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PubMed1988

Vitrectomy for diabetic eye disease.

Thirty four eyes which underwent vitrectomy because of diabetic proliferative retinopathy were reviewed. The overall success rate of the operation was 62%. Excluding table top retinal detachments, which all did badly, the success rate was 72%. Grading by ultrasound was found to be helpful in; (a) planning surgical approach, (b) assessing visual outcome. The most common late complication was cataract. Extracapsular cataract extraction with implantation was found to be successful in these cases.

Adult↗
PubMed1989

A closed microsurgical technique for anterior vitrectomy using a continuous air infusion.

A new technique of anterior vitrectomy using a continuous air infusion is described. It has a number of advantages over conventional techniques and is recommended for the management of vitreous loss during cataract extraction. The vitreous gel is displaced posteriorly by the surface tension of an air bubble. The identification of vitreous strands is facilitated by the air/vitreous interface. Air in the anterior chamber reduces the refractive power of the cornea, providing direct visualisation of the posterior segment.

Air↗
PubMed1990

Extended criteria for vitrectomy and fluid/silicone oil exchange.

The results of vitrectomy combined with fluid/silicone oil exchange at six months after surgery in 39 eyes with complex retinal detachments without (initially) severe proliferative vitreoretinopathy, proliferative diabetic retinopathy or giant retinal tears, are reported. Eyes with detachments as a result of macular holes, large multiple or posterior breaks, and eyes which had undergone previous, unsuccessful vitreoretinal surgery are included. In 90% the retina remained reattached, with functional improvement in 72%. These findings, together with the relatively low incidence of complications observed, lead us to recommend this technique in the management of selected detachments falling outside the parameters within which its use is generally accepted.

Cataract↗
PubMed1995

Cataract extraction following vitrectomy and silicone oil tamponade.

Surgery for cataract resulting from pars plana vitrectomy combined with fluid/silicone oil exchange is often rewarding in terms of visual acuity improvement. Careful choice of surgical method and suitable modifications of standard technique reduce the incidence of serious complications. Per-operative posterior capsulotomy is a safe method of maintaining a clear visual axis after ECCE.

Adult↗
PubMed1997

Giant retinal tears after pars plana vitrectomy.

Vitreous surgery is used to treat complicated vitreo-retinal pathology. Retinal tears are a serious complication of vitreous surgery. In this report, the development of giant retinal tears in four eyes after pars plana vitrectomy for posterior segment pathology is described. The pathogenesis and implications of this serious and infrequent complication are discussed.

Adult↗
PubMed1998

Combined phacoemulsification, pars plana vitrectomy, removal of intraocular foreign body (IOFB), and primary intraocular lens implantation for patients with IOFB and traumatic cataract.

PURPOSE AND METHODS: Small-incision cataract extraction by phacoemulsification through an anterior continuous circular capsulorhexis, pars plana vitrectomy, forceps removal of intraocular foreign body (IOFB) and primary intraocular lens implantation were performed in 4 eyes (4 patients) with IOFB and traumatic cataract, as an emergency combined procedure. RESULTS: At a mean follow-up of 12.3 months (range 7-19 months) the best corrected visual acuity of the 4 eyes ranged from 6/6 to 6/12. The only complication encountered in our series was an opacified posterior capsule that developed 10 months post-operatively in one case. This was easily dealt with by neodymium:YAG laser capsulotomy, with good final visual outcome. CONCLUSIONS: The results of combined one-stage instead of sequential surgeries, and phacoemulsification instead of lensectomy or extracapsular cataract extraction for patients with IOFB and cataract are encouraging. It could be a good option in selected cases. However, the safety and efficacy of this combined procedure need to be evaluated further by a larger-scale, longer follow-up study.

Adult↗
PubMed2002

Enzymatic-assisted vitrectomy.

PURPOSE: This paper discusses the approach of enzymatic vitrectomy and potential applications. METHODS: A description of available agents for enzymatic vitreous surgery will be given and the techniques that have been suggested. RESULTS: Both animal and human results will be presented in this article regarding trials of enzymatic vitreous surgery. CONCLUSION: Enzymatic vitreous surgery may be a useful adjunct or additional agent to treat several vitreoretinal diseases.

Chemotherapy, Adjuvant↗
PubMed2006

Vitrectomy for juvenile uveitis: prognostic factors for the long-term functional outcome.

PURPOSE: This study evaluated the long-term effect of pars plana vitrectomy (PPV) in children and adolescents with chronic uveitis on visual function, anatomical outcome, and the requirement of systemic treatment. Further, predictive preoperative factors associated with a beneficial visual outcome were assessed. METHODS: Retrospective review of 29 eyes of 23 consecutive paediatric and juvenile patients below 20 years of age with chronic uveitis who underwent a PPV for visually significant opacities in 25 eyes, vitreous haemorrhage in three eyes, and retinal detachment in one eye. The clinical diagnosis was chronic intermediate uveitis in 22 eyes and retinal vasculitis of different origin in seven eyes. RESULTS: LogMAR visual acuity improved from an average of 0.91 to 0.33 (P<0.001). Cystoid macular oedema (CME) was significantly reduced in eight of 10 eyes postoperatively (P=0.021). In the multiple regression analysis, a low preoperative logMAR visual acuity and the presence of a CME had a negative influence on the final logMAR visual acuity. Furthermore, the appearance of chronic uveitis relapses was significantly reduced from 15 eyes before to seven eyes after surgery (P=0.042). CONCLUSIONS: PPV has a beneficial effect on the course and the complications of chronic uveitis in paediatric and juvenile patients with respect to the anatomical and visual outcome. Preoperative logMAR visual acuity and clinically significant CME were the most accurate predictors for the functional outcome.

Adolescent↗
PubMed2005

Pars plana vitrectomy for diabetic macular oedema: OCT and functional correlations.

PURPOSE: A prospective study to evaluate the macular structural and functional effects of pars plana vitrectomy (PPV) for persistent diffuse clinically significant macular oedema (CSMO). METHOD: A total of 12 patients with persistent diffuse CSMO were recruited and underwent assessment including best-corrected visual acuity, fundus fluorescein angiography, optical coherence tomography (OCT) and fine matrix mapping (FMM) at baseline and over a period of a year poststandard three-port PPV. RESULTS: The median baseline ETDRS letters score for all 12 patients was 52 (range 41-63) while at 12 months it had increased to 65 (range of 27-68), an improvement of two complete ETDRS lines (P=0.037). Similarly, there was an improvement in the perifoveal cone thresholds (P=0.02). The foveal thickening for all 12 patients ranged from a median of 183 to 751 microm (normal range 126-180 microm) and the macular volume ranged from a median of 2.13 to 6.42 mm(3) (normal <1.66 mm(3)). After surgery, both the median foveal thickness (from 334 to 280 microm) and median macular volume (from 3.24 to 2.61 mm(3)) demonstrated decreases over 12 months (P=0.01). On baseline OCT, the patients fell into two anatomically distinct groups: Group 1 (n=4) had a dome-shaped thickened macula with a partial posterior hyaloid separation and a significantly higher foveal thickness and macular volume than Group 2 (n=8) which had a diffuse low-elevation profile of the thickened macula (P=0.007). CONCLUSIONS: In this prospective study of PPV for persistent fovea-involving CSMO there was structural and functional improvement.

Aged↗
PubMed2006

Ocular coherence tomographic examination of postoperative foveal architecture after scleral buckling vs vitrectomy for macular off retinal detachment.

AIMS: This pilot study uses Optical Coherence Tomography (OCT) imaging to compare the difference in foveal architecture after successful retinal detachment (RD) surgery by scleral buckling or pars plana vitrectomy (PPV). METHODS: Prospective recruitment of patients with macular off RDs. Detachment surgery was undertaken by scleral buckling, external drainage, and air injection (group 1) or by PPV (group 2). Postoperatively patients had clinical examinations and OCT at 1, 3, 6, and 12 months. If abnormalities persisted, a further OCT was obtained at 18 months. RESULTS: Retinal reattachment, including clinical macular reattachment, was achieved in all cases within 24 h postoperatively. In group 1 (n=22), postoperative OCT showed persistent foveal detachment in 63% of cases (n=14) at 1 and 3 months. At 6 and 12 months, 36% (n=8) and 9% (n=2) had a persistent foveal detachment, respectively, and at 18 months, foveal detachment eventually. In group 2 (n=21), postoperative OCT showed an attached fovea in all cases; however, foveal thickening suggesting intraretinal oedema was present in all cases. The oedematous appearance of retina on OCT settled in 1-3 months. No foveal abnormality was seen at 6 and 12 months postoperatively. CONCLUSIONS: A high proportion of patients with successful retinal reattachment surgery by scleral buckling had foveal detachments postoperatively. No cases who had PPV had foveal detachments; however, transient retinal oedema was evident in all cases. The aetiology of these changes is unknown and warrants further investigation, as there is the potential of a long-term effect on vision.

Aged↗
PubMed2006

Comparison of two acrylic intraocular lenses with different haptic designs in patients with combined phacoemulsification and pars plana vitrectomy.

PURPOSE: The intra- and postoperative characteristics of two foldable single-piece intraocular lenses (IOL) with identical hydrophilic acrylic material, but different haptic designs (Akreos Adapt and Akreos Fit), were compared in combined phacoemulsification and pars plana vitrectomy (PPV). METHODS: This was a prospective, randomized study in patients with simultaneous cataract and vitreoretinal surgery. Group A (n=47 patients) included implantation of Akreos Fit IOL (two-point haptic) and group B (n=46 patients) implantation of Akreos Adapt IOL (four-point haptic). All intraoperative modifications of small-incision phacoemulsification and three-port PPV and IOL implantation and centration were documented. At 1 and 2 days and 6 months after surgery, best-corrected visual acuity (BCVA), slit-lamp appearance (including inflammation, IOL centration, capsulorhexis diameter, posterior capsule opacification (PCO), tonometry, and fundus findings were evaluated. RESULTS: The groups did not differ with respect to age, surgical indications and modifications, intraoperative IOL handling, and centration. At day 2, inflammation and capsulorhexis diameters were similar, but IOL decentration was slightly more frequent with Akreos-Fit IOLs. Six months after surgery, the rates of PCO, posterior synechiae, and BCVA were similar. Akreos-Fit had slightly smaller capsulorhexis diameters and slightly more capsular contraction and IOL decentration (P>0.05). CONCLUSIONS: Both of the Akreos IOL are feasible for combined phacoemulsification and PPV. Although similar in intraoperative handling, BCVA, and PCO, IOL centration was slightly better with Akreos-Adapt than with Akreos-Fit after combined surgery.

Aged↗
PubMed2003

Lens sparing pars plana vitrectomy and retinal transplantation in cats.

Neuroretinal transplantation techniques have been evolving during recent years. Experiments in rodent models with degenerative retinal disease have been encouraging. This paper describes a surgical technique developed for use in the Abyssinian cat mutant. After two-port pars plana vitrectomy, retinotomy and bleb formation, whole sheets of neonatal neuroretinal allografts were placed into the subretinal space. The surgery was difficult but feasible, and the main complication was intraoperative hemorrhage.

Animals↗
PubMed2000

[Pars-plana vitrectomy in diabetic traction retinal detachments with holes].

PURPOSE: To evaluate results and prognostic factors of pars-plana vitrectomy (ppv) using membrane peeling and C2F6-gas for diabetic traction retinal detachments with a hole. METHODS: We retrospectively reviewed the healing course of 84 eyes, which were treated in this way consecutively (follow-up 6-32 month). C2F6 was always used in case of a retinal hole at the posterior pole or in the upper part of the eye. The influence of HBA1c, type of diabetes, preoperative visual acuity, preoperative laser-coagulation and macular status over treatment results and rate of complications were studied using multivariate logistic regression analysis. RESULTS: Preoperatively 56% of the eyes showed premacular vitreous hemorrhage and 69% macular detachment. Using on an average 1.3 treatments in 73% retina was completely reattached and in 85% visual acuity remained unchanged or improved. The most important prognostic factors were HBA1c < 9.3, type II diabetes and bad vision preoperatively. Postoperative complications such as rubeosis, secondary glaucoma and repeated vitreous hemorrhages were more frequent in case of type I diabetes, HBA1c > or = 9.3 and insufficient laser treatment. CONCLUSION: Best corrected blood sugar levels preoperatively and sufficient laser treatment seem to be very important to decrease the risk for rubeosis and repeated vitreous hemorrhages especially for patients with type I diabetes.

Adult↗
PubMed2002

[Wide-angle contact lenses of corundum monocrystal for pars plana vitrectomy].

BACKGROUND: A very light planoconcave (0.3 g) and biconcave (0.27 g) contact lens of corundum monocrystal is presented for simplification of pars plana vitrectomy. MATERIAL AND METHODS: Corundum monocrystal is corrosion-resistant and extremely hard and mar-proof. It can be sterilised by all conventional procedures without changing its shape or transparency. Corundum monocrystal is transparent like glass and has a high refractive index of n = 1.76 like sapphire. RESULTS: The high refractive index enables strong prismatic deflection and thus provides a good view of the peripheral retina. The lens is placed on the cornea over a drop of methylcellulose and requires no scleral fixation or irrigation system. An erect image is formed. CONCLUSION: Compared to other systems, the two contact lenses have the advantage of easy handling with excellent optical quality.

Aluminum Oxide↗
PubMed2002

[Hydrophobic AcrySof lenses or heparin-modified PMMA lenses in combined vitrectomy surgery -- results of a four-year study].

BACKGROUND: Combining pars plana vitrectomy with phacoemulsification and implantation of an intracapsular IOL provides many advantages and is performed as a routine operation. MATERIALS AND METHODS: Over a period of 3 years we compared foldable acrylic lenses AcrySof (Alcon) to heparin-modified PMMA lenses (Pharmacia) in a prospective study. The last implanted lenses had a follow-up period of at least 1 year. Out of 396 eyes from 329 patients we implanted 182 AcrySof lenses and 214 heparin-modified lenses. RESULTS: Both a smaller scleral tunnel incision and a lower rate of secondary cataract are advantages of foldable AcrySof lenses. Higher vulnerability of an AcrySof lens and a less stable lens-iris-diaphragm are of disadvantage. Heparin-modified PMMA lenses do not show these disadvantages, however, in consequence of using them you have to accept the wider scleral tunnel incision and a higher adhesion to cells. Furthermore, we found slightly more posterior synechiae with these lenses. CONCLUSIONS: In all, both types of intraocular lenses are suitable for combined surgery. We recommend using heparin-modified PMMA lenses in case of pre-existent instability of the lens-iris diaphragm or of patients' inability to maintain the prone position.

Acrylates↗
PubMed1990

[Ultrasonic diagnosis prior to vitrectomy. Critical evaluation of 51 cases].

In ophthalmology it is of increasing importance to assess intraocular pathology prior to vitroretinal surgery by means of B- and A-mode ultrasound. Even for the experienced examiner with advanced instrumentation, major problems can arise as to whether retinal detachment has developed or not. This task involves the ability for acoustical differentiation of thin tissue membranes. The authors compared preoperative ultrasonic results obtained in 51 cases with the surgical findings during vitrectomy. The presence or absence of retinal detachment was evaluated correctly in 33 cases (91.7%) using high resolution contact B-mode alone. In difficult cases maximal echo amplitudes reflected from the suspected membranes were evaluated using a hand-held A-mode transducer (level difference A-mode echography) in addition to contact B-mode. Even the combined technique, though helpful in most cases, could not detect the presence or absence of retinal detachment in all cases.

Diabetic Retinopathy↗
PubMed1998

[Pars plana vitrectomy in Borrelia burgdorferi endophthalmitis].

BACKGROUND: Ocular manifestations of Lyme borreliose present with unusual forms of conjunctivitis, keratitis, optic nerve disease, uveitis, vitritis and rarely endophthalmitis. CASE REPORT: A 57-year-old man working as logger in Sax-ony-Anhalt suffering from an endophthalmitis on his left eye was referred to us. The vision of his left eye was intact light perception and hand motions. The slit-lamp examination revealed severe inflammation of the anterior chamber with hypopyon, posterior synechiae, and opacity of the posterior lens capsule. Funduscopy showed no red reflex, no retinal details. In the local hospital serum analysis was performed and showed in Western-Blot IgM- and IgG-antibodies against Borrelia burgdorferi. Despite of intravenous application of ceftriaxon for 14 days panuveitis persisted, and endophthalmitis developed when antibiotic therapy was finished. RESULTS: During pars plana vitrectomy a sharply delineated cystic lesion containing yellowish fluid was revealed, and creamy yellow fluid was aspirated. Microscopically in hematoxylineosin stained slides of the aspirate structures consistent with Borrelia burgdorferi were found. Postoperatively vision increased to 1/15. Despite of a second intravenous ceftriaxon treatment for 14 days we observed a retinal vasculitis in the follow up of 6 months. CONCLUSIONS: Despite intravenous ceftriaxon-therapy borrelia burgdorferi must have survived in the vitreous body. Further investigations are required with respect to the use of other antibiotics or immunosuppressives.

Borrelia burgdorferi Group↗