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Pars plana vitrectomy in eyes with an anterior chamber intraocular lens poses several challenges. This becomes more obvious during fluid-air exchange. The use of viscoelastics during the surgery to overcome these problems is described. This technique allows better visibility intraoperatively, provides a stable anterior chamber, and maintains corneal clarity.
A retrospective study evaluates the importance of pars plana vitrectomy (PPV) in four patients with ocular form of toxocarosis. The results of laboratory determination of the titres of antibodies against Toxocara canis (the ELISA method) in samples of vitreous body were compared with those in the serum of the patient. The individual cases exemplify the problems in interpretation of laboratory findings and document the authors' experience in considering the diagnosis of ocular toxocarosis in individual cases. The authors' experience indicates that PPV is of diagnostic as well as of therapeutic significance.
62 Cases with unresolving Vitreous Haemorrhage due to varied etiology, underwent pars plana Vitrectomy. A vitreous rebleed on the table and post-operatively, was the main complication encountered. Despite limited equipment, a visual improvement was obtained in 59.68% eyes with visual acuity greater than FC 6 meters in 33.87% eyes. This is far better than not being able to offer any treatment at all.
Repeated vitreous haemorrhage is a common occurrence in Eales disease. 25 eyes of unresolving vitreous haemorrhage were subjected to pars plana vitrectomy. 18 eyes improved to 1/60 or better. Vitreous rebleed was the commonest problem encountered. We discuss our experience, complications and limitations.
Ten consecutive cases of perforating ocular injuries with retained intraocular foreign bodies over a period of 2 years were reviewed retrospectively in this study. All cases were operated upon by a 3 port pars plana vitrectomy and if necessary endolaser done. All ten cases (100%) were successful in terms of intraocular foreign body removal through the pars plana sclerotomy but ultimately we lost three [3] [30%] cases of which two had retinal detachments with P.V.R. D-3 preoperatively and the other had endophthalmitis. Of the seven (70%) successful cases four eyes (40%) had a post-operative vision of 6/12 or better while 2 [20%] had 6/24 and the last had 6/60 [10%]. Nine cases [90%] had a magnetic Intraocular foreign body. Various complications of Intraocular foreign bodies like vitreous haemorrhage, retinal incarceration, cataract and retinal detachment were noted preoperatively. Silicone oil was used in three (30%) cases. Sulfur Hexafluoride was used in 5 cases (50%). Endolaser photocoagulation was done in 7 cases (70%).
The authors present a case of fungal endophthalmitis in the immunosuppressed patient after renal transplantation. The treatment comprised pars plana vitrectomy with silicone oil tamponade, peribulbar injections of Fungizone and intravenous Diflucan. Diagnostic and therapeutic difficulties in endogenous endophthalmitis are discussed.
Macular edema remains one of the important therapeutic issues. Vitero-macular tractions are said, to be the cause of persistent, non responding to laser treatment diabetic macular edema. Surgical removal of these tractions is used in treatment of non resolving macular edema. However, vitrectomy in treatment of diabetic macular edema remains the experimental, method requiring further studying.
AIM: To analyze the outcome of combined clear cornea phacoemulsification, vitrectomy, foreign body extraction, and intraocular lens implantation in patients with traumatic cataract and intraocular foreign body. METHODS: Retrospective analysis included the results of combined cataract and vitreoretinal surgery in 16 patients. All patients had a penetrating eye injury, traumatic cataract, and intraocular foreign body. Twelve patients had a corneal entry site and in 4 patients intraocular foreign body entered through the sclera. RESULTS: After a mean follow-up of 25.2 months, 10 out of 16 patients had a visual acuity of 0.1 or better. Postoperative complications were encountered in 4 patients: 2 patients had retinal detachment, one had a massive retinal fibrosis, and one developed postoperative endophthalmitis. CONCLUSION: Simultaneous posterior chamber intraocular lens implantation with vitreoretinal surgery is safe in certain cases of severe ocular trauma due to intraocular foreign body. Visual outcome was mainly related to the underlying posterior segment pathology.
PURPOSE: To compare peroperative complications of standard phaco technique and phaco with pars plana infusion performed for cataract after pars plana vitrectomy. METHOD: This prospective study randomly divided group of 64 patients with cataract after PPV into group A (standard phaco, 38 patients) and group B (phaco with par olana infusion, 26 patients). The study verifies the rate of peroperative complications such as deep anterior chamber, diaphragma movement miosis, and zonular dehiscention in these two groups. RESULTS: Peroperative complications had slightly higher rate in group B (with infusion). No specific complication in group A (standard phaco) was found. CONCLUSION: Standard phaco technic without par plana infusion has at least the same level of safety as phaco with pars plana infusion.
PURPOSE: In retrospective study to evaluate the anatomical and functional results of pars plana vitrectomy (PPV) with peeling of the inner limiting membrane (ILM) on pseudophakic eyes with diabetic macular edema. MATERIAL AND METHOD: PPV with peeling of the ILM was performed in 5 eyes (5 diabetic patients) after cataract surgery with posterior chamber intraocular lens implantation. Group of patients enrolled 4 female and one male aged from 44 to 62 years (average 56.2 y.). 2 eyes had undergone focal fotocoagulation previously for clinically significant macular edema. The macular edema was diagnosed by clinical examination and by retinal fluorescein angiography from 3 to 8 months (mean 6 m.) after cataract surgery. Visual acuity (VA) and angiographic changes were monitoring. RESULTS: In pseudophakic eyes with diabetic macular edema that underwent surgery, the angiography documented decrease of hyperfluorescens in all cases. VA improved in 3 eyes (80%) more than +2 lines of Snellen test, stabilized in one eye (20%). VA detoriated in one eye by -1 line of Snellen test. CONCLUSION: Our results demonstrated that PPV with ILM peeling is effective surgical procedure on pseudophakic diabetic macular edema.
OBJECTIVE: To investigate the relation of the visual function recovery and the postoperative form of the idiopathic macular holes. METHODS: 38 eyes with macular holes which were closed after one surgery were selected and were grouped into type of complete healed, partial healed and no healed by Optical Coherent Tomography (OCT). Scanning Laser Ophthalmoscope (SLO) examination were performed preoperatively and 1 month, 3 months and 6 months postoperatively to detect the sensitivity, areas of absolute scotoma, relative scotoma and central visual acuity. RESULTS: Among type of complete healed group and type of partial healed group 6 months after vitrectomy the central vision, sensitivity, areas of absolute scotoma and relative scotoma had statistical significant improvement. The central vision and sensitivity improved postoperatively and areas of absolute scotoma and relative scotoma had no significant changes in type of no healed group. The extent of improvement of vision, sensitivity, absolute scotoma in type of complete healed group was more greater than type of partial healed group and no healed group. The fovea configuration of stage II macular holes was easier to recover completely. CONCLUSIONS: The recovery of the normal curvature of macular fovea is positive to the improvement of the visual function. The better the fovea contour recover, the more significantly the visual function improve. The early stage of macular holes (stage II) could get better improvement of visual function.
The treatment of choice for epiretinal membranes (ERM) causing marked retinal distortion and substantial visual impairment remains vitreoretinal surgery. The purpose of this study was to evaluate the results of surgery performed in our department and to investigate the prognostic value of different factors such as preoperative best-corrected visual acuity (BCVA), pre-existing cystoid macular edema (CME), intra-operative peeling of the internal limiting membrane (ILM), age and duration of symptoms. Eighty-eight consecutive eyes of 88 patients were operated on for ERM from July 1998 to June 2000. Both idiopathic and secondary cases were included. In all cases the ERM was successfully removed from the fovea. Mean BCVA after surgery increased from Snellen 0.2 (hand motion (HM) - 0.6) to Snellen 0.5 (HM - 1.0) (p<0.0001). Our results confirm the efficacy of surgical removal of the ERM in improving the visual acuity. Although not statistically significant, mean postoperative BCVA was slightly better in the group without pre-existing CME (p>0.05) and in the group where peeling of the ILM was performed (p>0.05). The data suggest that early surgery is likely to decrease the risk of developing irreversible macular damage (p<0.05). Because accelerated nuclear sclerosis with visual impairment is a common phenomenon after vitrectomy, one might consider performing a phaco-emulsification at the same time, especially in the elderly.
The authors present a case of ocular tuberculosis in otherwise healthy young men, diagnosed with positive tuberculin test and positive PCR for Mycobacterium tuberculosis in conjunctiva and vitreous samples. An early vitrectomy and typical systemic treatment (tuberculostatic drugs) resulted in regression of the disease.
Selected patients undergoing pars plana vitrectomy and lensectomy may be ideal candidates for scleral-fixated lenses. We present our current technique for implanting such lenses, a technique designed to avoid the problems of suture exposure, lens rotation, and infection.
A 16-year-old female had multiple retinal capillary angiomas, complicated by marked retinal and optic disc neovascularization, preretinal membranes, and retinal detachment in her right eye. Pars plana lensectomy, vitrectomy, fluid/gas exchange, direct transvitreal diathermy of the angiomas, endolaser scatter photocoagulation, and scleral buckling resulted in retinal reattachment and regression of the neovascularization. Although additional surgery was necessary for recurrent tractional retinal detachment, long-term retinal reattachment and stable vision was achieved following obliteration of all angiomas.
During the 1997-2002 period, 48 eyes of 41 patients of the mean age 58 years were operated on because of complications of proliferative diabetic retinopathy. In the cohort of operated patients, the type I diabetes mellitus was determined in 10 (21%) cases, the type II diabetes mellitus in 36 (75%) cases, and in two cases (4%), another type of diabetes was detected. One patient of those two had LADA type diabetes and the second one had secondary diabetes due to chronic pancreatitis. In the early postoperative period, or during first three months postoperatively, after the pars plana vitrectomy, the visual acuity (VA) in 28 (59%) eyes improved, in 16 (33%) eyes remained the same, and in 4 eyes (8%) worsened. VA 1/60 (0.017 or 3/200) and better had 37 (77%) eyes, VA 6/60 (0.1 or 20/200) and better had 17 (37%) eyes, and VA 6/12 and better (0.5 or 20/40) had 3 (6%) eyes only. VA worse than 1/60 (0.017 or 3/200) had 11 (23%) eyes. Authors emphasize the importance of regular and detailed ophthalmologic examinations with early diagnosis of pathological changes and early start of adequate treatment.
The aim of the study was to present current knowledge in the field of combined surgery: phacoemulsification with intraocular lens implantation and pars plana vitrectomy.
BACKGROUND AND OBJECTIVE: To assess surgical and visual outcomes with pars plana vitrectomy (PPV) in closed-globe injuries resulting in anterior and posterior segment pathologies and evaluate the factors influencing the prognosis. PATIENTS AND METHODS: Retrospective observational study. Forty-seven eyes of 47 consecutive patients who underwent PPV because of closed-globe injury between January 1992 and August 2003 were reviewed. Surgical and visual outcomes and prognostic factors were analyzed according to the Ocular Trauma Classification System. RESULTS: Preoperative visual acuity was less than 4/200 in 49% of eyes, classified as grades IV to V. After surgery, this ratio was 23% (P < .05). Final visual acuity was statistically significantly better in grade I (P = .0001), grade II (P = .002), and relative afferent pupillary defect-negative (P = .0001) injuries. Maculopathy was the most common adverse outcome influencing final visual acuity (32%), followed by secondary glaucoma (13%) and proliferative vitreoretinopathy (8%). CONCLUSION: PPV is a favorable treatment modality in severe closed-globe injuries. Assessment of injuries with respect to the Ocular Trauma Classification System seemed to predict visual outcomes in this series.