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At least 469 records · Page 26Linked to original sources

PubMed2004

Vitrectomy with internal limiting membrane removal for clinically significant macular oedema.

BACKGROUND: Little has been published on internal limiting membrane (ILM) removal for clinically significant macular oedema (CSME) in eyes not improving following maximal laser treatment. METHODS: Retrospective review of the charts and intraoperative video films of 30 consecutive eyes of 27 patients undergoing vitrectomy, ILM peeling, and gas tamponade by a single surgeon. RESULTS: The average patient was 52 years old; 56% were males. The oedema was caused by diabetes in 87% of the eyes, 42% of which had proliferative disease. The oedema was diffuse in 16 eyes (53%) and cystoid (CME) in 14 (47%). In 21% of eyes, spontaneous vitreous detachment was present or the eye had already undergone vitrectomy. All but one eye had at least 6 months of follow-up (mean 12 months). The oedema resolved completely in 26 eyes (90%) and partially in 3 eyes (10%). The visual acuity improved at least two Snellen lines in 19 eyes (66%) and one line in 4 eyes (14%); the average improvement was 4 lines. The acuity was unchanged in three eyes (10%) and worsened in three eyes (10%), all due to cataract. Among the 14 eyes with CME, 11 (79%) became completely dry and the visual acuity improved in 11 eyes (79%). No ILM-related complication was encountered in any eye. CONCLUSIONS: Vitrectomy with ILM peeling is a promising approach to eyes with CSME. It appears to offer visual improvement at a much higher rate than laser therapy and with a longer-lasting effect than that of intravitreal triamcinolone. A larger study is necessary to confirm these preliminary findings.

Adolescent↗

PubMed2005

Safety profile of the intravitreal streptokinase-plasmin complex as an adjunct to vitrectomy in the rabbit.

BACKGROUND: The generation of an atraumatic posterior vitreous detachment (PVD), a common goal in vitreoretinal surgery, is a challenge, particularly in children and young trauma patients. Plasmin has been proposed as an adjunct to vitrectomy to enzymatically generate a PVD. Low doses of streptokinase-activated plasmin were tested in human pilot studies. This dose-escalation study assesses the safety range of intravitreal human streptokinase-plasmin in rabbits. METHODS: Plasminogen was isolated from human plasma by affinity chromatography, followed by activation with streptokinase (1:1), to generate the streptokinase-plasmin complex. Enzyme doses from 0.1-7 activity units (AU, in 0.1 ml) were injected into the mid-vitreous of 35 eyes; six control eyes were injected with balanced salt solution (BSS, 0.1 ml). Thirty minutes after injection, a two-port vitrectomy was performed. Fundus and slit lamp examinations were performed on days 1 and 7. On days 2 and 7, bright flash electroretinography was performed and compared with preoperative recordings. Some animals receiving higher doses of streptokinase-plasmin (1-7 AU) were followed clinically and with electroretinography for up to 9 months. RESULTS: A mild-to-moderate inflammatory response was seen in both control and plasmin-treated eyes on day 1, but had disappeared completely by day 7 in most eyes. In the 7 AU group, inflammation was stronger and more protracted. Two of three eyes from this group developed wrinkling of the medullary rays; one of them showed discoloration and traction at the medullary rays in the late follow-up. Electroretinograms (ERGs) of vitrectomized control eyes showed the following changes from preoperative values: 48 h, a-wave -11.10% [no significant (n.s.)], b-wave -14.62% (P=0.046); 7 days, a-wave +9.18% (n.s.), b wave +11.69% (n.s.). For the enzyme-treated eyes: 48 h: a-wave -20.43% (P<0.001), b-wave -9.57% (p<0.001); 7 days: a wave -14.21% (P<0.001), b-wave +2.48% (P<0.001). There was no evidence of dose-dependent ERG changes in enzyme-treated eyes at doses up to 5 AU. Groups of up to 3 AU were investigated by light and transmission electron microscopy, without evidence of toxicity. CONCLUSION: Streptokinase-plasmin doses up to 3 AU were found to be safe when injected into rabbit eyes followed by vitrectomy.

Animals↗

PubMed2005

Vitrectomy for pre-macular hemorrhagic cyst in children and young adults.

BACKGROUND: A pre-macular accumulation of blood is termed a hemorrhagic macular cyst and may be found both in eyes with Terson's syndrome and in shaken baby syndrome. In this study, we report on our experience and results of vitreoretinal surgery for treatment of pre-macular hemorrhagic cyst in eyes of patients suffering from Terson's syndrome and shaken baby syndrome. PATIENTS AND METHODS: Between November 1995 and May 2003 seven eyes of six children underwent vitrectomy for pre-macular hemorrhagic cyst. Patients' age ranged from 5 months to 17 years. Indication for vitreoretinal surgery was pre-macular hemorrhagic cyst in eyes with Terson's syndrome (n=5) and shaken baby syndrome (n=2). During vitrectomy, rhexis of internal limiting membrane was performed. Four children received intensive orthoptic treatment postoperatively. RESULTS: All eyes in our series showed a submembranous localization of pre-macular hemorrhagic cyst. The results of electron microscopic examination showed that the excised anterior walls contain internal limiting membrane. In all eyes improvement of the anatomic situation and of visual acuity was achieved. Duration of follow-up ranged from 6 months to 5 years. CONCLUSIONS: Vitrectomy for hemorrhagic macular cyst in children is a safe and effective alternative to observation, offering visual rehabilitation, especially if amblyopia has developed or if both eyes are affected. If a hemorrhagic macular cyst is encountered, its complete removal is recommended to prevent development of proliferative vitreoretinopathy.

Adolescent↗

PubMed2006

Macular hole formation and spontaneous closure after vitrectomy for central retinal vein occlusion.

PURPOSE: The purpose was to describe the formation and spontaneous closure of an iatrogenic macular hole after vitrectomy for central retinal vein occlusion (CRVO). METHODS: A 45-year-old woman presented with loss of vision in the right eye due to CRVO. The left eye was normal. Best-corrected visual acuity (BCVA) was 3/60 in the right eye and 6/6 in the left. She underwent vitrectomy and radial optic neurotomy (RON) in the right eye. Fluorescein angiography and optical coherence tomography (OCT) were performed pre-operatively, on the first post-operative day, and subsequently at 1, 3, 6 and 12 months. RESULTS: There were no intra-operative complications. On the first post-operative day, fundus examination of the right eye revealed a small macular hole, confirmed by OCT. No additional intervention was carried out. Examination after a month revealed clearing of retinal haemorrhages, resolution of macular oedema and spontaneous closure of the macular hole. The closure was maintained until the last follow-up a year later. BCVA improved to 6/24 by 3 months, and was stable over the follow-up period. The left eye remained unchanged. CONCLUSION: While performing vitrectomy for CRVO, the induction of posterior vitreous detachment may deroof a foveal cyst in the highly oedematous macula to form a macular hole. A small macular hole, however, may close spontaneously without further intervention.

Female↗

PubMed1998

Rubeosis iridis after vitrectomy for diabetic retinopathy.

BACKGROUND: Iris rubeosis and neovascular glaucoma (NVG) are serious complications of vitrectomy for proliferative diabetic retinopathy. The present study analyzes incidence and risk factors of these complications. METHODS: Preoperative and postoperative iris rubeosis were compared in 389 diabetic eyes after vitrectomy. Minimum follow-up was 6 months (median 26 months). Risk factors were studied using multivariate logistic regression analysis. RESULTS: Following vitrectomy, in 8.5% of the eyes stromal iris rubeosis developed de novo; NVG occurred in 5%. Significant risk factors for postoperative rubeosis were preexisting iris neovascularizations and postoperative retinal detachment. Six months after surgery, regression of preexisting iris rubeosis was observed in 57% of the eyes. In eyes without preoperative iris rubeosis, progression was found in 13% of cases 6 months postoperatively. CONCLUSION: With current surgical techniques iris rubeosis is more commonly regressive than progressive after vitreous surgery in diabetic eyes.

Adult↗

PubMed2000

Quantitative measurements of changes of idiopathic stage 3 macular holes after vitrectomy using confocal scanning laser tomography.

PURPOSE: To perform quantitative three-dimensional analysis of changes of idiopathic full-thickness stage 3 macular holes following vitrectomy and gas tamponade using confocal scanning laser tomography to study the mechanism of repairing the holes and to correlate with visual recovery. METHODS: We studied 44 patients, 10 men and 34 women, aged between 40 and 76 years (mean 65.5 years) with stage 3 macular holes with symptoms of 1-4 months' duration (mean 2.7 months). Using the Heidelberg Retina Tomograph, we measured the macular area within 1 week before surgery (3.5+/-1.6 days), and between 2 and 4 weeks (2.4+/-0.6 weeks) and at least 3 months (3.8+/-00.8 months) after surgery. RESULTS: All 44 eyes showed closure of the holes and flattening of cuff and retinal striae after vitrectomy and gas tamponade. All the eyes showed small flat depressions that corresponded to each macular hole with the area of 0.027-0.184 mm2 (0. 110+/-0.042 mm2). Thirty-nine (89%) of 44 eyes showed large concave depressions that appeared to correspond to the preoperative retinal striae, with areas of 0.844 to 5.563 mm2 (3.688+/-1.263 mm2). The areas of the postoperative small depressions and large depressions were significantly correlated with the area, volume, and depth of the macular holes and the area of the cuff and retinal striae prior to treatment. Postoperative visual acuity showed significant correlations with the areas of the postoperative small depressions and large depressions. CONCLUSIONS: Confocal scanning laser tomography is potentially useful as a noninvasive diagnostic technique for quantitative measurements of changes of macular holes by vitrectomy and gas tamponade. Postoperative small depressions corresponding to the healed macular holes appeared to be caused by gliosis involving sealing of the holes. The large depressions and their concave shape may result from postoperative changes of the retina, including swelling of ganglion cells and loss of outer and inner segments of photoreceptor cells in regions of preoperative cuff and retinal striae.

Adult↗

PubMedDate not supplied

Effects of internal limiting membrane peeling in vitrectomy on diabetic cystoid macular edema patients.

PURPOSE: We evaluated the effects of the peeling of the internal limiting membrane (ILM) during vitrectomy in diabetic cystoid macular edema (CME) patients. METHODS: Visual outcome and intraoperative and postoperative complications were evaluated retrospectively in 84 CME patients (100 eyes), all of whom had been followed for at least 1 year postoperatively. Before January 2001, we did not perform ILM peeling at our hospitals; 57 patients (66 eyes) treated before 2001 were included in this retrospective study as the non-peeling group. After January 2001, ILM peeling was performed in 27 (34 eyes) CME patients, who were included in this study as the peeling group. In the peeling group, indocyanine green (ICG) staining was performed at the time of ILM peeling. RESULTS: Visual acuity improved significantly after vitrectomy regardless of ILM peeling. Visual acuity improved gradually from 6 months to 1 year after the operation, and improved further at the final observation point in both groups. Visual acuity did not differ significantly between the two groups at any time point. There was no difference in the incidence of intraoperative and postoperative complications between the two groups. There were no adverse events associated with ICG-assisted ILM peeling. CONCLUSIONS: Visual acuity improved with vitrectomy for diabetic cystoid macular edema in both groups. ILM peeling was not found to improve visual acuity postoperatively.

Adult↗

PubMed2006

Pars plana vitrectomy with removal of posterior hyaloid face in treatment of refractory diabetic macular edema resistant to triamcinolone acetonide.

BACKGROUND: Triamcinolone acetonide (TA) has recently been used to treat diabetic macular edema (DME) but its effectiveness is limited. CASES: Three patients (three eyes) with unresolved diffuse DME who did not respond to a posterior sub-Tenon's injection of TA underwent vitrectomy. OBSERVATIONS: Intraoperatively, it was found that all of the eyes had a posterior hyaloid face that was adherent to a large area of the posterior pole retina, although this had not been detected by slit-lamp biomicroscopy or optical coherence tomography. After vitrectomy and removal of the posterior hyaloid face, there was a significant reduction in the central macular thickness of all three eyes and an improvement in the visual acuity of the patients. CONCLUSIONS: When TA treatment is not effective for DME, vitrectomy with the complete removal of the posterior hyaloid face, including removal of the internal limiting membrane, should be considered.

Aged↗

PubMed2004

Assessment of macular function by multifocal electroretinogram in diabetic macular edema before and after vitrectomy.

The purpose of this study was to assess the effects of vitrectomy on retinal function in macular and paramacular areas in patients with diabetic macular edema (DME). Ten eyes of 9 patients with successful vitrectomy for DME were evaluated by multifocal electroretinogram (mfERG), optical coherence tomography (OCT), and visual acuity preoperatively and 1, 2, 3, 4, 5 and 6 months postoperatively. Compared with pretreatment values, the response of the positive wave (P1) in macular and paramacular areas tended to decrease in latency from the second postoperative month, and increase in amplitude at the third postoperative month. There was no significant change in response of the negative wave (N1). The tendency in the change of macular function is coincident with that of macular morphology. Therefore, The multifocal ERG may provide objective criteria for the functional evaluation of DME before and after vitrectomy.

Aged↗

PubMed2004

Morphological and functional changes of the macula after vitrectomy and creation of posterior vitreous detachment in eyes with diabetic macular edema.

The purpose of this study was to determine the morphological and functional changes in the macula after pars plana vitrectomy with the creation of a posterior vitreous detachment in eyes with diabetic macular edema (DME). A simple posterior vitreous detachment was created during pars plana vitrectomy accompanied by simultaneous cataract surgery in 19 eyes of 17 patients with DME. The visual acuity (log MAR units), multifocal electroretinograms (mfERGs), and optical coherence tomographically (OCT)-determined foveal thickness were determined preoperatively and at 6 months postoperatively. The median preoperative log MAR visual acuity was 0.7 (20/100; range, 0.3-1.1), and it improved significantly to 0.4 (20/50; range, 0.15-1.0) postoperatively (p = 0.016). The median foveal thickness was 510 (range, 194-800) microm preoperatively and was significantly reduced to 201 (range, 60-631) microm postoperatively (p =0.0002). The median of response density of the mfERGs in the macular area was 6.3 nV/ deg2 (range, 2.8-14.8) preoperatively, and 6.1 nV/deg2 (range, 2.4-14.3) postoperatively, a non-significant change (p = 0.27). The median of peak latency of the macular response was 30.0 ms (range, 25.0-44.2) preoperatively and it decreased significantly to 28.3 ms (range, 26.7-35.0) postoperatively (p = 0.003). In conclusion, vitrectomy with the creation of a PVD in eyes with DME improved the visual acuity and foveal thickness significantly. In addition, a decrease of the peak latency of the macular mfERGs suggested an improvement of the physiological function of the macula although the amplitude of the mfERGs was not changed significantly.

Aged↗

PubMedDate not supplied

Vitrectomy in the management of diabetic eye disease.

Vitrectomy techniques including endolaser photocoagulation allow visual rehabilitation in many eyes that are otherwise untreatable. Discerning the indications and timing for diabetic vitrectomy is increasingly important as the treatment of complications of diabetic retinopathy continues to undergo modification and redefinition. The most common indications for diabetic vitrectomy include: 1) severe nonclearing vitreous hemorrhage; 2) traction retinal detachment recently involving the macula; 3) combined traction and rhegmatogenous detachment; 4) progressive fibrovascular proliferation; and 5) rubeosis iridis and vitreous hemorrhage for eyes in which the media opacity has prevented adequate laser photocoagulation. Other less common indications in selected cases include dense premacular hemorrhage, ghost cell glaucoma, macular edema with premacular traction, cataract preventing treatment of severe, proliferative diabetic retinopathy, anterior hyaloidal fibrovascular proliferation, and fibrinoid syndrome with retinal detachment. The rationale and surgical objectives are discussed and results are summarized.

Diabetic Retinopathy↗

PubMed2004

Vitrectomy and internal limiting membrane peeling for myopic foveoschisis.

PURPOSE: Myopic foveoschisis is common in high myopia. We report results of a pilot study of vitrectomy for patients with myopic foveoschisis. DESIGN: Interventional case series. METHODS: In an institutional setting five patients with high myopia (six eyes), and who had progressive visual impairment presumably due to myopic foveoschisis were studied. No eyes had a macular hole preoperatively based on optical coherence tomography (OCT). We performed vitrectomy including vitreous cortex removal, internal limiting membrane (ILM) peeling, and gas tamponade. Patients were followed for at least 6 months. Best-corrected visual acuity (BCVA), OCT. Scanning laser ophthalmoscope (SLO) microperimetry was examined in three eyes. RESULTS: The foveal detachment resolved completely in five eyes and partially in one eye. No serious complications developed including macular hole formation or retinal detachment; BCVA improved more than two lines in all eyes (100%) 6 months postoperatively (P <.01); SLO microperimetry showed smaller scotoma compared with preoperatively and stabilized fixation. CONCLUSIONS: Vitrectomy with vitreous cortex removal, ILM peeling, and gas tamponade could be useful to treat myopic foveoschisis in highly myopic eyes. Because the natural course of the disease is not well-understood, further study should establish indications for this surgery.

Basement Membrane↗

PubMed2004

Functional outcome after trypan blue-assisted vitrectomy for macular pucker: a prospective, randomized, comparative trial.

PURPOSE: To evaluate functional outcome after the intraoperative application of 0.06% trypan blue during vitrectomy for macular pucker. DESIGN: Prospective, randomized, comparative study. METHODS: Forty-three eyes of 43 consecutive patients, 30 women and 13 men, were incorporated in the study. Patients were randomized into two groups: group 1 (n = 22) with trypan blue (0.06%) staining, and group 2 (n = 21) without trypan blue staining. Functional outcome (best-corrected visual acuity, Goldmann perimetry) was evaluated 1 day before surgery, at 6 weeks, and at intervals of 3, 6, and 12 or more months postoperatively. Only patients with an idiopathic macular pucker were included. In all patients, a standard three-port pars plana vitrectomy with peeling of an epiretinal membrane (ERM) and the internal limiting membrane was performed. No other modification of the surgical procedure, except the use of trypan blue was made between the two groups. RESULTS: Mean age was 68.9 years in group 1 (with trypan blue) and 69.4 in group 2 (without trypan blue). Median best-corrected visual acuity was 20/63 in both groups (range, 20/200-20/40; P >.5) before surgery. Mean follow-up time was 5.8 months in group 1 and 5.3 months in group 2. After surgery, median visual acuity had increased to 20/40 in both groups (range, 20/500 to 20/20 in group 1 and 20/100 to 20/20 in group 2; P <.001 for both groups). The difference between both groups was not statistically significant (P >.5). An improvement of visual acuity (gain of 2 or more lines) was seen in 16 patients of both groups. No postoperative visual field defects were noted. CONCLUSIONS: Trypan blue-assisted vitrectomy for macular pucker leads to good functional results with no dye-related adverse effects after short follow-up. Trypan blue might be especially applicable in cases in which the borders of the ERM are difficult to define. Hypothetical advantages, such as fewer recurrences of ERMs after trypan blue staining, will have to be evaluated during further follow-up of patients.

Aged↗

PubMed2004

Vitrectomy for a persisting macular fold in a case of resolved hypotony maculopathy.

PURPOSE: To describe a patient with resolved hypotony maculopathy with a persistent retinal fold (despite normalization of intraocular pressure [IOP]) who underwent successful surgical intervention by vitrectomy, internal limiting membrane peel, and gas tamponade. DESIGN: Interventional case report. METHODS: A 55-year-old man with a hypotony-induced macular retinal fold that did not improve following normalization of IOP underwent vitrectomy, internal limiting membrane peeling, and gas injection. Optical coherence tomography scans were performed both before and after surgery. RESULTS: Best-corrected visual acuity (BCVA) improved from 6/60 preoperatively to 6/9, with improvement in distortion. On repeat optical coherence tomography examination, the macular retinal fold had resolved. CONCLUSION: Vitrectomy, internal limiting membrane peeling and gas tamponade may be useful for cases of resolved hypotony maculopathy complicated by a persistent macular fold after normalization of IOP.

Basement Membrane↗

PubMed2004

Endophthalmitis after pars plana vitrectomy: Incidence, causative organisms, and visual acuity outcomes.

PURPOSE: To investigate the incidence, causative organisms, and visual acuity outcomes associated with endophthalmitis after pars plana vitrectomy. DESIGN: Retrospective, noncomparative, consecutive case series. METHODS: The medical records were reviewed of all patients who developed acute-onset postoperative endophthalmitis (within 6 weeks of surgery) after pars plana vitrectomy at Bascom Palmer Eye Institute between January 1, 1984 and December 31, 2003. RESULTS: During the 20-year study interval, the overall incidence rate of postvitrectomy endophthalmitis was 0.039% (6/15,326). Cultured organisms were Staphylococcus aureus (n = 3), Proteus mirabilus (n = 1), and Staphylococcus epidermidis/Pseudomonas aeruginosa (n = 1); one case was culture-negative. Visual acuity after treatment for endophthalmitis ranged from 2/200 to no light perception, with a final vision of light perception or no light perception in four of six (67%) eyes. CONCLUSION: The incidence of endophthalmitis after pars plana vitrectomy is low but the visual acuity outcomes after treatment are generally poor.

Acute Disease↗

PubMed2005

Trans-tenon retrobulbar triamcinolone injection for macular edema associated with branch retinal vein occlusion remaining after vitrectomy.

PURPOSE: To evaluate the effectiveness and safety of trans-Tenon retrobulbar triamcinolone injection for macular edema associated with branch retinal vein occlusion (BRVO) after vitrectomy. DESIGN: Prospective interventional case series. METHODS: The study included 20 eyes of 20 patients with BRVO, characterized by macular edema lasting more than 3 months after vitrectomy. Trans-Tenon retrobulbar injection of 40 mg triamcinolone was performed, and visual and anatomic responses were evaluated. RESULTS: Mean foveal thickness was 499.4 +/- 209.1 microm preoperatively, 281.8 +/- 110.1 microm at 2-week follow-up, and 196.9 +/- 92.1 microm at 6-month follow-up (P < .0001, at 2 weeks and 6 months, paired t test). Improvement of visual acuity by at least 0.2 logMAR (logarithm of the minimum angle of resolution) was seen in 14 (70%) of the 20 eyes. CONCLUSIONS: Trans-Tenon retrobulbar injection of triamcinolone may be an alternative for additional treatment of eyes with BRVO that remains after vitrectomy.

Aged↗

PubMed2006

Subjective visual sensation during vitrectomy under retrobulbar anesthesia.

PURPOSE: To report a precise illustrated image of patient's view during vitrectomy. DESIGN: Interventional case report. METHODS: A 56-year-old male with cystoid macular edema (CME) associated with epiretinal membrane underwent vitrectomy. The patient seemed to find gratification in being operated on because he was able to see what was going on. He was a professional artist in computer graphics, and he drew three different pictures depending on the surgical procedures. RESULTS: These pictures depicted the moving of pasty, whirling fluid during core vitrectomy, numerous black or gray spots like snowflakes by intravitrealy injected crystals of triamcinolone acetonide, and a sharp tapered instrument coming into the center and membrane-like material being peeled off. CONCLUSIONS: Patients may see a precise shape in a constant size, scale, and detailed movement as well, focused on the retina without described optics. Further investigation will be required to determine this mechanism.

Anesthesia, Local↗

PubMed2006

Reoperation for persistent myopic foveoschisis after primary vitrectomy.

PURPOSE: We performed vitrectomy on two eyes for persistent myopic foveoschisis (MF) after primary surgery that did not include internal limiting membrane (ILM) peeling. DESIGN: Interventional case reports. METHODS: Two highly myopic eyes of two patients with persistent MF after primary vitrectomy and gas tamponade but without ILM peeling were treated with pars plana vitrectomy, residual vitreous cortex removal, ILM peeling, and long-term gas tamponade. RESULTS: Total foveal reattachment was achieved and best-corrected visual acuity (BCVA) improved in both eyes. CONCLUSIONS: Reoperation including complete vitreous cortex removal and ILM peeling could be beneficial for patients with persistent MF after primary surgery, indicating that vitreous cortex removal and ILM peeling are critical in treating MF.

Aged↗