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At least 1,207 records · Page 67Linked to original sources

PubMed2004

Weak symptoms of bacterial endophthalmitis after a triamcinolone acetonide-assisted pars plana vitrectomy.

PURPOSE: To report a case of endophthalmitis after triamcinolone acetonide (TA)-assisted par plane vitrectomy (PPV). METHODS: A 60-year-old Japanese man developed endophthalmitis after TA-assisted PPV for diabetic macular edema. Preoperative visual acuity was 20/200. Four days after surgery, endophthalmitis associated with anterior chamber hypopyon was noticed; the patient's vision had deteriorated to hand motion. In spite of severe cell infiltration, the ciliary injection and ocular pain were not significant. RESULTS: The additional PPV with irrigation of cefazolin (40 microg/ml) and gentamicin (8 microg/ml) was performed. Endophthalmitis resolved soon after this treatment. Staphylococcus epidermidis was detected in the intravitreous samples. The patient's visual acuity improved to 20/100. CONCLUSION: Endophthalmitis may be a complication of TA-assisted PPV with unique signs and symptoms.

Anti-Inflammatory Agents↗

PubMed2005

Pars plana vitrectomy with internal limiting membrane removal for macular hole associated with proliferative diabetic retinopathy.

BACKGROUND: We describe the outcome of vitreous surgery in three eyes of three patients with macular hole associated with proliferative diabetic retinopathy (PDR) in the absence of fibrovascular proliferation, a combination of conditions where efficacy is incompletely known. METHODS: The patients, all male were 62, 65, and 66 years old. Panretinal photocoagulation had been performed preoperatively in all, and one eye had undergone vitreous surgery. No fibrovascular tissue causing macular traction was observed in any case. Fluorescein angiography and optical coherence tomography (OCT) demonstrated persistent diabetic macular edema surrounding the hole. Affected eyes were treated with vitrectomy including internal limiting membrane (ILM) peeling; 20% sulfur hexafluoride gas (SF(6)) was introduced for tamponade. RESULTS: Anatomical closure of the macular hole as well as resolution of macular edema was achieved in all cases, and vision improved considerably by more than two Snellen lines. CONCLUSIONS: Vitreous surgery with ILM peeling was effective for macular hole associated with PDR, attaining not only macular hole closure but also resolution of persistent diabetic macular edema.

Aged↗

PubMed2005

Intraocular humidity immediately after fluid-air exchange in pars plana vitrectomy.

PURPOSE: To study vitreous cavity humidity during fluid-air exchange in pars plana vitrectomy. METHODS: Intraocular humidity in the vitreous cavity was recorded for 2 min in six artificial eyes, six enucleated pig eyes, and ten patient eyes, after the eyes had been filled with either humidified air (75% humidity) or dry air (8% humidity). RESULTS: In artificial eyes the humidity levelled off at a value that was approximately equal to the humidity of the infused air, i.e., a mean of 71.9% when humidified air was used and a mean of 14.4% when dry air was used. In enucleated pig eyes humidity increased slightly with humidified air and remained stable with dry air. In patients intraocular humidity increased to over 90%, regardless of whether humidified or dry air was used. CONCLUSION: In the living eye, dry air deprives the retinal tissue of humidity, which is lost into the vitreous cavity. This effect can be reduced by using humidified air.

Acetates↗

PubMed2006

Modified technique for safer indocyanine-green-assisted peeling of the internal limiting membrane during vitrectomy for macular hole repair.

BACKGROUND: During macular hole surgery, indocyanine green (ICG) has access to the subretinal space and can lead to toxic and phototoxic damage of the retinal pigment epithelium (RPE). To reduce its toxicity and to avoid contact between ICG and the RPE, we have developed a modified technique by using autologous whole blood. METHODS: Thirty-one eyes underwent vitrectomy for idiopathic macular hole repair. Autologous whole blood (0.1 ml) was injected into the buffered saline solution (BSS)-filled vitreous cavity over the posterior pole and aspirated with a flute cannula. A small clot remained covering the macular hole. The internal limiting membrane (ILM) was stained by using 0.05% ICG solution. The ICG was dissolved in 5% glucose to obtain an iso-osmotic solution. This ICG was injected into the BSS-filled vitreous cavity over the posterior pole and removed after 10 s. The ILM was peeled and a long-acting gas tamponade applied. Pre- and postoperative best-corrected visual acuity and optical coherence tomography (OCT) findings are reported. RESULTS: Macular hole closure was achieved in 30 of 31 eyes (97%). The mean preoperative logMAR acuity was 0.99 (range: 0.4 to 2.0). Mean postoperative logMAR acuity was 0.496 (range: 0.0 to 1.0). The average improvement in vision was 0.66 logMAR units (range: 1.5 to 0.0). No postoperative RPE alterations were observed biomicroscopically or on OCT. CONCLUSION: This surgical technique leads to favorable anatomic and functional results. ICG toxicity is reduced by modifying osmolarity, concentration and contact time and by injecting ICG under BSS. Autologous whole blood acts as a mechanical barrier and prevents ICG from entering in the subretinal space.

Aged↗

PubMed2006

Postoperative retinal break after 25-gauge transconjunctival sutureless vitrectomy: report of four cases.

BACKGROUND: A 25-gauge transconjunctival sutureless vitrectomy (TSV) has been reported effective. However, complications such as postoperative retinal detachment have been reported. In this study, we report four cases of retinal breaks found after 25-gauge TSV. In this study, we investigated factors contributing to occurrence of postoperative complications. METHODS: Seventy-five patients (75 eyes) underwent 25-gauge TSV surgery at Kanazawa University hospital between April 2004 and September 2005. Postoperative follow-up monitoring was done for at least 3 months. The surgical charts were reviewed. RESULTS: Retinal breaks not accompanied by retinal detachment were noted postoperatively in four patients. All four of these patients had preoperative idiopathic macular holes. In all cases, there was no vitreous traction around the retinal break and photo coagulation was performed. One eye with age-related macular degeneration developed intraoperative rhegmatogenous retinal detachment. No other complications were observed during the intraoperative and postoperative periods. CONCLUSION: Upon performing 25-gauge TSV for macular hole repair, care should be taken to detect retinal breaks and retinal detachment intraoperatively and postoperatively.

Conjunctiva↗

PubMed2006

Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment study (SPR Study): recruitment list evaluation. Study report no. 2.

BACKGROUND: Accompanying the patient recruitment within the "Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment multicentre trial (SPR)", all patients with primary rhegmatogenous retinal detachment (RRD) had to be documented in a detailed recruitment list. The main goal of this analysis was to estimate the prevalence of "medium-severe" RRD (SPR Study eligible) as defined by the SPR Study inclusion criteria. In addition, the detailed anatomical situation of medium-severe RRD is investigated. METHODS: SPR Study recruitment was evaluated via a standardised questionnaire, which contained a coloured fundus drawing and information regarding possible reasons for exclusion from the SPR Study in each case. A team of three experienced vitreoretinal surgeons evaluated all fundus drawings from a 1-year period. The review led to a decision on SPR Study eligibility on the pure basis of anatomical assessment. The main outcome measures were assessment of feasible inclusion into the SPR Study by the evaluation team based on the fundus drawing and anatomical details. RESULTS: A total of 1,115 patients with RRD from 13 European centres were prospectively enrolled in the year 2000. The quality of the drawings sufficed for assessment in 1,107 cases (99.3%). Three hundred and twelve fundus drawings (28.2%) met the anatomic inclusion criteria of the SPR Study. RRD of medium severity is characterised by an average number of 2.6 (SD 2.4) retinal breaks, 5.8 (SD 2.8) clock hours of detached retina, unclear hole situation in 15.1% of cases (n=47), attached macula in 42.9% (n=134), bullous detachment in 15.1% (n=47) and vitreous haemorrhage/opacity in 7.7% (n=24). CONCLUSIONS: In the recruitment lists of the SPR Study of the year 2000, RRD of medium severity was present in nearly one third of the patients with primary RRD. These findings emphasise the clinical relevance of the SPR Study.

Adolescent↗

PubMed2006

Evaluation of the safety of xenon/bandpass light in vitrectomy using the A2E-laden RPE model.

BACKGROUND: The purpose of the study was to investigate the brightness of the xenon/bandpass light in vitrectomy and assess its phototoxic effects using A2E-laden retinal pigment epithelial (RPE) cells. METHODS: The total luminous flux and spectral irradiance of 20- and 25-gauge endoilluminators connected to xenon lamps were measured and compared to those of 20- and 25-gauge endoilluminators connected to a halogen lamp. In vitro, A2E-laden cells were evenly exposed to xenon/bandpass light for 5 to 30 min positioned at 1 cm and 2 cm for a standard light probe and an implantable "chandelier" light probe, respectively, above the cells, and the cell viability was assessed using WST-1 assay. The cell viability was compared with cells exposed to 30 min of halogen light projected through a 20-gauge endoilluminator. RESULTS: The maximal total luminous flux of xenon/bandpass light emitted through the 20-gauge endoilluminator was 2.8 times higher than that of the halogen light. The total luminous flux of the 25-gauge endoilluminators was 0.6-1.1 times greater than the 20-gauge endoilluminators connected to the halogen light. The viability of the A2E-laden cells after exposure to the xenon/bandpass light was no different than that of the cells exposed to the halogen light when the total luminous flux of these lights was at the same level. Xenon/bandpass light from an implantable "chandelier" light probe induced A2E-mediated RPE damage to a similar extent as that of the halogen light through a 20-gauge endoilluminator. CONCLUSIONS: A2E-mediated phototoxicity of xenon/bandpass light is comparable to that of halogen light.

Cell Survival↗

PubMed1998

Vitrectomy with endoscopy for management of retained lens fragments and/or posteriorly dislocated intraocular lens.

PURPOSE: To evaluate the advantages of vitrectomy combined with endoscopy for the management of retained lens fragments and/or posteriorly dislocated intraocular lens (IOL). METHODS: A consecutive series of 30 eyes with these complications treated by this technique was reviewed retrospectively. An endoscopic probe which incorporates a video channel, a fibreoptic light source, and a diode laser was used for visualization. Lens material or the IOL was extracted through the corneal wound in 18 eyes (60%). They were either aspired or grasped or lifted using perfluorocarbon liquids (PFCL), under endoscopic control. In 9 eyes (30%) pars plana phakoemulsification was performed. PFCL was used in 11 eyes (36.6%). In 16 eyes (53.3%) an IOL was sutured in the ciliary sulcus. RESULTS: Final visual acuity was > or = 20/40 in 19 eyes (63.3%), > or = 20/30 in 15 eyes (50%). Intraoperative breaks occurred early in the series in two eyes (in one case from use of the endoprobe, in the other from pars plana phakoemulsification). Poor final acuity was related to proliferative vitreoretinopathy, which developed in both cases with an intraoperative iatrogenic retinal break, senile macular degeneration, myopia and amblyopia, cystoid macular oedema, corneal oedema and high astigmatism. CONCLUSION: We found that endoscopy facilitated the management of these complications of cataract surgery once the peculiar difficulties of the technique (absence of stereoscopy, manipulation of the endoprobe, video monitor control) were mastered. Endoscopy facilitated and shortened localization of lens fragments embedded into the vitreous base for aspiration, grasping and phakoemulsification, enabled detection of small anterior retinal breaks, permitted resection of adhesions between anterior hyaloid, lens capsule and ciliary sulcus and facilitated PFCL manipulations, whatever the status of the anterior segment (corneal edema, myosis, synechiae, presence of IOL).

Aged↗

PubMed1998

Corneal shape changes after pars plana vitrectomy.

BACKGROUND: The purpose of this prospective, controlled, clinical study was to investigate corneal shape changes due to pars plana vitrectomy (PPV) in patients with potential visual improvement postoperatively. METHODS: A total of 36 consecutive patients undergoing conventional PPV combined with or without macular surgery were studied. Sequential determinations of the corneal curvature by manual keratometry and corneal topography were performed preoperatively, during the first postoperative week, at 4 weeks and after 2-8 months (mean 4 months). RESULTS: The mean surgically induced keratometric astigmatism was 2.92 +/- 1.98 diopters (D) (P < 0.0001) during the first postoperative week. After 4 weeks and 4 months the values decreased to 1.01 +/- 0.97 D and 0.67 +/- 0.43 D, respectively. Videokeratographic analysis confirmed significant curvature changes, with corneal steepening (P < 0.008) which corresponded to the superonasal and temporal semimeridian, and flattening (P < 0.008) along the inferior and inferonasal semimeridians. Corneal changes persisted in some cases for several weeks, partly in an asymmetric and irregular configuration. Shifts in axis to against-the-rule and oblique meridians were noted postoperatively with redistribution within preoperative values in 53% of the cases at 4 weeks after surgery. Subgroup analysis revealed that suture diameter, as well as the use of gas endotamponade, influenced the induced astigmatism. CONCLUSION: A substantial increase of the corneal astigmatism and distinct shape changes can occur after PPV in the immediate postoperative period. Consecutive stabilization at preoperative values was observed after several weeks. The time course of the corneal curvature alterations should be considered in the postoperative management to detect refractive causes of inadequate visual acuity.

Adult↗

PubMed1999

Correlation of quantitative three-dimensional measurements of macular hole size with visual acuity after vitrectomy.

OBJECTIVE: The purpose of the study was to study the relationship of postoperative visual outcome with anatomical parameters of macular holes using confocal scanning laser tomography and to predict the postoperative visual results. DESIGN: Cohort study. INTERVENTION AND PARTICIPANTS: We evaluated the eyes of 44 patients undergoing macular hole surgery (10 men and 34 women aged 40-76 years, mean 59.1 years). All patients showed idiopathic full-thickness stage 3 macular holes. The duration of symptoms was 1-4 months (mean 2.7 months). MAIN OUTCOME MEASURES: The area, volume, mean depth, and maximum depth of the macular holes and the areas of cuff and retinal striae were measured using the Heidelberg Retina Tomograph preoperatively. RESULTS: All 44 eyes showed closure of the holes and flattening of cuff and retinal striae after vitrectomy and gas tamponade. Postoperative visual acuity was significantly correlated with the area (r = 0.822, P<0.0001), volume (r = 0.840, P<0.0001), mean depth (r = 0.842, P<0.0001), and maximum depth (r = 0.831, P<0.0001) of the macular holes, area of cuff (r = 0.625, P<0.0001), and area of retinal striae (r = 0.648, P<0.0001). Multiple regression analysis showed that the combination of the preoperative mean depth of macular holes and logarithm of preoperative visual acuity was the strongest predictor of the postoperative visual acuity. CONCLUSIONS: Postoperative visual results vary significantly with the size of macular holes in patients with stage 3 macular holes of duration 1-4 months. The use of the confocal scanning laser tomography may facilitate the evaluation of macular holes before surgery. Ability to predict the postoperative visual results would be helpful in treating patients with macular holes.

Adult↗

PubMed1999

Pars plana vitrectomy, endolaser coagulation of the retina and the ciliary body combined with silicone oil endotamponade in the treatment of uncontrolled neovascular glaucoma.

PURPOSE: Neovascular glaucoma develops on a background of ischemic ocular pathologies, such as diabetic eye diseases or central retinal vein occlusion. Development of neovascular membranes in the chamber angle leads to elevated intraocular pressure (IOP). Since cyclodestructive therapy or drainage surgery often fails, we have examined intense antiproliferative surgery as a treatment for advanced neovascular glaucoma. PATIENTS AND METHODS: Thirty-two patients with uncontrolled neovascular glaucoma (mean IOP 45.5 mmHg) subsequent to central retinal vein occlusion or advanced diabetic retinopathy underwent antiproliferative surgery, which comprised pars plana vitrectomy, panretinal laser treatment and direct laser coagulation of the ciliary processes, followed by silicone oil tamponade. Patients were followed up for a minimum of 1 year and as long as 3 years. RESULTS: One week following surgery the IOP was normal, ranging from 8 to 21 mmHg, in 52% of eyes (15/29). After 3 months the IOP was normal in 50% (16/32); after 6 months, in 59% (16/27); and after 1 year, in 72% (18/25). Of the 10 eyes that lost all sight after the surgery, 7 eyes had a history of central retinal vein occlusion. Hypotony was observed in 6% of the eyes (2/32) 3 months after surgery; after 6 months hypotony was present in 15% (4/27), and after 1 year hypotony was present in 12% (3/25). CONCLUSIONS: The theoretical premise of our surgical intervention (antiproliferative surgery) is that laser treatment interrupts the self-enhancing pathway of retinal ischemia, release of proliferative factors and increase in intraocular pressure. The silicone oil endotamponade prevents postoperative complications and supports the rapid regression of rubeosis iridis by separating the anterior from the posterior segment.

Aged↗

PubMed1985

Vitrectomy for double penetrating ocular injuries.

During the five-year period from 1977 to 1982, 15 consecutive patients with double penetrating ocular injuries were treated at the University of Minnesota. The 13 males and two females ranged in age from 5 to 38 years. Four patients had bilateral involvement. Vitrectomy techniques were used to stabilize the eyes and prevent or treat retinal detachment in 18 eyes. One eye was enucleated. Anatomic success was achieved in 11 eyes and visual success (visual acuity of 5/200 or better) in ten eyes. Surgical success was related to initial visual acuity, extent of vitreous hemorrhage, and the ability of the surgeon to excise completely the vitreous from the circumference of the exit wound.

Adolescent↗

PubMed1986

Vitrectomy for advanced stages of retinopathy of prematurity.

We did a retrospective review of the consecutive vitrectomies for traction retinal detachment associated with retinopathy of prematurity performed at our institution. Fifty-eight eyes were operated on in 46 patients at less than 1 year of age, including 12 eyes with partial retinal detachments and 46 eyes with total retinal detachments. Only patients with at least six months follow-up were considered for success. Twenty-five eyes (43%) were anatomically reattached. Factors associated with good anatomic outcome included greater mean preoperative pupillary dilation, absence of posterior synechiae, deep anterior chamber, partial detachment or open-funnel total detachment configuration, and adequate posterior membrane removal. Of the 25 eyes with attached retinas, 11 had fixing and following visual acuities or better. Three eyes with attached retinas had no light perception and 11 eyes with attached retinas had light perception only. To maximize anatomic and functional results we emphasize the need to operate early, when the retinal funnel is still open.

Evaluation Studies as Topic↗

PubMed1986

Silicone oil for retinal detachment with advanced proliferative vitreoretinopathy following failed vitrectomy for proliferative diabetic retinopathy.

We used sophisticated vitreous surgical techniques in conjunction with silicone oil injection in ten eyes of ten patients with rhegmatogenous retinal detachment complicated by advanced proliferative vitreoretinopathy following failed vitrectomy for proliferative diabetic retinopathy. After a minimum follow-up of one year, three patients achieved total retinal reattachment and two patients regained ambulatory vision (5/200 or better). Maintenance of low to normal intraocular pressure was observed in nine of the ten eyes despite some cases of progressive anterior segment neovascularization and retinal detachment. Although treatment was more difficult and less successful than in either retinal detachment with proliferative diabetic retinopathy or proliferative vitreoretinopathy alone, these techniques allowed some success in eyes that otherwise would have a poor prognosis.

Adult↗

PubMed1987

Anterior hyaloidal fibrovascular proliferation after diabetic vitrectomy.

Vitrectomy was performed to treat 74 consecutive eyes for complications of diabetic retinopathy. Eight (13%) of 61 eyes followed up for an average of 12 months developed anterior hyaloidal fibrovascular proliferation. This was the most common postoperative complication, whose features included recurrent hemorrhages into the vitreous cavity or anterior vitreous, or both; vessels or fibrovascular tissue on the posterior lens capsule; anterior extraretinal vascularization extending toward the lens on the anterior hyaloid; traction detachment of the peripheral retina or ciliary body; and hypotony. Patients who developed this complication tended to be young males with severe retinal neovascularization and extensive retinal ischemia; traction retinal detachment as an indication for surgery; placement of a scleral buckle; postoperative rubeosis iridis, recurrent vitreous hemorrhages, and retinal detachment; and multiple surgeries. Four eyes progressed to atrophia bulbi. Early recognition followed by additional surgery in two patients and extensive additional photocoagulation in two other patients was successful in preserving good visual function.

Adult↗

PubMed1987

Long-term results of vitrectomy and silicone oil in 500 cases of complicated retinal detachments.

We retrospectively analyzed by life table analysis the visual and functional results in 500 eyes that underwent combined vitrectomy and silicone oil for various types of complicated retinal detachments. The cumulative proportion of eyes with attached retina was 77% at six months postoperatively, with a range of 71% for perforating injuries to 85% for posterior holes. The proportion of eyes with a visual acuity of 5/200 or better was 69% at six months, with a range of 56% for perforating injuries to 81% for posterior holes. Sixty-nine eyes had poor visual function despite an attached retina, primarily because of cataract (18 eyes) and preexisting retinal or optic disease (31 eyes). Visual function in eyes with clear optical media and an attached retina was stable over time, except in patients with diabetes. No clinical evidence of retinal toxicity to silicone oil was noted.

Adolescent↗

PubMed1987

Cataract extraction in the diabetic eye after vitrectomy.

We examined 289 phakic, diabetic eyes for evidence of cataract formation after a successful vitrectomy. Of 289 eyes, 107 (37%) developed or had significant progression of a cataract over a follow-up period of 16 to 108 months. Postvitrectomy hemorrhage and vitreous lavage were associated with an increased rate of cataract formation. Of the 107 eyes, 33 (31%) subsequently had cataract extraction, with 24 eyes (73%) treated by extracapsular cataract extraction and nine eyes (27%) with intracapsular surgery. A posterior chamber lens was used in 11 of the 24 eyes that underwent extracapsular surgery. Of the 33 eyes, 31 (94%) had improved visual acuity after cataract extraction. Intraoperative and postoperative complications were minimal and did not result in permanent reduction of vision. Intraocular lenses were well tolerated in the 11 patients in whom they were used.

Cataract Extraction↗

PubMed1988

Predictors of scleral rupture and the role of vitrectomy in severe blunt ocular trauma.

We reviewed retrospectively 40 eyes that had received blunt trauma and had been explored for scleral rupture. Twenty-nine eyes had scleral rupture. Of these 29, ten had ruptures seen preoperatively. Nineteen had occult ruptures. The preoperative findings predictive of scleral rupture were a visual acuity of light perception or no light perception, an intraocular pressure of less than 10 mm Hg, hyphema, and chemosis. Of the 29 ruptures, 27 involved the superior hemisphere and 25 involved the anterior hemisphere of the globe. Ten of 29 eyes (34%) with scleral rupture and eight of 11 eyes (73%) without rupture achieved a final visual acuity of 5/200 or better over an average follow-up period of 6.7 months. Factors prognostic of ambulatory vision for eyes with ruptured and intact globes included an initial visual acuity of 5/200 or better, absence of scleral rupture, and a rupture length of less than 11 mm in eyes with ruptures. The vitrectomized eyes also had a better result, suggesting that early pars plana vitrectomy is of benefit in selected rupture cases.

Eye Injuries↗