worsening inflammation or infection and were positive in 42%. Cultures obtained from the early additional procedures were positive more frequently in eyes with an initial TAP (71%) than in eyes with an initial VIT (13%). Both virulence of initial microbiologic organism isolated and poor presenting vision were risk factors for requirement of reoperation. In all cases in which a single organism was cultured at the initial procedure, when the reculture was positive, it was the same organism. Late additional procedures (after 7 days) were required in 27% of patients. Visual outcome was much worse for eyes that had an additional procedure compared to eyes that did not, and this was especially the case for eyes that had an early additional procedure. Only 15% of eyes that had an early additional procedure achieved 20/40 visual acuity as compared to 57% of eyes that did not. CONCLUSION: Need for an additional procedure was a marker of more severe disease, and patients who underwent additional procedures achieved poorer visual acuity at final follow-up.

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PubMed1975

Vitrectomy from the anterior approach. Vitrectomy for the anterior segment surgeon.

There are three basic needs for a vitrector or vitreophage. One is for the anterior segment surgeon so that he may have a machine available when vitreous is lost during anterior segment surgery and may spare himself the hazards and potential complications of doing vitrectomy solely with cellulose sponges. The simplified vitrector which is disposable, sterile, and rapidly made ready ideally serves this need in a way which is not served by any other technique. Two, the removal of normal vitreous may be necessary in patients with vitreous contact, and any type of vitreous removing machine may be useful for this. The vitrector we have worked with is simple and satisfactory, and has the potential advantage of having blades which are always sharp and always pushed firmly against the cutting edge of the hole since they are disposable and inexpensive. An infusor as well as simple cutting tips are available. Three, vitrectomy for serious vitreous pathology can be done with the simple vitrector through the anterior segment approach if the lens is absent or will be removed, and if heavy pre-retinal and vitreous bands are not present. For the handling of diabetic retinopathy and sheets of vitreous membranes which appear organized, other equipment may be superior.

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PubMedDate not supplied

Pars plana vitrectomy. Vitrectomy in diabetic retinopathy.

In spite of the rather high rate of complications, it is clear that in selected cases of proliferative diabetic retinopathy with massive long-standing vitreous hemorrhage, significant improvement can be accomplished by pars plana vitrectomy. However, the number of eyes recovering 20/40 vision or better remains small (7% in our series at 9 to 15 months postvitrectomy), and consideration needs to be given to means to improve these figures. Whether vitrectomy at an earlier stage of the retinopathy can accomplish this is the subject of an upcoming cooperative study under the sponsorship of the National Eye Institute.

Cataract Extraction↗

PubMedDate not supplied

Pars plana vitrectomy. The role of vitrectomy in traumatic vitreopathy.

Debridement of the vitreous from perforating injuries can be more effectively and expeditiously accomplished with the aid of vitreous suction and cutting instruments than with conventional sponge-forceps technique. This technique is of great value as part of primary closure of perforating ocular injuries. In addition, trauma which results in (1) lens rupture with expulsion of the lens material into the vitreous; (2) massive vitreous hemorrhage with ciliary body laceration or posterior globe laceration; (3) retinal detachment with vitreous hemorrhage; or (4) retained reactive intraocular foreign body, requires vitrectomy. Because of inflammatory and fibroplastic changes, the earliest possible surgical intervention is recommended in these situations. Removal of lens material, reactive foreign body, or traction membranes, and early repair of retinal detachment may all be facilitated by new vitrectomy instrumentation.

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PubMed1985

Vitrectomy. Clinical data and cytologic findings of vitrectomy specimens.

Fifty vitreous specimens obtained by routine pars plana vitrectomies were examined using Millipore filter processing and Papanicolaou staining technique. Cytological findings comprised of macrophages (melanophages, siderophages) and inflammatory cells, mainly lymphocytes. In a few cases, pigmented an nonpigmented epithelial cells of the ciliary body were encountered, retinal sensory cells only in one case. Fibroblasts and fragments of granulation tissue occurred in four of the 14 diabetic cases, in four of the 21 posttraumatic cases, in one case of chronic uveitis as well as in one case of retrolental fibroplasia. Fragments of ciliary body were in three specimens from injured eyes. In one case of chronic uveitis slight suspicion of ciliary body melanoma was aroused on the basis of distinct cellular atypia. There was agreement between clinical and cytological diagnosis in most cases, but particularly in posttraumatic and inflammatory diseases cytologic examination offered new diagnostic data. This is a new method of microscopical verification of the condition in the vitreous body in various diseases. Our experiences are preliminary but we feel that this method has proven its availability.

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PubMedDate not supplied

Combined pars plana vitrectomy, phacoemulsification, and intraocular lens implantation in the capsular bag: a comparison to vitrectomy and subsequent cataract surgery as a two-step procedure.

BACKGROUND AND OBJECTIVE: To evaluate the effectiveness and safety of combined surgery. PATIENTS AND METHODS: Combined surgery (CS) consisting of pars plana vitrectomy (PPV), phacoemulsification, and implantation of a posterior chamber intraocular lens (PC IOL) in the capsular bag was performed on 26 patients. Another 26 had phacoemulsification with PC IOL insertion one to 84 months (mean 17.3) after PPV (sequential surgery, SS). Mean follow-up was 21.9 months after CS and 19.5 months after the cataract surgery in the SS group. The data were analyzed in a prospective, nonrandomized fashion. RESULTS: Visual acuity and refraction, astigmatism, accuracy of biometry, intraocular pressure, intraoperative, postoperative and long-term complications, and medical treatment were comparable in the two groups. Among the four uveitis patients in each group, transient fibrin formation was more frequent with CS (100%) than with SS (25%). The advantages of CS are that only one operation is needed, intraoperative working conditions are good, macular recovery is not masked by postvitrectomy cataract formation, and ideal lens centration is achievable. Potential disadvantages of CS include a longer operative time and increased technical demand, shrinkage of the anterior capsular opening, which may interfere with fundus view, and increased inflammation may be seen in patients with preexisting uveitis. CONCLUSION: Combined surgery in selected patients is a safe and effective approach, and outcomes are comparable to sequential surgery.

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PubMed1996

[Vitrectomy in ocular complications of diabetes. I. Early and late results of vitrectomy].

Results of 168 pars plana vitrectomies (ppV) of 144 diabetics are presented. In 26.2% of eyes before surgery, vitreous hemorrhage without detachment of the retina was present. In the remaining eyes, different stages of tractional detachment occurred. Visual acuity worse than 1/50 was observed in 83.9% of eyes before surgery. Results of ppV were evaluated on the 7th day and after the 3rd, 6th, 12th and 18th month following the procedure. Anatomical and functional success was achieved in about 80% and 67% of treated eyes, respectively, over the whole follow-up period.

Adult↗

PubMed1998

[Vitrectomy for treatment of ocular complications from diabetes. II. Vitrectomy complications].

UNLABELLED: The aim of this study was to present complications of pars plana vitrectomies (ppV) for diabetic retinopathy. MATERIAL: The intraoperative and postoperative complications were described on the basis of results of 168 procedures performed in the period 1991-1993. RESULTS: The most frequent intraoperative complications were bleeding from the retina vessels and iatrogenic tears while the membrane peeling was done. The main postoperative complications were: detachment of the retina, hemorrhages to the vitreous cavity, secondary glaucoma with rubeosis iridis and cataract. The authors present their own experience in treating complications of ppV and postoperative care.

Cataract↗

PubMed1983

Pathologic processing of vitrectomy specimens. A comparison of pathologic findings with celloidin bag and cytocentrifugation preparation of 102 vitrectomy specimens.

Specimens obtained from 102 vitrectomies were processed by cytocentrifugation and celloidin bag techniques. The histopathology obtained with each procedure was compared with respect to cellular and tissue findings. Forty-five percent of cases had identical findings by the two techniques. Quantitative analysis of the discrepancies revealed better cellular recovery and identification by cytocentrifugation, and similar rates for the recovery and identification of tissue elements. Qualitative analysis showed better demonstration of tissue histopathology using celloidin bag thin sections. Thus, pathologic analysis was more complete when the two techniques were used together than when either was used alone.

Centrifugation↗

PubMed1982

Chemical vitrectomy: change of solid gel vitreous to sol for vitrectomy by changing pH of vitreous toward the slight acid side.

Solid gel vitreous was changed to sol by changing the pH of the vitreous toward the slightly acid side by using diluted acetic acid of various weak concentrations. For human and rabbit vitreous in vitro, the gel sol change with regard to time in respect to concentration of the weak acid was noted. Rabbit eyes in vivo were used. In vitro and in vivo complete change of gelly vitreous to sol was achieved in about one hour by use of 0.3 mL of 0.5% acetic acid without any effect on the retina, choroid, optic disc, or the lens. This chemical vitreous fragmentation for vitrectomy was tried successfully on human eyes using 0.5 mL of 0.5% acetic acid without any bad effect in cases of vitreous hemorrhage not clearing in two months, posterior perforating injuries, and before cutting vitreous bands. A simplified method for pars plana irrigation drainage of liquid or chemically liquefied vitreous is described.

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PubMedDate not supplied

Pars plana vitrectomy. Vitrectomy treatment of vitreous opacities.

Twenty-one patients suffering from vitreous opacities caused by central- and branch-vein occlusion, sickle cell retinopathy, retinal vasculitis, endophthalmitis, hypertensive retinopathy, and uveitis underwent pars plana vitrectomy with the vitrophage. Intraoperative complications included retinal tears in two eyes with sickle cell retinopathy and tractional retinal detachment. Both were successfully treated. Postoperative complications were recurrent vitreous hemorrhage, hemolytic glaucoma, and corneal blood staining in a patient suffering from sickle cell retinopathy. Long-standing corneal edema was observed in patients suffering from endophthalmitis. Visual acuity improved in 95% of our patients and was worse in 5% of the patients.

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