Role of PPV in Advanced Retinal Hemangioblastoma-A Systematic Review.

We evaluated the anatomical and functional outcomes after vitreoretinal surgery for complex retinal capillary hemangioblastoma (RCH). This was a retrospective case series of 15 patients (16 eyes) with tractional or combined retinal detachment (RD) managed with pars plana vitrectomy and tumor endoresection (ER) with/without feeder vessel ligation. The mean age at the time of surgery was 30 years (range, 14-46 years). The most common tumor locations were inferotemporal (six eyes) and temporal (six eyes) quadrants. Indications for surgery included exudative RD with fibrovascular proliferation (eight eyes), combined RD (five eyes), vitreous hemorrhage (four eyes), and rhegmatogenous RD (two eyes). Tumor destruction was performed with laser and/or cryotherapy in nine eyes (57%) and ER in seven eyes (43%). Feeder vessel was ligated and cauterized in 10 (63%) and six eyes (37%), respectively. Anatomical success after initial surgery was 50% (eight eyes), which improved to 88% (14 eyes) after they underwent a repeat procedure for recurrent RD (eight eyes). At the last visit, visual acuity improved in seven eyes (44%), was stable in four eyes (25%), and worsened in five eyes (31%) with a mean follow-up of 29 months (6-79 months). Comparison between the ER group and the laser/cryotherapy group revealed no significant difference in final retinal reattachment rate (89% vs. 86%, P > 0.05), with better visual outcomes in laser/cryotherapy group (57% vs. 78%, P < 0.05). Pars plana vitrectomy with/without tumor endoresection can be a safe and effective treatment option for complex RCHs, achieving good tumor control and anatomical success with limited functional success.

Purpose: to analyze the results of the treatment recurrent «inferior» retinal detachments (RD) depending on the volume of surgical intervention.Patients and methods. 81 patients (81 eyes) with recurrent «inferior» RD were included in this retrospective study. Groups were identified depending on the volume of surgical treatment of recurrents RDs: scleral buckling (SB), pars plana vitrectomy (PPV), combined surgery: PPV with SB, PPV with retinotomy (RT), including the use of perfluorocarbon fluid (PFCL). The volume of surgical treatment was assessed before recurrent RD, after the first and second recurrent «inferior» RD, the distribution of the grade and type of proliferative vitreoretinopathy (PVR) complicating these recurrents RD with different treatment tactics, analyzed the functional results and anatomical success (retinal reattachment) after surgical treatment of the first and second recurrents RD.Results. Primary anatomical success was achieved in 304 from 385 patients (79 %). In 81 cases, the first recurrent RD was detected (21 %). Surgical treatment of the first recurrent RD included: in 39 cases (48 %) — PPV; in 9 cases (11 %) — PPV with SB; in 13 cases (16 %) — PPV with RT. In 20 cases (25 %) for short-term tamponade with PFCL was used when performing PPV with RT. The second recurrent RD occurred in 42 cases, which accounted for 52 % of the first recurrent RD. The anterior type of PVR was in all cases (100 %). All patients underwent repeated surgery: PPV (100 %), of which in 15 cases (35.7 %) — PPV with RT; the use of short-term postoperative tamponade with PFCL was in 18 cases (42.9 %); additional SB — in 9 cases (21.4 %). Anatomical success was achieved in 100 % of cases after surgical treatment of the second recurrent RD, but in 8 cases (19 %) a retinal redetachment occurred.Conclusion. The increase in PVR continues to be the main cause of recurrent RD. In patients with recurrent «inferior» retinal detachments, grade C PVR type 4, 5, the additional use of SB for PPV, RT and the use of PFCL as a short-term postoperative tamponade allows achieving better results (functional and anatomical). During surgery of the second recurrent RD, when there are pronounced changes in the retina, performing SB is impractical, the alternative is RT.

Vitrectomy surgical techniques have rapidly developed over the last 15 years and continue to evolve with the introduction of perfluorocarbon liquids, multifunctional probes, improved endoillumination and sutureless microincision vitrectomy. In the context of rhegmatogenous retinal detachment (RRD) management, there is a decline in buckle surgery (El-Amir et al. 2009) and shift towards pars plana vitrectomy (PPV) as the procedure of choice. Other established indications for PPV include macular hole (MH), epiretinal membrane (ERM), non-clearing diabetic vitreous haemorrhage (NCVH), tractional retinal detachment (TRD) with variations in gases used, posturing regime and vital dyes. The surgical episodes for all patients having vitreoretinal procedures at three sites (St Thomas' Hospital, London Eye Clinic, Queen Mary's Hospital, United Kingdom) under a single surgeon were anonymized and prospectively recorded on an electronic medical record (Vitreor, AxSys Technologies, Glasgow, UK) between January 1997 and December 2013 and is being reported. Included in the study are data on baseline primary indication, details of surgical procedure, method of anaesthesia and intra-ocular agents. Two-sided t-tests and Pearson correlation were performed to test for slope, and all p values are presented with a Bonferroni correction. There were 7570 operations in 5591 patients (1.35 operation per patient), ratio of males to females (1.27:1), the mean age was 59.8 years (SD, 170.0 years), and 48.8% of operations were on left eyes and 51.2% on right eyes. The most common indication for surgery was RRD (42.8%) followed by intervention for vitreous haemorrhage (VH) (12.6%), TRD (6.1%), MH (10.4%) and ERM (7.7%). The relative frequency of vitreoretinal surgical intervention for most indications has remained similar over the past 16 years. In the management of RRD, 82.6% of the cases were pars plana vitrectomy procedures, and 16.6% were external buckle procedures with an increasing pattern towards PPV as the preferred choice (r = 0.229. R2 = 0.052, p < 0.001) (Fig. 1). The percentage of cases undergoing PPV, as compared to explant surgery, has increased from 60% in 1997 to over 90% in 2013. Macular hole surgery increased as a relative proportion of all cases (r = 0.95, p < 0.013) over the 16 years, and there was increasing use of hexafluoroethane (C2F6) as a tamponade agent following its introduction in 2009 rather than perfluoropropane (C3F8: r = −0.508, r2 = 0.252, p < 0.001). This trend in preferential use of C2F6 over C3F8 was also seen for other indications in later years. There was an increasing trend for combined lens and vitreous (CLV) extraction with PPV for the management of ERM and MH (Fig. 1). Brilliant blue is increasingly being used to stain internal limiting membrane in macular pathologies and was preferred over trypan blue. There was a general increasing preference for local anaesthesia across all surgical indications with time (p < 0.001). This study presents one of the largest series in the literature of patients who underwent vitreoretinal (VR) surgery over a prolonged period of 15 years. Overall, this study demonstrates that there is a move towards vitrectomy for both phakic and pseudophakic RRD. It is similar to increasing use of small gauge vitrectomy for the management of primary RRD is seen in many centres around the world (Falkner-Radler et al. 2011; Wong et al. 2014). The role of PPV is likely to further increase over time, as smaller gauge vitrectomy becomes more commonly used, and continuous improvement is seen in anatomical and visual outcomes (Tsang et al. 2008; Falkner-Radler et al. 2011). Our data have shown an increasing incidence of macular hole surgery which has coincided with improvement in optical coherence tomography and vital dyes (Rodrigues et al. 2007). The number of vitreoretinal surgical operations from complications of advanced diabetic retinopathy (tractional retinal detachment and vitreous haemorrhage) has remained constant which may be a reflection of better awareness amongst healthcare providers, improved diabetic control and the establishment of the national diabetic retinopathy screening programme. The study provides useful numbers for the planning of resources for a vitreoretinal service with detail on the pattern of surgical practice and use of various agents required for a vitreoretinal service. Changes in practice include an increased use of small gauge surgery and a resultant reduction in the need for per-operative suturing. Gases and intra-ocular dyes are used regularly, but changes in the agents used with time have been identified. Current trend has major implications on the future education and training of vitreoretinal surgeons and in particular suggests the use of scleral buckle surgery may further decrease in developed nations.

The aim of this investigation was to evaluate the effect on the anatomic surgical success with the changeover from 20 Gauge (G) (n = 206) to 23 G (n = 107) pars plana vitrectomy (PPV) in rhegmatogenous retinal detachment. 313 consecutive patients were retrolective-prospectively analysed. Several parameters including lens status, number of retinal breaks, extent of retinal detachment, proliferative vitreoretinopathy (PVR) and refractive error were examined. Primary success rate was defined as anatomic success after a minimum follow-up of 6 months. The secondary success rate was determined as anatomic success after one further operation if necessary. Moreover recurring retinal detachment after initial success was registered. In additional to the analysis over all patients, cases were grouped according to the severity of the preoperative baseline situation. Primary success rate was 87.4 % for 20 G PPV and 87.9 % for 23 G PPV, secondary success rate was 95.6 % for 20 G PPV and 94.4 % for 23 G PPV. 13.9 % (20 G) and 7.4 % (23 G) of patients with initially reattached retina after one surgery developed recurrent retinal detachment in the follow-up and were successfully treated in 17/25 and 7/7 cases. With 20 G PPV a primary success rate of 85 % was obtained in phakic eyes and 89.6 % in pseudophakic eyes, respectively. However, primary success rate with 23 G PPV was 90.4 % for phakic eyes and 85.5 % for pseudophakic eyes. For simple, medium and severe cases, the primary success rate decreased from 97.1 to 92.4 and 74.2 % in 20 G PPV, whereas no obvious tendency appeared for 23 G PPV (93.9, 83.7, 88 %). In 20 G PPV surgery the lens status had no influence on the primary success rate (p > 0.05), for medium and severe cases in 23 G PPV better results were obtained in phakic eyes (88.5 and 93.3 %) compared to pseudophakic eyes (78.3 and 80 %, n. s.). 20 G PPV as well as 23 G PPV are good surgical techniques in rhegmatogenous retinal detachment. Overall the miniaturisation of surgical instruments seems to be without any disadvantage for the surgical success.

BackgroundRhegmatogenous retinal detachment (RRD) is a serious condition that occurs when the retina detaches from its underlying retinal pigment epithelium. RRDs associated with giant retinal tears (GRTs) are caused by retinal tears at least 90° or one-quarter of the circumferential extent. This scoping review systematically identifies and summarizes clinical studies evaluating surgical techniques for the management of GRT-related RRDs, discusses functional and visual outcomes and the risk factors affecting treatment outcomes.MethodsThis study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Scopus, Google Scholar, and Springer Link databases were searched for relevant papers (from January 2001 to March 2023). Studies that were published in the English language and reported the risk factors, management, and treatment outcomes of GRT-related RRDs were included in the review. The outcome measures included anatomic success rates, changes in BCVA (logMAR) from baseline to the final follow-up, and adverse events.ResultsA total of 11,982 articles were identified. After the title and abstract review, 71 studies were deemed eligible for full-text review. Thirty-six studies that met the eligibility criteria were included in the final review. Four surgical techniques were identified: pars plana vitrectomy (PPV), combined PPV and scleral buckling, scleral buckling alone, and pneumatic retinopexy. Various types of tamponades, including gas, silicone oil, and air, have been used. PPV was the most commonly used surgical technique in 33.1–100% of patients. Among the 20 studies that used PPV alone, 17 were associated with preoperative PVR. In addition, scleral buckling alone or in combination with PPV was reported as a treatment option in 10 studies, with 2–100% of patients experiencing scleral buckling alone and 13.6–100% experiencing combined PPV and complementary scleral buckling. Primary anatomic success (PAS) was achieved with retinal reattachment via a single operation with no residual tamponade, whereas final anatomic success (FAS) was achieved via more than one operation with no residual tamponade. Reported single surgery anatomic success (SSAS) rates range from 65.51 to 100%. The preoperative best-corrected visual acuity (BCVA) ranged from 0.067 to 2.47 logMAR, whereas the postoperative BCVA ranged from 0.08 to 2.3 logMAR. An improvement in visual acuity was observed in 29 studies. Cataracts (3.9-28.3%) were the most common postoperative complication, followed by high IOP (0.01-51.2%) and PVR (0.8-31.57%).ConclusionPPV is the most common surgical technique, and currently microincision vitrectomy surgery (MIVS) systems are commonly employed. Silicone oil is the most frequently used tamponade in RRD repair. Risk factors for GRT-related RRD include age, sex, lens status, high myopia status, proliferative vitreoretinopathy (PVR), presenting visual acuity, the extent of the GRT and retinal detachment, and macular involvement. Future research areas include guidelines to reduce variability in the reporting of surgical methodology, choice of tamponades, and reporting of functional and visual outcomes to inform the best therapeutic interventions in GRT-related RRD.

Ocular injuries caused by intraocular or retrobulbar foreign bodies.

To evaluate the anatomical and functional outcomes of pars plana vitrectomy without adjuvant scleral buckling, prophylactic 360° endolaser photocoagulation, or perfluorocarbon liquid use for the treatment of primary uncomplicated rhegmatogenous retinal detachment. Retrospective interventional case series of consecutive patients undergoing vitrectomy for noncomplex rhegmatogenous retinal detachment over a 10-year period. Main outcome measures included primary anatomical success rate, defined as retinal reattachment at final follow-up after a single operation, proportion of eyes achieving a final best-corrected visual acuity ≤ logarithm of the minimum angle of resolution 0.3 (≥ Snellen 20/40), and postoperative complications. With a mean follow-up of 31 months, primary anatomical success was achieved in 95.7% (89 of 93) of eyes. Final anatomical success, defined as retinal attachment at final follow-up without regard to additional procedures, was achieved in 98.9% (92 of 93). Final best-corrected visual acuity of ≤ logarithm of the minimum angle of resolution 0.3 (≥ Snellen 20/40) was achieved in 77.4% of eyes in the cohort. Postoperative proliferative vitreoretinopathy developed in 3.2% of eyes. No new retinal breaks developed postoperatively in the absence of clinically evident proliferative vitreoretinopathy. Thorough pars plana vitrectomy alone, without adjuvant scleral buckling, 360° endolaser photocoagulation, or routine perfluorocarbon liquid use, yields high anatomical and functional success rates and low complication rates in the treatment of primary uncomplicated rhegmatogenous retinal detachment. In the absence of observable proliferative vitreoretinopathy, postoperative vitreous base contraction does not appear to be a clinically relevant phenomenon.

Complicated retinal re-detachment with inferior proliferative vitreoretinopathy (PVR) remains a challenge. This study's aim was to compare vitrectomy with conventional silicon oil (CSO) combined with an encircling band (EB) and vitrectomy with heavy silicon oil (HSO) alone to treat retinal re-detachment through inferior PVR, where standard procedures have already failed. A retrospective analysis was done on patients with inferior complex re-detachment with secondary PVR after primary surgery, who received pars plana vitrectomy (PPV) with CSO combined with EB (group 1) or PPV alone with HSO (group 2) between December 2006 and August 2017. The primary endpoint was retinal reattachment, and the secondary endpoint was visual acuity (VA) change and complications in both groups. This study included 119 eyes. Total single surgery anatomical success (SSAS) was 64%, with 80% (52/65) achieved in group 1 and 44.5% (24/54) in group 2 (p < 0.0001). The total final anatomical success (FAS) rate was 79% (94/119). In group 1, FAS was 91% (59/65) compared with 65% (35/54) in group 2 (p = 0.003). The pretreatment VA of group 1 had a median of 1.4 logMAR (95% CI 0.3-1.8), and group 2 showed a median of 1.4 logMAR (95% CI 0.2-1.8). The post-treatment decrease in group 1 was a median equal to - 0.6 versus - 0.1 for group 2 (p = 0.0001). Serious complications were similar in both groups. For complicated retinal re-detachment through inferior PVR, the combination of PPV with EB may lead to better anatomical (SSAS, FAS) and functional success compared with PPV alone with HSO.

A study was made of a consecutive series of 47 cases of rhegmatogenous retinal detachment treated by pars plana vitrectomy in which no holes were identified preoperatively. The view of the fundus during preoperative examination varied from being totally clear to completely obscured by media opacities. The role of pars plana vitrectomy in finding retinal holes peroperatively is considered. The incidence of discovering holes and the locations of those found at the time of surgery are presented. The significance of these findings is discussed. Where the preoperative view was good and the extent of proliferative vitreoretinopathy (PVR) did not exceed grade C2, retinal reattachment was achieved in 75% of the cases. A review made of a similar group of patients treated with conventional retinal buckling before the introduction of pars plana vitrectomy revealed that successful retinal reattachment was achieved in 70% of cases. The study concludes that pars plana vitrectomy, while being necessary for cases of rhegmatogenous retinal detachment when the view of the retina is obscured, will not always reveal the presence of a retinal break. If the preoperative view of the retina was good and the extent of PVR did not exceed grade C2, pars plana vitrectomy did not seem to offer obvious advantages over conventional buckling procedures.

To evaluate the surgical outcome of retinal detachment resulting from a posterior staphyloma-associated macular hole in highly myopic eyes. Fifty-seven consecutive highly myopic eyes with retinal detachment resulting from a posterior staphyloma-associated macular hole diagnosed between January 1993 and June 2003 were retrospectively studied. Anatomical reattachment of the retina and best-corrected visual acuity were measured. Six different operative methods were used to treat this condition with diverse retinal reattachment rates: long-acting gas tamponade only (12.5%); pars plana vitrectomy (PPV) with long-acting gas tamponade (42.8%); PPV with epiretinal membrane (ERM) peeling and long-acting gas tamponade (50.0%); encircling scleral buckling combined with PPV and long-acting gas tamponade (57.1%); encircling scleral buckling combined with PPV, ERM peeling, and long-acting gas tamponade (40.0%); and encircling scleral buckling combined with PPV and silicone oil tamponade (75.0%). Overall, successful retinal reattachment was achieved in 25 (43.9%) of 57 eyes after the first surgery. However, the ultimate success rate of retinal reattachment was 77.2% (44 of 57 eyes) after subsequent surgery. The mean preoperative visual acuity +/- SEM (in logarithm of the minimal angle of resolution units) was 2.08 +/- 0.55, and the mean postoperative visual acuity +/- SEM was significantly increased to 1.87 +/- 0.54 at the last follow-up (P = 0.038). The major cause of recurrent retinal detachment in the long-acting gas tamponade group was nonclosure of the macular hole. For vitrectomized eyes, the major cause was reopening of the macular hole, even with ERM formation and proliferative vitreoretinopathy. There was no obvious correlation between the extent of the detachment or lens status and the reattachment rate. The major causes of recurrent retinal detachment in the long-acting gas tamponade and vitrectomized groups were nonclosure of the macular hole and reopening of the macular hole, respectively. Furthermore, a lesser extent of retinal detachment was not associated with a higher anatomical success rate. More aggressive treatment such as silicone oil tamponade may need to be performed to overcome reduced natural adhesion due to posterior staphyloma with marked chorioretinal atrophy. Failure to initiate aggressive treatment can result in an unsatisfactory outcome and repeated surgery.

Background and Objectives: Here, we report the anatomical and functional outcomes of Pars Plana Vitrectomy (PPV) with feeder vessel ligation, with or without endoresection in cases of retinal detachment (RD) secondary to retinal capillary hemangioblastoma (RCH). Materials and Methods: This retrospective observational study included 12 eyes with RD secondary to RCH. Based on the location of the lesion and the features of the RD, eyes were divided into two groups. Seven eyes with RCH located in Zone 2 or Zone 3, associated with tractional retinal detachment (TRD), underwent PPV with feeder vessel ligation and tumor endoresection. Five eyes, either with RCH in Zone 2 or Zone 3 associated with exudative retinal detachment or with RCH in Zone 1 associated with RD, underwent PPV with feeder vessel ligation alone, without tumor endoresection. Outcome measures included local tumor control, best-corrected visual acuity (BCVA), anatomical success, and rates of complications. Results: RCH regressed completely in 100% of eyes with no evidence of recurrence. The mean follow-up was 4.6 years. In the endoresection group, the mean BCVA was 2.18 ± 0.3 logMAR at baseline and 0.95 ± 0.5 logMAR after surgery (p = 0.018), whereas in the second group, the baseline mean BCVA was 1.33 ± 0.2 logMAR and 1.52 ± 0.7 logMAR postoperatively. In the first group, retinal attachment was achieved in all eyes, whereas in the second group, two eyes presented with persistent RD and proliferative vitreoretinopathy (PVR). No cases of phthisis bulbi or neovascular glaucoma were observed. Conclusions: PPV combined with feeder vessel ligation and endoresection appears to be an effective treatment for TRD secondary to RCH located in Zones 2 and 3, providing satisfactory anatomical and visual outcomes considering the severity of the disease. In cases where tumor location precludes endoresection, PPV with feeder vessel ligation alone may still be a viable option, although the potential risk of PVR could persist.

PurposeTo describe the functional and anatomical results of complicated retinal detachment (RD) treated with small-gauge pars plana vitrectomy (PPV) and combined perfluorodecalin and polydimethylsiloxane tamponade (double filling, DF).MethodsRetrospective analysis of consecutive patients with complex RD (severe proliferative vitreoretinopathy, inferior/posterior/giant retinal tears, and traumatic detachments) treated with small-gauge PPV, membrane peeling, and DF at the Department of Ophthalmology at San Gerardo Hospital, Monza, Italy. Main outcome measures included best-corrected visual acuity (BCVA), rates of retinal reattachment, and complications.ResultsThis study included 15 patients with a median follow-up (FU) of 6 months (range 1–22). Three patients with early retinal redetachment under tamponade and FU shorter than 3 months were excluded from the final functional analysis, but they were considered anatomical failure. At the last examination, BCVA improved in 50% of patients and remained stable in 25% of patients and anatomical success was achieved in 73% of eyes, 64% of them without any endotamponade. Three eyes had retinal redetachment after perfluorodecalin/silicone oil exchange because of diffuse proliferative vitreoretinopathy (PVR) and required reoperation to achieve retinal attachment. In eyes with anatomical success, macular pucker was the most frequent long-term complication (27%).ConclusionIn the management of complex RD, small-gauge pars plana vitrectomy, and double filling endotamponade using wide-angle viewing systems was a well-tolerated and effective technique to preserve visual acuity and achieve anatomical success.

Vitrectomy versus Vitrectomy with Scleral Buckling in the Treatment of Giant Retinal Tear Related Retinal Detachments: An International Multicenter Study

Fibrovascular ingrowth at sclerotomy sites in vitrectomized diabetic eyes with recurrent vitreous hemorrhage: Ultrasound biomicroscopy findings

Inferior Pseudophakic Retinal Detachment