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At least 721 records · Page 40Linked to original sources

PubMed1995

Diagnostic pars plana vitrectomy report of a 21-year retrospective study.

PURPOSE: To review the experience of diagnostic pars plana vitrectomies (PPV). METHODS: The authors reviewed 405 consecutive diagnostic PPV's performed between November 1973 and October 1994. RESULTS: Diagnostic vitrectomy was performed in 215 (53%) of 405 eyes for suspected endophthalmitis. Of those 215 cases, acute inflammation was confirmed in 62 (28.8%), 60 (27.9%) had microbial organisms present and 36 (16.7%) were culture-positive. Microbial organisms were observed microscopically in 31 (20%) of 156 patients suspected of postoperative endophthalmitis. Of those 31 cases, 23 (74%) were gram-positive, eleven (37%) of 30 eyes had organisms associated with glaucoma filtering procedures and 20 (16%) of 126 eyes had organisms with non-filtering procedures. The pooled percentage of eyes that developed postoperative endophthalmitis as a complication during the period July 1990 thru June 1994 is 5 (0.046%) out of a heterogeneous group of 10,898 cases operated on at the Wilmer Eye Institute for cataract, glaucoma, corneal transplant, pars plana vitrectomy and retinal detachment. Bacteria were identified microscopically in 6 (18%) of 34 post-traumatic cases. Microbial organisms were identified in 23 (92%) of 25 cases with an endogenous infection. Patients with endogenous infections had the most fungal infections, and the majority were in males. Neoplasms were diagnosed in 58 (14%) of the 405 cases. The most common neoplasm was ocular lymphoma 42 (72%), 69% of which were in females. Only 42 (48.3%) of 87 patients clinically suspected of having ocular lymphoma, actually had ocular lymphoma. Those negative for lymphoma were significantly older (67.4 +/- 10 years) compared to those with lymphoma (60.4 +/- 14 years) (P = 0.01). CONCLUSION: Diagnostic PPV has proved to be valuable in confirming and establishing various clinical diagnoses.

Acute Disease↗

PubMed1996

Effects of local hypothermia on ischemic eyes in vitrectomy.

The effects of local hypothermia on postoperative inflammation, electroretinogram (ERG) and histological changes of the retina were evaluated in experimental vitrectomy in pressure-induced ischemic rabbit eyes. The solutions used for intraocular perfusion were maintained at 8 degrees C, 22 degrees C or 38 degrees C. Following closed vitrectomy, the vitreous cavities of the rabbit eyes were irrigated for 30 minutes with the perfusion pressure set at 70 mmHg. The blood flow in the posterior area of the eye was reduced to about one-sixth of the preoperative level during ischemia. Aqueous protein concentrations showed no significant diversities among the different temperature groups on postoperative days 1 and 7. Recovery of ERG was investigated after a given time of ischemia. There were no significant differences in the recovery of either a-wave or b-wave amplitudes among the different temperature groups; although the average b-wave amplitude in the 38 degrees C group alone failed to return to the preoperative level on the 7th postoperative day. Light microscopy showed an irregular distribution of retinal damage in all groups. The damaged regions showed significantly greater histologic impairment in the 38 degrees C group than in either the 8 degrees C or 22 degrees C group. The results of our experiments suggest that local hypothermia during vitrectomy in ischemic eyes decreases retinal damage and, therefore, it seems inadvisable to use intraocular solutions warmed to body temperature.

Animals↗

PubMed1996

Vitrectomy and systemic fluconazole for treatment of endogenous fungal endophthalmitis.

BACKGROUND AND OBJECTIVE: To investigate the efficacy of pars plana vitrectomy and oral fluconazole without injection of intravitreal antimycotic agents in the treatment of vitritis resulting from Candida endophthalmitis. PATIENTS AND METHODS: Six eyes of five patients with suspected Candida endophthalmitis were treated with pars plana vitrectomy and systemic fluconazole for at least 3 weeks. Patients were observed postoperatively for at least 4 months. RESULTS: Clinical signs of infection cleared and visual acuity improved postoperatively in all six cases. One recurrent case was attributed to a retained indwelling venous catheter. CONCLUSIONS: Treatment of advanced endogenous Candida endophthalmitis with vitrectomy and systemic fluconazole offers an effective alternative to management with intravitreal amphotericin B in selected cases.

Administration, Oral↗

PubMed1997

[Changes in the electroretinogram of eyes with diabetic retinopathy treated by vitrectomy].

Flash electroretinogram (ERG) and 30 Hz flicker ERG before and after operation were tested in 55 eyes of 46 patients with proliferative diabetic retinopathy who were treated by vitrectomy. The results were evaluated with preoperative ocular findings -the existence of retinal detachment, posterior vitreous detachment, panretinal photocoagulation (PRP) and vitreal hemorrhage and intraocular tamponade materials. In the group without retinal detachment, the amplitude of the ERG b-wave and a-wave after vitrectomy decreased significantly if PRP was not done before operation. In the group with retinal detachment, when retinal detachment was restricted to the posterior pole of the fundus, when posterior vitreous detachment had occurred in only a small area of the fundus, when there was vitreous hemorrhage or when silicone oil was injected in the operation, the amplitude of the ERG b-wave and a-wave decreased significantly after the operation. In both groups, the latency of 30 Hz flicker ERG was shortened significantly after vitrectomy.

Adult↗

PubMed1997

A case-control study of suprachoroidal hemorrhage during pars plana vitrectomy.

BACKGROUND AND OBJECTIVE: To investigate the risk factors associated with suprachoroidal hemorrhage (SCH) during vitrectomy. PATIENTS AND METHODS: Of 6971 pars plana vitrectomies performed between May 1988 and December 1994, SCH occurred intraoperatively in 12 (0.17%) cases. Forty-two age- and sex-matched control subjects were selected by computer-generated random numbers. Preoperative and intraoperative variables were subjected to univariate and conditional logistic regression analysis. RESULTS: Statistically significant risk factors for SCH after univariate analysis included myopia (P = .048), aphakia or pseudophakia (P = .024), rhegmatogenous retinal detachment (P = .044), scleral buckling and/or encirclage at vitrectomy (P = .029), and longer duration of surgery (P = .044). Multivariate analysis revealed independent risks associated with the absence of a lens and longer duration of the surgery. CONCLUSION: A knowledge of the risk factors involved with SCH helps the physician to identify patients who are at a greater risk for this complication.

Adult↗

PubMed1998

Recalcitrant malignant glaucoma following pars plana vitrectomy, scleral buckle, and extracapsular cataract extraction with posterior chamber intraocular lens implantation.

Pars plana vitrectomy is employed to treat cases of aqueous misdirection that are refractory to medical and laser treatment. The authors describe a 65-year-old man without previous aqueous misdirection in whom this condition developed after a procedure that included pars plana vitrectomy. The aqueous misdirection recurred despite multiple interventions, including medical treatment, transiently successful Nd:YAG laser capsulo-hyaloidotomy, and surgical disruption of the anterior hyaloid face. It finally resolved after repeated pars plana vitrectomy with hyaloido-capsulo-iridectomy. There has been no recurrence 7 months after this procedure. The authors conclude that the surgical treatment of aqueous misdirection refractory to more conservative measures should include adequate disruption of the anterior hyaloid to prevent recurrence.

Aged↗

PubMed1998

Bacterial contamination of the pressure receiver of a vitrectomy machine.

On a routine sterility check, the authors found bacteria in their vitrectomy machine. Serratia marcescens was detected in the pressure receiver of a roller pump vitrectomy machine. The authors improved the machine by installing a millipore filter in front of the receiver that prevents bacteria from entering it without interfering with the pressure measurements. The origin of Serratia was probably a patient with endophthalmitis who was operated on long before the routine check. Although this appears to be the first report of a bacterial contamination of a vitrectomy machine, the results of testing show that this situation is indeed possible. The authors strongly recommend routine checks of the equipment and suggest mounting an antibacterial filter.

DNA, Bacterial↗

PubMed1998

[Intraocular and serum antibody titers to Leptospira in 150 horses with equine recurrent uveitis (ERU) subjected to vitrectomy].

Between February 1993 and July 1997, 150 horses suffering from recurrent uveitis were subjected to parsplana vitrectomy. In these horses, antibody titers to Leptospira serovars were determined in serum samples and in samples from diluted vitreous collected during vitrectomy. Although the vitreous samples were diluted with 250 ml of balanced salt solution, in 86 of the 150 vitreous samples (= 57%) the antibody titers were higher than in the serum samples. Additionally, serum samples from 77 horses suffering from ERU, but which were not subjected to vitrectomy, and serum samples from 97 horses with clinically normal eyes were analyzed for antibodies to Leptospira serovars. Among the 227 horses with ERU (150 treated surgically, 77 treated conservatively) 50 horses (50 of 227 = 22%) had serum antibody titers to Leptospira serovars of > or = 1:800. Among the 97 horses with clinically normal eyes, 24 horses (24 of 97 = 25%) had serum antibody titers to Leptospira serovars of > or = 1:800. In undiluted vitreous samples from 20 horses with clinically normal eyes, no antibody titers to Leptospira serovars could be detected. Among the 150 horses with ERU, 90 animals (90 of 150 = 60%) had antibody titers of > or = 1:100 in the diluted vitreous samples, the difference being highly significant (p < 0.001). The findings are discussed in relation to the etiology of recurrent uveitis in horses.

Animals↗

PubMed1996

[Exploratory vitrectomy for traumatized eyes with no light perception and dense vitreous hemorrhage].

OBJECTIVE: To evaluate the efficacy of exploratory vitrectomy for certain traumatized eyes with no light perception (NLP) and dense vitreous hemorrhage. METHOD: We performed vitrectomy on 10 patients with NLP eyes after ocular trauma. Of them, eight had open globe injuries and two had closed blunt ocular trauma. RESULTS: Postoperatively, six had visual acuities of light perception to 0.25 and four remained NLP. In most eyes, a potentially functional posterior retina and optic disc were observed during surgery. CONCLUSION: Dense vitreous hemorrhage could be the most important factor for NLP after severe ocular trauma. Therefore, NLP does not always mean permanent loss of vision. Proper primary repair of the wound and timely vitrectomy may give a chance of visual recovery in selected traumatized eyes.

Adolescent↗

PubMed1998

Lack of effect of prophylactic gentamicin treatment on intraocular and extraocular fluid cultures after pars plana vitrectomy.

BACKGROUND AND OBJECTIVE: To analyze the effect of preoperative prophylatic 0.3% gentamicin sulfate eyedrops on intraocular and extraocular fluid cultures after pars plana vitrectomy. PATIENTS AND METHODS: Forty consecutive patients undergoing pars plana vitrectomy were randomly assigned to receive either 0.3% gentamicin eyedrops or placebo preoperatively. Fluids from the vitreous cavity and from the conjunctival sac were collected for bacteriologic studies. RESULTS: Positive cultures from extraocular fluids were obtained in 30.4% of the gentamicin group and 35.3% of the placebo group (P = .75). Furthermore, 1 (3%) of 40 cultures of intraocular fluid and 13 (33%) of 40 cultures of extraocular fluid were positive. Culture growth positivity was not influenced by the patients' age, by diabetes, or by the duration of the operation. CONCLUSIONS: Prophylactic gentamicin treatment by the method applied in this study is not effective on reducing growth positivity. Contaminated extraocular fluid may play an important role in the pathogenesis of bacterial endophthalmitis following pars plana vitrectomy.

Administration, Topical↗

PubMed1998

Surgical outcome on combined procedures of lens extraction, intraocular lens implantation, and vitrectomy during removal of the epiretinal membrane.

BACKGROUND AND OBJECTIVE: The authors evaluated the outcome of combined procedures of lens extraction, intraocular lens implantation, and vitrectomy during procedures for the removal of the epiretinal membrane, and attempt to clarify which factors affected the outcome of surgery. PATIENTS AND METHODS: Surgery for the removal of the epiretinal membrane was performed and a 2-year follow-up program was maintained for 32 eyes at the authors' clinic during the past 5 years. The combined procedure was undertaken in 15 eyes, whereas a simple vitrectomy was performed in 17 eyes. Results were analyzed by postoperative ophthalmoscopic and slit-lamp examinations for visual acuity and complications. RESULTS: Six months after surgery, visual acuity improved similarly in both groups. But, 2 years after surgery, 11 eyes (65%) that underwent a simple vitrectomy showed decreased visual acuity due to the advancement of cataracts. The postoperative visual acuity at 6 months correlated to preoperative visual acuity, and the advancement of cataracts tended to correlate inversely to the age of the patients. Major complications did not occur in any of the cases. CONCLUSION: Earlier surgical management is better for treatment of the epiretinal membrane, and a combined procedure has advantages in cost reduction and is less troublesome, especially for elderly patients.

Adult↗

PubMed1977

Vitrectomy technique for removal of retained lens material.

A posteriorly dislocated lens or non-encapsulated lens material in the vitreous cavity may be difficult to remove. The pars plana vitrectomy instrumentation and technique provide new methods to remove this material, including use of the cutting-aspiration system of the instrument with or without use of a second instrument to mechanically crush firm lens material. Also, the vitrectomy instrument can be used to mobilize a dislocated lens or lens nucleus and position it in the anterior chamber prior to removal through a limbus incision. These methods provide considerable flexibility and usually permit the surgeon to achieve the objectives of lens removal, vitrectomy, and treatment of any retinal complications under optimum control during one operation. We have used these methods to successfully treat ten consecutive cases.

Adult↗

PubMed1978

An improved method for practice vitrectomy.

Practice is essential for acquiring the skills necessary for the delicate technique of pars plana vitrectomy. An improved animal model is presented for the beginning surgeon and the assistant to learn basic as well as advanced vitrectomy techniques. A stepwise scheme progressing from simple vitrectomy in the phakic rabbit eye to complicated situations is introduced. Fluorescein staining helps in visualization of the normal vitreous. Double perforating injuries are created to simulate complicated vitreoretinal problems. Methods for learning manipulations with two instruments in the eye are described.

Animals↗

PubMed1979

The lens and pars plana vitrectomy for diabetic retinopathy complications.

Major cataracts developed in 28 of 168 eyes during the six months after pars plana vitrectomy for complications of diabetic retinopathy. In only ten of these cases did the cataract influence the visual results. The visual acuities of the phakic and aphakic eyes six months after vitrectomy were almost identical. Rubeosis iridis occurred in 23% of the phakic eyes and 45% of the aphakic eyes, with the difference being related to the loss in the aphakic eyes of a protective barrier lens quality. However, this same barrier quality increased the incidence of postoperative opaque vitreous hemorrhage from 8% of the aphakic eyes to 21% of the phakic eyes. Corneal epithelial edema at surgery occurred in 55% of those eyes that had lens removal combined with vitrectomy, but in only 36% of those that retained their lenses, and the difference was caused by the increase in operative time and procedure.

Adult↗

PubMed1980

Closed vitreous surgery. XVII. Results and complications of pars plana vitrectomy.

Two hundred consecutive closed vitrectomies through the pars plana were observed for at least five years after operation to determine the results and analyze the complications. Vitrectomy was performed to remove vitreous opacities in 56.5% of the eyes (group 1), as a preliminary procedure in the course of retinal reattachment in 42% (group 2), and to reconstruct the anterior segment in 1.5% (group 3). Of the group 1 eyes for which adequate follow-up data were available, visual acuity improved notably in 64.2% showed no change in 11.3%, and deteriorated in 24.5%. The respective percentages for the other groups were as follows: 23.3%, 19.2%, and 57.5% for group 2; and 0%, +66.7%, and +33.3% for group 3. The most common complication during operation was bleeding in the vitreous, especially in diabetic patients; retinal break, lens injury, and vitreous-base avulsion followed in frequency. Postoperative bleeding occurred in 23% of eyes but usually resolved spontaneously and required no further surgery. There was postoperative glaucoma in 20% of the eyes. Corneal decompensation (15% of all cases) and rubeosis iridis (also 15%) had a propensity to occur in diabetic patients. Multiple procedures seemed to predispose eyes undergoing vitrectomy to rubeosis. Fibrous ingrowth into the vitreous through the sclerotomy was seen in five eyes and was associated with retinal detachment in one.

Adolescent↗

PubMed1982

An update on vitrectomy surgery and retinal detachment repair in sickle cell disease.

Eighteen patients (19 eyes) with sickling hemoglobinopathies underwent vitrectomy or scleral buckling operations. The indications for surgery were tractional or rhegmatogenous retinal detachment or vitreous hemorrhage. The retina was reattached in all four patients with rhegmatogenous detachments requiring scleral buckling surgery but no vitrectomy. All had excellent visual acuity postoperatively. Four of the five patients with vitreous hemorrhage requiring vitrectomy without buckling had substantial improvement in visual acuity. In ten patients with vitreous hemorrhage with either preexisting or iatrogenic retinal breaks, rhegmatogenous detachment, or tractional detachment, the rate of improvement in visual acuity was only 50%. Problems associated with vitreous or retinal surgery in patients with sickling hemoglobinopathies include iatrogenic retinal breaks, intraocular bleeding and secondary glaucoma, anterior segment ischemia, and systemic sickling.

Adult↗

PubMed1982

Aphakic cystoid macular edema: occurrence in infants and children after transpupillary lensectomy and anterior vitrectomy.

Twenty-seven children and infants underwent surgery for bilateral infantile cataracts. In each infant, the lens in one eye was removed by discission and aspiration, and the other lens was removed by lensectomy and anterior vitrectomy. Ten of 27 eyes undergoing lensectomy and vitrectomy developed aphakic cystoid macular edema; in only one eye that underwent discission and aspiration did macular edema develop. Six of the eyes of the first group developed persistent cystoid macular edema, of which four seem to be visually important. Further long-term studies of the prevalence and functional importance of cystoid macular edema after lensectomy and anterior vitrectomy in children are needed. We do not presently advocate this technique except in the treatment of complicated infantile cataracts.

Aphakia, Postcataract↗

PubMed1983

Mode of ion movements into vitreous. Equilibration after vitrectomy.

Ion movements into and out of the vitreous space after closed vitrectomy were the same as in open-sky vitrectomy in rabbits. Ion increase or decrease depended primarily on passive penetration, although active transport contributed to increases during the early phase in equilibration. Ions penetrated from the entire area of tissue in contact with the vitreous space; and the posterior wall, comprising the largest area of contact, was an important route. This feature was related to compromise of the blood-retinal barrier following vitrectomy.

Animals↗