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At least 1,063 records · Page 59Linked to original sources

PubMed1993

Vitrectomy in ocular trauma. Factors influencing final visual outcome.

The results of vitrectomy in 240 consecutive cases of ocular trauma were reviewed. Of these cases, 71.2% were war injuries. Intraocular foreign bodies were present in 155 eyes, of which 74.8% were metallic and 61.9% ferromagnetic. Multivariate analysis identified the prognostic factors predictive of poor visual outcome, which included: (1) presence of an afferent pupillary defect; (2) double perforating injuries; and (3) presence of intraocular foreign bodies. Association of vitreous hemorrhage with intraocular foreign bodies was predictive of a poor prognosis. Eyes with foreign bodies retained in the anterior segment and vitreous had a better prognosis than those with foreign bodies embedded in the retina. Timing of vitrectomy and type of trauma had no significant effect on the final visual results. Prophylactic scleral buckling reduced the incidence of retinal detachment after surgery. Injuries confined to the cornea had a better prognosis than scleral injuries.

Adolescent↗

PubMed1993

[Prospective longitudinal studies on lens changes after vitrectomy--quantitative assessment by fluorophotometry and refractometry].

We prospectively evaluated lens changes after vitrectomy on 55 patients with vitreoretinal interface syndrome such as idiopathic epiretinal membrane, vitreomacular traction syndrome, and impending stages of idiopathic senile macular hole. Postoperative changes in crystalline lenses were assessed by fluorophotometric measurement of lens autofluorescence, measurement of refractive errors and biomicroscopic evaluation of progression of nuclear sclerosis. Examinations were repeated prior to surgery and at 1, 3, 6, and 12 months postoperatively. While autofluorescene and light transmittance of the lens were not affected by vitrectomy in patients less than 50 years old, older patients showed a significant increase of autofluorescence and decreased transmittance as early as 3 months after surgery. The refraction became myopic with time especially in the older patient group. Nuclear cataract was also found on biomicroscopic examination in the older patients as early as 1 month after surgery and progressed with time. The older the patients were, the more prominent those lens changes were.

Adult↗

PubMed1993

Variation of temporal stimulus characteristics to evaluate visual function prior to pars plana vitrectomy.

Electrophysiological examinations were carried out prior to pars plana vitrectomy in a series of consecutive patients with complicated diabetic retinopathy, proliferative vitreoretinopathy, and perforating injuries. In 141 eyes electroretinograms were evaluated. The amplitude of the a- and b-waves at dark and light adaptation and of the 30-Hz flicker response correlated with the postoperative visual acuity and the retinal morphology. Due to the variability of these parameters, however, the preoperative electroretinogram has no predictive value. In 245 eyes, flash and flicker (5, 10, 20, 30 Hz) visual evoked cortical potentials (VECP) were recorded. The flash VECP was of no value. The presence of a response to a flicker stimulus of 10 Hz or higher frequencies, however, indicated a better functional recovery (P < 0.02). More eyes with an attached central retina showed a 30-Hz flicker response as compared to eyes with central retinal detachment (P < 0.01). The flicker VECP therefore, has a predictive value prior to vitrectomy.

Dark Adaptation↗

PubMed1995

[Treatment of intraocular fibrin formation with tissue plasminogen activator after vitrectomy].

Twenty two eyes of 22 cases with severe intraocular fibrin formation after vitrectomy who had been all unresponsive to conventional therapy were treated with tissue plasminogen activator (t-PA), including complicated retinal detachment (14 eyes), intraocular foreign body (3 eyes), vitreous hemorrhage (2 eyes), traumatic cataract (2 eyes) and endophthalmitis (1 eye). The fibrin formation appeared 1-5 days with a mean of 2 days after operation. Of these 22 eyes, fibrin was seen in the pupillary area in 11, in the anterior chamber in 10 eyes and in the vitreous cavity in 1 eye. The initial injection of t-PA was given between the 5th and 15th (mean, 8.6 days) postoperative days after vitrectomy. The t-PA (5-30 micrograms) was injected into the anterior chamber in 21 cases and into the vitreous cavity in 1 case (25 micrograms). Once injection resulted in complete fibrinolysis in 19 of 22 eyes and partial fibrinolysis in 3 eyes, and the complete dissolution with one injection was achieved within 0.5-2.5 hours with a mean of 1 hour. 1 eye required repeated t-PA injection for recurrent fibrin formation and the repeated injection resulted in complete fibrinolysis in this case. The follow-up periods ranged from 1 to 20 months (mean period, 10 months). At the final follow-up examination, the retina was totally attached in 16 of 22 eyes and partially attached and detached in 6. Visual acuity improved in 13 eyes. Complications of t-PA injection included hyphema, elevated intraocular pressure (IOP) and hyphema with elevated IOP in 1 case respectively. Factors affecting the therapeutic effect of t-PA and methods preventing the complications of t-PA injection were discussed.

Adolescent↗

PubMed1995

Tissue plasminogen activator as a biochemical adjuvant in vitrectomy for proliferative diabetic vitreoretinopathy.

Tissue plasminogen activator (TPA) converts plasminogen to plasmin, thereby inducing fibrinolysis. In ophthalmologic surgery of subretinal hemorrhages, it is used to dissolve blood clots. As the blood-retina barrier of diabetic patients has broken down, plasminogen can enter the vitreous compartment in these cases. It is known that plasmin dissolves extracellular matrix protein in the vitreous interface. For that reason se used TPA in pars plana vitrectomy (ppV) of proliferative diabetic vitreous retinopathy (PDVR). Ten patients undergoing ppV for PDVR of stage A or B (Kroll classification) were included in a prospective study. At 15 min prior to vitrectomy, 100 microliters balanced salt solution was injected into the vitreous cavity. As randomized, the injection fluid contained either 25 micrograms TPA or only buffer solution. At this stage, the operating surgeon did not know whether TPA was injected or not. The grade of difficulty and complications of the operation were scored and documented. In all cases the operating surgeon correctly classified verum or placebo after surgery. Preparation of vitreous cortex and pathological membranes proved to be less difficult when TPA had been injected. Moreover, no severe bleeding occurred in this group in spite of marked PDVR. We conclude that TPA can be used in ppV without producing severe side effects. Disintegration of the vitreous interface causes a posterior detachment of the vitreous body, thus facilitating ppV.

Adolescent↗

PubMed1996

Cataract extraction and intraocular lens implantation with anterior vitrectomy in children.

OBJECTIVE: Extracapsular cataract extraction (ECCE) with selective intraocular lens (IOL) implantation has been the choice of the treatment for children with cataracts. With regard to surgical technique, ECCE with anterior segment vitrectomy has shown some success in reducing complications. Formation of a secondary membrane and opacity of the posterior capsule, however, are still major postoperative complications. To reduce these complications, we modified current surgical procedures with minimal incisions and manipulations. PATIENTS AND METHODS: ECCE with anterior segment vitrectomy was performed using Storz Protage's system in 84 eyes of 58 children ranging in age from 14 months to 14 years. Of 70 eyes of children aged above 3 years, IOLs were implanted simultaneously. Vision improvement and incidence of postoperative complications were compared with other standard procedures to determine the benefits of the operation for children with cataracts. After the anterior capsule was opened by continuous circular capsulorhexis or envelope-form capsulectomy, the lens cortex was excised. Subsequently, the IOL was implanted into the bag. RESULTS: Nine-30 months follow-up showed that all of the central area of the posterior capsule remained clear except one eye in which a secondary membrane was partially formed on the anterior surface of vitreous. No other operative or postoperative complications occurred. CONCLUSIONS: The results indicate that the modified procedure is beneficial in the prevention of secondary cataract formation and other postoperative complications in a short term follow-up, however, a long-term follow-up is warranted to evaluate its role in pediatric cataract surgery.

Adolescent↗

PubMed1996

Management of hypotonous cyclodialysis with pars plana vitrectomy, gas tamponade, and cryotherapy.

BACKGROUND AND OBJECTIVE: Cyclodialysis after ocular trauma or surgery may lead to hypotony and visual loss. A new surgical approach for the treatment of cyclodialysis is reported. PATIENTS AND METHODS: In three patients with long-standing cyclodialysis and hypotony, a pars plana vitrectomy with gas tamponade and transscleral cryotherapy to the region of the cleft was performed. RESULTS: In all patients intraocular pressure increased to normal or near normal, choroidal detachment and retinal and disc edema resolved, and visual acuity increased. CONCLUSION: A hypotonous cyclodialysis can be successfully treated with vitrectomy, gas tamponade, and cryotherapy. This approach may be superior to other techniques if there are also additional posterior segment problems, or if there is lens dislocation.

Adult↗

PubMed1996

[Vitrectomy-laser-gas for treating optic disk pits complicated by serous macular detachment].

PURPOSE: Optic nerve pit is a rare congenital anomaly. In two third of the patients, the severity of the disease is increased by the apparition of a serous macular detachment, which may compromise the visual prognosis. The aim of this study is to propose a therapy appropriate to such complication. METHODS: A prospective study was performed including 10 patients with a serous macular detachment caused by optic nerve pit. All patients underwent intraocular surgery including vitrectomy, peripapillary photocoagulation and intravitreal injection of gas. The mean postoperative follow-up period was 9.5 months. RESULTS: Therapy success was based on anatomical and functional results. Serous macular detachment reattached in 7 patients out of 10 and a recurrence was observed in one case. Visual acuity improved from 0 to 18 lines of the EDTRS chart (mean increase: 6.7 lines). CONCLUSION: These results confirm that intraocular surgery including vitrectomy-photocoagulation-gas injection is a valuable treatment for serous macular detachment associated with optic nerve pit.

Adolescent↗

PubMed1996

Effect of vitrectomy on epiretinal membranes after endogenous fungal endophthalmitis.

Pars plana vitrectomy was used to remove proliferative membranes caused by endogenous fungal endophthalmitis in 3 patients (3 eyes). Tractional retinal detachment was present in all. In 2 eyes, a fibrovascular membrane originated in the optic nerve head and was connected to a full-thickness chorioretinal scar. In the other, a thick preretinal membrane was found in the macula, with total retinal detachment. In all eyes, the epiretinal membrane was successfully removed and the retina reattached. Visual outcome depended on the site of the chorioretinal scar. We advocate pars plana vitrectomy as the method of choice for tractional retinal detachment following fungal endophthalmitis.

Endophthalmitis↗

PubMed1997

Vitrectomy for endogenous Klebsiella pneumoniae endophthalmitis with massive subretinal abscess.

A 39-year-old man with pyogenic liver abscess had bilateral endogenous Klebsiella pneumoniae endophthalmitis. At presentation, the left eye had a localized subretinal abscess. Despite repeated intravitreal amikacin and dexamethasone injections, a subretinal abscess spread and detached all of the retina. Pars plana vitrectomy with drainage of the subretinal abscess was performed. The retina was reattached, and the patient had 5/200 vision 5 months postoperatively. Early vitrectomy with drainage of the subretinal abscess may save some eyes with endogenous Klebsiella pneumoniae endophthalmitis.

Abscess↗

PubMed1997

Gentamicin retinal toxicity after cataract surgery in an eye that underwent vitrectomy.

A cataract developed in a 23-year-old man 4 months after a vitrectomy to repair a traumatic retinal detachment. An uneventful phacoemulsification was performed, using antibiotic-fortified infusion solution. Afterward, a large area of atrophic retina, consistent with gentamicin toxicity, was observed in the macula. The patient remains stable with 20/200 best-corrected acuity. The authors suggest that because the vitreous had been removed, gentamicin was able to settle over the macula during the entire cataract procedure. Therefore, gentamicin should be used intracamerally with caution, especially in eyes in which vitrectomy has been performed.

Adult↗

PubMed1995

[Vitrectomy combined with scleral buckling for the treatment of complicated retinal detachment].

PURPOSE: To raise operative successful rate of complicated retinal detachment, we used the methods of vitrectomy combined with scleral buckling for the treatment of complicated retinal detachment. METHODS: The operative methods included: scleral buckling, vitrectomy, membrane peeling, intraocular and extraocular drainage, gas and silicone oil tamponade. RESULT: Being followed up for 1-16 months, 22 eyes got anatomic reattachment in 29 eyes, the operative successful rate was 75.8%; 15 eyes were injected with silicone oil intraocular tamponade, with 12 eyes getting reattachment. The successful rate was 80%. CONCLUSION: Since the vitreous surgery is used, it is possible for the treatment of complicated retinal detachment, the operative successful rate can be raised. The technique of membrane peeling and intraocular tamponade was very important. Silicone oil has been accepted by more and more ophthalologists in the world, which acts as an effective material of intraocular tamponade.

Adolescent↗

PubMed1996

[Idiopathic epimacular membrane and vitreo-macular traction syndrome: vitrectomy functional results].

The retrospective study of 26 consecutive cases of idiopathic epimacular membrane and vitreomacular traction syndrome treated by vitrectomy with a mean follow-up of 19 months showed very good functional results. The visual acuity at the last visit improved by 2 lines or more when compared with the preoperative visual acuity in 77% of pseudophakic eyes and eyes with clear lens. The metamorphopsia disappeared or significantly diminished in half the cases. The main postoperative complication was the appearance or progression of nuclear sclerosis, which could mask the good functional results of vitrectomy.

Adult↗

PubMed1998

[Corneal endothelial cell damage associated with pars plana vitrectomy].

We performed a prospective study of corneal endothelial damage associated with pars plana vitrectomy in 51 eyes of 46 patients. The corneal endothelium was examined with a specular microscope preoperatively and three months postoperatively. The mean endothelial cell loss for 51 eyes was 11.54%. The 51 eyes were divided into three groups, and the mean cell loss was 25.85% in the pars plana lensectomy (including anterior capsule removal) combined group, 7.53% in the phacoemulsification combined group, and 1.91% in the phakic group. The corneal epithelium removal did not affected the cell loss. The cell loss for the phacoemulsification combined group did not differ significantly from that for the control group (6 eyes received only phacoemulsification). In the pars plana lensectomy combined group the cell loss was related significantly with gas tamponade duration. This study suggests that we must note the endothelial cell damage in vitrectomy-pars plana lensectomy combined with gas tamponade.

Adolescent↗

PubMed1998

[Neovascularization from the scleral wound as the cause of vitreous rebleeding after vitrectomy for proliferative diabetic retinopathy].

Vitreous hemorrhage recurred in 11 eyes out of a series of 120 eyes treated by vitrectomy for proliferative diabetic retinopathy during a 10-month period. Neovascularization from the scleral wound, or fibrovascular proliferation, was identified as the cause of rebleeding in 4 eyes from findings during revitrectomy. None of the 4 eyes showed retinal disorders attributable as the cause of rebleeding. Rebleeding in these 4 eyes developed after an average of 9.0 weeks after initial surgery. The proliferative membrane was oval in shape and expanded from the residual vitreous which had been incarcerated in the scleral wound. The proliferative membrane obtained during revitrectomy was poor in cellular components and contained extracellular matrix. Blood vessels of various sizes were also present. Electron microscopically, the membrane was rich in extracellular components. It contained two types of cells, i.e., high and low electron density cells. These cells often had microvilli and seemed to be of epithelial origin. The findings show that vitreous rebleeding may develop from fibrovascular proliferation from the scleral wound after diabetic vitrectomy. The proliferated membrane showed histological similarities with the fibrovascular proliferation usually seen in the diabetic retina and may represent a type of anterior proliferation secondary to retinal ischemia.

Aged↗

PubMed1997

[Malignant non-Hodgkin lymphoma of the central nervous system with ocular site. Value of vitrectomy for diagnosis].

Diagnosis of intraocular lymphoma is difficult and should be considered in middle-aged or older patients with a chronic uveitis. Many explorations (lumbar punctures, brain imaging and vitrectomies) may be needed before correct diagnosis is made. We report the case of a 50-year-old woman with an intraocular lymphoma for whom the diagnosis was confirmed by a vitrectomy.

Central Nervous System Neoplasms↗

PubMed1998

Pars plana vitrectomy, lensectomy, or extraction in transscleral intraocular lens fixation for the management of dislocated lenses in a family with Marfan's syndrome.

BACKGROUND AND OBJECTIVES: Congenital lens subluxation may be a difficult therapeutic problem. Surgical treatment options include iris manipulation or lens decision, aspiration, intracapsular or extracapsular extraction, and lensectomy through the pars plana. It is not established which kind of aphakic correction is the most appropriate in these cases. PATIENTS AND METHODS: A father and his two sons with Marfan's syndrome were operatively treated for lens dislocation in both eyes. Pars plana vitrectomy was done in all eyes. Dislocated lenses were removed by lensectomy in three eyes and with an intracapsular method in three eyes. The outside-in scleral fixation technique was used for primary posterior chamber intraocular lens (PC IOL) implantation in all cases. RESULTS: All eyes achieved good visual acuity (20/20-20/25). Time of observation ranged between 8 and 20 months. There were no intraoperative or post-operative complications. CONCLUSION: Pars plana vitrectomy and primary scleral-fixated IOL implantation is a safe procedure and gives good visual rehabilitation in adult patients with Marfan's syndrome.

Adult↗

PubMed1998

[Vitrectomy in diabetic retinopathy: outcome, risk factors, complications].

BACKGROUND: Functional results, risk factors and complications of vitrectomy for diabetic retinopathy were studied to improve our estimation for benefits and risks of vitreous surgery with current techniques. MATERIALS AND METHODS: The course of 389 consecutive eyes, who had undergone vitreous surgery for complications of diabetic retinopathy within a four year period, was retrospectively reviewed. The minimum follow-up was 6 months, the median 26 months. Risk factors were studied using multivariate logistic regression analysis. RESULTS: Six months postoperatively 25% of the eyes had a visual acuity of 20/60 or better, a vision of less than 5/200 was found in 25% of the eyes. The most important risk factors were detachment of the macula and iris rubeosis. Only 16% of the eyes with tractional detachment of the macula had a postoperative vision of 20/200 or better, although in 86% the macula was anatomically successfully reattached. Postoperative retinal detachment was observed in 18% of all eyes. The incidence of this serious complication was only 5% after surgery for vitreous hemorrhage, but 54% after vitrectomy for tractional detachment of the macula. CONCLUSIONS: In eyes with advanced stages of long-standing tractional detachment of the macula, the functional prognosis is very poor due to the underlying microvascular disease. In less advanced stages with vitreous hemorrhage and flat retina the risk of vitreous surgery is low.

Adult↗