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PubMed1995

[Vitrectomy for treatment of vitreous hemorrhage associated with age-related macular degeneration].

Age-related macular degeneration (AMD) is an aging disorder which has been a leading cause for blindness among old people. The wet type AMD is the main cause which deteriorates visual function rapidly because of the complications including detachment of retinal pigment epithelium, formation of subretinal neovascular membrane and scar, subretinal and vitreous hemorrhage. This assay reports the results of vitrectomy for treatment of 10 cases with vitreous hemorrhage associated with AMD. The follow-up periods ranged from 1/2 to 28 months. The visual acuities in 9 cases were increased and in 1 case decreased. The factors affecting the postoperative visual acuity, operative complications and therapeutic prospects of the surgery were discussed.

Age Factors↗

PubMed1996

[Surgical treatment by vitrectomy and autologous serum of 36 idiopathic macular holes].

PURPOSE: To analyse the surgical results of a second series of full thickness idiopathic macular hole operated with autologous serum as adjuvant therapy, and to compare them to the results of a first series without autologous serum and the results of literature. METHODS: In a series of thirty-six patients, autologous serum has been used as healing adjuvant therapy. The surgical procedure included a posterior and peripherical vitrectomy combined with posterior hyaloid separation, fluid-air exchange, autologous serum injection, and final flushing with 40% sulfur hexafluoride. The patients then maintained strict face-down position post-operatively for a minimum of ten days. RESULTS: Anatomic success was obtained in twenty-nine cases of thirty-six patients (80%), with an anatomic success rate of 100% for the stage 2 holes. Twenty-nine patients had a pre and postoperative measurable visual acuity. Among these twenty-nine patients, median postoperative visual acuity was 20/70, compared with 20/125 preoperatively. Final visual acuity was improved in twenty-seven patients (75%), was stable five times (14%), and declined four times (11%). Among the twenty-nine anatomic successes, twenty-four (85%) improved their visual acuity. Complications were rare, and observed in the same percentage as described in literature. No complication in relation to autologous serum was noticed. CONCLUSION: Autologous serum is an inexpensive, easy to obtain, healing adjuvant therapy. It seems improving the surgical results like the other adjuvants described in the litterature.

Adult↗

PubMed1996

Removal of silicone oil and epimacular proliferation from eyes following vitrectomy.

BACKGROUND AND OBJECTIVES: Epimacular proliferation (EMP) represents a localized form of reproliferation at the macula. The significance of EMP in eyes that have undergone vitrectomy is still not clear. This study investigated the redetachment rate following silicone oil removal when combined with removal of EMP. PATIENTS AND METHODS: Twenty-two consecutive eyes underwent removal of silicone oil and EMP These eyes had attached retinas following silicone oil injection used as an adjunct to complex vitreoretinal surgery. RESULTS: The retina remained attached in 19 (86.4%) of the eyes, with functional improvement it vision in 81.8% of the eyes. Visual acuity of 6/60 (20/200) or better was obtained in 12 (54.5%*) of the eyes. The mean follow-up time was 6.3 months. CONCLUSION: These results suggest that removal of EMP and silicone oil does not increase the risk of redetachment.

Adolescent↗

PubMed1996

[Outcome of corneal astigmatism after pars plana vitrectomy with or without simultaneous cataract extraction].

Changes in corneal astigmatism induced by pars plana vitrectomy (PPV) (group I, 44 eyes) and PPV combined with no-stitch cataract surgery (group II, 20 eyes) were studied prospectively for a period of at least 3 months. The amount and orientation of the keratometric cylinder and the surgically induced astigmatism (according to the methods of Jaffe and Clayman or Naeser) were analysed. In the first postoperative week both groups exhibited a marked against-the-rule to oblique astigmatism (in group I up to 3.65 +/- 1.40 D, in group II up to 3.05 +/- 1.60 D, according to Jaffe). After 3 months this had declined in group I to 0.40 +/- 0.27 D, whereas a slight induced astigmatism (0.97 +/- 0.41 D) persisted in group II. Gas endotamponade did not significantly aggravate the postoperative astigmatism in either group. Computerized video-keratography generally revealed an asymmetric bowtie pattern during the first week. Our results show that PPV alone induces no appreciable long-term corneal astigmatism. Optical rehabilitation, however, can be delayed by a marked short-term postoperative astigmatism. PPV with simultaneous no-stitch cataract surgery, by contrast, was found to induce a persisting slight astigmatism against the rule.

Adult↗

PubMed1996

[Pars plana vitrectomy in retinal detachment with a macular hole].

The long-term results of pars plana vitrectomy (PPV) for retinal detachment due to a macular hole were evaluated in 40 eyes of 40 patients. The patients were followed up for 6 to 72 months. In 9 eyes, subtotal PPV with expansive gases was used: in 5 of them, in addition, the macular hole was treated with laser endocoagulation. The operation was successful in 4 out of 5 eyes treated with laser barrage. In the remaining 5 eyes, the operation failed and reattachment was obtained after secondary silicone oil implantation (SOI). In 31 eyes, PPV was combined with a primary SOI. Twenty of them suffered from serious myopic degenerative changes of the posterior eye pole, and in 11 posterior stafyloma. Reattachment of the retina was achieved in 28 eyes (90.3%), visual acuity 1/24 (0.04) or better in 13 eyes (41.9%). Silicone oil was removed in 13 eyes (41.9%), in all these without complications. PPV with expansive gases and laser coagulation proved to be effective in macular holes with the well-preserved pigment epithelium. Silicone oil proved competent in macular holes associated with serious chorioretinal degeneration and posterior stafyloma.

Adult↗

PubMed1996

[Role of vitrectomy and intra-vitreous injections in the treatment of traumtic and iatrogenic endophthalmitis].

The survey of recent literature emphasises the usefulness of primary vitrectomy in the treatment of the most serious endophthalmitis. As soon as vitreous and aqueous humor samples have been obtained for bacteriologic analysis, intravitreal injection of a combination of antibiotics able to cover the most common causative germs is established as the standard of care. The beneficial effect of intravitreally-injected corticosteroids is still controversial.

Adrenal Cortex Hormones↗

PubMed1997

[Subconjunctival anesthesia: an alternative for vitrectomy in mitochondrial myopathy].

The case of a 63-year-old woman with mitochondrial myopathy with palpebral ptosis and nighttime nasal home oxygen therapy is reported. The patient successfully underwent outpatient vitrectomy with subconjunctival anesthesia, receiving no premedication or sedation during the operation. Subconjunctival analgesia was provided, with prior instillation of an anesthetic collyrium followed by subconjunctival injection of 1 ml of 0.4% bupivacaine and 2% lidocaine. Analgesia during surgery was satisfactory. We review the possibilities of using this technique in patients at high risk of presenting postoperative complications after general anesthesia, and discuss the possible side effects on musculature when peribulbar or retrobulbar anesthesia is provided.

Anesthesia, Local↗

PubMed1997

Idiopathic macular hole following vitrectomy: implications for pathogenesis.

BACKGROUND AND OBJECTIVE: Attention to the pathogenesis and clinical features of macular hole formation has increased with the advent of therapy. The purpose of this study is to present three cases that occurred in atypical settings that may have important pathogenic implications. PATIENTS AND METHODS: The authors conducted a retrospective study of three patients who presented with macular holes that developed 10 months to 5.5 years after previous vitrectomy. In each case, the cortical vitreous layer was absent in the region of the macula at the time of operation for the macular hole. RESULTS: The macular hole was successfully sealed and the visual acuity improved in all patients. All three cases in this report lacked an operculum, occurred long after vitreous removal, and had no evidence of any residual cortical vitreous. CONCLUSIONS: Macular hole formation in the absence of cortical vitreous suggests the possibility that the etiology of macular holes may involve a spontaneous umbo dehiscence rather than vitreous-induced surface traction. A mechanism involving a cystic degenerative process is proposed as the cause of atypical and typical macular hole formation.

Aged↗

PubMed1997

[Long-term results of pars plana vitrectomy and silicone oil in large retinal tears in children].

Pars plana vitrectomy (PPV) with implantation of silicone oil (ISO) was performed giant tears (GT) in 24 eyes of 22 children aged 6-15 years. In 15 eyes of 13 children idiopathic GT were involved (71%), in 9 eyes (29%) the GT was preceded by an injury-contusion in 5 eyes and a perforating injury in 4 eyes. The patients were followed up for 24-132 months after operation, on average for 55 months. The final anatomical success with an attached macula and functional success with a visual acuity of 0.02 or better were achieved in 18 eyes (75%). The results did not depend on the size of the GT and were better in post-traumatic than in idiopathic GT. The success of the operation declined from 82% after two years and 79% after 3 years to 45% after 5 and more years. The silicone oil was removed in 13 years (46%). Of those in 4 eyes (31%) the detachment relapsed and in two eyes (15%) the relapse was the cause of the final failure. PPV with ISO was a very effective operation in GT. Proliferative vitreoretinopathy was the main cause of surgical failures and a frequent obstacle for removal of silicone oil from the eye. Dispensarization, prophylactic cryopexy and early diagnosis of GT are the main prerequisites of a better prognosis and results in GT in children.

Adolescent↗

PubMed1997

Combined pars plana vitrectomy and scleral buckling for pseudophakic and aphakic retinal detachments in which a break is not seen preoperatively.

BACKGROUND AND OBJECTIVE: This study presents a group of patients with a pseudophakic or aphakic retinal detachment (RD) and an unseen retinal break who were treated with a pars plana vitrectomy (PPV), fluid-air exchange, internal drainage, and endolaser in addition to a scleral buckle (SB) procedure. PATIENTS AND METHODS: The charts of 10 consecutive patients with a pseudophakic or aphakic RD and an unseen retinal break who were treated with a PPV, fluid-air exchange, internal drainage, endolaser, and an SB were reviewed for preoperative and postoperative visual acuity, postoperative status of the retina, and surgical complications. RESULTS: All of the patients with a postoperative follow-up of at least 6 months continue to maintain an attached retina after one operation. Visual acuity has improved by at least 2 lines on the Snellen chart in 7 patients, remained the same in 2 patients, and decreased in 1 patient. CONCLUSIONS: This pilot study shows good anatomic results when performing a PPV, fluid-air exchange, internal drainage, and endolaser together with an SB for pseudophakic or aphakic patients with an RD and an unseen break.

Aged↗

PubMed1996

[Metallic intraocular foreign body extraction by primary vitrectomy and microforceps].

This retrospective study deals with 17 consecutive cases of metallic intraocular foreign body extraction with primary vitrectomy and microforceps. The methods of surgical treatment in this setting are controversial. We discuss these methods, and show that the surgical principles applied in this series have allowed us to obtain functional results which compare favorably with those previously published, and a very low level of retinal complications with respect to other studies.

Adult↗

PubMed1997

[Retinal detachment. The vitrectomy technique].

One hundred and ten eyes from 110 patients who in 1992 had undergone vitrectomy for regmatogenous retinal detachment were included in a retrospective study. Two year follow-up was obtained for 97 eyes. At the end of follow-up 45% of the eyes had complete anatomical success. Fifty-five percent had attachment of the macula. Anatomical success after a single operation was obtained in 33%. A visual acuity of more than 0.05 was obtained for 35% of the eyes at the end of follow-up. Eighty patients had a follow-up interview; of these 56% stated that the advantages of the operation outweighed the disadvantages.

Adolescent↗

PubMed1998

Phacoemulsification and posterior chamber intraocular lens implantation after scleral buckling, vitrectomy, or both.

BACKGROUND AND OBJECTIVE: Previous studies have documented the risk of complications for eyes with prior vitreoretinal surgery that later undergo intracapsular or extracapsular cataract extraction. The authors reviewed the records of patients with a history of vitreoretinal surgery and subsequent phacoemulsification to assess the visual outcome in the relatively early postoperative period and to determine the risk of postoperative complications. PATIENTS AND METHODS: The authors identified 21 eyes of 21 patients with a history of scleral buckling, vitrectomy, or both, who subsequently underwent phacoemulsification. Data recorded before, during, and after surgery were reviewed. RESULTS: The best-corrected visual acuity improved in 20 (95%) of 21 eyes, and the final best-corrected visual acuity was 20/40 or better in 12 (57%) of 21 eyes. The intraoperative complications included iridodialysis, zonular dialysis, and posterior capsular rupture. The immediate postoperative complications were microcorneal edema, anterior chamber hyphema, vitreous hemorrhage, and fibrinous pupillary membrane. No retinal detachments occurred during the postoperative follow-up period, which ranged from 3 to 10 months. Late complications included isolated cases of posterior capsular opacity, herpetic corneal ulcer, and iris posterior synechia; however, the final visual acuities were not limited, except in one eye with a corneal ulcer. CONCLUSION: Although some postoperative complications did occur, they did not limit final vision, and useful vision was achieved.

Adolescent↗

PubMed1998

Surgical results of pars plana vitrectomy combined with phacoemulsification and intraocular lens implantation for complications of proliferative diabetic retinopathy.

BACKGROUND AND OBJECTIVE: To evaluate the effectiveness and safety of combining phacoemulsification (PEA), pars plana vitrectomy (PPV), and intraocular lens (IOL) implantation. PATIENTS AND METHODS: Combined operations of PEA and PPV were performed in 76 eyes of 54 patients with cataract complicated by proliferative diabetic retinopathy (PDR). The mean follow-up period was 24.4 months. Gas tamponade was employed in 15 eyes. IOLs were implanted during surgery. RESULTS: Visual acuity improved by 2 lines or more in 59 eyes (78%). Forty-seven eyes (77%) without tamponade and 12 eyes (80%) with tamponade had improved visual acuity. Postoperative complications included fibrin reaction in 8 eyes (10%), posterior synechia of the iris in 11 eyes (14%), and recurrence of retinal detachment in 8 eyes (10%). The incidence of these complications and of additional operations was higher in eyes that required tamponade, which corresponded with the severity of each case and the complexity of the surgical procedures. CONCLUSIONS: Although further studies are indicated, this study suggests that the combined operation of PPV, PEA, and IOL implantation is safe and effective for patients with PDR. The choice of IOL may be correlated with postoperative complications.

Adult↗

PubMed1997

[Pars plana/plicata lensectomy with anterior vitrectomy in the treatment of complicated cataract in children].

Pars plana/plicata lensectomy with anterior vitrectomy was performed in a total of 16 eyes of 10 children with congenital cataract, microphthalmus, PHPV and other developmental anomalies and in three patients with complicated cataract due to chronic uveitis and in hydrophthalmus. The anatomical results of the operation are satisfactory, the functional results are limited in particular by the primary changes of the eyes and the child's age at extraction. An earlier diagnosis would be ensured by screening of the transparency of optic media in neonates.

Cataract↗

PubMed1997

[Self-sealing sclerotomies in pars plana vitrectomy].

PURPOSE: To study a technique of self-sealing sclerotomies, recently described. METHODS: After conjunctival peritomy, a tunnel incision is performed with a crescent knife, 2 mm posterior to the intended site of entry. Then a 20G microvitreoretinal blade is used to enter the vitreous cavity. From November 1996 to April 1997, 99 primary vitrectomies were prospectively studied. RESULTS: 292 sclerotomies were performed with this technique. Self-sealing sclerotomies were observed in 270 cases (92.5%). In 22 cases, leakage of fluid required closure with 8-0 nylon sutures. Leakage was related to multiple instruments used through the sclerotomy, or more frequently to a thin scleral wall. In 1 case, transient hypotony was observed. Ocular pressure spontaneously returned to normal. CONCLUSIONS: Self-sealing sclerotomies are difficult to perform if the sclera is thin, and leakage can be observed if multiple instruments have to be used through the same sclerotomy. But this technique prevents vitreous and retinal herniation through the sclerotomy, and ocular hypotony. It also reduces the operative time, and prevents irritation related to nonabsorbable sutures.

Humans↗

PubMed1998

[Perforation keratoplasty after pars plana vitrectomy and use of a temporary keratoprosthesis].

In 12 eyes of 12 patients with vitreoretinal abnormalities due to reduced transparency of the cornea perforation keratoplasty was performed after pars plana vitrectomy with the use of a temporary keratoprosthesis. The corneal transplant remained clear after a mean follow up period of 15.5 months in 5 patients (41.7%). The visual acuity improved in 7 patients (58.3%), however only three patients had a postoperative visual acuity better than or equal to 3/60 (6/18, 6/60, 3/60). The retina remained attached in 8 patients (66.7%).

Adolescent↗

PubMed1998

Endophthalmitis in eyes following vitrectomy.

The authors describe two patients who underwent pars plana vitrectomy for nonclearing vitreous hemorrhage. Both patients had severe pain, increased intraocular pressure, and orbital swelling. The anterior chamber became flat in a phakic eye. The infection progressed rapidly, and ultimately evisceration was required in both cases. The presence of a flat anterior chamber in gas-filled, phakic eyes and a severe orbital inflammatory reaction in the early postoperative period should alert the physician to the possibility of endophthalmitis.

Cataract Extraction↗