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At least 901 records · Page 50Linked to original sources

PubMed1987

Corneal astigmatic changes after pars plana vitrectomy.

The authors prospectively studied 67 eyes of 64 patients undergoing pars plana vitrectomy without a scleral buckle to determine the effect of surgery on postoperative corneal curvature. An average of 1 D of against-the-rule astigmatism was induced in the immediate postoperative period. This astigmatic change spontaneously regressed to less than 0.15 D by the 7th postoperative week. Pars plana vitrectomy does not induce clinically significant corneal astigmatism.

Astigmatism↗

PubMed1988

An illuminated air-fluid switch for vitrectomy.

An illuminated air-fluid switch has been developed to replace the tri-stopcock used for air-fluid exchange during vitrectomy. This system eliminates any confusion that might occur in the darkened operating room during vitrectomy.

Vitrectomy↗

PubMed1989

The successful removal of a subretinal cysticercus by pars plana vitrectomy.

A 39-year-old woman from Belize presented with recent vision loss in her left eye due to a subretinal cysticercus located near the macula. We are reporting the use of standard vitrectomy instrumentation and techniques to successfully remove the subretinal cysticercus by a transretinal approach. Pars plana vitrectomy with transretinal removal of the cysticercus is a useful alternative to the traditional external sclerotomy.

Adult↗

PubMed1994

Postoperative fibrin formation and visual outcome after pars plana vitrectomy.

PURPOSE: To determine whether postvitrectomy fibrin formation was associated with visual outcome, a prospective study of patients undergoing pars plana vitrectomy was performed. METHODS: In 121 patients undergoing vitrectomy at the Medical College of Wisconsin between July 1986 and April 1989, the association of fibrin formation and other perioperative factors with visual outcome was evaluated by univariate and multivariate regression analysis. Poor visual outcome was defined as visual acuity worse than 5/200. RESULTS: After a median follow-up period of 23 months (range 6 to 51 months), patients with severe fibrin formation experienced a higher rate of poor visual outcome (19 of 26 patients, 73%) than patients with little or no fibrin formation (23 of 95 patients, 24%; P < 0.0001, univariate analysis). After adjusting for a variety of factors with multivariate regression analysis, fibrin formation was not significantly predictive of final visual outcome. CONCLUSIONS: Factors associated with postvitrectomy fibrin formation may affect visual outcome more than fibrin formation itself.

Adolescent↗

PubMed1995

Removal of optic disc stalks during diabetic vitrectomy.

BACKGROUND: The morphologic features and clinical consequences of removing residual optic disc stalks during vitrectomy for complications of diabetic retinopathy have not been described. METHODS: Twenty-four residual optic disc stalks that were surgically removed from eyes with proliferative diabetic retinopathy and dense nonclearing vitreous hemorrhage and/or traction retinal detachment were studied histologically using conventional hematoxylin and eosin staining as well as a modified Glees staining technique. RESULTS: Histologic examination demonstrated that 79% of the specimens consisted of vascularized glial tissue with an infiltrate of mononuclear cells and 21% consisted of glial membranes devoid of vasculature. Axons were identified in 33% of all tissues studied. Intra-operative hemorrhage occurred in three eyes with strongly adherent optic disc stalks and was controlled with transient elevation of the intraocular pressure. The presence of axons in the removed optic disc stalks was not correlated with a decreased final postoperative visual acuity (median time to follow-up 21 months). CONCLUSIONS: Residual optic disc stalks removed during vitrectomy for proliferative diabetic retinopathy frequently contained axons. The presence of axons does not portend an unfavorable postoperative visual outcome.

Adult↗

PubMed1998

Vitrectomy and silicone oil injection in pediatric patients.

OBJECTIVE: To determine the functional and anatomic results of vitrectomy with silicone oil injection in complicated retinal detachments in children. DESIGN: A retrospective review of all records of children aged 15 years or younger who underwent vitrectomy with silicone oil injection between 1985 and 1994 in the Goldschleger eye institute. RESULTS: Twenty-eight eyes of 27 patients were included in the series, with a mean follow-up time of 24 months. The underlying pathologies included penetrating injury (11 eyes), high myopia (8 eyes), choroidal coloboma (2 eyes), retinopathy of prematurity (2 eyes), and various other pathologies (5 eyes). At the end of the follow-up, complete or partial anatomic success was obtained in 9 eyes (32%) and 3 eyes (10%), respectively. The final visual acuity was 20/400 or better in 5 eyes (18%) and hand motions or less in 19 eyes (68%). The visual acuity could not be determined in 3 eyes due to the age of the patients, and in 1 eye due to mental retardation. The worst results occurred in the perforating injury group. The usual complications associated with silicone oil occurred frequently. CONCLUSIONS: Satisfactory anatomic and functional results were obtained in a minority of the eyes included in our series. The grave prognosis was determined by the devastating nature of the external injury in the trauma cases and the severe vitreoretinal pathology in the other eyes.

Adolescent↗

PubMed1999

Primary vitrectomy with perfluoro-n-octane use in the treatment of pseudophakic retinal detachment with undetected retinal breaks.

PURPOSE: This report describes the results of a prospective trial to evaluate the efficacy of pars plana vitrectomy (PPV) in conjunction with perfluoro-n-octane (PFO) as initial treatment of pseudophakic retinal detachment (RD) with no breaks diagnosed preoperatively. METHODS: Fourteen consecutive eyes presenting with pseudophakic RD in which retinal breaks could not be identified preoperatively underwent primary PPV, internal microsurgical identification of the retinal breaks with endoillumination and noncontact wide angle viewing system, PFO retinal reattachment, transscleral cryopexy or endolaser treatment of breaks, PFO-air exchange, and final injection of 20% sulfur hexafluoride. In five eyes, a scleral buckle was also used. Mean follow-up period was 18 months. RESULTS: In 13 of the 14 eyes in which no breaks had been identified preoperatively, breaks were diagnosed during surgery. Perfluoro-n-octane retinal attachment facilitated accurate microscopic treatment of retinal breaks. The retina was reattached with a single operation in all eyes. Eleven eyes had final visual acuity of 20/60 or better. Complications were minimal. CONCLUSIONS: Pars plana vitrectomy in conjunction with PFO expression of subretinal fluid is effective in the initial treatment of pseudophakic RD with no preoperative diagnosis of retinal breaks.

Adult↗

PubMed1999

Intraoperative acetazolamide in the prevention of intraocular pressure rise after pars plana vitrectomy with fluid-gas exchange.

PURPOSE: To assess the effect of intraoperative acetazolamide (Diamox) on postoperative intraocular pressure (IOP) in gas-filled, vitrectomized eyes. METHODS: We conducted a prospective randomized clinical trial of 63 consecutive patients undergoing pars plana vitrectomy with total fluid-gas exchange and long-acting intraocular gas tamponade. Patients were randomized by a blind draw to receive either intravenous 500 mg acetazolamide (Diamox) (Group 1) or no treatment (Group 2) at the conclusion of the operative procedure. Intraocular pressures at the conclusion of surgery (IOP-1), 4-8 hours following surgery (IOP-2), and on the first postoperative day (IOP-3) were measured using an Oculab Tono-Pen. RESULTS: Patients in Groups 1 and 2 showed similar mean IOP on postoperative day 1 (20.48+/-7.84 mmHg versus 19.89+/-7.89 mmHg). A similar incidence of IOP-2 greater than 30 mmHg (1 versus 3 patients with high IOP) and IOP-3 greater than 30 mmHg (4 versus 3 patients with high IOP) was seen. Patients in Group 1 had a lower mean IOP at 4-8 hours postoperatively (16.25+/-6.47 mmHg) than those in Group 2 (20.13+/-6.33 mmHg). No correlation could be demonstrated between IOP-1 and subsequent IOP. However, IOP on the first postoperative day (IOP-3) was strongly correlated with IOP 4-8 hours after surgery (IOP-2) (P = 0.0001). No protective effect of Diamox could be demonstrated on either IOP-2 or IOP-3. CONCLUSIONS: No protective effect against pressure rise could be demonstrated for intraoperative acetazolamide (Diamox) in the prophylaxis of IOP rise following pars plana vitrectomy and total fluid-gas exchange with long-acting intraocular gas.

Acetazolamide↗

PubMed2000

Vitrectomy update for macular traction in ocular toxocariasis.

PURPOSE: To study the results of modern vitrectomy in traction and combined traction-rhegmatogenous retinal detachment involving the macula in cases of ocular toxocariasis. METHODS: This was a cohort study of patients seen in different institutions in the United States. Ten eyes of 10 patients were studied. Vitrectomy was performed in all eyes, combined with membrane removal, scleral buckle, fluid-gas exchange, silicone oil, or lensectomy in certain cases. The anatomic and visual results of surgery were reviewed. RESULTS: Ten eyes from 10 patients ranging in age from 2 to 33 years (median, 6 years) were reviewed. Follow-up ranged from 3 months to 8 years (median, 2 years). All eyes achieved macular attachment following surgery; vision improved in 5 (50%) eyes, and was unchanged in 5 (50%). Histologic specimens from six eyes were reviewed, and revealed combinations of fibrous tissue, eosinophils, plasma cells, lymphocytes, and giant cells. One specimen revealed an encysted Toxocara canis organism. CONCLUSION: Inflammation created in response to Toxocara larvae may lead to traction retinal detachment of the macula. Vitreoretinal surgery has a good chance of reattaching the macula and improving vision.

Adolescent↗

PubMed2001

The effect of pars plana vitrectomy in the management of Fuchs heterochromic cyclitis.

PURPOSE: Fuchs heterochromic cyclitis (FHC) is characterized by a unilateral chronic iridocyclitis of insidious onset and uncertain cause. Our aim was to evaluate the effect of vitreous surgery in patients with FHC and clinically significant visual symptoms caused by inflammatory vitreous debris. METHODS: This study was a review of 12 eyes of 12 consecutive patients with FHC who underwent pars plana vitrectomy for visually significant vitreous opacities. Cataract extraction with posterior chamber lens implantation had been performed on four eyes preoperatively. Four eyes had a concomitant lensectomy for cataracts, and one had a surgical posterior capsulotomy. Visual and anatomic data were recorded before surgery and for at least 6 months after surgery. RESULTS: Visual acuity improved in all patients from an average logMAR of 0.57 to 0.007 (P = 0.0004) and by more than 2 Snellen lines in 8 of 12 of the eyes (P < 0.05). Symptoms of floaters resolved in all 11 patients in whom they were a symptom. Vitreous haze was cleared completely from an average Nussenblatt grade of 1.7 to 0 after 1 week (P = 0.0001). CONCLUSIONS: Pars plana vitrectomy is a safe and effective treatment for the visual symptoms associated with FHC and can be combined safely with a lensectomy if required.

Adult↗

PubMed2001

Dispase facilitates posterior vitreous detachment during vitrectomy in young pigs.

PURPOSE: To evaluate the role of intravitreal dispase in conjunction with pars plana vitrectomy to facilitate the creation of a posterior vitreous detachment (PVD) in young pig eyes. METHODS: Twenty-four eyes of 24 animals were randomized to receive an intravitreal injection of dispase (50 microg/0.05 mL) or phosphate buffered saline (PBS) immediately after core vitrectomy and before attempted creation of a posterior cortical vitreous detachment. Following a 15-minute waiting period, surgical creation of a posterior vitreous separation was attempted by aspiration of the posterior vitreous immediately adjacent to the optic disk. Eyes were evaluated postoperatively by clinical examination (1, 4, and 8 weeks) and electroretinography (4 and 8 weeks), after which they were enucleated for light, scanning, and transmission electron microscopy. RESULTS: Based on intraoperative findings and postoperative scanning electron microscopy, eyes receiving intravitreal dispase exhibited a higher incidence of PVD compared to eyes receiving PBS (P = 0.029). Electroretinographic responses recorded at postoperative weeks 4 and 8 were similar in both dispase and PBS eyes compared to the unoperated fellow eyes. Clinical examinations, including indirect ophthalmoscopy, were indistinguishable between the PBS eyes and 11 of 12 eyes in the dispase group. Light and transmission electron microscopy demonstrated no differences in the retina between the dispase eyes and the PBS operated controls. CONCLUSION: Dispase is a useful adjunct in facilitating surgical creation of a PVDin young pig eyes.

Animals↗

PubMed2002

Types of macular holes encountered during diabetic vitrectomy.

PURPOSE: To determine the types of macular holes encountered during vitrectomy for complicated cases of diabetic retinopathy. METHODS: This is a retrospective study of consecutive cases of macular holes diagnosed either before or during pars plana vitrectomy for complications of proliferative diabetic retinopathy over a 6-year period. The morphology of these holes is described. Possible mechanisms of their development, surgical considerations, and results after a follow-up of at least 3 months are discussed. RESULTS: Nineteen consecutive cases of macular holes associated with proliferative diabetic retinopathy were reviewed over a 6-year period. Five cases were lamellar and 14 were full thickness. The 14 cases of full thickness macular holes occurred in patients with the following conditions: tractional rhegmatogenous retinal detachment (5); tractional retinal detachment (3); premacular hemorrhage (3); and cystic macular edema (3). Closure of the full thickness holes was achieved in 8 of 11 patients who were followed up for at least 3 months. All the patients had visual improvement, but no patient had a visual acuity of better than 20/100. CONCLUSION: Macular holes may occur in proliferative diabetic retinopathy in different configurations. Full thickness macular holes can be closed in most cases. Functional improvement can be achieved.

Adult↗

PubMed2002

Macular hole repair with minimal vitrectomy.

PURPOSE: Conventional macular hole surgery usually involves removing 80% of the intraocular contents to repair a hole a few hundred micrometers in diameter. Although the success rate for conventional surgery is good, it may be possible to reduce the number of complications with less invasive surgery. METHODS: A newly designed microspatula knife was used to dissect the connection between the vitreous and the retina previously delineated by optical coherence tomography. The posterior vitreous was not stripped from the retinal surface. Limited vitrectomy over the hole was performed to create a space for a gas bubble. RESULTS: The macular holes in three eyes of three patients were closed with this technique with no operative or postoperative complications after a mean follow-up of 8.7 months. The mean change in visual acuity was 6.3 lines. CONCLUSION: It is possible to repair macular holes by using optical coherence tomography to guide the dissection of the vitreous from the macular hole followed by limited vitrectomy. By using a less invasive approach, it may be possible to repair macular holes in less operative time and with fewer complications.

Aged↗

PubMed2002

Office-based sutureless transconjunctival pars plana vitrectomy.

PURPOSE: This is a preliminary report to describe our technique of office-based vitrectomy (OVIT) and to report the incidence of complications over a 6-year period. METHODS: In a retrospective, noncomparative case series, OVIT was performed on 225 patients in four participating offices. Each patient was operated on with a 23-gauge vitreous cutter that the authors have developed. They have also developed a 23-gauge transconjunctival infusion needle device. Diagnoses included endophthalmitis, uveitis, intravitreal lens fragments, ghost cell glaucoma, and rhegmatogenous retinal detachment. RESULTS: The surgical goal was accomplished in all cases, but supplemental office procedures were required for two eyes, and a scleral buckle was necessary in one eye. There were 15 complications in 14 eyes: "fish-egg" gas bubbles (one eye), intraocular hemorrhage (nine eyes), choroidal detachment (two eyes), new retinal breaks (one eye), retinal detachment (one eye), and temporary elevation of intraocular pressure (one eye). The hemorrhages, choroidal detachments, and fish-egg bubbles all resolved spontaneously. CONCLUSION: Office-based sutureless transconjunctival pars plana vitrectomy, with infusion when needed, is an effective operation for selected diseases of the posterior segment. In a multicenter series of 225 eyes, there were 15 complications in 14 (6%) eyes. Two of the complications were successfully managed with additional office procedures; one was managed in the operating room; and 12 resolved spontaneously.

Aged↗

PubMed2003

Penetrating keratoplasty surgery combined with vitrectomy after failing previous corneal surgery.

PURPOSE: The preoperative and postoperative factors influencing visual outcome were analyzed in 15 eyes of 15 patients with graft opacity after keratoplasty associated with vitreoretinal disease who underwent combined surgery of fresh corneal retransplantation and vitrectomy. MATERIALS AND METHODS: The data obtained consisted of diagnosis, preoperative visual acuity, corneal and vitreoretinal findings at the time of surgery, interval between the first visit and surgery, intraocular pressure before surgery, gonioscopic findings, results of bacterial culture of surgical specimens, surgical procedure for vitrectomy, corneal and vitreous findings after surgery, visual acuity 6 months after surgery, intraocular pressure after surgery, and additional surgical techniques. RESULTS: The cause of corneal opacity was graft rejection in all patients, who had been treated with high-dose administrations of steroids and cyclosporin. The preoperative diagnosis was proliferative vitreoretinopathy (PVR) in eight eyes and fungal endophthalmitis in seven eyes. Corneal transparency was achieved in 7 eyes (46.6%) 6 months after surgery. Vitreoretinal findings improved in 9 eyes (60%) and PVR recurred in 6 eyes (40%). Visual acuity improved in 7 eyes (46.6%), did not change in 2 eyes (13.3%), and deteriorated in 6 eyes (40%). The six eyes with decreased visual acuity developed phthisis bulbi. Preoperative intraocular pressure was 2.1 mmHg on average in the phthisis bulbi group, significantly lower than in the group with superior prognosis. Goniosynechia was noted before surgery and did not improve after surgery in all six eyes. CONCLUSIONS: The outcome was poor in eyes with goniosynechia and ocular hypotony, and combined surgery is not indicated for either anatomic or visual preservation in such cases. Care should be taken not to overlook intraocular infection in patients undergoing immunosuppressive therapy against graft rejection. The early detection of retinal detachment is also important in eyes exhibiting hypotony after surgery.

Adult↗

PubMed2003

Result of early vitrectomy for endogenous Klebsiella pneumoniae endophthalmitis.

PURPOSE: To determine the role of pars plana vitrectomy (PPV) in the treatment of Klebsiella pneumoniae endogenous endophthalmitis. METHODS: Records of seven consecutive patients (10 eyes) diagnosed with Klebsiella endogenous endophthalmitis were retrospectively reviewed. RESULTS: Five patients (71%) had diabetes, and four (57%) had a liver abscess as the source. In most cases, the inflammation progressed within days and resulted in decreased vision worse than hand motions and a total vitreous abscess, despite systemic and intravitreal antibiotic injections. A PPV with subretinal abscess drainage and silicone oil tamponade was performed within 2 weeks. After 6 months, the retina remained attached in all eyes (100%), and vision was counting fingers or better in five eyes (50%). Two eyes recovered visual acuity between 20/63 and 20/125. CONCLUSIONS: Physicians should be alerted to the development of endogenous endophthalmitis in patients with Klebsiella septicemia, especially in diabetics with a hepatobiliary abscess. Aggressive therapy, including early vitrectomy with antibiotic injection, may improve the final outcome in this otherwise devastating ocular condition.

Adult↗

PubMed2003

Evaluation and comparison of lens and peripheral retinal relationships with the use of endolaser probe and newly designed curved vitrectomy probe.

OBJECTIVE: To evaluate and compare the relationships between the posterior surface of the crystalline lens and peripheral retina with the use of curved vitrectomy instruments. MATERIALS AND METHODS: Specially designed curved endolaser and vitrectomy probes were compared with conventional straight probes through sclerotomy sites at 3.0 mm and 4.0 mm, in 12 fresh cadaver phakic eyes. For the safety profile, the perpendicular distance between the probe oriented toward a reference point on the retina and the midpoint of the posterior surface of the lens was measured. For access to the retinal periphery, the distance between the ora serrata and the most peripheral accessible point on the retina without touching the crystalline lens with the probes was measured. RESULTS: The perpendicular distance between the probe and posterior surface of the lens increased, and the ability of the probe to reach the most peripheral accessible point on the retina improved with the curved probes as compared with straight probes. CONCLUSIONS: Curved probes can access the peripheral retina and ora serrata with lesser possibility to injure the crystalline lens during vitreous surgery than the standard straight probes.

Equipment Design↗

PubMed2004

Trypan blue-assisted vitrectomy.

PURPOSE: To evaluate the efficacy of trypan blue dye for the staining and removal of the internal limiting membrane, epiretinal membranes, and the posterior hyaloid during pars plana vitrectomy. METHODS: The authors retrospectively reviewed a consecutive series of 26 eyes of 26 patients in whom trypan blue 0.15% dye was used to stain intraocular tissues during vitrectomy surgery. RESULTS: The cases reviewed included the following diagnoses: epiretinal membrane (13), macular hole (9), proliferative vitreoretinopathy (2), chronic pseudophakic cystoid macular edema (1), and chronic diabetic macular edema (1). The application of trypan blue resulted in a useful and consistent bluish staining, facilitating the identification, delineation, and removal of the epiretinal membrane, internal limiting membrane, or posterior hyaloid in all patients. Six months after the surgery, visual acuity was better or the same in 21 of the 26 patients. There were no clinical signs of retinal toxicity in any patients. CONCLUSION: Trypan blue staining of the internal limiting membrane, epiretinal membranes, and the posterior hyaloid is a useful adjunct in vitreoretinal surgery and improves the efficiency and safety of membrane identification and removal.

Aged↗