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At least 595 records · Page 33Linked to original sources

PubMed2001

Ultrasound biomicroscopy of sclerotomy sites: the effect of vitreous shaving around sclerotomy sites during pars plana vitrectomy.

PURPOSE: To study the difference in the amount of vitreous incarceration between conventional pars plana vitrectomy (PPV) and PPV with vitreous shaving around sclerotomy sites. METHODS: A dynamic in vivo examination using ultrasound biomicroscopy (UBM) was performed on the sclerotomy sites of 22 eyes after PPV. Patients were divided into two groups. In the study group (n = 11), the vitreous was completely shaved from the internal initial sclerotomy by cotton-tip depressed vitrectomy under coaxial illumination. In the control group (n = 11), no vitreous shaving was performed. RESULTS: Vitreous incarceration into sclerotomy sites was significantly less in the study group compared with the control group (P <0.001). No difference was seen among the three sclerotomy sites regarding vitreous incarceration within individual eyes. No difference was seen between eyes operated by right- and left-handed surgeons. CONCLUSIONS: Vitreous shaving of sclerotomy sites using depressed vitrectomy significantly reduces vitreous incarceration. This may reduce the rate of sclerotomy-related complications following PPV in selected cases.

Case-Control Studies↗

PubMed2003

Perfluorocarbon liquid utilization in primary vitrectomy repair of retinal detachment with multiple breaks.

PURPOSE: To evaluate the efficacy of pars plana vitrectomy in conjunction with intraoperative perfluoro-n-octane (PFO) use as initial treatment of retinal detachment (RD) with multiple breaks located at various distances from the ora serrata. METHODS: Twenty-two consecutive eyes (15 phakic, 2 aphakic, and 5 pseudophakic) presenting with RD with multiple breaks and tears underwent primary pars plana vitrectomy, PFO retinal reattachment, transcleral cryopexy or endolaser treatment of breaks, PFO/air exchange, and final injection of 18% perfluoropropane (C3F8). Scleral buckles were not used. The mean follow-up period was 29 months. RESULTS: Temporary PFO utilization attached the posterior retina and facilitated the safe removal of vitreous at its base and around the retinal tears. Intraoperative complications included new breaks (3 eyes), enlargement of breaks (2 eyes), and a small bubble of subretinal PFO (1 eye). Postoperatively, the retina remained attached during follow-up in 19 eyes. Cataract developed or progressed in 13 phakic eyes. CONCLUSIONS: Pars plana vitrectomy in conjunction with intraoperative PFO utilization is effective as initial treatment of RDs with multiple breaks. The main limitation of this technique is the postoperative progressive cataract formation in phakic eyes.

Adult↗

PubMed2003

Management of giant retinal tears with vitrectomy, internal tamponade, and peripheral 360 degrees retinal photocoagulation.

PURPOSE: To determine the effectiveness of vitrectomy, internal tamponade, and peripheral 360 degrees retinal photocoagulation in the management of giant retinal tears (GRTs). PARTICIPANTS: Eighteen eyes of 18 consecutive patients with GRTs were operated on at Jules Gonin Eye Hospital between 1992 and 1999. None of them had previous vitreoretinal surgery. METHODS: Eyes in the series underwent pars plana vitrectomy, perfluorocarbon liquid and silicone oil (17 eyes) or gas (one eye) exchange, and retinopexy. Retinopexy was applied to the edges of the tear using photocoagulation, and it was extended over 360 degrees to the peripheral attached retina. No scleral buckle was placed, even if proliferative vitreoretinopathy (PVR) was present. RESULTS: The GRT was 180 degrees or greater in seven eyes and 90 degrees to 180 degrees in 11 eyes. The lower edge of the GRT was located in an inferior quadrant in 15 eyes. PVR was grade A in seven eyes, grade B in eight eyes, and grade C in three eyes. In the last three eyes, PVR was anterior (C-A9, Patient 4) and posterior (C-P6 subretinal, Patient 11; C-P3, Patient 13). In 16 (88.8%) of the 18 eyes, the retina was successfully reattached after surgery, and silicone oil was removed after a mean period of 7.7 weeks. In the other two eyes, the retina remained detached or redetached despite the silicon oil tamponade. One of these two eyes underwent three further surgeries, but the retina did not reattach. The other eye was successfully reoperated on with an encircling and radial scleral buckle, and silicone oil was removed later. At the end of the follow-up, the retina was attached in 17 (94.4%) of the 18 eyes. The mean follow-up was 28.6 months (range, 4.5-73 months). CONCLUSIONS: The success rate of management of GRTs with vitrectomy, internal tamponade, and peripheral 360 degrees photocoagulation of the retina without scleral buckle is high. Photocoagulation of the peripheral retina over 360 degrees appears to decrease the risk of secondary peripheral retinal tears.

Adult↗

PubMed2003

Vitrectomy for posterior segment intraocular foreign bodies: visual results and prognostic factors.

PURPOSE: To evaluate the visual results and determine the prognostic factors after the removal of retained posterior segment intraocular foreign bodies (IOFBs) by pars plana vitrectomy. METHODS: A retrospective study of 40 consecutive cases of pars plana vitrectomy for the removal of IOFBs during the period of January 1991 to June 2000 was conducted. Association between visual outcome and various preoperative, operative, and postoperative variables was statistically analyzed. RESULTS: Of the 40 cases available for the study, the IOFBs could be removed in 36 eyes. Half the patients had removal of the IOFB within 14 days of the injury. Nineteen patients (47.5%) achieved a visual acuity of 20/40 or better. Postoperative retinal detachment occurred in 13 patients (32.5%). Poor visual outcome was found to be significantly associated with poor initial visual acuity and postoperative retinal detachment, whereas good visual outcome was significantly associated with the absence of lens injury and absence of postoperative retinal detachment. CONCLUSIONS: Acceptable visual results could be achieved after the removal of posterior segment IOFBs by vitrectomy, despite a delay in surgery. Postoperative retinal detachment, poor initial visual acuity, and the absence of lens injury were the factors that played a significant role in determining the visual outcome.

Adolescent↗

PubMed2004

Long-term results of vitrectomy for removal of submacular hard exudates in patients with diabetic maculopathy.

PURPOSE: To investigate long-term results of vitrectomy for the removal of submacular hard exudates in patients with diabetic maculopathy. METHODS: Thirteen eyes of 10 patients with diabetic maculopathy underwent vitrectomy to remove submacular hard exudates from December 1993 to March 1999. The mean preoperative logMAR visual acuity +/- SD was 1.54 +/- 0.43. Preoperatively, the exudates ranged from 0.5 to 3 disk diameters (average, 1.25 disk diameters). Exudates were removed using subretinal forceps through a minimal paramacular retinotomy after vitrectomy. In all cases, 20% SF6 gas tamponade was added. The mean postoperative observation period was 43.2 months. RESULTS: Visual acuity was improved in 7 eyes (54%) 1 year after surgery; however, visual acuity over longer periods was improved in only 5 eyes (38%) as compared with the preoperative findings. The mean final visual acuity +/- SD was 1.62 +/- 0.59, which did not show statistically significant improvement over that in the control group. Although submacular hard exudates and macular edema disappeared during the postoperative period, atrophic or degenerative changes occurred in many cases. CONCLUSION: Visual improvement could not be obtained for a long period after removing submacular hard exudates in most of the patients, suggesting that diabetic maculopathy should be treated before massive exudate deposits appear in the macula.

Aged↗

PubMed2004

Delayed visual loss after pars plana vitrectomy for retained lens fragments.

PURPOSE: To report visual results and postoperative complications in patients undergoing vitrectomy for retained lens fragments. METHODS: Retrospective, noncomparative, interventional case series of 42 consecutive patients undergoing vitrectomy for retained lens fragments by a single surgeon, all with a minimum of 6 months' follow-up. The main outcome measurement was best corrected visual acuity at 3 months and at final follow-up visit. RESULTS: Although 67% of eyes achieved a postoperative visual acuity of 20/40 or better at 3 months, 17% had events during follow-up that resulted in loss of vision to less than 20/40. Final best corrected visual acuity 20/40 or better was achieved in 50% of eyes. Retinal detachment occurred in 17%, and 21% of eyes required long-term therapy for glaucoma. CONCLUSION: Patients undergoing vitrectomy for retained lens fragments often develop delayed visual loss. Long-term surveillance is necessary in these patients.

Adult↗

PubMed2004

Bioptic significance of incarcerated contents at sclerotomy sites during vitrectomy.

PURPOSE: To study the clinical significance of incarcerated materials at sclerotomy sites during vitrectomy. METHODS: Fifty samples prolapsed from the entries to standard three-port pars plana vitrectomies were collected along the scleral surface. Samples from rhegmatogenous retinal detachments (RD) (n = 28), traumatic RD (n = 4), miscellaneous vitreous hemorrhages (n = 12), and intraocular foreign bodies (n = 6) were stained with hematoxylineosin and examined under light microscopy after being fixed in paraffin sections or smeared on slides. RESULTS: The specimens collected after sclerotomy contained vitreous tissue mixed with dispersive and sheet nonpigmented ciliary epithelia, scattered pigment granules, and small pigment gobbets. Specimens collected during vitrectomy contained pigment granules and various cells with a jellylike appearance. Fibrous tissue and remnants of ciliary body and retina were found in some specimens. The incarcerated tissues caused 12 cases of iatrogenic retinal breaks, among which RD recurred in six cases postoperatively due to anterior proliferative vitreoretinopathy. In the noniatrogenic retinal break group, only 4 RD recurred (6/12 versus 4/38, chi2 = 6.586, P = 0.01). CONCLUSION: The incarcerated contents at sclerotomy sites were mainly adjacent tissues and cells. Prolapsed and incarcerated ciliary body and retina fragments were common and might cause iatrogenic retinal breaks. Attention should be paid to this material intraoperatively.

Biopsy↗

PubMedDate not supplied

Primary vitrectomy for combined rhegmatogenous retinal detachment and choroidal detachment with or without oral corticosteroids: a pilot study.

PURPOSE: The occurrence of choroidal detachment (CD) in eyes with primary rhegmatogenous retinal detachment (RRD) is relatively uncommon (2%-4.5%). Recent reports suggest that primary vitrectomy yields better anatomic success than scleral buckling. However, for these inflamed eyes with low intraocular pressure, the influence of preoperative oral steroids on reattachment rates has not been elucidated yet. METHODS: Twenty eyes with combined RRD and CD that underwent primary vitrectomy were randomized to receive oral steroids (for 1 week) or no oral steroids before surgery. RESULTS: Preoperative clinical data such as mean age, lens status, Snellen visual acuity, duration of macular detachment, CD (size and extent), and retinal detachment characteristics (e.g., extent, number of retinal breaks, atrophic or tractional retinal break, size of retinal break, and location of retinal break) were similarly distributed in both groups. Single-operation anatomic success was 81.8% (9/11) among those patients who received preoperative oral steroids and was 66.7% (6/9) among those who did not receive preoperative oral steroids. After reoperation, anatomic success was 100% in both groups. The mean follow-up was 20.1 months. CONCLUSION: The results suggest that administration of oral steroids before primary vitrectomy in eyes with combined RRD and CD improves reattachment rates.

Administration, Oral↗

PubMedDate not supplied

Endophthalmitis after pars plana vitrectomy: a New Zealand experience.

PURPOSE: To describe the clinical course and estimate the incidence of endophthalmitis after pars plana vitrectomy in New Zealand. METHODS: A retrospective analysis was performed on all cases of culture-positive endophthalmitis after vitreoretinal surgery over a 10-year period. RESULTS: Five cases of culture-positive endophthalmitis were identified between 1993 and 2002. During this interval, 10,397 vitrectomies were performed, equating to an overall incidence of 0.048%. All patients presented within 7 days of surgery. CONCLUSIONS: Endophthalmitis after pars plana vitrectomy is uncommon but is associated with a poor functional outcome.

Adult↗

PubMedDate not supplied

Macular hole diameter after vitrectomy for macular hole and retinal detachment.

PURPOSE: We measured postoperative macular hole (MH) size after vitrectomy for MH and retinal detachment (MHRD) in high myopia and investigated potentially associated factors. METHODS: Eleven patients (11 eyes) with high myopia (axial length, 25.6-30.8 mm; mean patient age +/- SD, 64.0 +/- 4.31 years) who had retinal attachment without MH closure after vitrectomy for MHRD were included in the study. Postoperative MHs were measured using optical coherence tomography. A horizontal 5.65-mm-long scan of the retina was obtained, and the MH size was measured as the length between the edges of the MH using the retinal thickness mode of the optical coherence tomography system. RESULTS: The mean postoperative MH size +/- SD was 1,220 +/- 450 microm. Only axial length was significantly associated with postoperative MH size (P < 0.05). There was a tendency for smaller MH sizes to be associated with better postoperative best-corrected visual acuity (P = 0.06). CONCLUSIONS: Persistent MHs after vitrectomy were enlarged according to axial length elongation in highly myopic eyes. Even if MH closure was not successful, the maximum effort to shorten postoperative MH size led to a better postoperative outcome.

Aged↗

PubMed2006

Management of retinal detachment due to closed globe injury by pars plana vitrectomy with and without scleral buckling.

BACKGROUND AND PURPOSE: To investigate the effect of circumferential scleral buckling on the prognosis for patients undergoing pars plana vitrectomy and lensectomy for severe closed globe injury. METHODS: A total of 33 cases in which pars plana vitrectomy and lensectomy were performed after severe closed globe injury between January 1990 and January 2003 were studied retrospectively. All patients had zone III contusion type injury according to The Ocular Trauma Classification Group criteria. Of the 33 patients, 15 (group 1) also underwent peripheral scleral buckling; 18 did not (group 2). RESULTS: The mean age +/- SD was 34.8 +/- 17.5 years (range, 8-73 years). There were 6 female (18%) and 27 male (82%) patients. The two groups did not differ significantly in terms of preoperative visual acuity (P = 0.76) or postoperative visual improvement (P = 0.46). In groups 1 and 2, 4 (26%) and 3 (17%) patients developed recurrent retinal detachment for which they underwent reoperation. Other postoperative complications were as follows: group 1-phthisis (1 patient; 7%), proliferative vitreoretinopathy (1 patient; 7%), and optic atrophy (1 patient; 7%); group 2, proliferative vitreoretinopathy (2 patients; 11%) and optic atrophy (2 patients; 11%). CONCLUSION: Circumferential scleral buckling did not appear to offer advantages for patients undergoing pars plana vitrectomy and lensectomy for severe closed ocular injury involving the posterior chamber.

Adolescent↗

PubMed2006

Retinal damage caused by air-fluid exchange during pars plana vitrectomy.

PURPOSE: To report two cases of retinal damage associated with air infusion during pars plana vitrectomy. DESIGN: Observational case report. METHODS: The authors reviewed the course of two patients who had retinal damage during par plana vitrectomy and air-fluid exchange for the treatment of macular hole and optic pit-related macular detachment, respectively. The intraoperative observations, postoperative course, and outcomes were reported. RESULTS: As a result of high air infusion flow during air-fluid exchange, retinal damage was created in the area contralateral to the infusion port. In Case 1, an oval area of whitening was noted on the first postoperative day. This area subsequently developed into a large retinal break associated with retinal detachment. In the second case, retinal whitening was noted intraoperatively. This region of pallor resolved quickly during the early postoperative period but resulted in a corresponding inferotemporal visual field defect. CONCLUSIONS: High infusion flow during air-fluid exchange in eyes undergoing vitrectomy surgery may result in significant retinal damage. This pressure-induced trauma initially causes retinal whitening that may be seen intraoperatively or during the early postoperative period. The region of damaged retina may develop a retinal break and detachment or a corresponding visual field defect.

Adult↗

PubMed1995

Comparison of pars plana vitrectomy and scleral buckling for uncomplicated rhegmatogenous retinal detachment.

Retinal detachment surgery can now achieve a final reattachment rate in over 90% of cases. The operation of choice in most cases is that of external scleral buckling with or without drainage of subretinal fluid. However, in a minority of cases these techniques are difficult to apply either when the breaks are unseen due to media opacities or when the breaks are complex, eg, posterior, large, or multiple breaks at different distances from the ora. Improvements in the technique of pars plana vitrectomy for retinal detachment now offers us an alternative method for treating these difficult cases. Pars plana vitrectomy for retinal detachments with unseen or complex breaks has a final attachment rate of over 90%, is technically easier to perform than conventional surgery, and avoids the refractive and ocular motility problems associated with complicated buckles. For these reasons and despite the high risk of nuclear sclerosis in phakic eyes, a pars plana vitrectomy may be the preferred option in selected cases of primary retinal detachment.

Humans↗

PubMed1996

Lensectomy, vitrectomy indications, and techniques in cataract surgery.

Removal of a cataract during a vitrectomy can be performed to improve visualization for the surgeon or to facilitate visual rehabilitation for the patient. Because aphakic eyeglasses or contact lenses are often poor options to correct aphakia, placement of an intraocular lens during or after a vitrectomy is becoming increasingly common. A cataractous lens can be removed by pars plana lensectomy, phacoemulsification, or extracapsular cataract extraction. Options for intraocular lens placement include no intraocular lens, anterior chamber lens or sutured posterior capsular lens in the absence of capsular support, "in-the-bag" posterior capsular lens, or sulcus-fixated posterior capsular lens. This article reviews the current indications and techniques for cataract removal with or without intraocular lens placement in patients undergoing vitrectomy.

Cataract Extraction↗

PubMed1996

Long-term results of pars plana vitrectomy in the management of intermediate uveitis.

Pars plana vitrectomy is a useful tool for the management of certain complications in chronic intermediate uveitis. Media opacities obscuring the visual axis, vitreous membranes causing tractional retinal detachment, macular puckers, and ciliary traction leading to hypotony are clear indications for this approach. Furthermore, it has been suggested that vitrectomy may have a favorable long-term effect on the course of disease. The procedure may achieve regression of inflammation, tapering of immunosuppression, and improvement of cystoid macular edema. However, randomized prospective trials are still needed to define the role of vitrectomy in altering the course of uveitis.

Chronic Disease↗

PubMed2006

Primary retinal detachment: scleral buckle or pars plana vitrectomy?

PURPOSE OF REVIEW: There remains no consensus among vitreoretinal surgeons regarding the optimal management of primary rhegmatogenous retinal detachment. In this article, fundamental principles are discussed and applied to recent clinical reports. RECENT FINDINGS: The consensus of the peer-reviewed literature appears to be that scleral buckling and primary pars plana vitrectomy may yield comparable single-operation success rates and visual acuity outcomes for a wide variety of rhegmatogenous retinal detachments. SUMMARY: No definitive prospective, randomized, multicenter trial compares scleral buckling with pars plana vitrectomy. The upcoming Scleral Buckling versus Primary Vitrectomy in Rhegmatogenous Retinal Detachment study may yield useful information in this regard. Even when this study is completed, the choice of surgical modality is complex and may be individualized for specific patients.

Humans↗

PubMed2006

Diabetic vitrectomy: risks, prognosis, future trends.

PURPOSE OF REVIEW: We review the current standards, risks, prognosis, and indications for diabetic pars plana vitrectomy and consider recent developments in surgical techniques. We also examine surgery's role as a treatment modality for diabetic eye disease among the other accepted and developing treatment options, such as systemic and intravitreal pharmacotherapy. RECENT FINDINGS: Pars plana vitrectomy for diabetic macular edema and for traction retinal detachment is addressed. Techniques to decrease retinal swelling and ischemia are showing promising results. The use of the smaller 25-gauge and 23-gauge vitrectors is gaining acceptance and offers advantages such as less trauma, less postoperative discomfort, and quicker healing. Techniques are being developed and refined to help prevent postoperative vitreous hemorrhage using cryotherapy around sclerotomy sites and/or endolaser in a near-confluent pattern in an effort to quell fibrovascular ingrowth and subsequent hemorrhage. Finally, pharmacological advances include targeting three levels of intervention: achieving the best glycemic control, correcting altered retinal metabolism secondary to increased glucose availability, and employing neuroprotective and vasoprotective agents. SUMMARY: The combination of therapies and interventions as they improve and evolve offers the potential to revolutionize the approach to the complications of diabetic eye disease and may soon render many current interventions obsolete. Diabetic pars plana vitrectomy continues to advance with better anatomic and visual success.

Diabetic Retinopathy↗

PubMed2005

Pars plana vitrectomy in ocular injury with intraocular foreign body.

BACKGROUND: We evaluated 70 cases of ocular injuries with intraocular foreign bodies to determine the results of surgical management. METHODS: The site of penetration was cornea in 58 (82.9%), sclera in 8 (11.4%), and limbus in 4 (5.7%) eyes. The foreign body was in the vitreous in 40 (57.1%) and embedded in the retina in 30 (42.9%) cases. Before pars plana vitrectomy, the most common findings were found to be lens perforation (77.1%), vitreous hemorrhage (45.7%), endophthalmitis (20%), hyphema (4.3%), and retinal detachment (2.9%). RESULTS: After pars plana vitrectomy, visual acuity improved in 39 (55.7%), did not change in 19 (27.2%), and decreased in 8 (11.4%) cases. We observed secondary glaucoma in 11 (15.7%), retinal detachment in 10 (14.3%), and phthisis bulbi in 3 (4.3%) cases postoperatively. CONCLUSION: Pars plana vitrectomy is found to be an effective therapeutic approach in removing intraocular foreign bodies, but the preoperative and postoperative complications determine the visual outcome.

Adolescent↗