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At least 847 records · Page 47Linked to original sources

PubMed1979

Uveitis: effect of vitrectomy combined with lensectomy.

Combined lensectomy-vitrectomy was performed on 25 eyes in 20 patients with cataracta complicata associated with uveitis from various etiologies. Postoperative follow-up averaged 15 months, with visual improvement in 24 of the 25 eyes. Primary cause of postoperative decreased vision was cystoid macular edema. Operative complications included retinal detachment and choroidal ischemia. The technique employed and the effect of lensectomy-vitrectomy on decreasing the number and severity of recurrent attacks of uveitis are discussed.

Adolescent↗

PubMed1984

Prevention of lens opacification during diabetic vitrectomy.

Lensectomy at the time of vitrectomy on diabetic patients markedly increases the risk of postoperative neovascular glaucoma, and is to be avoided when possible. We conducted a randomized prospective double-blind trial to determine if the addition of supplemental glucose to BSS Plus intraocular irrigating solution would lessen or prevent intraoperative lens opacification. Ten subjects received BSS Plus (glucose = 100 mg/dl); five (50%) developed intraoperative lens changes which interfered with the surgeon's view (three to an extent necessitating lensectomy). Ten subjects received glucose fortified BSS Plus (glucose = 400 mg/dl); none developed intraoperative lens changes (P less than 0.03, Mann-Whitney Rank). There was no statistically significant difference between the two study groups with respect to preoperative lens changes, infusion fluid volume, operative time, patient age, duration of diabetes, fasting blood glucose level, hemoglobin A1 level or lens clarity 5 months after surgery. We conclude that glucose fortification of BSS Plus significantly reduces intraoperative lens opacification during diabetic vitrectomy.

Acetates↗

PubMed1985

Vitrectomy for chronic aphakic cystoid macular edema. Results of a national, collaborative, prospective, randomized investigation.

A five-year (1979-1984) prospective, randomized, controlled, collaborative study was performed by 27 experienced vitrectomy surgeons in 15 medical centers on 136 surgically aphakic eyes without lens implants but with vitreous adherent to the corneoscleral wound and with chronic aphakic cystoid macular edema (ACME). One hundred fifteen eyes completed the entire course of investigation. The purpose of the study was twofold: to determine the effectiveness of vitrectomy in eliminating established ACME and to determine the natural history of this condition. Following criteria contained within the study protocol, 68 eyes were randomized to surgery (RAN-S) or control (RAN-C), and 47 eyes were observed in the long-term observation group (LTO). Twenty-one eyes were eliminated from the investigation for reasons stated in the text. The RAN-S group proved to have a significantly better visual course than the RAN-C group (P = less than 0.01). An analysis of the LTO group revealed that if central vision did not decline to a level of 20/80 or worse, 27% of the eyes had a chance of spontaneously improving to a level of 20/50 or better. However, if central vision declines to or beyond this point, spontaneous visual improvement to 20/50 or better only occurred in 8% of eyes. Also reported are other important clinical findings such as the role of systemic diseases in ACME, the incidence of vitreous traction on the macula, prognostic value of pre-surgical medical therapy, a comparison of limbal versus pars plana surgical approach, the timing of surgery, and the effectiveness of fluorescein angiography as an objective monitor of visual function.

Aged↗

PubMed1985

Long-term diabetic vitrectomy results. Report of 10 year follow-up.

Ten year follow-up examinations were obtained on 72 cases having pars plana vitrectomies for diabetic retinopathy complications from 1970 to 1973. Forty-two percent of the cases maintained 6/60 or better visual acuities through the tenth year. The visual results were quite stable, with 53% of the cases having the same or better visual acuities at ten years compared with six months. Neovascular glaucoma developed in 11 eyes, usually during the first six months, and open-angle glaucoma developed in 16 eyes, usually after the five-year follow-up examination. Both types of glaucoma occurred almost exclusively in aphakic eyes. Cataracts developed in 75% of retained clear lenses. The vitreous cavities remained clear in 67% of the eyes, and the maculas were attached in 65% of the eyes 10 years following vitrectomy. Fundus neovascularization did not recur.

Cataract Extraction↗

PubMed1986

The use of intravitreal thrombin to control hemorrhage during vitrectomy.

The ability of intravitreal bovine thrombin to control intraoperative bleeding was investigated by a prospective double blind study of 28 consecutive patients with vascularized preretinal membranes undergoing vitrectomy for diabetic retinopathy. Addition of thrombin (100 units/ml) to the vitrectomy infusate was associated with a significantly reduced intraocular bleeding time after cutting vascularized membranes. The mean bleeding time without thrombin was 111.5 seconds, compared to 12.3 seconds with intravitreal thrombin (P less than 0.0001). Patients receiving thrombin had less overall bleeding during surgery and less vitreous hemorrhage on the second postoperative day. Intravitreal bovine thrombin was associated with increased postoperative intraocular inflammation in 20% of patients receiving thrombin. This inflammation could be controlled by use of frequent topical steroids.

Animals↗

PubMed1986

Comparison of intraocular irrigating solutions in pars plana vitrectomy.

A prospective, randomized, masked clinical study was conducted to examine the effects of pars plana vitrectomy on the corneal endothelium comparing Balanced Salt Solution (BSS) to BSS-Plus as an intraocular irrigating solution. Seventy-one patients were followed for at least six months. A significant 6.9% decrease in endothelial cell density was observed among all patients at six months postoperatively, compared to preoperative values, using the contralateral eye as a control. However, no significant difference in endothelial cell loss was found between BSS and BSS-Plus eyes. Both aphakic eyes and those undergoing lensectomy (with vitrectomy) showed a significantly greater reduction of endothelial cell density at six months compared to phakic eyes. No significant difference in corneal thickness was observed at six months postoperatively compared to preoperative values. For the one-year duration of our study BSS was as efficacious in preserving the integrity of the corneal endothelium as was BSS-Plus.

Acetates↗

PubMed1988

Pars plana lensectomy and vitrectomy for complicated cataracts in juvenile rheumatoid arthritis.

Anterior surgical approaches to cataracts in juvenile rheumatoid arthritis (JRA) patients are compromised by chronic anterior and posterior uveitis, miotic pupils, and posterior synechiae. The authors retrospectively reviewed the results of pars plana lensectomy and vitrectomy in ten eyes from seven JRA patients with cataracts associated with chronic iridocyclitis and vitritis. Visual acuities improved from 20/100 or worse preoperatively to 20/60 or better postoperatively. Transient postoperative hypotony lasting 1 week to 4 months occurred in four of the ten eyes. Patients with glaucoma continued to require antiglaucoma therapy after surgery. Pars plana lensectomy and vitrectomy provides a theoretically preferrable approach to complicated cataracts and vitritis in JRA patients because it allows removal of peripheral lens material in the presence of a miotic pupil, eliminates the potential for synechiae to the posterior capsule and/or anterior hyaloid, and clears the visual axis of inflammatory debris.

Adolescent↗

PubMed1989

Mechanisms of intraocular pressure elevation after pars plana vitrectomy.

A prospective study of 222 consecutive patients undergoing pars plana vitrectomy was done to determine the incidence and mechanisms of postoperative intraocular pressure (IOP) elevation. Within 48 hours of surgery, postoperative IOP increased by at least 5 to 22 mmHg in 136 eyes (61.3%) and to 30 mmHg or more in 79 eyes (35.6%). Presumed mechanisms of open-angle glaucoma included intraocular gas expansion (28.4%), inflammatory trabecular meshwork obstruction (4.5%), silicone oil-related glaucoma (3.6%), and erythroclastic glaucoma (2.2%). Closed-angle mechanisms included pupillary block glaucoma (6.8%) and ciliary body edema (3.6%). Factors which were associated with postvitrectomy pressure elevation included placement of a scleral buckle, either intraoperatively (P = 0.003) or before vitrectomy (P = 0.001), intraoperative scatter endophotocoagulation (P = 0.041), intra-operative lensectomy (P = 0.024), and development of postoperative fibrin membranes (P = 0.038). Surgery was required to lower IOP or relieve pupillary block in 25 eyes (11.3%).

Adolescent↗

PubMed1990

Iatrogenic retinal breaks complicating pars plana vitrectomy.

To determine the current incidence and outcome of iatrogenic retinal breaks occurring during pars plana vitrectomy, the authors reviewed 404 consecutive operations done on eyes without preexisting retinal breaks. Thirteen eyes had 14 iatrogenic peripheral retinal breaks. Three other eyes had both peripheral breaks and posterior breaks. Twenty-five eyes had 43 posterior breaks. The incidence of peripheral breaks was 4% and of posterior breaks was 6%. Patients with proliferative diabetic retinopathy had a higher incidence of iatrogenic retinal breaks than those with other diagnoses. Peripheral breaks occurred most commonly just posterior to the site of insertion of the vitrectomy probe. Although six eyes required reoperation, 33 of 38 eyes had a successful anatomic outcome.

Cohort Studies↗

PubMed1990

Vitrectomy in eyes at risk for macular hole formation.

Fifteen eyes believed to be at increased risk for macular hole formation underwent vitrectomy in an attempt to prevent macular hole formation. Full-thickness macular holes have not developed in 10 of 11 eyes with stage 1 macular holes. Four eyes were noted to have small full-thickness foveal defects (stage 2 macular holes) at the time of vitrectomy. Two of the four eyes have not progressed to macular hole formation and have 20/25 visual acuity. All patients have been followed for a minimum of 13 months (median, 18 months). The 12 eyes that have not experienced macular hole formation have had a significant (P less than 0.001) improvement in vision with seven (58%) attaining visual acuity of 20/25 or better. The postoperative foveal electroretinogram (ERG) amplitude was higher than the preoperative amplitude in five of the six eyes tested.

Aged↗

PubMed1990

Subluxated (ectopic) lenses in adults. Long-term results of pars plana lensectomy-vitrectomy by ultrasonic fragmentation with and without a phacoprosthesis.

The long-term results of pars plana lensectomy-vitrectomy by ultrasonic fragmentation for 18 consecutive subluxated (ectopic) lenses were retrospectively reviewed. There were no serious operative or postoperative complications at the 16-year follow-up. Visual acuity of 20/15 to 20/50 was obtained in 16 (89%) of 18 eyes. Lensectomy-vitrectomy for subluxated lenses appears to be a relatively safe and effective procedure. The technique can be combined with a phacoprosthesis (intraocular lens implant) in adults.

Adult↗

PubMed1993

Retreatment of full-thickness macular holes persisting after prior vitrectomy. A pilot study.

PURPOSE: Vitrectomy with fluid-gas exchange has been shown to close more than one half of full-thickness macular holes, with improvement in visual acuity. By adding the appropriate dose of transforming growth factor-beta 2, a higher success rate has been reported. However, there still remain cases of macular holes that fail to close after vitreous surgery. The current pilot study is designed to determine whether reoperation may have a role in the management of cases that fail after vitreous surgery. METHODS: Twelve eyes with persistent full-thickness macular holes that failed to close after an initial vitrectomy underwent reoperation using 1330 ng transforming growth factor-beta 2. RESULTS: After the second operation, closure occurred in 12 (100%) of 12 eyes. Follow-up ranged from 8 to 16 months. Visual acuity also improved by two or more lines in 5 (42%) of 12 patients. Increased nuclear sclerosis occurred in nine (90%) of the ten phakic eyes. Of the five eyes showing visual improvement, four required cataract extraction and intraocular lens implantation. CONCLUSION: Retreatment of persistent full-thickness macular holes with transforming growth factor-beta 2 appears to have a beneficial effect on both neurosensory retinal flattening and visual outcome.

Adult↗

PubMed1994

A modified en bloc excision technique during vitrectomy for diabetic traction retinal detachment. Results and complications.

PURPOSE: The visual results and complications were determined for a modified en bloc excision technique for management of diabetic traction macular detachment. PATIENTS AND METHODS: A consecutive series of 30 eyes with this condition underwent pars plana vitrectomy, during which all posterior hyaloid except for portions essential for membrane dissection were excised. Bimanual dissection techniques then allowed excision of fibrovascular membranes "en bloc" with the retained hyaloid. RESULTS: After 6 to 44 months of follow-up, visual acuity of 5/200 or better was obtained in 23 (77%) of 30 eyes, with complete reattachment in 29 (97%) of 30 eyes. Iatrogenic retinal breaks occurred in 6 (20%) of 30 eyes. Two eyes required repeat vitrectomy. CONCLUSIONS: The modified en bloc excision technique allowed similar visual outcome, a higher reattachment rate, and less postoperative morbidity than previously reported surgical approaches to diabetic traction macular detachment.

Adult↗

PubMed1996

Full panretinal photocoagulation and early vitrectomy improve prognosis of florid diabetic retinopathy.

BACKGROUND: Florid diabetic retinopathy (FDR) is a rare form of proliferative diabetic retinopathy (PDR) that is characterized by a bilateral rapidly progressive, very severe ischemic retinopathy. Florid diabetic retinopathy was reported to carry a high risk of blindness. This study was conducted to determine whether visual prognosis of FDR can be improved by appropriate photocoagulation and surgical management. METHODS: The authors retrospectively studied 20 patients (40 eyes) who were treated from October 1978 to February 1994. Systemic risk factors, visual acuity, complete ocular examination, and fundus findings, as well as fluorescein angiography, were analyzed with respect to photocoagulation and surgical management. Mean follow-up was 3.6 years. RESULTS: All patients had poorly controlled type I diabetes (mean duration, 13.5 years), which often was associated with systemic complications. Mean initial visual acuity was equal to or better than 20/40 in 32 eyes (80%). During the course of the study, high-risk PDR was observed in 38 eyes (95%) and vitreous hemorrhage occurred in 26 eyes (65%). Extensive full subconfluent panretinal photocoagulation was performed completely in 37 eyes (92.5%). Vitrectomy was necessary in 15 eyes (37.5%). Macular edema was present in 30 eyes (75%). Major complications included retinal detachment that required surgery (2 eyes, 5%) and neovascular glaucoma (2 eyes, 5%). However, final visual acuity was equal to or better than 20/40 in 23 eyes (57.5%) and less than 5/200 in only 4 eyes (10%). CONCLUSION: These results suggest that aggressive treatment of FDR with extensive panretinal photocoagulation and early vitrectomy, when necessary, may result in a much better prognosis than has been reported previously.

Adolescent↗

PubMed1996

Vitrectomy in eyes with peripheral retinal angioma associated with traction macular detachment.

PURPOSE: Peripheral angiomas have been associated with epiretinal membranes and traction retinal detachment. The authors investigated the timing, results, and complications of vitreous surgery to remove the retinal traction and treat the peripheral vascular tumor. METHODS: The authors reviewed the results of ten eyes that had undergone vitrectomy for macular pucker and/or traction retinal detachment. These eyes had either preoperative or intraoperative treatment of the peripheral tumor. RESULTS: Patients were followed 4 to 95 months. Six eyes had nonfamilial peripheral acquired retinal hemangioma, three had von Hippel angiomas, and one had multiple large peripheral retinal angiomas associated with extensive retinal telangiectasis. Four eyes received cryotherapy and/or laser photocoagulation 2 to 3 months before surgery. In the remaining six eyes, initial treatment to the peripheral angioma was performed at the time of vitreous surgery. At final follow-up, all eyes were attached without retinal traction. Vision improved in all eyes; six (60%) achieved 20/50 or better visual acuity. Complications included recurrent epiretinal membrane (n=3); nonregressed angiomas (n=3); increased nuclear sclerosis (n=2); and retinal detachment (n=1). CONCLUSION: Vitreous surgery, when applied to epiretinal membranes or traction retinal detachments associated with peripheral vascular tumors, has a good chance of improving vision. Treatment of the hemangioma, before or during vitrectomy, usually results in tumor regression.

Adult↗

PubMed1996

Recognition of vitreoschisis in proliferative diabetic retinopathy. A useful landmark in vitrectomy for diabetic traction retinal detachment.

INTRODUCTION: In the late stages of proliferative diabetic retinopathy (PDR) the vascularized posterior cortical gel (PCG) contracts leading to a partial posterior hyaloidal separation, hemorrhage, and traction retinal detachment (TRD). "Additional epiretinal membranes" have been described previously. These are thin, usually transparent epiretinal membranes which extend anteriorly from the point of attachment of the elevated posterior cortical gel to the edge of the TRD. The origin and frequency of the occurrence as well as the clinical significance of such additional epiretinal membranes are the subjects of controversy. PURPOSE: To quantitate the authors' clinical impression that additional epiretinal membranes are common in advanced PDR, to characterize them immunohistochemically, and to demonstrate the rationale for the authors' surgical approach. METHODS: Intraoperative observations for all patients undergoing diabetic vitrectomy and delamination over the last 2 years were reviewed retrospectively. The presence of additional epiretinal membrane was searched for in the initial stages of vitrectomy. When identified, their apparent continuity with the elevated portion of the PCG was confirmed. Surgical specimens were obtained from nine patients for immunohistochemical study. RESULTS: Additional epiretinal membranes were observes in 145 (81%) of 179 consecutive eyes with PDR that underwent surgery for macular TRD. Immunohistochemical staining with type II collagen antibody was positive in all specimens, suggesting that these membranes were of vitreous origin. CONCLUSIONS: It is likely that the additional epiretinal membranes represent the posterior leaf of a split PCG, the anterior leaf being the elevated portion of the PCG. The two leaves remain fused in the main, fibrovascular portion of the epiretinal membrane. These findings help explain the clinical experience that once the posterior leaf of the PCG is identified and elevated, it provides an accurate point of entry into the surgical plane facilitating delamination of the fused (vascularized) portion of the PCG from the detached retina.

Aged↗

PubMed1998

Terson syndrome. Results of vitrectomy and the significance of vitreous hemorrhage in patients with subarachnoid hemorrhage.

OBJECTIVE: The purpose of study A was to assess the effectiveness of vitrectomy for Terson syndrome. The purpose of study B was to determine the incidence and significance of vitreous hemorrhage in patients with subarachnoid hemorrhage. DESIGN: Study A is a retrospective review of case series. Study B is a prospective study. PARTICIPANTS: Study A examined a consecutive series of 4 children (7 eyes) and 23 adults (26 eyes). Study B examined a consecutive series of 100 patients. INTERVENTION: Subjects in study A underwent pars plana vitrectomy for dense vitreous hemorrhage following intracranial hemorrhage. In study B, ophthalmoscopic examination of patients undergoing neurosurgery for ruptured cerebral aneurysms was used. MAIN OUTCOME MEASURES: In study A, the extent and rapidity of visual recovery and intraoperative and postoperative complications were examined. In study B, the incidences of intraocular hemorrhage and Terson syndrome in the cohort and the significance of the presence of vitreous hemorrhage in patients with subarachnoid hemorrhage were examined. RESULTS: Study A: There was substantial and rapid visual improvement in 25 of the 26 eyes (96%) of the adult patients, with 21 eyes (81%) achieving > or = 20/30 final visual acuity. Only limited improvement was achieved in children's eyes (< or = 20/60). Study B: Intraocular hemorrhage was found in 17% of eyes in patients with subarachnoid hemorrhage; the incidence of Terson syndrome was 8%. All patients with Terson syndrome and 89% of the patients with other types of intraocular hemorrhage had a history of coma compared with 46% of those without intraocular hemorrhage (P = 0.0003). CONCLUSIONS: Vitreous hemorrhage in patients surviving subarachnoid hemorrhage appears to be more common than previously thought, underscoring the need for routine funduscopic screening. Surgical intervention is highly effective in hastening visual rehabilitation of adults with Terson syndrome. The less encouraging results in infants may be due to amblyopia or direct brain damage caused by the cerebrovascular incident.

Adult↗

PubMed1998

Treatment of reopened macular hole after vitrectomy by laser and outpatient fluid-gas exchange.

OBJECTIVE: This study aimed to assess a new nonsurgical treatment for patients who have previously undergone vitrectomy for macular hole with either persistent or reopened holes. DESIGN: A prospective, noncomparative, consecutive case series. PARTICIPANTS: Fifteen patients (15 eyes) were studied. INTERVENTION: Patients were treated by an outpatient method consisting of laser photocoagulation to the foveal pigment epithelium followed by fluid-gas exchange with 20% perfluoropropane gas and prone positioning. Patients without known allergy were treated with two doses of oral Diamox (250 mg) and ciprofloxacin (500 mg). MAIN OUTCOME MEASURES: Visual acuity, intraocular pressure, anatomic status of the macular hole, and cataract were the principal outcome measures studied. RESULTS: Thirteen of 15 macular holes were closed successfully with 1 or more procedures. All patients with macular hole closure achieved two lines or greater of vision improvement on Snellen testing. Three patients (20%) achieved 20/40 and nine (60%) achieved 20/80 or better. Three patients required more than one procedure. Four patients developed mild transient ocular hypertension. CONCLUSIONS: The combination of office-based outpatient fluid-gas exchange and laser appears to be a safe and cost-effective alternative to repeat surgery in selected patients with persistent or reopened macular holes after vitrectomy, in whom there are no visible epiretinal membranes, or in whom return to the operating room is undesirable for medical or personal reasons.

Aged↗