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PubMedDate not supplied

Long-term visual outcomes of vitrectomy for cystoid macular edema due to nonischemic central retinal vein occlusion.

PURPOSE: To report the long-term surgical outcome of vitrectomy for cystoid macular edema due to nonischemic central retinal vein occlusion (CRVO). METHODS: A retrospective chart review of 25 consecutive eyes (25 patients) with cystoid macular edema due to nonischemic CRVO treated with vitrectomy was performed. All patients underwent a pars plana vitrectomy with the creation of a posterior vitreous detachment if still attached. Simultaneous phacoemulsification with intraocular lens implantation was also performed in phakic eyes. The main outcome measures were best-corrected visual acuity (BCVA) and changes in macular edema shown by contact-lens biomicroscopy. The mean follow-up time was 49 months (range, 16-108). RESULTS: The median BCVA before surgery was 0.31 and the median BCVA at last follow-up was 0.67. The BCVA at the last follow-up improved at least two Snellen lines in 17 (68%), remained unchanged in 4 (16%), and worsened in 4 (16%). The BCVA was 20/40 or better in 3 eyes (12%) preoperatively and in 18 eyes (72%) at the last follow-up. During the follow-up, four patients progressed to ischemic CRVO; one of them had neovascular glaucoma requiring surgical intervention. CONCLUSION: The data indicate that vitrectomy appears to be a possibly effective treatment in some eyes with cystoid macular edema associated with nonischemic CRVO.

Aged↗

PubMedDate not supplied

Prognostic value of preoperative flash and pattern visual evoked potentials for diabetic retinopathy vitrectomy.

In view of the continuing controversy about the prognostic value of preoperative visual evoked potentials in diabetic vitrectomy, we retrospectively studied 31 eyes undergoing vitrectomy for diabetic retinopathy after recording pattern and/or flash visual evoked potential recording. Preoperative pattern visual evoked potentials were of no prognostic value in these eyes but a decrease in the amplitude of preoperative flash visual evoked potentials was significantly correlated with unchanged or worsened postoperative visual acuity when compared with preoperative visual acuity (P = 0.0156, Fisher's exact test). Therefore, while acknowledging that diabetic vitrectomy functional prognosis is actually multifactorial, we still recommend recording preoperative flash visual evoked potentials for diabetic patients in whom significant opacities of the intraocular media preclude correct examination of the ocular fundus, because a decrease in peak III amplitude may indicate a guarded vitrectomy functional prognosis.

Adult↗

PubMedDate not supplied

Primary vitrectomy for bullous rhegmatogenous retinal detachments due to complex breaks.

INTRODUCTION: The role of vitrectomy for the treatment of uncomplicated retinal detachments has not been clearly defined. This study reports the results of a series of eyes with bullous rhegmatogenous retinal detachment (RRD) due to complex breaks that were managed by primary vitrectomy. METHODS: The study consisted of a consecutive series of 22 eyes (22 patients) with a bullous RRD not complicated by proliferative vitreoretinopathy (PVR) associated with large, multiple, or posterior breaks. All eyes underwent vitrectomy, injection of perfluorocarbon liquid (PFCL), cryopexy and gas tamponade as the primary procedure. Encircling scleral bands were placed in all cases. Follow-up ranged from 6 to 24 months (mean 10.9 +/- 6.5 months). RESULTS: Anatomical retinal re-attachment was achieved in all eyes after one operation. Best-corrected final visual acuity was improved in all cases. Complications included progressive posterior subcapsular and nucleosclerotic cataract in four (22%) of the 18 phakic eyes and epiretinal membrane in one patient. CONCLUSIONS: These results, together with the relatively low incidence of complications, lead us to conclude that this technique is an effective method for treatment of bullous RRD not complicated by PVR associated with technically difficult breaks. A controlled, prospective, randomized study would be necessary to thoroughly assess the advantages of vitrectomy over scleral buckling alone in these cases.

Adult↗

PubMed1990

The influence of vitrectomy and lensectomy on experimental uveitis.

A secondary immune response in the rabbit eye can be provoked by intravenous injection of the antigen, previously injected intravitreally. The inflammation process consists of iris hyperemia, pericorneal redness and cellular and proteinous exudates in the anterior chamber and vitreous. The influence of vitrectomy combined with lensectomy or preceded by extracapsular lens extraction on the character of the secondary immune response has been studied in the rabbit eye. Both eyes of adult rabbits were injected intravitreally with human serum albumin. Five to ten weeks later, when the primary inflammation process had vanished, the vitreous and the lens were removed from the right eye in one group of animals. In a second group of rabbits, an extracapsular lens extraction was performed upon both eyes, later followed by vitrectomy of the right eye. Four weeks later all animals received an intravenous booster injection with human serum albumin. The eyes which still contained the vitreous developed a secondary inflammation consisting predominantly of cells and fibrin clots in the anterior chamber however without flare. On the contrary, the eyes which underwent vitrectomy developed a flare in the anterior chamber with only a few cells detectable. Analysis of cells and protein in the anterior chamber and histological evaluation supported the clinically observed differences between both eyes. These results suggest that the persistence of the vitreous is associated with the reactivation of a secondary immune response. Vitrectomy combined with lensectomy or preceded by extracapsular lens extraction leads to increased passive transfer of proteinous material through the vessels.

Animals↗

PubMed2006

25 gauge vitrectomy under topical anesthesia: a pilot study.

AIMS: To evaluate the safety and efficacy of transconjunctival 25 gauge vitrectomy under topical anesthesia. SETTINGS AND DESIGN: A pilot study of consecutive cases which underwent 25 gauge vitrectomy under topical anesthesia. MATERIALS AND METHODS: Seven eyes of 7 patients underwent 25 gauge vitrectomy under topical anesthesia with a pledget soaked in anesthetic, for vitreous hemorrhage (2 eyes), retained cortex (1 eye) and postoperative endophthalmitis (4 eyes). Subjective pain and discomfort were graded from 0 (no pain or discomfort) to 4 (severe pain and discomfort). Patients underwent an immediate postoperative assessment, followed by day one and one week postoperative evaluation. RESULTS: All patients had grade 0 pain during the surgery. Five patients had grade 2 pain during the placement of the sclerotomies. None of the patients required any sedation during the procedure. No inadvertent eye movements were noted during surgery. Except one patient, none required postoperative analgesics. Five eyes had a favorable outcome. No eyes in this pilot study had any procedure-related complications. CONCLUSION: With appropriate case selection, topical anesthesia is a safe and effective alternative to infiltrative anesthesia for 25 gauge vitrectomy. A larger series of patients with a longer follow-up is required to validate the findings of this pilot study.

Administration, Topical↗

PubMed1997

[Pseudohypopyon after vitrectomy for vitreous hemorrhage].

OBJECTIVE: To describe an uninfective hypopyon phenomenon after vitrectomy (pseudohypopyon). METHODS: 1,250 cases (consecutive cases) who had undergone vitrectomy were collected. Among them, 418 cases were vitreous hemorrhage due to various disorders. Pseudohypopyon was found in 7 cases. All of them were the patients with vitreous hemorrhage. RESULTS: Pseudohypopyon occurred in 3-5 days after vitrectomy, like precipitation of muddy sand; systemic and local treatment of antibiotic and steroid were not effective, intraocular centesis for smear and culture could not find any germs; and the patients were painless and no irritation in the eyes. The relatively effective method for this kind of hypopyon was paracentesis of anterior chamber and its natural absorption. After a follow-up period of 3 months, 3 cases obtained the vision above 0.05. CONCLUSIONS: Pseudo-hypopyon might happen after vitrectomy for vitreous hemorrhage, and it should be differentiated from infective ophthalmitis.

Diagnosis, Differential↗

PubMedDate not supplied

Combined scleral buckle and pars plana vitrectomy as a primary procedure for pseudophakic retinal detachments.

BACKGROUND AND OBJECTIVE: Pseudophakic and aphakic retinal detachments are associated with a lower percentage of successful primary repair with standard scleral buckling surgery, than phakic retinal detachments. The objective of this study was to determine whether a combined scleral buckle and vitrectomy, as a primary procedure, offers any advantage over conventional scleral buckling in primary pseudophakic and aphakic retinal detachments, without proliferative vitreoretinopathy. MATERIALS AND METHODS: This was a prospective, non-randomized clinical study. Ninety-four consecutive pseudophakic and aphakic retinal detachments were included in the study. All patients were operated upon by the same surgeon. Each patient underwent a combined scleral buckle and pars plana vitrectomy with perfluorocarbon injection and air-fluid exchange. Each patient was followed by the operating surgeon for a minimum of 6 months. Patients were followed with respect to anatomic reattachment, visual acuity improvement, and surgical complications. RESULTS: All eyes were anatomically reattached after a single operation. All demonstrated an increase in their visual acuity, and there were no complications attributable to the vitrectomy procedure. CONCLUSIONS: We conclude that such a combined approach to primary pseudophakic and aphakic retinal detachments offers significant benefits to scleral buckling alone. We believe that the improved success rate is a function of vitrectomy contributing to both an improved peripheral visibility, resulting in fewer missed peripheral breaks, and a lower likelihood of proliferative vitreoretinopathy. We recommend this combined surgical approach for all primary pseudophakic and aphakic retinal detachments.

Adult↗

PubMed2000

[Vitrectomy for the treatment of expulsive hemorrhage].

PURPOSE: To evaluate the surgical outcome of vitrectomy in the treatment of expulsive hemorrhage associated with intraocular surgery. METHODS: We reviewed 12 eyes from 12 patients with expulsive hemorrhage, occurring after or during cataract extraction (4 eyes), phacoemulsification (2 eyes), glaucoma filtering surgery (4 eyes), or vitrectomy (2 eyes). Mean follow-up period was 21 months. RESULTS: The retina was reattached in 6 eyes (50%) after the initial surgery and ultimately in 9 eyes (75%). Three eyes, which failed to achieve retinal reattachment, resulted in phthisis bulbi. Final visual acuity was 0.1 or belter in 4 eyes and 0.01 to 0.09 in 4 eyes. The incidence of expulsive hemorrhage was 0% for cataract surgery, 0.57% for trabeculectomy, and 0.09% for vitrectomy at Toho University Sakura Hospital. CONCLUSION: In the treatment of expulsive hemorrhage, vitrectomy is an effective surgical procedure to improve the visual function.

Adolescent↗

PubMed2000

[Pars plana vitrectomy in cases of endophthalmitis non-responding to antibiotic therapy].

UNLABELLED: The aim of the study is the evaluation of the results of pars plana vitrectomy in the cases of endophthalmitis unresponding to antibiotictherapy. MATERIAL AND METHODS: The procedure of pars plana vitrectomy was carried out in 7 patients treated preoperatively by intraocular injections of antibiotics because of endophthalmitis at Ophthalmological Department of Medical University in Wrocław in the years 1996-1998. The age of patients was 33-88 years (mean 67). The postoperative follow up was 6 to 28 months. RESULTS: Endophthalmitis resulted in all cases from cataract surgery. The positive microbiological traces were in 4 cases. In 3 cases pathogenic microbes were Staphylococcus epidermidis, in 1 Staphylococcus aureus and Micrococcus. In all patients the symptoms of inflammatory process disappeared after vitrectomy. In 5 patients we achieved the full visual acuity (0.8-1.0), in 1 patient bullous kerathopathy developed and in 1 phthisis bulbi. CONCLUSIONS: Vitrectomy may lead to good functional outcome in 70% of postoperative endophthalmitis.

Adult↗

PubMedDate not supplied

Postoperative refractive error after simultaneous vitrectomy and cataract surgery.

PURPOSE: To evaluate the effect of vitrectomy on postoperative refraction after simultaneous vitrectomy and cataract surgery. METHODS: We compared the spread between predicted and actual refractions in 206 eyes after a simultaneous vitrectomy, phacoemulsification, aspiration and acrylic lens insertion (combined surgery group), and in 67 eyes after cataract surgery only (cataract surgery group) as control. A vitrectomy was performed for diabetic retinopathy in 127 eyes, macular hole in 32 eyes, rhegmatogenous retinal detachment in 16 eyes, branch retinal vein occlusion in 15 eyes, and other conditions in 26 eyes. In the combined surgery group, 79 eyes had a gas tamponade after insertion of the intraocular lens. RESULTS: The spread between predicted and actual refractions was - 0.05 +/- 1.18 diopters (average +/- SD) in the combined surgery group and +0.55 +/- 1.32 D in the cataract surgery group. The actual refractive errors in the combined surgery group were found to shift toward myopia when compared with the controls. Among the combined surgery group, 127 eyes without a gas tamponade showed a postoperative refractive error of +0.14 +/- 1.11 D, while 79 eyes with a gas tamponade demonstrated an error of -0.36 +/- 1.22 D. CONCLUSIONS: Use of a gas tamponade in the combined surgery group increased the myopic change and was thought to have pressed the intraocular lens forward.

Adult↗

PubMedDate not supplied

Aqueous flare elevation in the fellow eye after vitrectomy.

OBJECTIVE: Aqueous flare elevation has been shown to occur in the fellow eye after cataract surgery. This study tests whether such subclinical sympathetic reaction also takes place after vitrectomy. PATIENTS AND METHODS: In a prospective clinical study, preoperative and postoperative 2-week levels of aqueous flare in the fellow eyes of 38 patients who underwent vitrectomy during a 6-month period were measured with a laser flare-cell meter. RESULTS: Aqueous flare levels in the fellow eyes 2 weeks after vitrectomy (mean, 15.70 photon counts/millisecond) were significantly higher than preoperative flare levels (mean, 11.78 photon counts/millisecond, Wilcoxon's signed rank test, P = 0.04). CONCLUSION: This study demonstrated that subclinical sympathetic reaction did occur in the fellow eyes after vitrectomy.

Adult↗

PubMed2000

[Idiopathic giant retinal tears: treatment with vitrectomy and temporary silicone oil tamponade].

PURPOSE: Vitrectomy with intraoperative use of perfluorocarbon liquids facilitates the treatment of giant retinal tears and permits the reattachment of the retina. This surgical technique maximizes the anatomic results with decreasing of failures and complications associated with the extraocular surgical approach. MATERIAL: and METHODS: Fourteen patients were operated on for idiopathic giant retinal tears without proliferative vitreoretinopathy. All patients underwent pars plana vitrectomy, unfolding of the giant retinal tears by perfluoro-n-octane, endophotocoagulation, cryoapplication and temporary silicone oil tamponade (ablation after 2 months). Visual acuity, anterior segment examination and fundus examination with a contact lens were performed preoperatively, followed by a control one week later, as well as monthly for 6 months and after that every 3 months postoperatively. RESULTS: Visual acuity at the end of the follow-up (mean 22 months) was increased by 3 lines or more in all cases but one. Postoperatively the retina was reattached in all of the cases. A recurrence of localized retinal detachment secondary to a focal proliferative vitreoretinopathy was observed in one case. Cataract formation (80% of the cases) and epiretinal macular membranes (50% of the cases) were the most frequent complications. CONCLUSION: The treatment of idiopathic giant retinal tears with vitrectomy and temporary silicone oil tamponade maximizes the functional results and permits the definitive reattachment of the retina in detriment of the classic complications of vitrectomy.

Adult↗

PubMed2000

[Pseudophakic retinal detachment: treatment by vitrectomy and scleral buckling. Pilot study].

INTRODUCTION: Localization of retinal tears generating a pseudophakic retinal detachment (RD) is not always possible; subsequently, segmental indentation by external compression often causes a residual RD. Vitrectomy enables a detailed view of the peripheral part of the retina and better detection of small size retinal breaks. Our pilot survey report anatomic and functional results of a surgical treatment of pseudophakic RD, associating vitrectomy and scleral buckling. MATERIAL AND METHODS: Twenty three consecutive pseudophakic eyes showing an RD were operated on with scleral buckling, vitrectomy, internal subretinal fluid drainage, endolaser and fluid-air exchange by SF(6) 20%. Preoperative findings, intraoperative and postoperative complications, and final results were analyzed. RESULTS: The retina was successfully reattached with a single operation in 21 eyes (92%). One eye presented a recurrence of RD due to a preexisting retinal tear. PVR was observed in one case with the recurrence of the RD. In both cases, a second operation achieved the retinal reattachment. After surgery, visual acuity improved on an average of 3 lines. The most frequently occurring complication was a transitory hypertony in 6 cases (26%). CONCLUSION: Surgical treatment of the pseudophakic RD, combining vitrectomy and scleral buckling shows very good anatomic and functional results; it seems to offer the advantage of a better localization of peripheral retina tears, which enables a recovery with a lower recurrence rate than by extra-ocular surgery only.

Adult↗

PubMed2001

[Vitrectomy and perfluorocarbons in the management of luxated lenses].

PURPOSE: To evaluate the use of vitrectomy with perfluorocarbon liquids (Perfluoro-DK-line) (PFCL) to refloat the luxated lenses of surgical etiology. Follow-up complications are considered. METHODS: The cases with vitreous posteriorly luxated lenses were reviewed between 1989 and 1999. 8 cases were found, all had similar surgery with vitrectomy and PFCL performed by the same surgeon. In two cases an anterior chamber IOL and in 6 cases a posterior chamber IOL sulcus fixated were used. RESULTS: The average age of the 8 cases with unilateral vitreous luxated lenses of no surgical etiology was 64.5 years. 3 of them were myopic with a history of spontaneous luxation with a duration of 5.9 and 10 years respectively. The other 5 cases reported a history of ocular trauma with a shorter time of luxation (between 1 week and 3 years). 7 cases (87.5%) had ocular hypertension, 6 cases (75%) showed epithelial corneal edema and one case retinal detachment preoperatively. Vitrectomy with PFCL normalized IOP and corneal edema. The complications related with decreased final VA were cystoid macular edema (1 case), macular atrophy (1 case) and retinal detachment (1 case). Only in one case a postsurgical retinal detachment was found likely to be iatrogenic. CONCLUSION: As vitrectomy with PFCL simplifies surgical technique with good results and modern sulcus fixated IOL may be used during the same surgery offering visual restoration, we believe this combined technique must be recommended always after posterior lens dislocation, to prevent complications and to preserve visual acuity.

Aged↗

PubMedDate not supplied

Suprachoroidal hemorrhage as a complication of vitrectomy.

OBJECTIVE: To study the risk factors, management, and end results of suprachoroidal hemorrhage that occur during or after vitrectomy. MATERIALS AND METHODS: This retrospective study involves patients suffering from this complication either during the curing process or immediately after vitrectomy. Preoperative risk factors, operative management, postoperative picture, and end results are reported. RESULTS: During the study period, surgery was performed on 3342 patients with primary vitrectomy. Complications were experienced by 4 patients: 2 occurred near the end of vitrectomy, and 2 in the first postoperative day. The 4 patients were myopic more than 7 diopters, 2 were pseudophakic and 2 were aphakic. Cryopexy was used to treat the retinal breaks in the operative cases. Perfluorophenanthrene was used as a postoperative tamponade in one operative case. Reoperation was done in the 4 patients 3 to 8 weeks after surgery. Silicone oil was used as a prolonged tamponade in all cases. Hypotony persisted in operative cases. All the patients had vision more than 20/400 at the end of follow-up (6 to 24 months). CONCLUSION: The risk factors for suprachoroidal hemorrhage were old age, high myopia, aphakia or pseudophakia, retinal detachment, and scleral buckle. Postoperative suprachoroidal hemorrhage has a better prognosis than the operative type. Perfluorophenanthrene "vitreon" as an operative and postoperative tamponade has a beneficial effect in keeping the retina attached and in preventing pooling of blood under the macula.

Choroid Hemorrhage↗

PubMed2001

[Vitrectomy in the treatment of endophthalmitis].

PURPOSE: To present our experience with the surgical management of endophthalmitis. MATERIAL AND METHODS: The results of 27 pars plana vitrectomies in 19 patients with clinical evidence of endophthalmitis were analysed. The endophthalmitis was considered as endogenous in 4 cases and exogenous in 15 cases. RESULTS: With the use of vitrectomy good anatomical and functional results were obtained. Pre-operative visual acuity was worse than 1/50 in 16 patients and ranged from 1/50 to 4/50 in 3 patients. Postoperative visual acuity was worse than 1/50 in 7 patients, ranged from 1/50 to 4/50 in 3 patients and was better than 5/50 in 9 patients. CONCLUSIONS: Pars plana vitrectomy in the management of endophthalmitis makes it possible to collect material for culture, removal of viable organisms and inflammatory products. In cases of posttraumatic endophthalmitis vitrectomy allows to prevent future complications.

Adolescent↗

PubMed1999

[A study of vitrectomy for retinal redetachment with silicone oil retained].

OBJECTIVE: To evaluate the outcome of vitrectomy for retinal redetachment in eyes with silicone oil tamponade and investigate the indications and surgical techniques of this surgery. METHODS: A total of 17 eyes (17 cases), in which retinal redetachment developed after the management of silicone oil tamponade, underwent pars plana vitrectomy with silicone oil retained. Directed by endoilluminator, membrane peeling, membrane inside-cut, full thickness retinal incision, internal drainage, endolaser, removal of subretinal perfluorocarbon liquids and injection of additional silicone oil, etc. were performed to make retinal reattachment. RESULTS: 14 eyes achieved retinal reattachment in total 17 eyes (82.4%). During operation, silicone oil migrated into anterior chamber in 1 eye and into suprachoroidal space in 1 eye. There was 1 eye with vitreous hemorrhage and ocular hypertension postoperatively. Retinal reattachment was not achieved in 3 eyes. CONCLUSIONS: Vitrectomy with silicone oil retained is an effective management for retinal redetachment of eyes with silicone oil tamponade. The advantages of this method are economical and time-saving. But the surgeon should be well trained and competent with vitrectomy.

Adolescent↗

PubMed2002

[Glutathione-related enzymes activity during vitrectomy. Effect of BSS Plus(R) in retinal tissue].

PURPOSE: To determine changes in the retinal activity of two enzymes related to the glutathione metabolism (Glutathione synthetase -GSHS- and glutathione reductase -GSSGR-) after vitrectomy using BSS Plus(R). MATERIAL AND METHODS: Forty-five pigmented rabbits were distributed in 6 groups: group I (GSHS control in retinal tissue); Group II (analysis of GSHS at 3 hours post-vitrectomy); Group III (determination of GSHS at 48 hours after vitrectomy); Group IV (GSSGR control in retinal tissue); Group V (measurement of GSSGR at 3 hours post-surgery) and Group VI (study of GSSGR at 48 hours post-vitrectomy). Statistical analysis was done by a parametric test (ANOVA of single factor) (p<0.05). RESULTS: The activity of these enzymes was: Group I (n=5, basal GSHS). 2785,63 D.S. 419,51 U/g; Group II (n=4, GSHS at 3 hours). 6053,50 D.S. 2788,84 U/g; Group III (n=4, GSHS at 48 hours). 7424,30 D.S. 997,47 U/g; Group IV (n=10, basal GSSGR). 150,86 D.S. 24,40 mU/mL; Group V (n=7, GSSGR at 3 hours). 212,03 D.S. 53,30 mU/mL; Group VI (n=8, GSSGR at 48 hours). 210,84 D.S. 46,03 mU/mL. CONCLUSIONS: At retinal tissue, BSS Plus(R) intraocular irrigating solution increases GSHS activity without modifications of GSSGR levels. It seems to be related to the < > synthesis of glutathione.

Animals↗