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At least 1,423 records · Page 79Linked to original sources

PubMed2003

A pilot study of pars plana vitrectomy, intraocular gas, and radial neurotomy in ischaemic central retinal vein occlusion.

BACKGROUND/AIMS: There is no effective treatment for ischaemic central retinal vein occlusion (CRVO). The two major negative outcomes are neovascular glaucoma (NVG) and severe central visual loss. In this study pars plana vitrectomy (PPV), mild panretinal photocoagulation, and intraocular gas injection were employed to prevent NVG. The potential role of incision of the lamina cribrosa (radial neurotomy) for visual recovery was examined. METHODS: Eight eyes of seven patients with ischaemic CRVO had PPV, mild panretinal photocoagulation, and intraocular perfluoropropane gas injection. Four eyes had radial neurotomies performed. The patients were examined by fundus photography, fundus fluorescein angiography, optical coherence tomography, and Goldmann visual field analysis. RESULTS: No patients suffered from neovascular glaucoma. Visual recovery was seen in patients with and without neurotomy but some patients had cataract extraction to allow visualisation for PPV. Fundus photography demonstrated reduced engorgement of retinal veins in two of the patients with neurotomy and one with PPV alone. Optical coherence tomography demonstrated macular oedema in three patients with neurotomy and all patients with PPV alone. Segmental visual field loss was seen in one patient with neurotomy suggesting damage to the optic nerve head. CONCLUSIONS: PPV is safe in ischaemic CRVO. Combined with mild PRP and intraocular gas injection the risk of neovascular glaucoma is low. Neurotomy can be added to try to improve the chances of recovery of central vision but may cause additional peripheral visual field loss.

Aged↗

PubMedDate not supplied

Combined Phaco-Emulsification Cataract Extraction and Pars plana Vitrectomy without Intra-Ocular Lens Implantation.

PURPOSE: To report the indications, surgical technique and visual outcome of combined phaco-emulsification cataract surgery and three-port pars plana vitrectomy (CPPV) in patients unsuitable for primary intra-ocular lens (IOL) implantation. METHOD: A 4-year review in a tertiary referral hospital. RESULTS: Thirty patients (30 eyes) had CPPV without primary IOL insertion. The patients had a mean pre-operative logMAR acuity of 1.81 (SD 0.49) which improved to 1.50 (SD 0.72) postoperatively (p = 0.036). CONCLUSION: CPPV with primary IOL insertion is now an established surgical technique. This series suggests that patients with contra-indications to primary IOL insertion may also benefit from CPPV.

Adolescent↗

PubMedDate not supplied

Suction-assisted one-piece self-retaining wide-angle contact lens for vitrectomy.

INTRODUCTION: We have developed a suction-assisted one-piece self-retaining wide-angle contact lens for vitrectomy. DESIGN: The wide-angle contact lens is a one-piece lens without the case, making it lightweight. The contact inferior surface is enhanced by four quadrant plate extensions. A metal housing is attached to the side of the plate extension with an opening at the inferior surface. A negative suction device is attached to the housing of the lens. METHOD OF USE: A drop of viscoelastic is placed between the lens and the cornea. Suction created by a syringe device holds the contact lens on the cornea. CONCLUSION: This specially designed lens is lightweight and eliminates the need for a skilled assistant to stabilize the contact lens. It provides a stable well-centered view of the peripheral fundus during vitreous surgery.

Contact Lenses↗

PubMedDate not supplied

Primary vitrectomy in complicated rhegmatogenous retinal detachment--a survey of 205 eyes.

INTRODUCTION: In a few types of rhegmatogenous retinal detachment (RRD), scleral buckling (SB) has a lower success, and, here, pars plana vitrectomy (PPV) is a good alternative option. This survey reviews the indications and the surgical outcome of primary PPV with internal tamponade. PATIENTS AND METHODS: We reviewed 205 eyes operated by primary PPV for RRD at the Department of Ophthalmology of the Philipps University Marburg between the years 1990 and 1997. The indications of PPV were: holes greater than 90 degrees; holes posterior to the equator; proliferative vitreoretinopathy grade C; pseudophakic status. RESULTS: A complete reattachment of the retina after absorption of the gas or after silicone oil removal was achieved by 1 operation in 146 eyes (71.2%) and in 195 eyes (95.2%) by a second intervention. CONCLUSION: Although SB is the standard procedure for the treatment of RRD, complicated cases can be treated successfully with primary PPV.

Adolescent↗

PubMedDate not supplied

Autoclavable two-piece noncased wide-angle contact lens system for vitrectomy.

PURPOSE: To describe an autoclavable wide-angle two-piece noncased contact lens system (two lenses: equatorial and wider-angle lens) for vitrectomy. DESIGN: The inferior lens is made of an autoclavable plastic with a concave contact surface of 7.7 mm and the superior lens is a convex glass lens. The superior lens is mounted on the inferior one to make the lens assembly. RESULT: The equatorial lens has a power of +81 D and a field of view of 80-96 degrees, while the wider-angle lens power is +151 D and the field 110-120 degrees. The lens is kept on the cornea upon a drop of viscoelastic substance. An assistant holds it with a conventional lens holder. The lens is easy to sterilize by autoclaving and does not require expensive gas sterilization or potentially injurious chemical sterilization. CONCLUSION: This lens system provides a panoramic wide-angle view of the retina during vitreous surgery. The autoclaving makes this lens system cost-effective and fast to reuse.

Contact Lenses↗

PubMedDate not supplied

Pars plana vitrectomy without long-acting gas tamponade for primary rhegmatogenous retinal detachment.

PURPOSE: To report the anatomical and visual results of primary pars plana vitrectomy (PPV) without long-acting gas tamponade to repair primary rhegmatogenous retinal detachments (RRDs). METHODS: Twenty-seven consecutive patients (27 eyes) with peripheral retinal tears and new RRDs were treated according to the surgical protocol. Patients underwent PPV with fluid-air exchange and endolaser treatment to repair the RRD. Neither long-acting gas nor silicone oil tamponade was combined with PPV. All patients were followed from 6 to 26 months with an average follow-up of 11 months. Reattachment of the retina and visual outcome were compared to the results of previously published studies. RESULTS: Reattachment was achieved in 24 of 27 eyes (89%) with a single operation, and in all 27 (100%) eyes, the retina was ultimately reattached with subsequent operations. The median initial visual acuity was 0.4, and the median final visual acuity was 1.0. CONCLUSIONS: Primary PPV with fluid-air exchange alone and laser treatment is a safe, effective method for the repair of primary retinal detachments. The anatomical reattachment rate and the visual acuity obtained with this technique appear to be at least as good as those reported in the literature for primary PPV combined with long-acting gas tamponade.

Aged↗

PubMedDate not supplied

Improvement of visual acuity in eyes with diabetic macular edema after treatment with pars plana vitrectomy.

BACKGROUND: Diabetic macular edema (DME) is the leading cause of severe visual loss in patients with diabetic retinopathy. This is so despite the fact that argon laser photocoagulation of the macula (M-ALC) has been shown to be beneficial. Recently, it has been suggested that pars plana vitrectomy (PPV) can lead to the resolution of DME and stop the deterioration of central visual acuity. PURPOSE: To explore the potential benefit of PPV for the treatment of DME. PATIENTS AND METHODS: PPV was carried out in 30 eyes of 21 consecutive patients (median age 71 years, range 61-88 years) with type II diabetes mellitus suffering from DME. 23 eyes had non-proliferative diabetic retinopathy (NPDR) and 7 eyes had proliferative diabetic retinopathy (PDR) in addition to DME. Posterior vitreous detachment had to be carried out in all cases. If epiretinal membranes were present (23 eyes), they were removed. In 13 eyes (initially 11 eyes) the internal limiting membrane (ILM) was also removed. Prior to PPV 8 eyes had received M-ALC. Three eyes had M-ALC after PPV. One eye developed a retinal detachment 6 weeks after PPV and was excluded form the analysis. After an initial treatment failure two eyes underwent repeat PPV with peeling of the ILM. Both eyes of another patient had 2 repeat PPVs because of recurrent vitreous hemorrhage. Median follow-up was 16 months (range 1-62 months). RESULTS: Following PPV the macula flattened or became attached in 20/27 (74%) eyes. 15/18 (83%) eyes showed reduction or disappearance of leakage during fluorescein-angiography. Central visual acuity increased by two to six lines in 15/27 (56%) for the whole group at 6 months after PPV. For the subgroup (18 eyes) for which the evolution of visual acuity prior to PPV could be documented mean and median visual acuity had decreased markedly from 0.26 +/- 0.19 resp. 0.2 (range 0.03-0.6) to 0.12 +/- 0.09 resp. 0.1 (range 0.02-0.4) during the 12 months preceding PPV and increased to 0.28 +/- 0.23 resp. 0.2 (range 0.03-0.8) during the 12 months following PPV. CONCLUSION: PPV almost always results in a reduction and often complete disappearance of DME as evidenced by ophthalmoscopy and fluorescein-angiography. Most importantly, central visual acuity often increases, sometimes to a very large extent with dramatic improvement in quality of life of the patients.

Aged↗

PubMed2006

Endoscopy-guided subretinal fluid drainage in vitrectomy for retinal detachment.

PURPOSE: To study the usefulness of endoscopy-guided subretinal fluid drainage in pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD). PARTICIPANTS/METHODS: A prospective non-comparative study of a small number of RRD cases. The study involved examining 10 eyes of 10 patients with RRD that received PPV. Two eyes had hazy corneas, which hindered the observation by surgical microscopy. Fluid-gas exchange was performed and then subretinal fluid was drained through a primary retinal break guided by an endoscope. No drainage retinotomy was made. Each clinical feature was studied and the surgical outcome and complications were evaluated. RESULTS: All eyes had retinal reattachment by a single operation. No serious complication related to surgery was experienced. CONCLUSIONS: Endoscopy-guided subretinal fluid drainage is the safe and effective procedure in PPV for RRD.

Aged↗

PubMed1983

Five years pars plana vitrectomy.

Between November 1976 and October 1981, 516 pars plana vitrectomies have been done with the vitreous stripper of Klöti. The indications and the results are discussed.

Cataract Extraction↗

PubMed1985

Treatment of endophthalmitis with and without pars plana vitrectomy.

Two series of patients with endophthalmitis were compared. In the group treated with antibiotics or fungistatics, only 1 eye (4.3%) could be salvaged, whereas in the group with pars plana vitrectomy and antibiotics or fungistatics, 7 eyes (33%) had adequate visual acuity afterwards.

Amphotericin B↗

PubMed1989

Vitrectomy for diabetic eye disease. The prognostic value of pre-operative electroretinography and visual evoked cortical potentials.

An investigation was carried out into the prognostic value of standard flash electroretinography (ERG) and visual-evoked cortical potentials (VECP) recorded for 87 diabetic eyes prior to vitrectomy. 95% of the eyes with a recordable ERG b-wave achieved a post-operative visual acuity (VA) of 0.05 or better (positive predictive value), but only 35% of the eyes with a good post-operative VA had a recordable b-wave (sensitivity). The corresponding values for the ERG a-wave were 67 and 72%, and for the VECP 77 and 69%, respectively. A non-recordable b-wave in the ERG was associated with a poor visual outcome (VA less than 0.05) in 45% of cases (negative predictive value), and 97% of the eyes with a poor visual outcome had a nonrecordable b-wave (specificity). The corresponding values for the ERG a-wave were 42 and 37%, and for the VECP 53 and 63%, respectively. Consequently, the odds ratio for an unfavourable visual outcome (VA less than 0.05) was greater for a non-recordable b-wave (15.7) than for a nonrecordable VECP (3.8) or a non-recordable a-wave (1.5). Recordability of the b-wave gave the best prediction for attached macula. Extensive photocoagulation diminished all ERG and VECP amplitudes. Vitreous opacities had no significant effect on the ERG or VECP.

Adolescent↗

PubMedDate not supplied

Visual outcome and prognostic factors after vitrectomy for posterior segment foreign bodies.

PURPOSE: To identify the prognostic factors that predict final visual outcome in eyes with posterior segment intraocular foreign body (IOFB) injuries managed by primary pars plana vitrectomy. METHODS: Ninety-six consecutive patients with posterior segment IOFB injuries were retrospectively reviewed. Factors analyzed included initial visual acuity (VA), time between injury and presentation, site of entrance wound, uveal prolapse, vitreous prolapse, traumatized iris, endophthalmitis, location and size of IOFB, use of scleral buckling and/or an encircling band, gas tamponade, lensectomy, number of surgical procedures, and development of retinal detachment. Data were analyzed using univariate and multivariate logistic regression analysis. RESULTS: After a mean follow-up of 8.6 months, 63 eyes (65.6%) achieved VA of 20/200 or better, and 9 eyes (9.4%) had total retinal detachment complicated by inoperable proliferative vitreoretinopathy. On univariate analysis, predictors of poor vision (hand movements or less) were poor initial VA, corneoscleral entrance wound, uveal prolapse, vitreous prolapse, traumatized iris, and development of retinal detachment. In contrast, predictors of good visual outcome (20/200 or better) were absence of uveal prolapse, no endophthalmitis, and no retinal detachment. Multivariate analysis identified corneoscleral entrance wound, uveal prolapse, and development of retinal detachment as the only factors significantly associated with poor visual outcome. Absence of uveal prolapse was the only factor significantly associated with good visual outcome. CONCLUSIONS: Final visual outcome is greatly determined by the severity of the primary injury. On multivariate analysis, significant predictive factors of final VA were corneoscleral entrance wound, presence or absence of uveal prolapse, and development of retinal detachment.

Adolescent↗

PubMed2003

Choroidal neovascularization secondary to vitrectomy for idiopathic epiretinal membrane: report of an unusual case.

PURPOSE: Epiretinal membranes (ERM) are a common finding in old patients. Pars plana vitrectomy is effective for removing ERM from the macula, but some postoperative complications are relatively frequent. In the present report, we describe a 73-year-old man in whom extrafoveal choroidal neovascularization developed four months after surgery. METHODS: Choroidal neovascularization was treated by argon laser photocoagulation. RESULTS: Six months after treatment, the choroidal neovascularization was obliterated, with no recurrence of ERM. CONCLUSIONS: Choroidal neovascularization can be an unusual complication of ERM surgery, and should be suspected in case of poor visual outcome or recurrence of symptoms.

Aged↗

PubMedDate not supplied

Use of autologous plasmin during vitrectomy for diabetic maculopathy.

PURPOSE: To evaluate the efficacy of autologous plasmin enzyme as an adjunct to vitrectomy in diabetic macular edema. METHODS: Plasmin derived from autologous blood was injected intravitreally into seven eyes 15 min before vitreous surgery. The development and progression of a posterior vitreous detachment (PVD) was followed, and the time required for vitreous removal was measured. Both pre- and postoperative visual acuities and optical coherence tomography (OCT)-determined macular thickness were measured. RESULTS: In the seven eyes in which plasmin was used, a PVD developed approximately 5 min after the injection and was confirmed to extend to the far periphery. In all cases, the removal of the vitreous was completed in a shorter time and no complications were observed. A restoration of the shape of the macula was observed in all cases. The visual acuity improved by two or more lines in four eyes, and remained unchanged in the remaining three eyes. CONCLUSIONS: Autologous plasmin alone will create a full PVD, and eliminates the need for a mechanical creation of a PVD. Thus, plasmin is a safe and effective adjunct to vitreous surgery for the treatment of diabetic maculopathy.

Aged↗

PubMedDate not supplied

Surgical results of combined pars plana vitrectomy, phacoemulsification, and intraocular lens implantation.

PURPOSE: To evaluate the results and complications of combined pars plana vitrectomy (PPV), phacoemulsification and aspiration (PEA), and intraocular lens (IOL) implantation. METHODS: A total of 117 eyes from 114 patients who had undergone PPV combined with PEA and IOL implantation were retrospectively analyzed. Combined surgery was performed for a wide variety of vitreoretinal diseases. Intraoperative and postoperative complications were also reviewed. RESULTS: The postoperative BCVA improved by 2 lines or more in 85 eyes (72.6%). Intraoperative complications consisted of retinal tears in 14 eyes (12.0%) and posterior capsular rupture in 2 eyes (1.7%). Iatrogenic retinal tears occurred more frequently in eyes with a macular hole than in eyes with any other disease (p=0.005, chi-square test). Postoperative complications consisted of posterior capsule opacification (PCO) (21 eyes), transient IOP elevation (29 eyes), vitreous hemorrhage (6 eyes), anterior chamber fibrin exudation (11 eyes), posterior iris synechia (8 eyes), neovascular glaucoma (1 eye), and recurrent retinal detachment (RD) (2 eyes). Fibrin exudation occurred more frequently in eyes with proliferative diabetic retinopathy (PDR) and RD than in eyes with any other disease (p=0.03, chi-square test). PCO occurred more frequently in eyes with PDR than in eyes with any other disease (p=0.03, chi-square test). CONCLUSIONS: The present study suggests that a high success rate can be achieved when recently improved PPV techniques are combined wi th PEA and IOL implantation. The complications that were observed following this combined treatment varied with respect to the vitreoretinal disease present prior to surgery.

Adult↗

PubMedDate not supplied

Pars plana vitrectomy and removal of the internal limiting membrane in diabetic macular edema unresponsive to grid laser photocoagulation.

PURPOSE: To evaluate the effectiveness of pars plana vitrectomy (PPV) with removal of the internal limiting membrane (ILM) in diabetic patients with macular edema unresponsive to grid laser photocoagulation. METHODS: In this randomized controlled study, 20 eyes of 10 patients with diabetic macular edema unresponsive to grid laser photocoagulation were evaluated. PPV with ILM removal was performed randomly in one eye each of 10 patients and taken as the study group; the untreated fellow eyes were taken as the control group. Main outcome measures were foveal thickness changes measured with optical coherence tomography and preoperative and post-operative visual acuity. Mann-Whitney U, Wilcoxon, and chi-square tests were used in statistical analysis. RESULTS: The mean age of the patients was 61.5+/-6 years (range 51 to 71). All patients were followed up for 12 months. In the study group, mean foveal thickness was 391.3+/-91.6 microm preoperatively and 225.5+/-49.4 microm postoperatively (p=0.009). In the control group, mean foveal thickness was 356.2+/-140 microm at baseline and 318.4+/-111.1 microm at 12-month follow-up (p=0.138). Mean decrease in foveal thickness was 165.8+/-114.8 microm in the study group and 37.8+/-71.2 microm in the control group (p=0.016). In the study group, best-corrected log-MAR visual acuity was 0.71+/-0.43 preoperatively and 0.54+/-0.45 postoperatively (p=0.125). In the control group, best-corrected logMAR visual acuity was 0.43+/-0.44 at baseline and 0.59+/-0.55 at 12-month follow-up (p=0.235). In the study group, visual acuity improved by two or more lines in 4 eyes (40%) and remained stable in 6 eyes (60%). In the control group, visual acuity improved by two or more lines in 1 eye (10%) and decreased by two or more lines in 3 eyes (30%). CONCLUSIONS: PPV with ILM removal appears to be an effective procedure for reducing diabetic macular edema unresponsive to grid laser photocoagulation. A further study with a large number of patients is required to assess the effectiveness and safety of this procedure.

Aged↗

PubMedDate not supplied

Sympathetic ophthalmia after successful retinal reattachment surgery with vitrectomy.

PURPOSE: To report a case of sympathetic ophthalmia (SO) following one successful pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment. METHODS: Case report. RESULTS: A 50-year-old man developed SO 5 weeks after successful repair of rhegmatogenous retinal detachment with PPV and intraocular gas tamponade. The patient presented with bilateral multifocal exudative retinal detachments and inflamed optic nerve with characteristic changes of SO detected by fluorescein angiography, indocyanine green angiography, and optical coherence tomography. Prompt use of systemic steroids and cyclosporin A resulted in control of the uveitis with significant visual improvement. CONCLUSIONS: PPV should be viewed as a major risk factor for development of SO.

Coloring Agents↗

PubMedDate not supplied

Functional results after vitrectomy with silicone oil injection.

In a prospective study we investigated the visual acuity and differential light sensitivity in 39 patients (40 eyes) with reattached macula. One group, treated with an encircling band (21 eyes), was compared to another, where vitrectomy and silicone oil injection had been necessary (19 eyes). Intraoperatively 9 of the vitrectomized eyes received an infusion of daunomycin (7.5 mg/l for 10 min). On average the vitrectomized eyes had a greater loss of visual acuity and differential light sensitivity. In all groups we found a positive correlation between visual acuity and the differential light sensitivity. At the same visual acuity we did not find any obvious difference in sensitivity between the groups. Correlation and regression line were similar for both groups. The mean relative sensitivity was lower in the fovea than in the rest of the tested field. A selective effect of silicone oil on either spatial resolution or differential light sensitivity could not be verified. The intraoperative application of daunomycin had no influence on the functional results.

Adolescent↗