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At least 883 records · Page 49Linked to original sources

PubMed2002

[The combination of retrobulbar block with general anaesthesia may lead to pre-emptive analgesia in patients undergoing pars plana vitrectomy].

SUBJECT: To determine whether additional regional blocking provides pre-emptive analgesia in patients undergoing elective pars plana vitrectomy. METHODS: In a prospectively randomised, double-blinded trial we investigated the potential benefit of combining regional anaesthesia (RA) with general anaesthesia (GA). In each group 25 patients undergoing pars plana vitrectomy were either done under GA (group A), GA combined with retrobulbar block (group B) or GA combined with peribulbar block (group C). Patients were examined by assessing NAS (numeric analogue scale). RESULTS: At all times, patients of group B experienced significantly less pain than patients in either group A or C (p < 0.001). There were no significant differences in pain scores between patients in groups A and C. Only 4 patients in group B required analgesics, whereas 17 patients in group A and 12 patients in group C. CONCLUSION: Certain ophthalmic operations are likely to cause postoperative pain when performed under GA alone, whereas the combination of retrobulbar block with GA reduces the development of pain as pre-emptive analgesia.

Adult↗

PubMed2003

[Morganella morganii endophthalmitis after vitrectomy: case report and review of the literature].

BACKGROUND: Postoperative bacterial endophthalmitis are caused in 80 % of the cases by the patient's own flora. Most of the time, bacterial agents are Gram-positive ((2/3) of cases) and more rarely Gram-negative ((1/3) of cases). Usually, Pseudomonas sp, Proteus sp or Klebsiella sp are isolated, but very rarely Morganella morganii. HISTORY AND SIGNS: We describe a case of a Morganella morganii endophthalmitis which occurred after a vitrectomy. THERAPY AND OUTCOME: Bacterial examinations disclosed the presence of Morganella morganii in the vitreous. An aggressive treatment (intravitreous [ceftazidim, vancomycin], topical [gentamycin, chloramphenicol] and intravenous [imipenem, ofloxacin] antibiotics) was introduced. In spite of this treatment, the outcome was not favorable. CONCLUSIONS: Post-vitrectomy endophthalmitis is very rare and the isolation of a Gram-negative bacteria, in this case Morganella morganii, is infrequent. The outcome of these infections is often poor despite the introduction of a rapid, specific and aggressive treatment.

Aged↗

PubMed2005

[Pars plana vitrectomy for idiopathic vitreous floaters].

BACKGROUND: The aim of this study was to evaluate the role of pars plana vitrectomy (PPV) in patients with persistent vitreous floaters (VF) in phakic (56.7 %) or pseudophakic (43.3 %) eyes. SUBJECTS AND METHODS: A retrospective study of 24 consecutive patients (30 eyes) who underwent a 2-port-PPV using indirect opthalmoscopy between 1992 and 2003 was carried out. Main outcome measures were postoperative visual acuity (PVA), incidence of postoperative complications and patient satisfaction, which has been assessed retrospectively using a detailed questionnaire. RESULTS: Symptoms resolved in all patients. PVA was significantly better (0.91 +/- 0.2 vs. 0.84 +/- 0.2 preoperative visual acuity) or equal in 25 patients (83.3 %). One pseudophakic patient (3.3 %) experienced a retinal detachment 48 months after surgery. In 5 of 17 phakic eyes (35 %) a cataract extraction had to be performed during the follow-up period. All patients were satisfied with their overall visual function. DISCUSSION: This study shows PPV to be a safe and effective primary treatment for visually disturbing VF. In spite of the small number of cases with a lower PVA (5 eyes/16.7 %), which in the most severe case corresponded to a reduction of VA from 1.0 to 0.6 due to a nuclear sclerosis of the lens, all patients were satisfied. As vitreoretinal complications may occur, a critical patient selection and a careful preoperative assessment of specific risks of vitrectomy are mandatory.

Adult↗

PubMed2006

[Pseudophakic inferior retinal detachment or detachment with inferior breaks: clinical outcome and recurrences after primary vitrectomy-gas].

BACKGROUND: This study aims to evaluate the outcome of primary vitrectomy/gas for pseudophakic retinal detachment (RD) located inferiorly or associated to inferior breaks. PATIENTS AND METHODS: We performed a retrospective, non-randomised study comprising 18 pseudophakic RD eyes with inferior RD (group A) and 19 pseudophakic RD eyes with inferior breaks (group B) treated with primary vitrectomy and gas tamponade (SF (6) 20 %). Pre- and postoperative characteristics were analysed, focusing on RD recurrences. RESULTS: In group A, RD recurred in 2/18 eyes (11 %) and was associated to proliferative vitreoretinopathy (PVR) both at first intervention and on recurrence. In group B, RD recurred in 4/19 eyes (21 %). One eye presented PVR at first intervention and all at re-intervention. Anatomic reapplication was achieved after second vitrectomy/gas in 2/4 eyes of group B, whereas long-term silicon oil tamponade was needed in 2 eyes of each group. CONCLUSIONS: This series shows a high success rate of primary vitrectomy/gas in pseudophakic RD patients with inferior RD or detachment associated to inferior breaks. Recurrences after vitrectomy are most often related to the presence of PVR.

Aged↗

PubMed1995

[Larger sclerotomies for use of the multiport illumination system do not increase the complication risk of vitrectomy].

PURPOSE: To free both of the surgeon's hands for bimanual work in the vitreous cavity, Koch and coworkers developed the multiport illumination system, which, however, requires enlarged sclerotomies. PATIENTS AND METHODS: To evaluate the safety of the multiport illumination system we analyzed the first postoperative year of those 104 vitrectomies, that were performed using this system between January and December 1991. It was used only for patients suffering from advanced vitreoretinal changes that most likely require bimanual surgery. RESULTS: No specific intraoperative or postoperative complications were encountered that might possibly have been caused by the multiport illumination system. Postoperative fibrinous reactions were noted in the vitreous cavity of 7 patients, and in the anterior chamber of 15 patients. Rebleeding was observed in a total of 17 patients. CONCLUSION: When these complications were compared to data from other retrospective studies of vitrectomy and its complications, the multiport illumination, system was found to be as safe as conventional devices.

Diabetic Retinopathy↗

PubMed1991

[Vitrectomy in secondary complications caused by intraocular foreign body].

Endophthalmitis and reduced vision as late complications of penetrating ocular injuries cause specific diagnostic problems. A persisting endopthalmitis may be caused by unnoticed organic foreign bodies (f.b.) like lashes or a splinter of glas. Endophthalmitis recurring months or years after a perforating injury indicates the possibility of a spontaneous mobilization of a f.b. Vitrectomy and removal of the f.b. is the therapy of choice in either situation. Five typical cases are presented: lashes encapsulated in the ciliary body following a limbal perforation; an intraretinal incarceration of a lash of unknown history; spontaneous dislocation of a glas splinter from the ciliary body into the anterior chamber; delayed spontaneous translocation of a 10 x 11 mm metallic f.b. from tenon's space transsclerally into the subretinal space leading to endophthalmitis one year after a severe perforating injury; secondary mobilization of an intraretinal piece of stone during a posterior hyaloid detachment. In each case, vitrectomy was performed and the f.b. removed via pars plana. Secondary surgery for retinal detachment or PVR was necessary in 2 cases. The final visual acuity was 20/20 in 3 cases and 10/20 or better in 2 cases.

Adult↗

PubMed1991

[Lens changes following intraocular tamponade in vitrectomy. Linear densitometric image analysis of Scheimpflug photographs 6 months after operation].

A complication arising from vitrectomy is the formation of cataract. As a result of an intra- and postoperative tamponade chosen (BSS, air, SF6-gas, silicon oil) the size and frequency of the cataract varies accordingly. 6 months after vitrectomy Scheimpflug photography and microdensitometric evaluation of the negatives were performed on 30 pairs of phacic eyes showing changes in the transparency of the lens. Following silicon oil tamponade a significant deterioration of transparency (t-test) was observed in the lens nucleus of the operated eye; in the area of the lens in front of the nucleus a marked but not significant deterioration of transparency was discovered following both silicon oil and SF6-gas tamponade. In the case of the area in front of the nucleus following SF6-gas tamponade as well as the whole of the lens following BSS or air tamponade a small but not at all significant difference in lens transparency was apparent after comparison of the operated to the non-operated eyes.

Cataract↗

PubMed1989

[Pars plana vitrectomy in chronic uveitis in the child].

In five children aged between 8 and 14, suffering from chronic recurrent uveitis of undetermined etiology, pars plana vitrectomy was performed in order to halt progression of the disease. Postoperatively there was a clear improvement in vision in all five patients, and in the follow-up period of 5 to 26 months there were no further recurrences of uveitis in the eyes which had been treated. These observations support the assumption that vitrectomy has a favorable effect not only in adults but also in children with therapy-resistant uveitis.

Adolescent↗

PubMed1986

[Vitrectomy and subsequent photocoagulation in proliferative diabetic retinopathy with vitreous hemorrhage].

Forty eyes in 39 patients with proliferative diabetic retinopathy, vitreal hemorrhage and progressive neovascularization in at least 3 fundus quadrants were treated with panretinal xenon photocoagulation immediately after pars plana vitrectomy. Lens extraction was performed on 7 eyes and 2 eyes were aphakic. Six months after treatment, 68% of the eyes showed an improvement in vision, 25% had vitreal rebleeding and 11% developed rubeosis iridis. While treatment had no effect on peripheral rubeosis iridis in 5 eyes, all 7 eyes with pupillary rubeosis iridis showed complete regression. The results indicate the clinical value of combining, pars plana vitrectomy with panretinal xenon photocoagulation in selected patients.

Adult↗

PubMed1984

[Candida albicans endophthalmitis. Results of pars plana vitrectomy without intraocular antimycotic therapy].

An early pars plana vitrectomy was performed without any additional intravitreal antimycotic therapy in 8 eyes of 5 patients with candida endophthalmitis; anatomic healing with a good functional result was obtained. The good prognosis of vitrectomy without intravitreal antimycotic therapy in our patients is seen in (1) a total surgical extraction of the abscess and (2) the better intraocular ventilation obtained for endogenous resistance.

Adult↗

PubMed1983

[Vitrectomy in inflammatory diseases of the posterior segment of the eye].

Eight patients with chronic endogenous uveitis, chorioretinitis, toxoplasmosis and infective endophthalmitis underwent pars plana vitrectomy mainly to improve vision by clearing the media or removing membranes. Beyond this it turned out that in eyes with chronic endogenous uveitis vitrectomy might also alter or diminish the severity as well as the frequency of attacks. The role of the vitreous as an autoimmune agent is discussed.

Adult↗

PubMed1999

Effects of irrigation fluid temperature on choroidal circulation during vitrectomy.

PURPOSE: To investigate the effects of irrigation temperature on choroidal circulation during vitrectomy. METHODS: After anesthetized albino rabbits underwent closed vitrectomy, choroidal blood flow was monitored while the vitreous cavity was irrigated with solutions (BSS plus) of various temperatures (6-42 degrees C). Irrigation pressure was maintained at 15 mmHg. A non-contact Doppler laser flowmeter was used to measure choroidal blood flow. Temperature change at the retina and mid-vitreous was also measured during irrigation. RESULTS: Choroidal blood flow showed a downward peak when perfused at 34 degrees C. As irrigation temperatures deviated above or below 34 degrees C, the blood flow increased. However, when irrigation temperature was below 16 degrees C, the blood flow decreased as the temperature declined. The temperature at the retina was maintained at a relatively constant level when irrigation was between 30 degrees C and 40 degrees C. CONCLUSION: The choroid acts as a thermostat to minimize intraocular temperature fluctuations by changing its blood flow.

Animals↗

PubMed2001

The effect of partial vitrectomy on blood-ocular barrier function in the rabbit.

PURPOSE: To compare ocular vascular permeability in the rabbit after vitrectomy as assessed by contrast-enhanced magnetic imaging (CE-MRI) and measurements of aqueous and vitreous humor protein concentration. METHODS: Partial vitrectomies were performed, irrigating with BSS or BSS PLUS. Post-operative vascular leakage was determined by CE-MRI following intravenous administration of gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA). Aqueous and vitreous protein concentrations were quantified by standard biochemical assay. ERG evaluations were performed on postoperative days 1, 3, and 7. RESULTS: Using BSS as irrigant, breakdown of the inner blood-retinal barrier (BRB) occurred in 4/7 eyes on post-operative day 1. The rate of Gd-DTPA leakage was significantly greater on postoperative day 1 than that in unoperated, control eyes, but declined approximately 50% by day 3. At both time points, outer BRB breakdown was restricted to the sclerotomy wounds. No BRB leakage was detectable in control eyes. Blood-aqueous barrier (BAB) leakage was bilateral on day 1. Significantly greater Gd-DTPA leakage occurred in the operated eye than in the nonsurgical contralateral eye. On day 3, approximately 40% bilateral reduction in leakage indicated resolution of BAB leakage. Notably, Gd-DTPA leakage of the BAB and BRB was significantly reduced in the BSS PLUS treated group. In contrast to MRI assessments, protein concentrations of the aqueous and vitreous in the surgical eye showed no detectable differences between BSS and BSS PLUS. Concurrent with the transient loss of ocular barrier function, ERG responses also declined. However, by day 7 greater than 90% recovery was noted in BSS PLUS treated animals but not in the BSS treatment group. CONCLUSIONS: CE-MRI is capable of detecting subtle changes in vascular permeability following ocular surgery. Advantages of using BSS PLUS compared to BSS as the irrigating solution can be detected using this technique. BSS PLUS's protection of barrier function is consistent with a rapid recovery in retinal function not observed in BSS treated eyes.

Animals↗

PubMed2001

Pars plana vitrectomy combined with penetrating keratoplasty.

Pars plana vitrectomy combined with keratoplasty using a temporary keratoprosthesis is a surgical procedure used in patients with vitreoretinal disorders complicated by severe corneal opacification. Temporary keratoprostheses include the Landers type and Eckardt type. Use of the Eckardt temporary keratoprosthesis is superior because of a wider optical diameter and easier visualization of the peripheral fundus. However, one problem with this procedure is that many patients develop postoperative rejection and loss of transparency of the corneal graft. To maintain good transparency of the corneal graft after surgery, vitrectomy must be minimally invasive and postoperative anti-inflammation must be ensured.

Corneal Diseases↗

PubMed2003

Combined pars plana vitrectomy and lens management in complex vitreoretinal disease.

Concurrent cataract and vitreoretinal disorders are relatively common. Additionally, a considerable number of phakic eyes develop visually significant cataract following pars plana vitrectomy. The ophthalmic literature is replete with reports of a combined procedure consisting of simultaneous cataract extraction, intraocular lens implantation, and pars plana vitrectomy to treat a wide range of vitreoretinal disorders and co-existing cataracts. Historical concerns of increased risk of complications with the combined procedure have been shown not to be clinically significant. The combined procedure offers the advantages of a single procedure, including faster recovery time and cost effectiveness. Earlier reports of the combined procedure describe pars plana lensectomy and extracapsular cataract extraction as techniques for cataract extraction. Currently, phacoemulsification with implantation of a foldable posterior intraocular lens implantation has become the preferred technique of cataract removal. With advances in instrumentation and surgical techniques, the combined procedure offers a safe and effective way to manage concurrent cataract and complex vitreoretinal disease.

Cataract↗

PubMed2004

Vitrectomy with fluconazole infusion: retinal toxicity, pharmacokinetics, and efficacy in the treatment of experimental candidal endophthalmitis.

The aim of this study was to determine the retinal toxicity and intraocular pharmacokinetics of vitrectomy with fluconazole infusion in rabbit eyes and to study its efficacy in the treatment of experimental candidal endophthalmitis. The right eyes of 13 New Zealand White (NZW) rabbits were vitrectomized and infused with 20 mL of 0.2 mg/mL, 1 mg/mL, or 2 mg/mL of fluconazole. An electroretinogram (ERG) was performed on both eyes of each rabbit at different time points. The right eyes of 26 different NZW rabbits were vitrectomized and infused with 20 mL of 2 mg/mL of fluconazole. These rabbits were sacrificed, and their right eyes were enucleated at hours 2, 4, 8, and 24 after the operation, and the concentration of fluconazole in the vitreous was measured by highpressure liquid chromatography. Experimental candidal endophthalmitis was induced in the right eye of 42 other NZW rabbits. Twenty-six (26) of the eyes were then vitrectomized and infused with 20 mL of 2 mg/mL of fluconazole, and the other 16 rabbits served as control. Severity of ocular infection was graded from 0-4 at different time intervals, using an indirect ophthalmoscope. In the first group, ERG showed no significant difference between the experimental eyes and the control eyes--in all concentrations of fluconazole--for up to 3 months. In the second group, the intraocular concentration of fluconazole declined so rapidly that, as of 8 hours after operation, there was none in the vitreous cavity. In the third group, significantly less vitreous opacity was found in the treated eyes on days 3 and 6. However, the difference ceased to be apparent on day 15. Our study suggests that there is no retinal toxicity resulting from vitrectomy with a 2 mg/mL fluconazole infusion, and that it is temporally effective in the treatment of experimental candidal endophthalmitis.

Animals↗

PubMedDate not supplied

Surgical results of vitrectomy in ocular trauma.

The authors have analyzed 49 consecutive eyes with trauma that had undergone vitrectomy. Anatomic success (eyes with attached retinas and generally clear media, regardless of visual function) was achieved in 80% of eyes. This high rate of success resulted from the use of silicone oil in 20 eyes with complicated retinal detachment that was judged otherwise as irreversible. Functional success (eyes with a final visual acuity of 0.2 [20/100] or better, or a postoperative improvement in visual acuity of two lines on the Snellen chart) was achieved in 53% of eyes. In most of the eyes that underwent vitrectomy 2 months or longer after injury, the visual outcome was poor, even when anatomic success was achieved. Retinal detachment was a major factor in poor surgical prognosis. Prophylactic scleral buckling and/or an encircling procedure significantly decreased the incidence of postoperative retinal detachment.

Accidents, Occupational↗

PubMedDate not supplied

Enzyme-assisted vitrectomy with bacterial collagenase. Pilot human studies.

Clostridiopeptidase A, a bacterial collagenase, was used to assist vitrectomy with membrane stripping in six patients with dense intravitreal fibroproliferative tissue associated with retinopathy of prematurity, diabetic retinopathy, or proliferative vitreoretinopathy. When it was injected intra-operatively, allowed to incubate for 15 minutes, and then removed by irrigation/aspiration, no side effects of lens opacity, lens dislocation, or retinal hemorrhage were observed. Use of this enzyme may facilitate removal of fibroproliferative tissue in certain difficult vitrectomy cases.

Adolescent↗