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At least 577 records · Page 32Linked to original sources

PubMed2005

Risk factors for postoperative hemorrhage after vitrectomy for diabetic retinopathy.

OBJECTIVE: To identify the potential risk factors for postvitrectomy diabetic vitreous hemorrhage (PDVH). METHODS: A matched case-control nested into a retrospective follow-up study was done to review the surgical results in 68 consecutive eyes undergoing primary pars plana vitrectomy for vitreous hemorrhage. The eyes were divided into two groups based on the presence of PDVH (19 cases and 49 controls) and were matched on surgeon and the date of surgery. Twenty-three factors related to the preoperative examination and eight factors related to the operative procedure were analyzed. Statistical analysis was based on conditional logistic regression models with PDVH as the dependent variable. The mean follow-up interval was six months. RESULTS: The factors associated with the incidence of PDVH were iris neovascularization (OR = 9.8, P = 0.03), lower extremity amputations (OR = 8.3, P = 0.02) and the use of antihypertensive agents within three months before vitrectomy (OR = 0.2, P = 0.04). Phakic and aphakic eyes of diabetic patients with lower extremity amputations would have a 70% probability of developing PDVH. This probability would have dropped to 30-40% had they been taking antihypertensive treatment. CONCLUSIONS: Iris neovascularization and lower extremity amputations increase the risk of PDVH. Antihypertensive treatment before vitrectomy decreases this risk.

Aged↗

PubMedDate not supplied

Preoperative electroretinograms and visual evoked cortical potentials for predicting outcome of vitrectomy in diabetics.

In order to find that the outcome of vitrectomy could be predicted in diabetics with very low visual acuity (finger counting at 3 m--approximately 20/400--or less), flash electroretinograms (ERG) and visual evoked cortical potentials (VECP) were simultaneously recorded from about 300 patients within one month before the operation. From this series two groups were formed, based on the outcome of surgery. One group (30 patients) had improved visual acuity, with finger counting at 0.1 to 1.0 m (20/200-20/20). The other group (29 patients) was unimproved by surgery. The groups were matched with regard to age, duration of diabetes, preoperative visual acuity and occurrence of cataract and previous panretinal photocoagulation. All patients had dense vitreal opacities, precluding inspection of the ocular fundus. Only patients without surgical and postoperative complications were included. There was a statistically significant (P less than 0.05) difference between the groups in ERG amplitude, but not in VECP latency or amplitude. Based on ERG amplitude, the outcome of vitrectomy could be predicted correctly in 36 of 59 patients (61%) and in 35 of 56 patients (63%) based on VECP latency. The VECP amplitude or the combination of ERG and VECP parameters did not improve the prediction rate. Thus, preoperative flash ERG and VECP can not safely predict the outcome of vitrectomy in diabetics with very low visual acuity.

Adult↗

PubMed1987

Retinal toxicity of ganciclovir in vitrectomy infusion solution.

The authors investigated the retinal toxicity of the antiviral agent ganciclovir after its addition to vitrectomy infusion fluid in rabbit eyes. Intravitreal infusion of the drug in concentrations up to 30 micrograms/ml produced no electroretinographic or histologic changes suggestive of retinal toxicity. Ganciclovir in vitrectomy infusion fluid has potential therapeutic benefit in viral retinitis (particularly in cytomegalovirus retinitis) associated with vitreous traction or rhegmatogenous retinal detachment. Based on the median inhibitory doses of ganciclovir against various herpes group viruses and the results of this study, a concentration of 30 micrograms/ml or less of the drug is recommended for vitrectomy infusion solution.

Acyclovir↗

PubMed1993

Vitrectomy with silicone oil or perfluoropropane gas in eyes with severe proliferative vitreoretinopathy. Silicone Study Report 3.

Between 1985 and 1990, 340 eyes with rhegmatogenous retinal detachment (RRD) and severe (stage C3 or worse) proliferative vitreoretinopathy (PVR) were treated with vitrectomy and randomly selected to receive perfluoropropane gas or silicone oil; 183 eyes had undergone no prior vitrectomy (group 1), and 157 eyes had undergone prior vitrectomy with intraocular gas tamponade (group 2). No differences were found between eyes in the two groups in achieving visual acuity of 5/200 or better (44% vs. 39%), macular reattachment (78% vs. 77%), or complete retinal reattachment (67% for both groups). In group 1, 74 eyes achieved complete retinal reattachment after only one operation; 41 additional eyes achieved reattachment after a second surgical procedure. In group 2, these numbers were 74 and 26, respectively. Eyes treated successfully after more than one operation were less likely to regain a visual acuity of 5/200 or better than those successfully treated with one operation (P < 0.01). There was no difference in hypotony between groups, but keratopathy was more frequent in eyes in group 2 (P < 0.05). The results suggest that differences in outcomes between group 1 and group 2 eyes are not as great as previously believed.

Adult↗

PubMed1995

Early pars plana vitrectomy without buckling procedure in cytomegalovirus retinitis-induced retinal detachment.

BACKGROUND: Retinal detachments induced by cytomegalovirus (CMV) retinitis can often be treated successfully with a buckling procedure combined with vitrectomy and silicone oil instillation, but this technique yields varying visual results. METHODS: To minimize operational trauma, pars plana vitrectomy and silicone oil instillation without additional buckling was performed in a series of 11 consecutive patients with acquired immune deficiency syndrome (AIDS) and CMV-retinitis-induced retinal detachment. Surgery was performed early in the course of the retinal detachment: 6 patients (55%) had an attached macula, and 7 patients (64%) had a visual acuity of 20/200 or better. RESULTS: After a mean follow-up period of 5 months (range, 1-9 months) 9 patients (82%) had a completely reattached retina and 9 patients (82%) had visual acuity of 20/200 or better. The macula was reattached in all patients. A localized detachment of the inferior retina was noted in 2 patients (18%), and a second operation was required in one eye. Significant cataract formation occurred in two patients during the follow-up period. Proliferative vitreoretinopathy and increased intraocular pressure were not observed. CONCLUSION: Early vitrectomy without additional buckling procedures is justified in patients with CMV-associated retinal detachment because it stabilizes the retinal situation without major complications and improves visual function.

AIDS-Related Opportunistic Infections↗

PubMed1995

Vitrectomy for accidental intraocular steroid injection.

BACKGROUND: Accidental perforation of the globe and intraocular injection of steroid is a potential complication of periocular injections. Final outcomes in eyes in which this complication has occurred have been reported to be unsatisfactory in the past. However, the advent of vitrectomy has altered their prognosis significantly. METHODS: A retrospective analysis was done of five cases of accidental intraocular steroid injection, treated by vitrectomy. Additional procedures involved treatment of retinal breaks (where required) with endolaser or transscleral cryopexy. Scleral buckling was done in one case. RESULTS: Barring one case in which retinal detachment developed, there were no postoperative complications. At last follow up all patients had satisfactory recovery of visual acuity; had attached retina; and quiet anterior chamber and vitreous cavities. CONCLUSION: Vitrectomy is associated with satisfactory results in cases of accidental intraocular steroid injection. Delay up to a few days does not seem to materially influence the outcome.

Adolescent↗

PubMed1997

Severe ocular trauma managed with primary pars plana vitrectomy and silicone oil.

PURPOSE: This study evaluated the outcome of severely injured eyes treated with early primary vitrectomy with silicone oil filling. METHODS: A total of 435 eye injuries, which required surgical intervention, were reviewed retrospectively. In 13 eyes (3%) pars plana vitrectomy and silicone oil filling were performed as primary surgical repair. Silicone oil filling was restricted to cases with laceration of the retina larger than 4 disc diameters (nine eyes), primary retinal detachment larger than two quadrants (two eyes) and/or persistent intrasurgical hemorrhage (12 eyes). All patients underwent surgery within 24 hours. RESULTS: After a mean follow-up period of 28.7 months (range, 9-70 months), 11 eyes achieved a visual acuity ranging from 20/25 to 20/200. Silicone oil was removed in 11 of 13 eyes after 5.8 +/- 4.6 months. Recurrent proliferative vitreoretinopathy developed in two eyes. CONCLUSIONS: Silicone oil tamponade after early primary pars plana vitrectomy may be an alternative for primary repair after trauma, especially in severely injured eyes with retinal lacerations larger than 4 disc diameters, persistent intrasurgical bleeding, and/or primary retinal detachments.

Adolescent↗

PubMed1997

Influence of the cannulated vitrectomy system on the occurrence of iatrogenic sclerotomy retinal tears.

PURPOSE: To determine whether the use of the cannulated vitrectomy system decreases the incidence of sclerotomy-related retinal tears relative to traditional vitrectomy techniques. METHODS: Forty-one eyes of 77 patients in this study were randomly selected to undergo treatment with the cannulated port system. RESULTS: We demonstrated a statistically significant decreased incidence of sclerotomy tears in the cannulated group relative to the noncannulated group (1% vs. 7.7%, P < 0.05). The benefit of the cannulated port system appears to be greatest in cases in which an inexperienced surgeon is learning the techniques of vitreoretinal surgery, in eyes with a preoperative diagnosis of tractional diabetic detachment, and in surgery requiring membrane delamination (simple and extensive). CONCLUSION: The three-port vitrectomy system decreases the incidence of sclerotomy-related retinal tears.

Catheterization↗

PubMed1998

Vitrectomy for proliferative diabetic retinopathy with asteroid hyalosis.

PURPOSE: To characterize the clinical features of proliferative diabetic retinopathy (PDR) with asteroid hyalosis treated by pars plana vitrectomy. METHODS: Vitrectomy was performed in 26 eyes with PDR accompanied by asteroid hyalosis (7 eyes with vitreous hemorrhage, 6 eyes with tractional retinal detachment with vitreous hemorrhage, and 13 eyes with tractional retinal detachment without vitreous hemorrhage). We observed the occurrence of posterior vitreous detachment intraoperatively and evaluated the clinical characteristics retrospectively. RESULTS: In 24 eyes, posterior vitreous detachment was slight, necessitating artificial detachment. Of the 26 eyes, 20 experienced iatrogenic retinal breaks and 6 (23%) experienced postoperative retinal detachment due to iatrogenic breaks. Three cases worsened to anterior proliferative vitreoretinopathy and retinal reattachment could not be achieved. CONCLUSIONS: In vitrectomy for PDR with asteroid hyalosis, and in cases of simple vitreous hemorrhage, surgery should be performed with full understanding of the anatomic characteristics. Notably, if posterior vitreous detachment is not present, the occurrence of iatrogenic retinal breaks is more likely.

Adult↗

PubMed1999

Microbiologic yields and complication rates of vitreous needle aspiration versus mechanized vitreous biopsy in the Endophthalmitis Vitrectomy Study.

PURPOSE: To compare the microbiologic yields and complication rates associated with vitreous needle tap and vitreous biopsy in the Endophthalmitis Vitrectomy Study (EVS). METHODS: Of 420 EVS patients with postoperative endophthalmitis, 201 received immediate vitreous tap or biopsy (without pars plana vitrectomy) by random assignment and 193 completed 9-12 months of follow-up. Vitreous specimens were obtained by biopsy with a 20-gauge vitrectomy cutting instrument or by needle tap with a 22-27-gauge needle. If resistance to aspiration by needle tap was noted, a vitreous biopsy was performed. RESULTS: Of 201 patients undergoing tap or biopsy, 70 (35%) had needle tap, 127 (63%) had mechanized biopsy, and 4 (2%) had initial needle tap that was aborted to mechanized biopsy ("abort" eyes). Intraoperative hyphema occurred in 2 tap eyes (3%), 3 biopsy eyes (2%), and 0 (0%) abort eyes. Postoperative retinal detachment developed in 8 (11%) tap eyes, 10 (8%) biopsy eyes, and 0 (0%) abort eyes (not significant). Respective rates of culture and gram stain positivity were 69% and 42% in tap eyes and 66% and 41% in biopsy eyes (not significant). The rate of severe visual loss (final acuity <5/200) was significantly higher in tap eyes (16 eyes, 24%) compared with biopsy eyes (13 eyes, 11%) and abort eyes (0 eyes, 0%; P = 0.043). The difference was largely explained by the greater proportion of virulent organisms in the tap eyes compared with biopsy eyes. When visual acuity outcome was defined by other thresholds (20/40 and 20/100), the difference was not significant. CONCLUSIONS: This study showed no significant differences between mechanized vitreous biopsy and needle tap with respect to microbiologic yield, operative complications, short-term (9-12 months) retinal detachment risk, or visual outcome. Choice of vitreous sampling procedure must depend on the clinical judgment of the surgeon.

Biopsy, Needle↗

PubMed1999

Experimental prophylaxis of Staphylococcus aureus endophthalmitis after vitrectomy: the use of antibiotics in irrigating solution.

PURPOSE: To test the efficacy of clindamycin and gentamicin in irrigating solution during vitrectomy to prevent experimental Staphylococcus aureus endophthalmitis. MATERIALS AND METHODS: Thirty-six New Zealand white rabbits were divided into six groups. Vitrectomy using two different irrigating solutions was followed by intravitreal injection of S. aureus: Group 1, balanced salt solution (BSS) followed by 1,000 colony-forming units (CFU) S. aureus; Group 2, BSS fortified with clindamycin, 10 microg/mL, and gentamicin, 8 microg/mL (CGBSS), followed by intravitreal injection of 1,000 CFU S. aureus; Group 3, BSS followed by 2,000 CFU S. aureus; Group 4, CGBSS followed by 2,000 CFU S. aureus; Group 5, BSS followed by 4,000 CFU S. aureus; and Group 6, CGBSS followed by 4,000 CFU S. aureus. The eyes were examined clinically after surgery. Vitreous samples were cultured and histologic studies were performed. RESULTS: Severe endophthalmitis developed in all eyes in Groups 1, 3, and 5 (not given antibiotics). No endophthalmitis developed in Group 2. In Group 4, five of the six eyes were normal and one eye had endophthalmitis. In Group 6, one eye had clear vitreous and fundus, three eyes had moderate vitreous haze, and the other four eyes demonstrated severe endophthalmitis. Bacterial growth in Groups 1, 2, 3, 4, 5, and 6 were 4/4, 0/4, 6/6, 1/6, 4/6, and 2/8 eyes, respectively. CONCLUSION: When 1,000 to 2,000 CFU S. aureus were injected after vitrectomy, clindamycin and gentamicin in the irrigating solution significantly diminished the intraocular inflammation and the rate of positive bacterial culture. Clindamycin and gentamicin in the irrigating solution were not significantly effective when 4,000 CFU bacteria was injected; however, the degree of inflammation was less severe than in the control group.

Acetates↗

PubMed1999

Corneal epithelial defects following vitrectomy surgery using hand-held, sew-on, and noncontact viewing lenses.

PURPOSE: To compare the incidence of corneal epithelial defects following vitrectomy surgery with Charles hand-held infusion lenses, Landers sew-on lenses, and the Oculus BIOM noncontact lens system. METHODS: We performed a retrospective chart review of 234 patients who underwent initial vitrectomy surgery by one surgeon. We determined the presence and duration of postoperative epithelial defects and identified predisposing factors. RESULTS: There were more corneal epithelial defects noted postoperatively in eyes with hand-held infusion lenses (23.8%) compared with eyes with sew-on lenses (8.6%; P = 0.010) and eyes with noncontact lenses (0%; P < 0.001). There were also more defects in sew-on versus noncontact lenses (P = 0.014). Diabetic patients had more postoperative epithelial defects with hand-held infusion lenses (32.1 %) than with sew-on lenses (8.8%; P = 0.011) or with noncontact lenses (0%; P < 0.001). The average operative time for patients with epithelial defects (169 minutes) was longer than for patients without defects (117 minutes) (P < 0.001). The risk of these defects remained significant after controlling for both length of surgery and diabetes status. CONCLUSIONS: Corneal epithelial defects were more common after vitrectomy surgery using hand-held infusion lenses than after surgery using sew-on lenses and did not occur with the noncontact lens system. In addition, reducing the operative time may independently reduce the risk of epithelial defects, regardless of lens type.

Corneal Diseases↗

PubMed1999

TPA-assisted vitrectomy for proliferative diabetic retinopathy: results of a double-masked, multicenter trial.

OBJECTIVE: Some complications of vitrectomy are related to adherence of the vitreous body to the retina. We studied whether these complications could be decreased by injecting a proteolytic enzyme, tissue plasminogen activator (TPA), at the beginning of surgery to aid separation of the vitreous from the retina. METHODS: Fifty-six patients receiving surgery for complications of proliferative diabetic retinopathy were divided into two groups in this prospective, randomized, double-blind study. Group I patients received 25 microg of intravitreal TPA in buffered salt solution (BSS) 15 minutes before vitrectomy. Group II received BSS alone. Postoperative follow-up lasted up to 3 months. The major criteria for comparison were the number of perioperative iatrogenic tears, the gain in visual acuity, and the reattachment rate of tractional retinal detachments. RESULTS: No difference was found between the two groups for the principal indicators or for complications. CONCLUSION: In proliferative diabetic retinopathy, the use of 25 microg of TPA by intravitreal injection 15 minutes before vitrectomy does not improve the results. No specific complications of the method were noted. The failure can be attributed to a too-short delay between TPA injection and beginning of surgery, an insufficient dose, or an insufficient quantity of plasminogen in the vitreous at the beginning of the intervention.

Diabetic Retinopathy↗

PubMed2000

The role of preoperative subconjunctival mydricaine and topical diclofenac sodium 0.1% in maintaining mydriasis during vitrectomy.

PURPOSE: To establish the role of preoperative subconjunctival mydricaine and diclofenac 0.1% in maintaining mydriasis during vitrectomy. METHODS: Fifty-seven patients were entered into the study. All were given cyclopentolate 1% and phenylephrine 2.5% preoperatively. Each patient was randomly allocated to one of three groups. In Group 1, patients received mydricaine by subconjunctival injection and diclofenac 0.1% topically preoperatively. In Group 2, patients received only subconjunctival mydricaine. Group 3 patients received only topical diclofenac preoperatively. Pupil diameter was measured with calipers before and at the end of the operation. RESULTS: There was no statistically significant difference in the change in pupil size between Groups 2 and 3. In all patients in Group 1 (who received both subconjunctival mydricaine and diclofenac preoperatively), pupil size was either maintained or increased after vitrectomy. This result was statistically significant when compared with the other groups (for Group 1 versus Group 2, P<0.005; for Group 1 versus Group 3, P<4.7x10(-06)). CONCLUSION: Topical diclofenac is useful for maintaining pupil size during vitrectomy only when used in conjunction with subconjunctival mydricaine, especially in patients in whom prolonged surgery is anticipated.

Adolescent↗

PubMed2000

Ultrasound biomicroscopy for examination of the sclerotomy site in eyes with proliferative diabetic retinopathy after vitrectomy.

PURPOSE: We evaluated the capability of ultrasound biomicroscopy (UBM) to predict fibrovascular proliferation at sclerotomy sites in eyes with postoperative vitreous hemorrhage due to proliferative diabetic retinopathy (PDR). METHODS: Ultrasound biomicroscopy was used for examining the sclerotomy sites in 13 eyes of 11 patients with PDR experiencing postoperative vitreous hemorrhage (PDR group). Thirty-nine sclerotomy sites (all entry sites of each eye) were examined before reoperation, and the UBM images were compared with findings obtained during revision of the vitrectomy. Thirteen eyes of 13 patients undergoing vitrectomy for nondiabetic diseases were used as controls and examined after vitrectomy. RESULTS: The UBM images were classified into the following four categories: A, tent; B, spheroid; C, trapezoid; and N, none. The findings were distributed as follows in the PDR group: category A, 18%; B, 5%; C, 56%; and N, 21 %; and as follows in the control group: category A, 28%; B, 5%; C, 5%; and N, 62%. In the PDR group, 11 of 12 sclerotomy sites disclosing fibrovascular proliferation possessed the trapezoidal image. Mean length of trapezoidal base was 2.49+/-0.97 mm and 1.51+/-0.75 mm in the groups with and without fibrovascular proliferation, respectively (P<0.01). The average relative reflectivity of the trapezoidal image against the sclera was 0.501+/-0.169 in the fibrovascular proliferation group and 0.891+/-0.183 in the fibrous ingrowth group (P<0.01). CONCLUSION: Ultrasound biomicroscopy is useful in detecting fibrovascular proliferation at sclerotomy sites because a large and low-reflecting trapezoidal UBM image is highly correlated to its presence.

Adult↗

PubMed2000

Primary vitrectomy alone for repair of retinal detachments following cataract surgery.

PURPOSE: To report the visual, anatomic, and refractive results of primary vitrectomy alone for the repair of retinal detachments (RD) following cataract surgery. METHODS: Retrospective review of office charts and operative reports of 83 eyes. RESULTS: A minimum of 4 months' follow-up was achieved for 78 pseudophakic or aphakic eyes that underwent primary vitrectomy, internal drainage of subretinal fluid, retinopexy, and intravitreal gas injection for RD repair. Anatomic reattachment was achieved in 93.6% of cases after one procedure and in 96.2% eventually. Median preoperative Snellen acuity was 20/200 and increased to 20/25 at final examination. For the 45 eyes with macula-off detachments, 80% achieved final acuities greater than or equal to 20/40. The average refractive change following surgery was -0.11 diopters. Transient postoperative ocular hypertension was seen in 17.9% and proliferative vitreoretinopathy with recurrent RD in 5.1%. CONCLUSION: Primary pars plana vitrectomy is a highly effective treatment modality for the repair of RD following cataract surgery, and appears to be refractively neutral.

Adult↗

PubMed2000

Pars plana vitrectomy for persistent, visually significant vitreous opacities.

PURPOSE: To evaluate the role of vitrectomy in patients with persistent, visually disabling vitreous opacities. METHODS: Six consecutive eyes of five men (age 58-66 years) with pseudophakia or aphakia and vitreous opacities resulting in visual symptoms for more than 1 year that underwent vitrectomy were retrospectively reviewed. Postoperative questionnaires regarding functional performance and quality-of-life issues were completed by the participants to assess subjective patient satisfaction. RESULTS: Postoperative Snellen visual acuity was improved or equal to preoperative acuity in all cases (8-44 month follow-up) and there were no surgical complications. All patients expressed high satisfaction with overall visual function. Analysis of the National Eye Institute Visual Function Questionnaire-39 indicated that general vision, near activities, distance activities, mental health, role difficulties, and peripheral vision were significantly improved (P < 0.05) following surgical intervention. CONCLUSIONS: Vitrectomy may be indicated in a select group of patients with visually disabling vitreous floaters, although objective assessment of visual dysfunction from vitreous floaters requires further evaluation.

Aged↗

PubMed2001

Vitrectomy for retinal detachments with both peripheral retinal breaks and macular holes. An assessment of outcome and the status of the macular hole.

PURPOSE: To establish the effectiveness of vitrectomy and gas tamponade for treating retinal detachments due to peripheral retinal breaks with an associated macular hole and to discover the status of the macular hole at long-term follow-up. METHODS: Twenty-three consecutive patients with combined peripheral break and macular hole retinal detachments were treated by pars plana vitrectomy. The main outcome measures were reattachment of the retina and status of the macular hole. RESULTS: Seventy-eight percent of the operations were successful in reattaching the retina initially, improving to 87% after two patients had another operation. Three patients declined further surgery. Long-term follow-up of macular hole status was possible in 16 cases. Closure rate was 31%. CONCLUSION: Pars plana vitrectomy with gas tamponade is an effective method of treating this form of retinal detachment. Some macular holes close after this surgery.

Adult↗