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PubMedDate not supplied

Long-term results of pars plana vitrectomy and silicone oil for complications of diabetic retinopathy.

Pars plana vitrectomy (PPV) with silicone oil implantation (SOI) was performed for advanced proliferative diabetic retinopathy (PDR) in 110 eyes of 98 diabetic patients. In 77 eyes (70%) it was a primary SOI as part of the initial operation; in 33 eyes (30%) it was a secondary SOI in reoperations. Indications for SOI were traction retinal detachment of the posterior pole, combined traction and rhegmatogenous detachment, vitreous haemorrhage with florid vascularised fibrous proliferations, and recurrent vitreous haemorrhage after PPV. The patients were followed up for 24 to 72 months, with a mean of 53 months. At the end of follow-up, anatomical success was achieved in 63 eyes (57%), and functional success with visual acuity 0.01 and better in 35 eyes (32%). Functional failures were caused by retinal redetachment in 47 eyes (43%), by secondary glaucoma in 10 eyes (9%), retinal ischemia in 15 eyes (13%) and keratopathy in three eyes (3%). The functional success rate decreased with follow-up from 67% after six months to 50% by 60 months after SOI. Silicone oil bubble in the anterior chamber, rubeosis iridis, cataract, and glaucoma were the most frequent postoperative complications. PPV with SOI was highly effective in many serious complications of advanced PDR. Functional success was mostly lasting and markedly improved the quality of life of these patients.

Adult↗

PubMedDate not supplied

Long-term results of pars plana vitrectomy and silicone oil for giant tears.

PURPOSE: To evaluate the long-term results of pars plana vitrectomy (PPV) and silicone oil implantation (SOI) for giant retinal tears (GT). METHODS: PPV with SOI was performed for GT in 50 eyes of 46 patients. Thirty-one eyes (62%) of 27 patients suffered from idiopathic GT. A direct injury of the eye preceded GT in 19 eyes (38%), a contusion in 14 and perforation of the sclera in five. The patients were followed up for 12 to 96 months, with a mean of 33 months. RESULTS: At the end of follow-up, anatomical success with a flat macula was achieved in 39 eyes (78%). Functional success with visual acuity 0.02 or better was obtained in 37 eyes (74%). The final functional results did not depend on the size of the GT, and were better in post-traumatic GT (success in 84%) than in idiopathic ones (success in 68%). The functional success rate by life table analysis decreased from 81% after one year and 79% after three years to 55% after five or more years. Silicone oil was removed from 22 eyes (44%). After removal, the retina redetached in seven eyes (30%), and the redetachment caused final failure in two (9%). CONCLUSIONS: PPV with SOI proved highly effective in GT. Proliferative vitreoretinopathy was the main cause of surgical failure and a frequent obstacle to silicone oil removal. The risks of redetachment have to be evaluated especially carefully when dealing with the only eye.

Adolescent↗

PubMedDate not supplied

Pars plana vitrectomy in the pediatric population: indications and long-term results.

PURPOSE: To establish the indications and the long-term results of pars plana vitrectomy (PPV) in the pediatric population. METHODS: PPV was performed in 60 eyes of 57 children, 45 boys and 12 girls, aged from 6 to 15 years. Twenty-nine eyes (48%) suffered from complicated rhegmatogenous or traction retinal detachment (RD) with advanced proliferative vitreoretinopathy (PVR), 19 eyes (32%) had RD due to an idiopathic or traumatic giant tear (GT), 7 eyes (11%) had an intraocular foreign body (IOFB), and 5 eyes (9%) had hemorrhage or exudation into the vitreous. In 43 eyes (65%) silicone oil implantation (SOI) was indicated, in 39 eyes (91%) a primary SOI, and in 4 eyes (9%) a secondary SOI. The patients were followed up for 6-72 months, mean 42 months. RESULTS: At the end of follow-up, anatomical success with a flat macula was achieved in 77% of the eyes, and functional success with visual acuity of 0.02 and better in 72%. The results were best in IOFB and traction RD after penetrating injury (success in 100% and 91%); the worst results were in RD after regressed retinopathy of prematurity and RD due to idiopathic GT (success in 50% and 54%). After SOI silicone oil was removed in 27 out of 43 eyes (63%), and the retina remained attached in 23 of these eyes (85%). CONCLUSIONS: Indications and the long-term results of PPV in children were comparable with those in the adult. By far the most frequent indications were injuries and their complications. In complicated RD, a radical approach with primary SOI and later silicone oil removal proved useful. In children, with their long life expectancy, timely removal of silicone oil is vital for maintaining the function of the eye.

Adolescent↗

PubMed1994

Vitrectomy for severe proliferative diabetic retinopathy.

To analyse the results of diabetic vitrectomy according to the severity of proliferation [severe (SPG) vs. less-severe proliferation group (LSPG)], and methods of the operation, which was complete removal of anteroposterior vitreous traction with or without complete removal of preretinal memebrane, we compared both groups by using anatomic success rate and postoperative visual acuities (VA). The results were as follows: The anatomic success rate and postoperative VA were significantly better in LSPG than in SPG. In SPG, anatomic success rate and postoperative VA tended to be better when complete removal of anteroposterior traction was possible than when impossible. In SPG, postoperative VA tended to be better when complete removal of preretinal membrane was possible, but the anatomic success rate was the same for each group. So, when severe proliferation (including table-top elevation of posterior retina), complete removal of anteroposterior traction only can improve the anatomic success rate of the surgery.

Adult↗

PubMed2000

Management of posteriorly dislocated intraocular lens using pars plana vitrectomy.

In order to evaluate the results of pars plana vitrectomy (PPV) for the treatment of posteriorly dislocated intraocular lens (PC-IOL), we retrospectively examined and analyzed the hospital records of patients who had undergone PPV to exchange or reposition a PC-IOL dislocated into the vitreous cavity. Of 20 eyes in 20 patients, IOL exchange was performed in 6 eyes, and IOL repositioning in 14 eyes. Posteriorly dislocated IOL occurred in 14 eyes during or within 2 days, and in 6 eyes 6 months after the IOL implantation. Thirteen eyes were surgically treated early after the occurrence, within 3 days, while 7 eyes were treated later, between 5 to 7 days. Compared with preoperative best-corrected visual acuity, the final visual acuity improved more than 2 lines in 12 eyes. With no significant difference on the statistics, earlier visual rehabilitation seemed to be shown in late-treated patients than in early-treated. Accordingly, a posterior dislocation of IOL can be successfully treated with PPV, and barring any serious complications such as retinal detachment, there is no need for surgery immediately following the occurrence.

Adolescent↗

PubMed2005

[Spontaneous resolution of branch retinal vein occlusion in cases with non-ischemic macular edema. Significance of a waiting period before considering treatment with vitrectomy].

OBJECTIVES/METHODS: It is well established that some patients with branch retinal vein occlusion undergo a spontaneous resolution after a suitable waiting period. We present a series of 22 patients with initial acuity under 0.2 for whom we allowed three months of observation before considering vitrectomy. RESULTS/CONCLUSIONS: 13% of the patients developed enough spontaneous improvement to be excluded from subsequent treatment. We thus believe a waiting period should be considered before instituting treatment in patients with this particular problem.

Female↗

PubMed2005

[A case of triamcinolone-induced pseudo-endophthalmitis after vitrectomy].

CASE REPORT: Vitrectomy with vitreous injection of triamcinolone in a patient suffering cystoid macular edema, secondary to a lens fragment luxation after subluxated cataract phacoemulsification, was performed. Four days after the surgery she presented because of discomfort and visual loss in the operated eye, and was found to have a 3.4 mm hypopyon. DISCUSSION: We describe the differences between infectious endophthalmitis, toxic endophthalmitis and pseudo-endophthalmitis.

Endophthalmitis↗

PubMed1999

Combined lensectomy, vitrectomy and scleral fixation of intraocular lens implant after closed-globe injury.

PURPOSE: To describe our experience in the surgical management of cataracts in patients with complications of closed-globe injury using pars plana lensectomy (PPL), pars plana vitrectomy (PPV), and scleral fixation of posterior chamber intraocular lens (PCIOL). METHODS: We retrospectively reviewed charts of all patients with closed-globe injury who underwent PPL, PPV and scleral fixation of PCIOL at our institution between January 1991 and July 1997. We identified 28 eyes; because of less than 2 weeks follow-up, 4 eyes were excluded from the current study. All eyes had lens subluxation/dislocation and visually significant cataract. Additional indications for surgery included secondary glaucoma (10 eyes), vitreous hemorrhage (3 eyes) and retinal detachment (1 eye). RESULTS: The postoperative follow-up interval ranged from 6 to 61 months (mean 18.5 months). Preoperative visual acuity (VA) ranged from 20/60 to hand motion and was 20/100 or better in 6 eyes (25%). Postoperatively, 19 eyes (79%) improved to 20/100 or better. Five eyes had subsequent surgery for the following indications: retinal detachment (2 eyes), poorly controlled glaucoma (2 eyes), and epiretinal membrane formation (1 eye). CONCLUSIONS: In patients undergoing PPL, PPV and scleral fixation of PCIOL for cataract after a closed-globe injury, a substantial visual improvement occurred in a majority of the involved eyes.

Adolescent↗

PubMed1998

The use of topical aqueous suppressants in the prevention of postoperative intraocular pressure elevation following pars plana vitrectomy with long-acting gas tamponade.

PURPOSE: To determine if topical aqueous suppressant therapy applied after pars plana vitrectomy (PPV) with gas tamponade successfully prevents postoperative elevation of intraocular pressure (IOP). METHODS: A prospective, controlled study was performed on patients who met inclusion criteria and underwent PPV with gas tamponade (SF6 18%-20% or C3F8 12%-16%) over a 1-year period. Treatment eyes received topical aqueous suppressants at the end of surgery. Postoperative IOP checks were performed at 4 to 6 hours, 1 day, and 1 week. RESULTS: Twenty-one control (C) and 20 treatment (T) eyes met the inclusion criteria. The IOP (in mm Hg) measured at 4 to 6 hours (23.05 [C], 14.73 [T] and 1 day (23.24 [C], 17.28 [T]) postoperatively showed a statistically significant difference between the groups (P = .0038) at 4 to 6 hours, and a trend toward significance (P = .057) at 1 day. Eleven control and 3 treatment eyes had an IOP spike above 25 mm Hg at 4 to 6 hours or 1 day postoperatively (P = .02), and 6 control and 1 treatment eye had a postoperative IOP above 30 mm Hg. A pressure rise above 40 mm Hg was seen in 2 control eyes and no treatment eyes. CONCLUSIONS: Use of topical aqueous suppressants following PPV with long-acting gas tamponade is effective in preventing significant postoperative IOP elevation in a majority of cases.

Adrenergic alpha-Agonists↗

PubMed1999

[Use of the multifocal electroretinogram to evaluate retinal function after pars plana vitrectomy for diabetic macular edema].

PURPOSE: Multifocal electroretinograms (multifocal ERGs) were performed to evaluate retinal function in patients with diabetic macular edema. MATERIALS & METHODS: Eight eyes of 5 patients underwent pars plana vitrectomy for diabetic macular edema. Multifocal ERGs, fundus examinations, and fluorescent angiographies were done both before and after the operation. RESULTS: Post-operative visual acuity was improved by two or more lines in 3 eyes. In multifocal ERGs, the amplitude of the positive wave (P1) from the macular area decreased transiently after surgery (p < 0.05), but it improved with the passage of time. The P1 amplitude from the peripheral area was decreased throughout the observation period of six months (p < 0.05). For both areas, the P1 latency was increased significantly (p < 0.05) at one month post-operatively, and then decreased. CONCLUSION: These findings are consistent with the possibility that the surgical method, especially removal of the posterior cortical vitreous, can cause retinal damage.

Diabetic Retinopathy↗

PubMedDate not supplied

[Role of vitrectomy in the treatment of retinal arterial macroaneurysms].

INTRODUCTION: Retinal arterial macroaneurysms are a rare cause of macular hemorrhage. Their treatment by photocoagulation is difficult and often ineffective. MATERIAL AND METHOD: Five aneurysmal cases complicated by a pre or retromacular hematoma or an intravitreal hemorrhage were treated surgically by vitrectomy with peeling of the vitreous cortex, hematoma drainage, dissection of the fibrinous aneurysmal body, perfluorocarbon fluid tamponade facilitating endophotocoagulation and temporary internal gas tamponade. RESULTS: Anatomical and functional results were satisfactory in this short series. One year after surgery, one case of secondary cataract was reported. DISCUSSION: Arterial abnormalities, located on the superior temporal retinal artery, are often discovered after assessment pre or submacular hemorrhage. Functional prognosis of aneurysmal rupture depends on the course of the retrofoveal hematoma. CONCLUSION: Early access to this surgery and good results in this series argue for rapid surgical treatment in sizeable submacular hemorrhage in order to avoid severe effects of subretinal fibrosis.

Aged↗

PubMed1997

[Immunohistochemical study on vitrectomy specimens of proliferative retinal diseases].

OBJECTIVE: To evaluate the characteristics of cellular proliferation in different retinal diseases. METHODS: Three specific antibodies [to cytokeratin (CK), glial fibrillary acidic protein (GFAP) and actin, respectively] were used. Vitrectomy specimens from 28 cases with different proliferative retinal diseases were studied immunohistochemically. RESULTS: In the vitreous with proliferative vetreoretinopathy (PVR), most of the proliferative cells were derived from glial and retinal pigment epithelial (RPE) cells. In the vitreous of proliferative diabetic retinopathy (PDR), RPE cells might enhance the contraction of proliferative membranes. Increase in actin in firovascular membranes with PDR may play a positive role on the pericytes dropping out from microvessels. CONCLUSION: The cell proliferation in the vitreous associated with the increase of levels of growth factors in pathological vitreous, possibly, is one of the mechanisms for the deterioration of proliferative retinal diseases.

Actins↗

PubMed1999

[Vitrectomy and autologous thrombocyte concentrate in the treatment of idiopathic macular holes].

OBJECTIVE: To evaluate the results of surgery of idiopathic macular holes (IMH) using or not using autologous thrombocyte concentrates (ATC). METHOD: Fifty eyes with IMH, stage 2-4, were divided into two groups. Group 1 comprised 27 eyes with an average persistence of complaints of 12 months where pars plana vitrectomy (PPV) and tamponade with 16% C3F8 were combined with the use of ATC. Group 2 comprised 23 eyes with a mean duration of complaints of 14 months which were treated by PPV and 16% C3F8 without ATC. In all IMH stage 2 and 3 the posterior vitreous membrane was detached from the retina. The epimacular membrane was removed, if present. The mean follow-up period in group 1 was 17.2 months and in group 2 12.3 months. RESULTS: In group 1 anatomical success was achieved in 21 eyes (78%), visual acuity improved by two lines and more in 16 eyes (59%). In group 2 anatomical success was recorded in 15 eyes (69%) (p = 0.326) and visual acuity improved in 10 eyes (44%) (p = 0.265). Nine eyes were reoperated with ATC. Reoperations improved the anatomical success in the whole series to 90% and the functional success to 62%. The visual acuity improved in 70% operated eyes within 12 months from the onset of complaints and in 47% eyes with a longer case-history (p = 0.1182). Complications included retinal tears in 5 eyes (10%), detachment of the retina in one eye (2%), minor facete-like defects in the pigmented epithelium in 22 eyes (44%), disciform maculopathy in 5 eyes (10%) and atrophy of the optic disc in 3 eyes (6%). CONCLUSIONS: PPV is beneficial in IMH in the majority of patients. ATC can improve anatomical and functional results. Functional success is more likely after surgery in the early stage of the disease. The results of surgery are jeopardized by various complications. It is important to inform patients on the limitations and risk of surgery.

Adult↗

PubMed1999

[Vitrectomy in optic nerve disc pit with maculopathy].

There is described a rare case of a congenital optic disc pit of the 20-years old man that was accompanied by a cyst-like change in the macula with serous retinal detachment. Visual impairment in his right eye was treated with pars-plana-vitrectomy with surgical posterior vitreous detachment and gas tamponade. After temporary pneumatic displacement of the subretinal fluid inferiorly the corrected visual acuity improved to 6/9. Schisislike changes persisted in the macular area. Our findings could support the view on the two-layer structure of optic disk pit maculopathy and an important role of tangential vitreous traction in the pathogenesis of the central retinal detachment.

Adult↗

PubMedDate not supplied

Combined temporal phacoemulsification and pars plana vitrectomy for the treatment of cataract and giant retinal tear in a buphthalmic eye.

The standard approach to a three-port to pars plana vitrectomy is by placing the sclerotomies in the superotemporal and superonasal quadrant and the infusion port in the inferotemporal quadrant. This approach may be adjusted in selected cases that exhibit structural abnormalities of the globe at the superior site by placement of the sclerotomies in the temporal quadrants. We describe a case of a buphthalmic eye with a huge filtering bleb from previous glaucoma surgery that successfully underwent combined cataract and vitreoretinal surgery from a temporal approach for the repair of a giant retinal tear with cataract.

Cataract↗

PubMedDate not supplied

[Vitrectomy in traumatic cataracts and in the complications of surgery in congenital cataract in children].

Vitrectomies were carried out in 35 children with traumatic cataracts and complications of surgery for cataracts, caused by injury to the posterior lenticular capsule and incorporation of its fragments to the vitreous. Complete removal of lenticular rudiments rapidly eliminated phacogenic iridocyclitis and improved visual acuity. Improvement of visual functions was attained in 66.6% cases; in 33.4% cases visual acuity did not change. Hemorrhages to the vitreous cavity occurred in 4 cases with pronounced iridocyclitis; therefore, a corneal approach is preferable for cases with pronounced iridocyclitis.

Adolescent↗

PubMed1997

[Clinical observation on pars plana lensectomy-vitrectomy preserving lens anterior capsule].

OBJECTIVE: To investigate the therapeutic effect of combined operation on cataract complicated with vitreous pathology. METHOD: 19 patients (20 eyes) with coexisting cataract and vitreous opacification or endophthalmitis or intraocular foreign bodies were operated with pars plana lensectomy-vitrectomy preserving lens anterior capsule. The ciliary sulcus intraocular lenses (IOLs) were primarily implanted for sixteen eyes of 19 cases in the operation. RESULTS: All cases were followed up for 12-36 months. Visual acuities of 18 cases were improved, 7 eyes between 0.3-0.5, 11 eyes beyond 0.5, the best one at 1.2. Anterior capsule opacification occurred merely in one eye, and in others the capsule kept being transparent. CONCLUSION: Preserving anterior lens capsule in the operation is beneficial to the insertion of IOL, and the anterior segment is affected slightly, thus it is a promising method for treating cataract complicated with vitreous opacification.

Adult↗

PubMedDate not supplied

Pars plana vitrectomy for macular holes combined with cataract extraction and lens implantation.

BACKGROUND AND OBJECTIVE: To evaluate the safety and efficacy of cataract extraction and lens implantation at the time of pars plana vitrectomy (PPV) for macular hole (MH) repair. MATERIALS AND METHODS: A retrospective study was conducted of 21 eyes that had PPV for MH combined with cataract extraction and lens implantation. Visual acuities (VA) were followed and complications noted. RESULTS: Of 21 eyes, successful anatomic closure was achieved in 16 (76.2%), and 13 (62.0%) improved in VA by at least 2 Snellen lines. Few complications occurred. CONCLUSION: Procedures that combine PPV for MH with cataract extraction and lens implantation decrease the need for future ophthalmic surgery, allow for clearer intraoperative visualization, and facilitate visual rehabilitation. This combined procedure is a relatively safe and effective alternative to separate pars plana and cataract surgeries.

Aged↗