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At least 451 records · Page 25Linked to original sources

PubMed1996

Does the presence of heparin and dexamethasone in the vitrectomy infusate reduce reproliferation in proliferative vitreoretinopathy?

BACKGROUND: Reproliferation following vitrectomy for proliferative vitreoretinopathy (PVR) causes redetachment in up to 55% of cases. Heparin and corticosteroids have each been shown to inhibit the development of proliferative vitreoretinopathy (PVR) in experimental models. However, little information is available on the use of these agents in humans. METHODS: In this pilot study, 62 eyes of 62 patients with severe PVR requiring vitrectomy were prospectively randomized to receive either BSS Plus (control) or BSS Plus with heparin and dexamethasone (HD) in the infusate. RESULTS: After one operation, the retina was reattached in 42 (71%) of 59 eyes: 22 (65%) of 34 eyes in the control group and 20 (80%) of 25 eyes in the HD group (P = 0.16). Reproliferation developed in 26.5% of the control group (9 of 34 eyes) and 16% of the HD group (4 of 25 eyes; P = 0.26). Postoperative hemorrhage was significantly more frequent in the HD group (P = 0.02) but did not influence final visual or anatomic outcome. Hypotony was less frequent in the HD group but the difference was not significant (P = 0.063). CONCLUSION: The trend from this randomized pilot study suggests that HD supplementation of the vitrectomy infusate may reduce the reproliferation rate in PVR and possibly reduce the rate of hypotony. Postoperative hemorrhage was more frequent with HD but did not cause redetachment or alter visual outcome. A multicenter trial involving more patients would be required to better evaluate the efficacy of HD as a pharmacologic adjunct to PVR surgery.

Adolescent↗

PubMed1996

Primary vitrectomy without scleral buckling for rhegmatogenous retinal detachment.

BACKGROUND: Pars planta vitrectomy has evolved as an alternative method in the treatment of more complicated rhegmatogenous retinal detachments. We report a series of patients who underwent primary vitrectomy with gas tamponade without the use of additional scleral buckling. METHODS: A retrospective study of 53 patients with a follow-up of 6-45 months (mean 17.8 months) was carried out. Preoperative findings included unusual, multiple or large breaks, vitreous haemorrhage, proliferative vitreoretinopathy and bullous retinal detachment. Preoperative visual acuity was between light perception and 1.0, with 30% (16/53) of patients with 0.4 or better. RESULTS: Retinal reattachment was achieved in 64% of cases (34/53) with one and in 92% (49/53) with one or more operations. Final visual acuity was between light perception and 1.0, with 41% (22/53) of patients with 0.4 or better. Cataract formation occurred in 86% (37/43) of all patients with a clear lens preoperatively. Macular pucker was noted in 11% (6/53) and postoperative proliferative vitreoretinopathy causing redetachment in 6% (3/53). CONCLUSION: With primary vitrectomy, a high final anatomical success rate with few intraoperative complications can be achieved in more complicated forms of rhegmatogenous retinal detachment. The major drawback of the procedure is the high incidence of post-operative cataract formation.

Adult↗

PubMed1993

Primary vitrectomy for rhegmatogenous retinal detachment.

One hundred and twenty-four eyes with a rhegmatogenous retinal detachment, considered to be at high risk of failure if treated conventionally, underwent vitrectomy and internal tamponade, with or without scleral buckling, as the primary procedure. The retina was reattached in 64.5% of eyes after one operation, 75.0% after two, and in 83% of eyes after more than two operations, with no difference in the success rate between those eyes which underwent vitrectomy alone, and those that received adjunctive scleral buckling; duration of surgery was significantly shorter, however, in the former group. Twenty percent of eyes redetached in association with proliferative vitreoretinopathy, and 20% of phakic eyes developed posterior subcapsular lens opacities after surgery. Vitrectomy is now an established method in the management of selected cases of rhegmatogenous retinal detachments.

Adolescent↗

PubMedDate not supplied

Full-thickness macular holes treated with vitrectomy and tissue glue.

In the surgical treatment of full-thickness macular holes good results have been published with the combination of vitrectomy, gas and application of Transforming Growth Factor beta 2. Other authors report a 73% success rate in closing a full-thickness macular hole after vitrectomy and gas tamponade alone. We used, in addition to vitrectomy and gas tamponade, a tissue glue to stimulate adhesion of the elevated cuff of neurosensory retina surrounding a full-thickness macular hole and to close to hole itself. A total of 15 eyes of 13 patients (3 men, 10 women), with stage 3 and 4 macular holes were operated. All of the 13 uncomplicated cases showed complete closure of the macular hole. In one case (8%) the visual acuity decreased one line in spite of a funduscopically closed hole, and in two cases (16%) visual acuity remained the same despite closure. Increased visual acuity was seen in ten cases (76%), eight of which improved more than two lines.

Adult↗

PubMed1987

Does vitrectomy followed by intraocular gas tamponade offer sufficiently effective treatment of retinal detachment due to holes in the posterior pole?

We report on 17 consecutive cases of retinal detachment due to macular hole surgically treated by one of the authors (S.B.) between the fall of 1982 and 1985. The standard method used was pars plana vitrectomy and intraocular air tamponade. In cases of subsequent reaccumulation of subretinal fluid, the macular hole was cautiously coagulated. With repeated redetachment and as a last resort, silicone oil was injected into the vitreous cavity. After a follow-up period ranging from 5 to 42 months, 13 of the 17 eyes were cured; in 2 aphakic eyes treatment remained unsuccessful; in 2 eyes a small central detachment with some accumulation of subretinal fluid persisted but did not progress. Vitrectomy and gas tamponade alone, without coagulation, constitute the safest and most sparing treatment of this type of retinal detachment. Unfortunately, approximately one half of these cases require subsequent additional photocoagulation because of renewed accumulation of subretinal fluid. In about one fourth of macular hole retinal detachments, however, lasting reattachment is achieved only by silicone oil tamponade following initial vitrectomy and air/gas tamponade.

Adult↗

PubMed1986

Early pars plana vitrectomy in chronic endophthalmitis of toxocariasis.

Pars plana vitrectomy was performed in 12 eyes affected with chronic endophthalmitis in patients 4-38 years of age. In 3 cases the indication was severe vitreitis and the surgical response was excellent. The other 9 eyes were operated upon during the cicatricial and sequelae stages, and the results were better the earlier surgery was performed. Lensectomy was associated in 5 cases. Good anatomical results were obtained in 9 eyes (75%); the other 3 (25%) were failures because of complications. Visual acuity improved after vitrectomy in 8 cases (66%), remained the same in 1 and became worse in the 3 anatomical failures (25%). Early pars plana vitrectomy is indicated in the chronic endophthalmitis of toxocariasis to prevent development of complications leading to loss of the eye and in order to obtain good functional results with little risk of complications. The ELISA test was performed on 5 vitreous samples and was positive in all. Toxocariasis should be strongly suspected in cases of unilateral vitreitis and/or pars planitis.

Adolescent↗

PubMed1987

The place of elective vitrectomy in the management of patients with Candida endophthalmitis.

A general review of the treatment of Candida endophthalmitis is undertaken, with particular emphasis on the efficacy of various drugs currently in use. Their absorption by the eye when given systemically is also considered. The limitations of medical treatment for this condition are discussed and the theoretical reasons for vitrectomy considered. Six cases that underwent vitrectomy are reviewed, and the indications for vitrectomy in Candida endophthalmitis are discussed. A tentative overall plan for the management of such cases is given.

Amphotericin B↗

PubMed1996

Prognostic factors associated with the visual outcome after vitrectomy for endophthalmitis.

BACKGROUND: Functional results following vitrectomy with intraocular and systemic antibiotic treatment for endophthalmitis are influenced by numerous factors. METHODS: A retrospective study of 65 cases of endophthalmitis treated between October 1988 and May 1994 at the Department of Ophthalmology, University of Cologne, Germany was conducted. All eyes underwent pars plana vitrectomy and intraocular and systemic antibiotic treatment. RESULTS: Vision of 20/400 or better could be obtained in 66% of eyes following extracapsular cataract extraction and intraocular lens implantation (ECCE + IOL), in 62% after severe eye injury, in 36% of eyes after intraocular surgery for other reasons than cataract extraction with lens implantation and in 33% of patients with endogenous endophthalmitis. Vision of 20/50 or better could be achieved in 41% of eyes following ECCE + IOL and additional systemic steroid treatment. In 22% of cases primary silicone endotamponade was performed; 57% of these eyes obtained visual acuity of 20/400 or better. Fifteen patients (23%) suffered diabetes mellitus; 20/400 vision or better could be achieved in 73% of these eyes. Visual acuity of hand movements or better before vitrectomy was associated with 20/400 vision or better in 69% of cases, whereas ambulatory vision could be attained in only 33% of patients with visual acuity of worse than hand movements at the initial presentation. Visual acuity of less than 20/400 was found in all eyes with haemolytic streptococcal infections. CONCLUSION: Prompt treatment of endophthalmitis is crucial. Additional treatment using systemic steroids and, if necessary, silicone oil can improve the functional outcome in some cases.

Adult↗

PubMed2006

[Incidence and prophylaxis of retinal detachment following pars plana vitrectomy].

PURPOSE: The aim of this study was to investigate the incidence of retinal detachment (RD) following pars plana vitrectomy and the efficacy of prophylactic means by cryoapplication central to the superior sclerotomies. PATIENTS AND METHODS: From February 2002 to January 2005 a total of 2,298 eyes received a pars plana vitrectomy in our department. Excluding eyes with previous peripheral coagulation therapy, preexisting retinal detachment, and endophthalmitis 1,640 eyes could be reexamined at least 6 months after surgery (mean: 17+/-12 months). The incidence of RD was compared between two groups: one with intraoperative cryoapplication central to the superior sclerotomies (n=533) and one without any prophylactic treatment (n=1,107). RESULTS: A total of 66 rhegmatogenous RD occurred during the follow-up, 23 with prophylactic cryotherapy and 43 without. This difference does not reach the level of significance. Only a subgroup of eyes operated on for macular pucker and venous occlusions showed a strong trend to prove the efficacy of prophylactic cryotherapy (p=0.07). Comparing the first 934 surgeries performed with the last 706 the incidence of RD decreased from 5.25 to 2.41%. CONCLUSIONS: The incidence of RD could be decreased significantly during the period investigated. Cryoapplication at the superior sclerotomies failed to reach statistical significance in the total group, though the results in eyes in two special subgroups showed a strong trend towards a protective effect of cryoapplication (p=0.07). Other factors may have contributed to the reduction of RD after pars plana vitrectomy.

Comorbidity↗

PubMed1997

[Retinal detachment in Ehlers-Danlos syndrome. Treatment by pars plana vitrectomy].

UNLABELLED: Ehlers-Danlos syndrome (EDS) is an hereditary connective tissue disorder caused by defective collagen synthesis, the main features being hyperelasticity and vulnerability of the skin, recurrent bleeding from fragile blood vessels, and secondary deformities of the joints. Ocular involvement is a rare occurrence, e.g., corneal and scleral rupture from minor blunt injury, lens displacement, rhegmatogenous retinal detachment. To date, few reports exist concerning the treatment of retinal detachment in Ehlers-Danlos syndrome, all of them dealing exclusively with conventional scleral buckling surgery. PATIENT AND METHODS: We report on a 47-year-old male patient suffering from EDS type VI (so-called ocular type, lysine-hydroxylase deficiency). He presented with rhegmatogenous retinal detachment in his only eye. A scleral buckling procedure was not feasible because of marked scleral atrophy. A three-port vitrectomy was therefore carried out. RESULTS: During the operation, pronounced choroidal detachment and bleeding developed, subsiding within weeks postoperatively. Closure of the sclerotomies was difficult due to scleral thinning. Two revitrectomies were necessary because anterior PVR with traction retinal detachment occurred. The last revitrectomy was performed 18 months ago, and the retina has been completely reattached under 5000 cs silicone oil since then. Visual acuity is 0.1. CONCLUSION: Primary vitrectomy permits successful treatment of retinal detachment in EDS patients if a buckling procedure cannot be performed because of scleral atrophy. However, serious complications may occur. Surgical procedures other than primary vitrectomy should therefore always be carefully considered, e.g., pneumatic retinopexy, temporary balloon, dura patch with episcleral pocket.

Ehlers-Danlos Syndrome↗

PubMed2000

[Erbium:YAG laser vitrectomy: temperature measurements in different replacement materials].

BACKGROUND: The erbium:YAG laser has the potential of being used routinely for vitrectomy because of the excellent quality of liquefying vitreous structures and the low vacuum forces required. However, the use of silicone oil and perfluorocarbon may lead to unwanted temperature increases in the microsurgery probe. The aim of this work was to investigate this side effect. MATERIALS AND METHODS: Different replacement materials such as water, methocel, silicone oil and perfluorocarbon were used in a simple eye model. The temperature increase during laser application was measured by means of thermocouples. The maximum temperature increase and time decay were derived with and without aspiration from these time-resolved measurements. The average power at the distal end of the microsurgery probe was chosen to be 1 W. RESULTS: The temperature increase with aspiration in water was found to be significantly smaller than all other replacement materials. Interruption of aspiration leads to a critical temperature increase of approximately 14 K; however, this increase occurred very slowly (decay time 200 s). A comparable result could be observed for methocel, which was used to simulate condensed vitreous structures. In perfluorocarbon and silicone oil we measured a far higher increase in temperature of up to 130 K within a few seconds. Furthermore, small remnants of carbonized materials can be seen in the microsurgery probe after laser application. CONCLUSIONS: The temperature increase during erbium:YAG laser vitrectomy in water can be considered to be harmless for other intraocular structures. However, insufficient aspiration or increased vitreous condensation leads to increased temperature in the microsurgery probe. Our results demonstrate that the use of erbium:YAG laser vitrectomy in materials such as silicone oil or perfluorocarbons is contraindicated.

Contraindications↗

PubMed2001

[Vitrectomy in advanced Coats disease].

BACKGROUND: Coats disease is a retinal vasculopathy of unknown cause. Untreated cases usually lead to an exudative retinal detachment and rubeosis iridis with secondary glaucoma. Photocoagulation and/or cryotherapy are generally the first interventions in treating the disease. Pars plana vitrectomy may be indicated in cases of vitreous hemorrhage or retinal detachment. METHODS: We performed pars plana vitrectomy in 9 eyes with Coats disease between 1992 and 1999. A retinal detachment was present in 3 cases, and three showed a vitreous hemorrhage. In two cases surgery was indicated because of paramacular localization of the pathological vessels with associated exudations. RESULTS: The two cases with paramacular involvement showed improvement in visual acuity of eight lines. In the remaining cases visual acuity remained within two lines compared to the initial visual acuity. All eyes except one could be saved. CONCLUSION: Pars plana vitrectomy is a useful option in treating advanced Coats disease, especially in cases associated with vitreous hemorrhage or retinal traction.

Adolescent↗

PubMed2001

[Cavitation bubble formation during Erbium:YAG laser vitrectomy].

BACKGROUND: Clinical and experimental studies demonstrated the potential advantages of Erbium:YAG laser vitrectomy for posterior segment surgery. However, a detailed knowledge on the laser-tissue interaction is needed for an optimization of new ophthalmic applications. The aim of this experimental work was to investigate the cavitation bubble formation during Erbium:YAG laser vitrectomy and to find optimized laser parameters and the best geometry of the aspiration port of the microsurgical probe. MATERIALS AND METHODS: We investigated the formation of cavitation bubbles in water by high-speed photography. The output energy at the quartz tip reached up to 50 mJ and the laser pulse duration ranged from 50 to 300 microseconds. Various commercially available microsurgery probes were investigated regarding the extent of the cavitation bubbles. RESULTS: The threshold for laser-induced cavitation bubble formation was found to be 0.32 +/- 0.1 mJ for a laser pulse duration of 130 microseconds and a core diameter of 320 microns of the quartz fiber tip. The length of the cavitation bubbles increases with the laser pulse energy up to a length of 1.6 mm at a pulse energy of 10 mJ. In contrast, the size of the vapor bubbles decreases with an increase of the laser pulse duration. A slit-shaped aspiration port led to a 50% smaller volume of the cavitation bubble exiting the port compared with a circular aspiration port. CONCLUSIONS: The optimized laser parameters and microsurgery probe geometry may significantly decrease the risk of intraoperative ocular damages during Erbium:YAG laser vitrectomy.

Animals↗

PubMed2003

Lensectomy and vitrectomy decrease the rate of photoreceptor loss in rhodopsin P347L transgenic pigs.

BACKGROUND: Photoreceptor degeneration in retinitis pigmentosa (RP) runs an inevitable, gradually progressive course. A wide variety of growth factors of different origins have been shown to slow the rate of degeneration in some rodent models of RP. Recently, lens-derived neurotrophic factors have been shown to rescue degenerating ganglion cells in crush models of the optic nerve. Our objective was to evaluate the potential rescue effect of lensectomy and vitrectomy (L&V) on photoreceptor degeneration in a large-animal model, the rhodopsin P347L transgenic pig. METHODS: We operated on one eye of each of 49 3-week-old pigs--15 vitrectomies and 34 L&V, 6 of which received steroids. Retinal paraffin sections were prepared for all eyes, in addition to immunohistochemistry in four eyes, 8 weeks after L&V. RESULTS: At eight weeks after L&V, operated eyes showed significantly more nuclei in the outer nuclear layer (ONL) than the unoperated fellow eyes. The better preservation of the ONL persisted but was less prominent by 20 weeks after surgery. Steroid treatment did not markedly reduce the better preservation of the ONL seen at 8, 10, and 12 weeks after surgery. The significant difference in cell count between operated and unoperated eyes in the L&V group at 8 weeks was due to the difference in the number of rods, not the cones. CONCLUSION: Lensectomy and vitrectomy delay photoreceptor degeneration in rhodopsin P347L transgenic pigs. Lens-related rescue effect is a probable reason for the delayed degeneration.

Animals↗

PubMed2003

Clinical variables and their relation to visual outcome after vitrectomy in eyes with diabetic retinal traction detachment.

BACKGROUND: To analyse vitrectomy results in diabetic eyes with retinal traction detachment and to investigate which variables are associated with a worse visual outcome. METHODS: Forty-four diabetic eyes (33 patients) with central retinal traction detachment were analyzed retrospectively. RESULTS: After a median follow-up of 10 months, median visual acuity significantly improved from 20/800 to 20/160 (P=0.02), despite the fact that the majority of patients had a long-standing macular traction detachment (median 120 days). Twenty-two eyes (50%) achieved a visual acuity of >20/200. The retina was finally reattached in 38 eyes (86.3%). Univariate analysis showed that patients with type 2 diabetes, age older than 50 years, preoperative visual acuity <20/200, iris neovascularisation and macular detachment of >30 days had a significantly worse final visual outcome. After multiple logistic regression analysis, age and iris neovascularisation were the strongest predictors of a worse visual outcome; if both were present, the chance of a obtaining a visual outcome of <20/200 was almost 90%. CONCLUSIONS: Age and iris neovascularisation were the strongest predictors for a low visual outcome. In a review of vitrectomy studies in eyes with severe diabetic traction detachment in the past 2 decades, we found a trend towards higher anatomic success rates, while visual outcome only slightly improved. The current study confirmed the importance of ophthalmic variables, but also indicates the importance of evaluating systemic variables in larger series in order to predict which eyes may truly benefit from vitrectomy.

Adult↗

PubMed2003

Management of branch retinal vein occlusion with vitrectomy and arteriovenous adventitial sheathotomy, the possible role of surgical posterior vitreous detachment.

BACKGROUND: To analyze the results of vitrectomy and adventitial sheathotomy in the management of branch retinal vein occlusion (BRVO). This is a nonrandomized interventional case series. METHODS: Patients with BRVO with progressive decrease in visual acuity underwent surgery and were prospectively evaluated in two centers. Surgical procedure included a 3-port pars plana vitrectomy, removal of the internal limiting membrane and arteriovenous crossing sheathotomy. Clinical evaluation consisted of best-corrected visual acuity, fluorescein angiography and optical coherence tomography. RESULTS: Thirteen eyes were analyzed consecutively. An improvement in visual acuity of two ETDRS lines or more was observed in nine eyes (69%). The mean gain was 1.9 ETDRS lines. The absence of previous posterior vitreous detachment (PVD), poor initial visual acuity and the presence of retinal ischemia were correlated to the improvement in vision (P=0.014, P=0.002 and P=0.052, respectively). Eyes with initial PVD had a mean loss postoperatively of -5.7 lines, but eyes without PVD experienced a gain of 4.2 lines (P<0.001). Macular edema decreased significantly (preoperative thickness: 714 micro m, postoperative thickness: 353 micro m, P=0.04), whereas the aspect of the vein at the crossing and the non-perfused area remained unchanged. CONCLUSION: Vitrectomy with sheathotomy seems to be of benefit in the management of BRVO, particularly in eyes with no previous PVD, and the main postoperative feature was the decrease in macular edema. The surgical detachment of posterior hyaloid could be as important (or more) as the sheathotomy itself. Further studies are needed to define the most efficient surgical management of BRVO.

Adult↗

PubMed2004

Topical exposure of mitomycin C reduces opacification of the residual anterior lens capsule and lenticular regeneration after vitrectomy and lensectomy in rabbits.

PURPOSE: To examine the effect of topical administration of mitomycin C (MMC) on the opacification of residual anterior lens capsule in a vitrectomized/lensectomized eye. METHODS: Adult Japanese albino rabbits ( n=8) received two-port vitrectomy and lensectomy with or without topical administration of MMC (0.4 mg/ml) to the residual anterior lens capsule in one eye under both general and topical anesthesia. Four eyes after vitrectomy and lensectomy were exposed to MMC for 1 min and washed out with balanced salt solution. After 1 month, the anterior segment of each globe was observed with EAS-1000 in vivo under general anesthesia and then the enucleated globes were observed through the Miyake view. Histological examination was performed. RESULTS: During healing intervals in eyes without MMC exposure, regenerated lens structure of Soemmering's ring or fibrous tissue was formed in peripheral or central areas of the residual capsule, respectively. Both the anterior lens capsule opacification and lens fiber regeneration were statistically significantly reduced by MMC topical exposure. CONCLUSION: Lens epithelial cells produce regenerated lenticular structure and fibrous tissue on the residual capsule following vitrectomy and lensectomy in rabbits. Exposure of the residual anterior capsule to MMC may be effective in reducing both its opacification and lens fiber regeneration after vitrectomy/lensectomy.

Administration, Topical↗

PubMed2004

Vitrectomy with removal of the internal limiting membrane in chronic diabetic macular oedema.

PURPOSE: To assess the effect of pars-plana vitrectomy including peeling of the internal limiting membrane (ILM) on the resolution of chronic diabetic macular oedema. METHODS: We performed a prospective evaluation of 60 eyes of 55 patients with chronic diabetic macular oedema who underwent pars-plana vitrectomy with ILM removal. All patients had a history of macular oedema of at least 6 months. In most of the eyes, grid laser photocoagulation had been performed previously. Eyes with further vitreoretinal pathologies such as vitreous haemorrhage, evident macular traction or significant loss of the foveal capillary net were excluded. Fluorescein angiography, funduscopic examination and the assessment of best-corrected visual acuity (BCVA) were performed pre- and postoperatively. The mean duration of follow-up was 3.0 months. Additionally BCVA was inquired of the referring ophthalmologists after a postoperative period of at least 9 months. RESULTS: Fluorescein angiography and clinical examination revealed a decrease of leakage within the macula or a decrease of macular thickening in 55 (93%) eyes. Mean visual acuity (LogMAR) significantly improved from 1.05 preoperatively to 0.87 postoperatively (P=0.0000034). Twenty-six eyes (43%) gained 2 or more lines of vision; four eyes (7%) lost 2 lines. Data concerning BCVA after a follow-up of at least 9 months were available in 37 patients (41 eyes) and confirmed the results 3 months postoperatively. CONCLUSION: Pars-plana vitrectomy with ILM peeling reduced macular oedema in most cases. In contrast, visual acuity improved significantly in 43% of the treated eyes only. The discrepancy between anatomical and functional results of ILM removal in chronic diabetic macular oedema is likely to be caused by structural changes of the macula due to long-standing oedema.

Aged↗