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PubMed1983

Complete and core vitrectomies in the treatment of experimental posterior penetrating eye injury in the rhesus monkey. I. Clinical features.

A controlled trial of pars plana vitrectomy for posterior penetrating eye injury was done in a group of rhesus monkeys to compare the results of limited (core) and complete vitrectomies performed one day and two weeks after injury. Although core vitrectomy was technically easier and led to fewer operative complications, the frequency of traction retinal detachment was significantly higher than after a complete vitrectomy. There was no significant difference between eyes operated on one day or two weeks after injury.

Animals↗

PubMed1975

Management of cataract in patients undergoing vitrectomy.

We developed two techniques to combine vitrectomy with cataract extraction. In technique 1, we used the lens fragmenter to break up cataractous lenses with 1+ to 2+ nuclear sclerosis. The vitrophage removed the lens and opaque vitreous body through a single pars plana incision. In technique 2, if the knife did not penetrate the nucleus (in the presence of 3+ or more nuclear sclerosis), we removed the lens through a corneal incision and immediately performed a vitrectomy with a vitrophage through a corneal incision and immediately performed a vitrectomy with a vitrophage through the pars plana. In ten consecutive patients, we used these techniques successfully to remove ca((taractous lenses in patients undergoing vitrectomy for vitreous hemorrhage.

Adult↗

PubMed1981

Clinical and research aspects of subtotal open-sky vitrectomy. XXXVII Edward Jackson Memorial Lecture.

Subtotal open-sky vitrectomy can be used to improve visual function in some eyes for which closed vitrectomy is useless. Open-sky vitrectomy allows easier access for surgical instruments, especially to anterior fundus structures. The technique also improves the visibility of intraocular structures. The surgical procedure, which uses special instruments and high-molecular-weight hyaluronic acid, is divided into four stages: preparation, operating inside the vitreous cavity, wound closure, and retinal reattachment. In 290 consecutive operations for which complete follow-up data are available, retinal reattachment was achieved in 61 eyes (21%). The greatest number of successes (16 of 30 cases [53%]) was achieved in severe tractional retinal detachments. Such results are encouraging because these eyes were considered inoperable by other techniques. Open-sky vitreous surgery is performed through a corneal incision, but a scleral incision over the pars plana may become the method of choice in selected cases. The development of a preretinal fibrin membrane, as a result of either a closed vitrectomy or an open-sky procedure, may be a major cause of postoperative failure. Hypotony during surgery is probably the main precipitating factor of intraocular fibrin membrane formation.

Adolescent↗

PubMed1983

The effect of lensectomy on the incidence of iris neovascularization and neovascular glaucoma after vitrectomy for diabetic retinopathy.

We analyzed a consecutive series of 596 eyes that underwent vitrectomy for complications of diabetic retinopathy to determine the postoperative incidence of iris neovascularization and neovascular glaucoma. Survival curves for various factors were plotted, showing the cumulative incidence of these complications at various postoperative times up to one year. Eyes in which the lens was removed during vitrectomy had a statistically significant (P less than .001 by log-rank test) increase in the postoperative incidence of both iris neovascularization and neovascular glaucoma compared to eyes in which the lens was not removed. Lens removal at vitrectomy increased the risk of postoperative iris neovascularization by a factor of more than three and the risk of neovascular glaucoma by a factor of more than four. Other factors associated with a significantly increased incidence of postoperative iris neovascularization were severe preoperative retinal neovascularization and the absence of preoperative scatter retinal photocoagulation. Neither of these two factors nor postoperative retinal detachment invalidated or reduced the effect of lensectomy on increased postoperative iris neovascularization when all factors were considered simultaneously. This study showed a statistically significant increase in the postoperative incidence of neovascular glaucoma in eyes undergoing combined lensectomy and vitrectomy compared to eyes in which the lens was not removed.

Cataract Extraction↗

PubMed2000

Vitrectomy for the Treatment of Expulsive Hemorrhage.

Purpose: An evaluation of 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 better 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.

Journal Article↗

PubMed1978

Management of surgically dislocated intravitreal lens fragments by pars plana vitrectomy.

We examined 26 eyes (19 of them following phacoemulsification) with surgically dislocated intravitreal lens fragments; 24 eyes were subsequently operated on using pars plana vitrectomy for removal of lens fragments. From this select group of patients we found moderate to severe uveitis, glaucoma, and vitreous opacification present in virtually all cases. Less common complications were retinal detachments (six cases) and bullous keratopathy; the latter problem was found most commonly in eyes subjected to anterior segment maneuvers such as the use of lens loops or vitreous irrigation for removal of the lens material. Pars plana vitrectomy proved an excellent method for removal of lens fragments. A simultaneous two-instrument technique using the Wilson foreign-body forceps and the vitrectomy machine facilitated removal of the denser sclerotic lens fragments. This procedure resulted in resolution of the uveitis and glaucoma with improvement in visual acuity in 20 of the 24 eyes. However, only 10 of the 24 patients operated on obtained 20/40 or better visual acuity. A relatively prompt pars plana vitrectomy in eyes subjected to a minimum of surgical trauma yielded the best visual results.

Aged↗

PubMed1980

Vitrectomy and cystoid macular edema.

Twenty-two patients who underwent vitrectomy surgery for chronic cystoid macular edema (CME) were evaluated. These patients all had uneventful intracapsular cataract extraction, but CME with vitreous adhesions to the cataract incision later developed. Vitrectomy was performed to remove the vitreous from the anterior segment structures in each case. Nineteen of the 22 patients showed improved visual acuities within six months, and all but two had complete resolutions of the CME by one year. These two patients did show marked improvements of visual acuity. The majority of patients younger than 65 years of age had final visual acuities of 20/50 or better, whereas the majority of those older than 65 years had less than 20/50. The results were not influenced by the duration or the pattern of the CME prior to vitrectomy. A prospective study to determine the value of vitrectomy in this type of patient is suggested.

Aged↗

PubMed1998

Surgical management of equine recurrent uveitis with single port pars plana vitrectomy.

Current information suggests that equine recurrent uveitis (ERU) is an immune-mediated reaction to infectious agents or to autologous ophthalmic tissue. Recurrences are associated with progression of irreversible ocular damage. This report describes the intraoperative technique, complications, and long-term results of 38 eyes in 35 horses with ERU that underwent pars plana vitrectomy. The majority of the horses were warm-blooded. Recurrence of ERU was prevented in 35 of the 38 eyes. Some horses, especially in patients with incipient cataracts, developed vision loss in postoperative, quiescent eyes which was usually associated with cataract formation. Vision was stable in 85% of all eyes that underwent vitrectomy. Pars plana vitrectomy in horses appears successful in interrupting the cycle of repeated episodes of ERU, and the subsequent globe destruction in the majority of eyes. Removal of uveitis-induced 'immunologic memory' in the vitreous by vitrectomy may reduce adverse interaction between the vitreous and the uveal tract, and therefore reduce the recurrence of ERU.

Journal Article↗

PubMed1982

Vitrectomy, lensectomy, and ocular oxygenation.

The effect of vitrectomy and lensectomy upon the anterior chamber oxygen tension of the cat eye was measured polarographically. After vitrectomy and lensectomy alone, a reduction of 12 mm Hg (35%) was observed and when retinal veins were also partially occluded, a reduction of 17 mm Hg (50%) was measured as compared with the normal oxygen tension (PO2) of 34 mm Hg. If vitrectomy and lensectomy allow aqueous to deliver oxygen from the anterior part of the eye to the retina, the poorer oxygenation of the iris and the improved oxygenation of the retina might explain both the development of rubeosis iridis and stabilization of proliferative diabetic retinopathy so commonly seen following vitrectomy.

Animals↗

PubMed1981

Vitrectomy in the management of endophthalmitis.

Four cases of endophthalmitis were managed with pars plana vitrectomy and intravitreal antibiotics. All four cases made a good structural recovery, but the only cases which regained good vision were the two which had vitrectomy within three days of the first signs of endophthalmitis. The vitreous aspirate in all four cases showed polymorphonuclear leukocytes, but in only one case were organisms cultured. Vitrectomy is a means of removing the bulk of the infected material, of allowing dispersion of intra-ocular antibiotic, of removing membranes which may lead to later traction detachment of the ciliary body or retina, and of clearing the visual pathway. Microbiological diagnosis is best made by culture of vitreous aspirate. Retinal function is affected early in the course of the inflammatory process. Vitrectomy is recommended as the emergency primary treatment of acute endophthalmitis.

Adult↗

PubMed1984

Vitrectomy in severe ocular trauma.

This report describes the outcome of 73 consecutive cases of severe ocular trauma that were managed by pars plana vitrectomy and followed for an average of 37 months. 38% of operated eyes achieved a final visual acuity of at least 0.5 (20/40) and 69% obtained 0.025 (5/200) or better vision. These results are similar to other published reports. The final visual acuity in this series proved to be similar in patients who had early vitrectomy (1-14 days) and those who underwent vitrectomy after 14 days. The best results were achieved when vitrectomy was performed between 15 and 30 days following injury. In contrast to other reports no decrease in the final visual result was noted in eyes that had definite blood-lens-vitreous mixing, nor was there evidence of increased fibrovascular ingrowth or a poorer visual prognosis in the 1- to 15-year-old age group.

Adolescent↗

PubMed2000

[A case of proliferative sarcoid retinopathy with sarcoid nodules in tissue obtained during vitrectomy].

BACKGROUND: In previous studies, intraocular proliferative tissues obtained from proliferative sarcoid retinopathy cases during vitrectomy have been examined histopathologically. However, there is no report of identification of sarcoid nodules in examined tissues. We performed vitrectomy for a case of proliferative sarcoid retinopathy with extensive proliferative changes. Histopathologically, sarcoid nodules were identified in the fibrovascular membranes. CASE: A 25-year-old man was treated for sarcoid uveitis in the right eye by his local ophthalmologist. Lens aspiration was performed for complicated cataract. He was referred to our hospital with vitreous opacity and traction retinal detachment which occurred after the surgery. FINDINGS: The vitreous opacity was so severe that details of the fundus were not visible. Traction retinal detachment was suspected from findings of B-mode echography. Vitrectomy was performed, and total retinal detachment due to contraction of the fibrovascular membrane around the optic disc and posterior pole was observed. Sarcoid nodules were identified histopathologically in fibrovascular membranes obtained during vitrectomy. CONCLUSION: In proliferative sarcoid retinopathy cases, sarcoid lesions may be one of the causes of fibrovascular membrane formation.

Adult↗

PubMed1975

[The status of vitrectomy at present (author's transl)].

Besides vitreous suction, vitrectomy gains an increasing method in vitreous surgery. Regarding the access to the vitreous cavity, the open sky vitrectomy and the vitrectomy via pars plana have been introduced. The principles of the various instruments for simultaneous cutting and suction of the vitreous body are discussed. From the published results some conclusions can be made concerning the actual indications of vitrectomy. Finally the prospects and limitations of the operation are ventilated as far as it can be done in the present state of development.

Humans↗

PubMed1977

Rationale and techniques of closed vitrectomy.

The three indications for vitrectomy are opacity causing severe visual deficit, vitreo-retinal traction causing or threatening retinal detachment, and displacement of the vitreous from its normal position. The types of pathology which cause opacity and/or traction and which are amenable to treatment by closed vitrectomy are lens changes or lens/iris remnants, opaque vitreous gel, ochre membranes, transgel traction bands, posterior hyaloid membranes, and epiretinal membranes. Closed vitrectomy has superseded the open sky method because the integrity of the cornea is preserved, the crystalline lens can be preserved, the intraocular pressure can be regulated, and the visualization and access to the posterior segment are good. More than 200 closed vitrectomies have been carried out at this hospital since 1974, using the Machemer VISC VII, the Douvas Rotoextractor, and the Peyman Vitrophage. The techniques which have been evolved as a result of experience with these instruments are demonstrated in a film.

Cataract Extraction↗

PubMed1979

[The significance of vitrectomy after perforating injuries].

This paper presents three cases that show the importance of vitrectomy after perforating injuries of the eye. Whenever a trauma produces a mixing of vitreous and lens material in the anterior chamber, vitrectomy is the method of choice. Chronic posttraumatic uveitis can be prevented through this procedure. The three young patients, who were operated with the Vitrektor, reached a 6/6 vision with contact lenses after 1 1/2, 2 and 3 years respectively of observation. No consent can be given to the opinion recently expressed that the removal of infected vitreous after a cataract extraction nearly by an irrigation of the anterior chamber is considered to be a vitrectomy performed for decades. Priority for vitrectomy should be given to Kasner.

Adolescent↗

PubMed1979

Pars plana vitrectomy after intraocular foreign bodies.

Pars plana vitrectomy after intraocular foreign body injuries led to a good or at least useful vision in 60% of the cases. Without exception, these were eyes which were practically blind or eyes which according to our experience would have been blinded without vitrectomy. Retinal detachments which have arisen preoperatively have a decisive negative effect on the prognosis: there is a low rate of healing in consequence of traumatic, contusional and metallotic retinal lesions and high MPP rate. Increasing surgical experience, so-called secondary vitrectomy 'in time' as well as improved and more refined vitrectomy instruments lead to better results.

Eye Foreign Bodies↗

PubMed1978

[Indications for pars plana vitrectomy after perforating injuries (author's transl)].

A preliminary report is given on 100 consecutive cases of pars plana vitrectomy after perforating injuries due to nonmagnetic IOFB (9 cases), magnetic IOFB (32 cases) and lacerating injuries (19 cases). Pars plana vitrectomy was performed to remove persistent vitreous membranes, to prevent proliferative transformation with following retinal detachment or to make the IOFB become visible for extraction. These eyes were practically amaurotic but in 43 cases out of 100 a positive results could be achieved (i.e. the retina being attached, posterior pole becoming visible). Indications, technique and complications of both pars plana vitrectomy and FB extraction are discussed. As a result pars plana vitrectomy should be performed within an interval of at least 2 weeks after the first intervention (i.e. wound closure of FB extraction).

Eye Foreign Bodies↗

PubMed1980

[Vitrectomy via pars plana. A histological study and an analysis of clinical results (author's transl)].

The histological examination of the vitreous body after partial vitrectomy in the rabbit eye shows a rarefication and coarsening of the vitreous fibres after refilling the vitreous cavity either with sodium hyaluronate, regular Ringer solution or with Ringer-lactate solution containing dextrose and sodiumbicarbonate. An analysis of postoperative results of 139 eyes yields the following conclusions: 1. Removal of clear lenses is not justified since following vitrectomy the vitreous body in aphakes is not significantly clearer than in phakic eyes. 2. Moderate lens opacities do not constitute an indication for cataract surgery, they have been found to progress following vitrectomy only in 5% of the cases. 2. Important factors in the development of postoperative keratopathy are: Presence or absence of the corneal epithelium, type of contact lens used, age of the patient, stage of a diabetic retinopathy, duration of the surgical procedure, and the combined removal of lens and vitreous body via pars plana. 4. Rubeosis iridis indicates a terminal stage of the diabetic retinopathy and cannot be considered a complication of vitrectomy. 5. Postoperative haemorrhage occur at almost equal rate either with or without the intraocular application of daithermy, however, diathermy-coagulation has been applied only in advanced stages of proliferative diabetic retinopathy. 6. In the course of lavage of the vitreous cavity in cases of recurrent haemorrhages a progression of diabetic retinopathy was usually observed. Vitreous lavage within short periods of time, preferentially with 6 to 8 weeks following the initial procedure is therefore recommended in cases of recurrent haemorrhages.

Animals↗