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At least 775 records · Page 43Linked to original sources

PubMed1992

Reoperation following diabetic vitrectomy.

A review of 484 consecutive eyes that were undergoing an initial pars plana vitrectomy for the sequelae of proliferative diabetic retinopathy disclosed that 41 eyes (8.5%) required one or more additional vitrectomy operations. The primary causes for reoperation included rhegmatogenous retinal detachment in 18 (44%) of the 41 eyes, recurrent vitreous hemorrhage in 21 eyes (51%), and glaucoma in two eyes (5%). The visual prognosis was worse in the group with rhegmatogenous retinal detachment, with 10 (56%) of 18 eyes progressing to no light perception (P = .003). Severe preretinal and subretinal fibrous proliferation, as demonstrated histopathologically, accounted in large part for the poor result. The preretinal membrane formation appeared to occur secondary to a combination of diabetic extraretinal vascular growth and proliferative vitreoretinopathy. Among the total group of 41 eyes that required subsequent surgery, the retina eventually remained detached in 18 eyes (44%), and phthisis bulbi occurred in 13 eyes (32%). Rubeosis iridis developed in 17 (94%) of 18 eyes in which the retina remained detached.

Adult↗

PubMed1992

Vitrectomy with silicone oil or sulfur hexafluoride gas in eyes with severe proliferative vitreoretinopathy: results of a randomized clinical trial. Silicone Study Report 1.

Between September 1985 and September 1987, 101 eyes with rhegmatogenous retinal detachment and severe (with a classification of at least C-3) proliferative vitreoretinopathy but without prior vitrectomy were treated with vitrectomy and randomized to either a mixture of 20% sulfur hexafluoride gas and air or to 1000 centistokes of silicone oil. Between 50% and 60% of eyes that received silicone oil had visual acuity better than or equal to 5/200 compared with 30% to 40% of the eyes that received sulfur hexafluoride gas (P less than .05). Macula attachment was more frequent in eyes that received silicone oil than in those that received sulfur hexafluoride gas (80% vs 60%, P less than .05). Hypotony was more prevalent in eyes with a detached macula (40% to 50% for sulfur hexafluoride gas vs 25% to 30% for silicone oil) when compared with those with attached maculas (less than 5% for either modality). Keratopathy was more prevalent in eyes with detached maculas (about 55% to 60% for either modality) compared with eyes with attached maculas (25% to 30% for sulfur hexafluoride gas vs 10% to 15% for silicone oil). In a companion article, we show that these differences between a gas tamponade and silicone oil are not found for perfluoropropane gas.

Adult↗

PubMed1992

The absorption of mixtures of air and perfluoropropane after pars plana vitrectomy.

The duration of mixtures of perfluoropropane and air (0% to 20% C3F8) were analyzed in 206 eyes following pars plana vitrectomy for a variety of vitreoretinal disorders using a noninvasive model for calculating the intraocular gas bubble volume. The accuracy of the noninvasive model was tested by comparing the estimated bubble volume with the actual volume withdrawn from 12 eyes with intraocular gas bubbles undergoing a subsequent vitrectomy. The method for estimating intraocular bubble volume had a mean difference between the actual and estimated bubble volume of 0.1 +/- 0.35 mL. The half-life of air (0% C3F8) was 1.3 +/- 0.1 days; 5% C3F8, 4.2 +/- 0.1 days; 10% C3F8, 6.5 +/- 0.2 days; 15% C3F8, 8.0 +/- 0.6 days; and 20% C3F8, 12.5 +/- 1.1 days. The difference between each half-life was statistically significant (P < .01). Linear regression analysis of the half-lives of C3F8 mixtures of up to 20% C3F8 showed a linear increase in half-lives with increasing concentrations of C3F8. The duration of intraocular gas tamponade can be controlled by selecting the appropriate concentration of air and C3F8.

Absorption↗

PubMed1995

Double-mirror peripheral vitrectomy lens.

Many surgeons use prism lenses to see the periphery of the fundus during vitrectomy; however, chromatic aberrations in higher-power prismatic lenses cause blurring of the peripheral image. For better visualization of the periphery of the fundus, we developed a new contact lens, the double-mirror peripheral vitrectomy lens. The new lens is a quartz cylinder with two mirrors, and it provides a crisp, clear, upright image of much more of the peripheral fundus than is visible through conventional prism lenses. The new lens also provides a wider area of view than conventional prism lenses.

Eye Diseases↗

PubMed1996

Sutureless pars plana vitrectomy through self-sealing sclerotomies.

A new technique of creating self-sealing pars plana sclerotomies is described. In a series of 50 consecutive vitrectomies, no complication was encountered related to this new technique. All of the 47 primary vitrectomy procedures performed had self-sealing sclerotomies that did not require suturing at the end of surgery. This type of wound construction allows for sutureless closure of sclerotomies with better control of intraoperative ocular pressure.

Eye Diseases↗

PubMed1997

Vitrectomy with silicone oil or long-acting gas in eyes with severe proliferative vitreoretinopathy: results of additional and long-term follow-up. Silicone Study report 11.

BACKGROUND: The Silicone Study evaluated the outcomes of vitreoretinal surgery for retinal detachment with proliferative vitreoretinopathy (PVR). OBJECTIVE: To evaluate short-term (up to 36 months) outcomes in eyes randomized to silicone oil or perfluoropropane gas and long-term (up to 72 months) outcomes in eyes with attached maculas at 36 months. DESIGN: Prospective, randomized, multicentered surgical trial. SETTING: Community- and university-based vitreoretinal practices. PATIENTS: Two-hundred sixty-five eyes with PVR randomized to perfluoropropane gas and silicone oil with follow-up through 3 years (cohort 1) and 249 eyes with attached maculas at 36 months (121 eyes randomized to long-acting gas [either sulfur hexafluoride or perfluoropropane] and 128 eyes randomized to silicone oil) with follow-up up to 6 years (cohort 2). Both cohorts consisted of eyes that had and had not undergone vitrectomy for PVR (groups 1 and 2, respectively) before randomization. Of the 265 eyes in cohort 1, 24-month follow-up data were available for 218 eyes (82%) and 36-month follow-up data were available for 196 eyes (74%). Of 208 eyes in cohort 2, 48-month follow-up data were available for 146 eyes (70%), 60-month follow-up data for 119 eyes (57%), and 72-month follow-up data for 73 eyes (35%). INTERVENTIONS: Vitrectomy surgery for PVR with a long-acting gas or silicone oil as the intraocular tamponade. MAIN OUTCOME MEASURES: Changes in visual acuity, recurrent retinal detachment, and incidence of complications. RESULTS: In group 1 of cohort 1, compared with oil-treated eyes, gas-treated eyes had a higher rate of complete retinal reattachment from 18 to 36 months (P < .05). No other differences were found. In group 2 of cohort 1, no notable differences were found between treatment arms. In cohort 2, during 6 years of follow-up, attachment of the macula was maintained for all eyes. No notable differences in the rates of complete retinal attachment, visual acuity of 5/200 or better, or glaucoma were found between treatment groups. In contrast, gas-treated eyes had more hypotony (P < .001). Silicone oil-treated eyes that underwent subsequent surgery were more likely to have the oil retained (P = .02). Compared with oil-retained eyes, oil-removed eyes had higher rates of complete posterior attachment (P = .01) and of a visual acuity of 5/200 or better (P < .001) and less keratopathy (P < .05). Compared with oil-removed eyes, gas-treated eyes had a worse visual acuity outcome (P < .05) and more hypotony (P < .01). CONCLUSION: The Silicone Study showed that silicone oil and perfluoropropane gas were equal in most respects for the management of retinal detachments with PVR. Success in the first surgery for PVR is paramount for obtaining better visual results. Overall, surgery for PVR had a high likelihood of retinal reattachment, and if anatomically and visually successful at 3 years, there is an excellent chance that the results will be maintained over the long-term.

Adult↗

PubMed1995

Pars plana vitrectomy in the management of ghost cell glaucoma.

In this report we describe, herewith, 5 cases of ghost cell glaucoma that followed spontaneous vitreous hemorrhage complicating branch retinal vein occlusion in a phakic eye (one case), and traumatic vitreous hemorrhage (4 cases). Because intraocular pressure was uncontrolled, pars plana vitrectomy was performed to remove the reservoir of ghost cells. Vitrectomy resulted in successful control of intraocular pressure without medications and visual improvement.

Child↗

PubMed1983

Vitrectomy in two cases of bilateral Terson syndrome.

We report on two patients with bilateral vitreous haemorrhage after a subarachnoid haemorrhage (Terson syndrome). We performed vitrectomy in four eyes with complete recovery of vision in three eyes; one eye had visual acuity of 1/6 due to preretinal fibrosis. The patient who had 20/20 vision in both eyes had a retinal detachment in one eye two months after the vitrectomy; this was operated upon and vision did not deteriorate.

Eye Diseases↗

PubMed1983

Pars plana vitrectomy in eyes with malignant melanoma.

Three patients underwent pars plana vitrectomy for vitreous hemorrhage secondary to an intraocular malignant melanoma. In all three cases the tumour was unsuspected and had been missed during pre-operative ultrasound examination. In each case vitreous haemorrhage was caused by invasion and perforation of the sensory retina and tumour growth into the vitreous cavity with bleeding from large vessels near the tumour surface (Knapp-Rønne growth pattern). One 75-year-old patient still has useful vision 3 years after surgery; in two patients the eyes were enucleated. Histology revealed in one case a diffuse spreading of tumour cells covering all intraocular surfaces: the posterior and anterior surface of the iris, the angle structures, the posterior corneal surface, and most of the inner retinal surface--probably due to transformation of growth pattern following vitrectomy.

Adult↗

PubMed1989

Pars plana vitrectomy and silicone oil injection in proliferative diabetic retinopathy.

A retrospective study is reported on 106 eyes with proliferative diabetic retinopathy, treated by vitrectomy and silicone oil injection. Indications were traction detachment in 91 eyes and nonclearing rebleeding in 15 eyes; 31 eyes had previously had vitrectomy. Anatomical success was obtained at the end surgery in 91 eyes, and after a minimum follow-up of 6 months in 68 eyes (64%). Functional results were as follows: satisfactory visual acuity (0.5-0.05) in 23 eyes (22%), ambulatory vision (0.03-CF) in 14 eyes (13%), HM-LP in 54 eyes (51%), and NLP in 15 eyes (14%). The functional results are limited by recurrent detachments due to characteristic reproliferations under the silicone bubble or by ischemic diabetic angiopathy in the attached retina. A positive effect of silicone oil is demonstrated in the reduction of preexisting or postoperatively new iris neovascularization and in preventing postoperative rebleeding.

Adult↗

PubMed1986

Xenon-arc endophotocoagulation during vitrectomy for diabetic vitreous haemorrhage.

The value of scatter xenon-arc endophotocoagulation in stabilising eyes with respect to post-operative rubeosis iridis and vitreous haemorrhage is demonstrated in a consecutive series of 100 vitrectomies undertaken for diabetic vitreous haemorrhage. Seventy eyes ultimately achieved 6/36 or better vision. Endophotocoagulation of untreated ischaemic retina is recommended in eyes undergoing vitrectomy for diabetic vitreous haemorrhage.

Diabetes Complications↗

PubMed1990

Response of Müller cells following experimental lensectomy-vitrectomy.

We used morphological, biochemical and immunohistochemical methods to assess the response of Müller cells after experimental lensectomy-vitrectomy in rabbits. We observed widened intercellular spaces between the Müller cells and nerve fibers of ganglion cells, and increased electron opacity in the Müller cells of eyes injected with silicone oil. No apparent morphological changes were detected in the Müller cells of air-injected eyes. The specific and total activities of Müller cell-marker enzymes (glucose 6-phosphatase and glutamine synthetase) showed an initial increase, followed by a decrease. Glial fibrillary acidic protein immunoreactivity was not found in the Müller cells of the normal rabbit retina but was exhibited after surgery. Our results showed that markers of Müller cells associated with glycogenolysis and/or gluconeogenesis, glutamate-glutamine cycle and cytoskeletal protein metabolism were affected by the experimental lensectomy-vitrectomy.

Air↗

PubMed2004

[Vitrectomy with or without cerclage in the treatment of retinal detachment].

In the beginning, pars plana vitrectomy was often combined with encircling elements in the treatment of complicated retinal detachments. Initial considerations were the limited control of the vitreous base due to the restricted view of the fundus periphery and the prevention of redetachment by anterior tears or traction. Today, additional encircling is justified in specified conditions of retinal surgery, e.g., retinal shortening by long-lasting detachments, anterior PVR, or choroidal injuries. Despite several synergistic effects in surgical management, severe complications have to be taken into account for scleral buckling in vitreoretinal surgery. Nevertheless, primary vitrectomy in combination with scleral buckling has led to a marked decrease of primary failure rate and improvement of functional results in retinal detachment surgery.

Combined Modality Therapy↗

PubMed1996

[Change in hole size and area of retinal detachment after pars plana vitrectomy in Gass stage III macular foramina].

UNLABELLED: In 15 patients with a stage III macular hole a pars plana vitrectomy with membrane peeling was performed. At the end of the operation a gas/air exchange was performed and patients had to lie face down for some days. METHODS: Before and 4-7 months after the operation a picture of the posterior pole was taken with a Zeiss fundus camera. Pictures were digitized, and the area of the hole and of the surrounding detached retina was measured using a special image analyzer software. RESULTS: In seven cases an improvement of visual acuity was found; in the remaining eight cases visual acuity remained unchanged. In five cases (33%) the retina was totally attached around the hole. In eight cases the detached area had become smaller, in two cases larger, and in two cases we could no longer observe the rim of the hole. In the remaining cases the area of the holes changes by less than 10%. CONCLUSIONS: The results show that even in cases where total attachment of the surrounded retina cannot be achieved, reduction of the detached area can be expected in most cases. Simultaneously, a reduction of metamorphopsia can be observed. However, the improvement of visual acuity is not very high. That is why we will perform pars plana vitrectomy in stage III holes only in exceptional cases.

Follow-Up Studies↗

PubMed2000

[Sterilization of phacoemulsification and vitrectomy instruments. Contamination and evaluation].

BACKGROUND: Contamination of automated surgical equipment is widely disregarded as a potential source of perioperative infection. We investigated the possibility of contamination of the aspiration fluid by the vacuum control manifold (VCM). The normal, unsterile internal VCM was compared with a modified external VCM that was regularly disinfected. MATERIALS AND METHODS: We investigated 37 aspiration fluid specimens from routine cataract and vitrectomy operations performed with automated evacuation systems. There were 25 specimens from three automated evacuation systems equipped with an internal VCM (experimental groups) and 12 specimens from one system equipped with a modified external VCM (control group). No hygiene procedures were used with the hidden internal VCM, but the modified external VCM was regularly rinsed and filled with 70% isopropanol overnight. Specimens were collected under sterile conditions, centrifuged, cultured for bacterial growth on blood agar and MacConkey agar for 24-48 h at 37 degrees C, and analyzed microbiologically. RESULTS: Aspiration fluids of irrigation/aspiration systems used for intraocular surgery were found to be severely contaminated with bacteria originating from the VCM. In all aspiration fluid specimens from internal VCM systems, 2(+)-4+ bacterial growth was found. Stenotrophomonas maltophilia (17), Comamonas acidovorans (8), and Agrobacterium radiobacter (13) were found most frequently. All specimens from the modified external VCM system remained sterile. There was a significant difference with regard to the frequency of contamination of the aspiration fluid between experimental and control groups (P = 0.0001, chi 2). CONCLUSIONS: We found that the aspiration fluid of common phaco- and vitrectomy systems was strongly contaminated by bacteria originating from the internal VCM. The technical modification of an external VCM allows easy disinfection and prevents contamination of the aspiration fluid.

Bacteriological Techniques↗

PubMed2001

[Conventional ablation surgery or primary vitrectomy in complicated retinal holes].

BACKGROUND: We retrospectively evaluated 100 difficult cases out of 803 consecutive eyes with retinal detachment in order to determine the best surgical procedure in cases with difficult break configurations such as multiple, large, and central holes. METHODS: We treated the eyes either with conventional buckling surgery (n = 60) encircling buckle (EB) plus sponge exoplant (SP) (n = 45) or multiple sponge exoplants (n = 15) or with primary vitrectomy (PV) (n = 40). From the 40 patients in the PV group, 10 underwent vitrectomy plus intraocular gas only, in the other cases an encircling band was used (n = 30). RESULTS: In the EB/SP group the retina was attached directly after surgery in 59/60 cases. During a mean follow-up of 14.5 months redetachment occurred in 4/60 cases. In the PV group the retina was attached in 37/40 cases after resorption of gas and during the mean follow-up of 9.3 months redetachment occurred in an additional 4/40 cases. Complications during surgery in the EB/SP group were retinal incarceration (n = 2) and subretinal hemorrhage (n = 2). In the PV group intraoperative complications included choroidal detachment (n = 1) and iatrogenic holes (15%). Postoperative complications were choroidal detachment in 6/60 vs 0/40, transitory increased intraocular pressure (30% vs 68%). Double vision, however correctable by means of prisms, occurred in 4/60 vs 0/40. CONCLUSIONS: The primary attachment rate is high and similar with both procedures. The spectrum of intra- and postoperative complications is however different between both groups.

Aged↗

PubMed2002

Intentional complete interruption of a retinal vein after vitrectomy might improve the rate of successful chorioretinal venous anastomosis formation in central retinal vein occlusion.

BACKGROUND: Laser or surgical chorioretinal venous anastomosis has not become widespread as suitable treatment for central retinal vein occlusion (CRVO). We report here the effectiveness of cutting off a retinal vein with vitrectomy in making a chorioretinal venous anastomosis in CRVO. METHODS: We performed a vitrectomy accompanied by a chorioretinal venous anastomosis procedure for seven consecutive patients with CRVO. These patients had shown no improvement in their visual acuity in the month following their first visit to our hospital and had a visual acuity of less than 20/200. Their preoperative visual acuity ranged from counting fingers to 20/300. The procedure included the complete cutting of the affected retinal vein, and the making of a small incision at both sides of the vein interruption through the full thickness of the retina, the retinal pigment epithelium and Bruch's membrane. RESULTS: In five of the seven patients, successful chorioretinal venous anastomosis was observed. All five patients showed an improvement of two or more lines in visual acuity 6 months postoperatively. In three of the five, visual acuity was 20/100 or better. A postoperative complication of recurrent vitreous hemorrhage and fibrous proliferation was observed in one patient, and a second operation was necessary. CONCLUSIONS: Surgical interruption of an affected vein was a feasible procedure and could raise the rate of successful chorioretinal venous anastomosis in CRVO.

Aged↗

PubMed2004

Conventional buckling surgery or primary vitrectomy with silicone oil tamponade in rhegmatogenous retinal detachment with multiple breaks.

BACKGROUND: There is controversy about the most appropriate operating methods for complicated rhegmatogenous retinal detachment (RD) including multiple tears, and surgical techniques may be changed according to the preference of the surgeon. In this retrospective study, we compared the surgical results of conventional buckling surgery and vitrectomy with silicone oil tamponade for rhegmatogenous (RD) with multiple breaks. METHODS: Thirty patients who underwent scleral buckling surgery (group 1) and 22 patients who underwent pars plana vitrectomy with silicone oil tamponade (group 2) as the primary surgery for rhegmatogenous RD with multiple breaks were included in this study. The follow-up period was longer than 6 months after surgery. The anatomical success rates and complications were evaluated for both groups. RESULTS: Retinal reattachment was achieved in 24 of 30 eyes (80%) in group 1 and in 20 of 22 eyes (90.9%) in group 2 after the initial surgery. In group 1, subretinal hemorrhage developed due to the drainage of subretinal fluid in 2 eyes (6.6%) intraoperatively. Elevated intraocular pressure (3.3%), ocular motility disturbances (13.2%), and proliferative vitreoretinopathy (3.3%) were seen in the postoperative period. In group 2, iatrogenic breaks (7.3%) and lens damage (9.09%) occurred during the operation. Macular pucker (4.5%), postoperative cataract progression (22.7%), ocular hypertension (9.09%) and PVR (9.09%) were noted postoperatively. CONCLUSIONS: Both surgical procedures can achieve favorable and comparable anatomic outcomes in the majority of patients in the treatment of RD with multiple breaks. Intra-and postoperative complications are different in the two procedures.

Adolescent↗