23G Vitrectomy Research Articles

Результаты хирургического лечения макулярных разрывов большого диаметра

Purpose. Analysis of functional and anatomical results of surgical treatment of large diameter macular holes (MH). Material and methods. The clinical material consisted of 15 patients with idiopathic MH of stages 3–4 (15 eyes). The fracture diameter varied from 404 to 607 µm (on average, 475 ± 63 µm). The best corrected visual acuity (BCVA) ranged from 0.02 to 0.2 (mean 0.08 ± 0.06). Surgical treatment consisted of a three-port 25G vitrectomy (Constellation), with removal of posterior hyaloid and internal limiting membrane (ILM) of the retina. After removal of the ILM, the vitreal cavity was filled with air, and the MH was closed by passive aspiration using a metal cannula, achieving maximum convergence of the edges of rupture. If the MH was not closed, repeated surgical treatment was performed 4–5 days after the primary operation. Results. 12 patients had MH closure. In 3 cases, the gap did not close; according to OCT data, there was a decrease in diameter of the gap with the retina adjacent to the pigment epithelium. After repeated surgical treatment, on the first day in all 3 cases, complete closure of the MH was achieved. In all cases (15 patients), BCVA improved, ranging from 0.02 to 0.4 (mean 0.17 ± 0.1). Conclusion. Thus, after primary surgery, complete MH closure with anatomical restoration of the macula profile was achieved in 12 patients (80 %). Keywords: idiopathic macular hole, vitrectomy, method of approaching the edges of the gap, pneumoretinopexy, visometry parameters, optical coherence tomography

Влияние степени адгезии внутренней пограничной мембраны на результаты хирургии тракционного диабетического макулярного отека

Internal limiting membrane (ILM) peeling is a technically complex manipulation that is performed during macular surgery. Experts'opinions vary on its necessity. Visual inspection during surgery does not always make it possible to assess the degree of ILM adhesion to the retina. The aimof the study was to evaluate the morphofunctional parameters of the macular zone after ILM peeling with different degree of adhesion in the long-term postoperative period. Material and methods. A study was conducted that included 119 patients with type 1 (65 (55%) and type 2 (54 (45%) diabetes mellitus with proliferative stage of diabetic retinopathy (PDR) and tractional diabetic macular edema (tDME). All patients underwent a standard three-port 25G vitrectomy with the use of an additional endo-luminaire «chandelier» and bimanual membrane peeling technique. During ILM peeling, all patients underwent intraoperative optical coherence tomography (I-OCT) in order to assess the degree of ILM adhesion to the retina. Before, 1 and 12 months after the operation, the determination of the maximum corrected visual acuity (MCVA), OCT of the macular zone with the measurement of the central retinal thickness (CRT) was performed. Results and discussion. 3 degrees of adhesion of ILM to the retina were identified with I-OCT during ILM peeling. The degree of ILM adhesion in fovea significantly correlated with the development of a retinal defect in its central area. The development of retinal central zone atrophy showed a significant correlation with a decrease in MCVA 12 months after surgery and with the degree of ILM adhesion to the retina in patients with both types of DM. Conclusions. According to the results of this study, a significant correlation was shown between the degree of ILM adhesion to the retina determined by I-OCT and the risk of macular atrophy, which in turn is associated with low visual functions of patients after tDME surgery with ILM peeling. The resulting principle can be used in surgery of other vitreomacular interface pathologies. Keywords: vitreomacular interface, epiretinal membrane, diabetic macular edema, tractional diabetic macular edema, intraoperative optical coherence tomography, vitreoretinal surgery, proliferative diabetic retinopathy

A sutureless technique for securing leaking sclerotomies with viscoelastic substances in 23-gauge microincision vitrectomy surgery.

To introduce and evaluate the clinical efficacy of a new technique, the use of viscoelastic substances (VS) to close leaking sclerotomy in 23G microincision vitrectomy, and to observe its effect on the visual acuity and intraocular pressure (IOP) of patients. Patients who underwent 23G vitrectomy in Ningbo Eye Hospital before the use of VS technique (June 2019 to September 2020) and after the use of VS technique (October 2020 to December 2021) were selected as the subjects of this study. The above cases underwent operation by the same surgeon and were retrospectively analyzed. VS technique was used as the alternative to suturing, in which a small amount of VS was injected at the leaking sclerotomy and then gently massaged to confirm leaking sclerotomy closure. A total of 174 eyes were covered in the study, including 84 eyes in the control group (before the use of VS technique) and 90 eyes in the VS technique group. The number of eyes that needed to be sutured decreased considerably from 42.9% in the control group to 3.3% in the VS technique group, and the proportion of subconjunctival hemorrhage at 1-2d after surgery decreased remarkably from 35.7% in the control group to 2.2% in the VS technique group. No substantial differences in the incidence of mean IOP and low IOP were found between 1-2 and 3-20d after surgery in the VS technique group. No major complications associated with VS technique were identified during the study. In 23G microincision vitrectomy, VS technique is a safe, simple, and effective method to close leaking sclerotomy.

Outcomes of air versus sulfur hexafluoride tamponade in primary rhegmatogenous retinal detachment in phakic eyes

Purpose To evaluate the outcomes of using air versus sulfur hexafluoride (SF6) gas tamponade in management of primary rhegmatogenous retinal detachment (RRD). Study design Retrospective case-series comparative study. Patients and methods We collected data from 120 patients in three tertiary university hospitals, that were diagnosed as primary RRD due to upper retinal break in the period from January 2021 to November 2022 and had undergone 23-G lens-sparing pars-plana vitrectomy with either air tamponade (Air group) or SF6 gas tamponade (SF6 group) and were followed up for 6 months. We analyzed the final visual outcomes between both groups. Results The mean age of the studied patients was 51±13 years (Air group=60 eyes, SF6 group=60 eyes). The mean axial length in Air group was 26.59±1.84 mm, the mean axial length was 26.46±1.49 mm in SF6 group. Best-corrected visual acuity was improved in both groups at the sixth month. In Air group 18.33% had recurrent RRD, while 10% in SF6 group. No significant difference regarding metamorphopsia was reported. Higher rate for cataract progression was noted among SF6 group. Conclusions Both Air and SF6 gas showed favorable results regarding the final visual outcome. Air is a less expensive tamponade with less timing for postoperative-prone positioning. Cataract progression was higher among SF6 group, however, the incidence of recurrent RRD was lower among SF6 group. Missed break was the primary cause for failed retinal reattachment.

Optical coherence tomography angiography changes after vitrectomy for rhegmatogenous retinal detachment and its correlation to visual outcome

Purpose The aim of this study was to evaluate the capillary vessel density (CVD) and the flow of superficial and deep capillary plexuses (SCP and DCP) using optical coherence tomography angiography (OCTA) after vitrectomy for rhegmatogenous retinal detachment (RRD) and to correlate these changes with the visual outcome. Patients and methods This is a prospective interventional study that was conducted on 17 eyes with macula-off RRD. All patients underwent 23-G vitrectomy with silicone oil (SO) injection. OCTA was performed 1 month after SO removal. The outcome measures included the CVD, SCP arcade disruption, capillary dropout, SCP and DCP disorganization, and best corrected visual acuity (BCVA). Results There was a statistically significantly less density of the mean DCP (40.82±6.87%, P=0.03), and the mean SCP (38.95±6.75%, P=0.007) in the operated eye compared to the fellow eye. The central foveal thickness (CFT) was statistically significantly higher in the operated eye (309.06±92.12 μm) compared to the fellow eye (242.29±25.48 μm), (P=0.019). The SCP capillary arcade disruption was statistically significantly more frequent in the operated eyes (12=70.6%) especially in the eyes with subretinal fluid (SRF) (P=0.049) and those with cystoid spaces (P=0.049). Conclusion The CVD, excluding the fovea, was significantly worse in the operated eyes. The SCP arcade disruption, capillary dropout, and SCP and DCP disorganization were detected in most patients following RRD repair, but with no significant correlation with BCVA.

Case Report: Acute Retinal Necrosis following Unexpanded Gas Tamponade Acute Retinal Necrosis following Unexpanded Gas Tamponade

Purpose: To present 2 cases of acute non-hemorrhagic retinal necrosis occurring following pars plana vitrectomy for epiretinal membrane peeling following the use of unexpanded gas tamponade. Case Report: Two eyes (both right eyes) of 2 healthy females presented with decreased visual acuity due to Epiretinal membrane, and they underwent 25G vitrectomy and membrane peeling. The vitrectomy operation was uneventful and was concluded with the insertion of 20% sulfur hexafluoride (SF6) tamponade. Both eyes were pseudophakic and had no other ocular or systemic pathology. Patients were controlled 24 hours following the surgery and both presented with normal anterior segment examination and normal intraocular pressure. Both patients complained of central scotoma and both had very difficult light perception. Fundus examination showed devitalized macula structures in the presence of gas bubbles occupying almost 100% of the vitreous cavity. OCT examination done a few days after surgery revealed necrotic retinal tissue. Four weeks later, both eyes had light perception vision, and devitalization of the central macula and spicule-like pigment changes in the midperiphery of the retinal in both eyes. Conclusion: We present 2 cases of blindness after vitrectomy with ILM peeling combined with 20% SF6 Intraocular tamponade. This severe complication was not related to elevated intraocular pressure due to gas expansion.

Selective laser capsulotomy complications: Management and prevention.

To report how to manage and prevent the incomplete laser cut and following uncut tags of anterior capsular lens, performed using the selective laser capsulotomy. We describe three possible approaches: peeling the anterior capsulotomy disc with forceps, breaking the tags using the cystotomy needle tip, or cutting them using a 23-G vitrectomy scissors. Using the 23-G vitrectomy scissors resulted in no complication. Peeling the anterior capsulotomy using the forceps instead caused zonular stress with subsequent risks of zonular dialysis, whereas using the cystotomy needle tip resulted in irregular capsulotomy rim and weakness all along the capsulotomy edge where micro tears caused a tear during the rest of cataract surgery. Incomplete laser cut and subsequent discontinuous capsulotomy results in the presence of multiple tags which create strong adherence between the central capsulotomy disc and the peripheral capsule. Key steps of the procedure to prevent an incomplete laser cut, which are the anterior lens capsule staining and laser beam focusing, and how to correctly manage them, which may shorten the learning curve and enhance the outcomes.

Effect of Adjunctive Intravitreal Conbercept Injection at the End of 25G Vitrectomy on Severe Proliferative Diabetic Retinopathy: 6-Month Outcomes of a Randomised Controlled Trial.

This study aimed to evaluate the effect of pre-operative versus pre-operative plus post-operative intravitreal conbercept (IVC) injection on severe proliferative diabetic retinopathy (PDR). This was a prospective, comparative and randomised study. A total of 84 patients who underwent vitrectomy for severe PDR were included in this study. Patients were randomly divided into control (41 eyes) and experiment (43 eyes) groups. Patients in the experiment group received adjunctive pre-operative and post-operative IVC injection, whereas patients in the control group only received pre-operative IVC injection. The incidence of post-operative vitreous haemorrhage (POVH), best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were determined. The incidence of early POVH was significantly different between the two groups, but no significant difference was observed between groups at 3 and 6months. In the experiment group, the BCVA was significantly improved 1month after surgery when compared with the control group (p 0.019). There was no marked difference in the mean post-operative BCVA at 3 and 6months between groups (p 0.063 and 0.082). CRT was significantly lower in the experiment group than in the control group at 1 and 3months after surgery (p 0.037 and 0.041), but there was no significant difference at 6months (p 0.894). Additional IVC injected at the end of surgery improves the POVH and BCVA at the early stage after surgery in severe PDR, but this benefit is absent at 6months. Further studies are needed to investigate the effect of IVC at the end of vitrectomy. chictr.org.cn identifier: ChiCTR2200060735. Retrospectively registered, register date: 9 June 2022.

27-GAUGE PARS PLANA/PLICATA VITRECTOMY FOR PEDIATRIC VITREORETINAL SURGERY.

To report on the feasibility of 27-gauge (G) vitrectomy for pediatric patients. This study is an international, multicenter, retrospective, interventional case series. Participants were patients 17 years or younger who underwent 27-G vitrectomy for various indications. The records of 56 eyes from 47 patients were reviewed. Mean age was 5.7 ± 5.2 years. Diagnoses included retinopathy of prematurity (Stages 3 with vitreous hemorrhage, 4A, 4B, and 5), Terson's syndrome, traumatic macular hole, posterior capsular opacification, endophthalmitis, and others. Instruments used were the 27-G infusion, 27-G vitreous cutter, 27-G light pipe, and 27-G internal limiting membrane forceps. Instrument bending was noted in one (1.8%) case. There were no cases with intraoperative complications, infusion issues, or postoperative endophthalmitis. There were 67/145 (46%) sclerotomies that required suturing, of which most (51/145) were sutured out of precaution. There were four cases (7.1%) that required conversion to a larger gauge and three cases (5.3%) that developed postoperative hypotony. Mean visual acuity improved from logarithm of the minimum angle of resolution 1.32 (20/420) to 0.72 (20/105), after a mean follow-up of 125.1 days (P = 0.01). Anatomic success was achieved in 96.4% of eyes after a single surgery. Twenty-seven-gauge vitrectomy was safe and feasible in selected pediatric vitreoretinopathies. Further studies are warranted to examine indications and outcomes.

Evaluation of twenty-seven-gauge vitrectomy for complex proliferative diabetic retinopathy.

To evaluate the outcomes of twenty-seven-gauge (27G) vitrectomy in cases with complex proliferative diabetic retinopathy (PDR). This was a retrospective interventional study of eyes that underwent 27G vitrectomy for complex PDR. The demographic profile, history, examination findings, and intraoperative surgical steps (especially use of other instruments such as intravitreal scissors/forceps) were reviewed. All the eyes were followed up for a minimum of 3 months at 1-week, 1-month, and 3-month interval. Visual acuity, intraocular pressure (IOP), and retinal status were documented at every follow-up. Nineteen eyes of 17 patients with complex PDR were included in the study. Seven eyes had tractional retinal detachment involving the macula, three had tractional retinal detachment threatening the macula, one had secondary rhegmatogenous retinal detachment, and eight eyes had nonresolving vitreous hemorrhage along with thick fibrovascular proliferation (FVP) at posterior pole. Anatomical attachment was seen in all cases at the end of follow-up with a single surgery. Visual acuity improved from logMAR 2.5 preoperatively to logMAR 1.01 at 3 months (P = 0.0003). None of the cases required use of intravitreal scissors/forceps for the removal of FVP. Early postoperative vitreous hemorrhage was seen in two eyes. Hypotony was not seen in any eye, while increased IOP was seen in five eyes. 27G vitrectomy is a safe and effective technique in cases with complex diabetic surgery. Due to smaller size cutter, it offers advantages in the dissection of tissue and is associated with lower incidence of early postoperative hemorrhage.

Small Gauge Techniques for Removing a Fluocinolone Acetonide Implant.

Long-acting injectable fluocinolone releasing implants are used in clinical practice. While limited in scope, situations may arise where removal of the implant is warranted. We set out to describe possible explantation techniques and to determine whether these implants can be safely removed from a standard sclerotomy or eliminated using a vitrectomy system. A vitreoretinal surgery system was designed using a porcine eye model. A fluocinolone implant was injected into the vitreous cavity. Pars plana vitrectomy was performed and the vitreous cavity was infused with balanced salt solution. The injected implants were removed from 23-Gauge (G) and 25-Gauge (G) vitrectomy cannulas with 27-G forceps. The implants were examined under the microscope for induced defects. Implants were injected into the eye model and eliminated using a 23-G and 25-G vitrector system. The implant was removed from both the 23-G and 25-G vitrectomy cannulas with only mild structural damage to the implant. During implant extraction through the 25-G sclerotomy, the cannula was dislodged from the incision along with the implant. The most technically challenging portion involved aligning the implant coaxially to allow for removal en bloc through the sclerotomy site. Implants could be eliminated using both the 23-G and 25-G vitrector using a low-cut rate. The fluocinolone implant was removed safely via standard 23-G or 25-G vitrectomy systems. It is unknown whether intraocular manipulation will affect pharmacokinetics of drug delivery if the implant is not explanted.

Perioperative systemic blood pressure parameters and clinical outcomes following 27g vitrectomy for diabetic tractional detachment repair

BackgroundExtremes in perioperative blood pressures are known risk factors for adverse outcomes after surgical interventions. There is scarce literature studying these parameters as predictors of outcomes after ocular surgery.MethodsThis was...

Trea tment of polypoid choroidal vasculopathy complicated by extensive subretinal hemorrhage. A case report

Polypoid choroidal vasculopathy (PCV) is a type of wet form of age-related macular degeneration (AMD). It is characterized by formation aneurysmal dilations of abnormal choroidal vessels (polyps) under the retinal pigment epithelium (RPE) in the choroid. The disease leads to a vision loss due to formation of serous retinal detachment, neuroepithelium detachment and RPE, subretinal hemorrhages, fibrosis, atrophy of RPE. The generally accepted treatment of PCV is antiangiogenic therapy.The purpose of this work is to present and to analyze the clinical case of polypoid choroidal vasculopathy treatment complicated by extensive subretinal hemorrhage.Description of the case. This clinical case of PCV in the right eye that is complicated by extensive subretinal hemorrhage on the background of antiangiogenic therapy in a 72-year-old man is presented. In addition to standard ophthalmological research methods, we performed optical coherence tomography (OCT) with Cirrus HD-OCT 5000 Zeiss (Carl Zeiss, Germany), angio-OCT with Optovue Solix High-Speed Spectral Optical Coherence Tomograph (Optovue, USA) and fundus photo registration with Topcon TRC-NW8F Retinal Camera (Topcon, Japan). The comprehensive surgical approach was applied to this patient, including posterior subtotal vitrectomy with our Stellaris PC microsurgical system (Baush&Lomb, USA) and the prourokinase subretinal injection against the background of aflibercept antiangiogenic therapy and removal of a concomitant cataract with implantation of an intraocular lens (IOL).Discussion. The early treatment of this patient and at the right time procedure of microinvasive 25-G vitrectomy combined with prourokinase subretinal injection contributed to the resorption of hemorrhage in the shortest possible time and improved visual functions from 0.02 to 0.6.Conclusions. The presented comprehensive approach of PCV treatment and its complications made possible to provide social rehabilitation of the patient and to preserve high values of visual functions in the affected eye.

Complete manuscript title: role of sub-silicone oil application of triamcinolone acetonide (TA) drops on outcomes after 360° relaxing retinectomy: a pilot study.

To perform a pilot study to evaluate the role of sub-silicone oil Triamcinolone Acetonide (TA) crystal drops in complex Retinal Detachment (RD) with extreme proliferative vitreoretinopathy (PVR) requiring 360-degree relaxing retinectomy (RR). It was a retrospective pilot study. It was a retrospective case-control pilot study. TA-assisted 23G or 25G vitrectomy was done in 24 complex RDs with extreme PVR where 360 degree RR had to be performed. Group A (n = 13) included cases where additional TA crystal drops were applied, after settling the detached retina, over the site of RR under silicone oil (SO 5000 CSt) tamponade. In the control arm, group B (n = 11), additional TA crystals were not applied. Mean pre- and post-operative BCVA, ultra-widefield fundus photograph by Optos 200Tx, macular OCT and the propensity to remove silicone oil were measured. Mean pre-operative and post-operative BCVA at final follow-up were Log MAR 2.69 ± 0.41 and Log MAR 1.51 ± 0.90 (Mann-Whitney U test, p < 0.05), respectively, in Group A and Log MAR 2.9 and Log MAR 2.37 ± 0.86 (Mann-Whitney U test, p < 0.05), respectively, in group B. Visual improvement in group A was significantly better than group B (Wilcoxon W test, p < 0.025) with significantly less recurrence of RD (Fisher's Exact Test, p = 0.002). Silicone oil removal was done significantly more in group A (Fisher's Exact Test, p = 0.0017). Sub-silicone oil crystals application over sites of RR after 360-degree relaxing retinectomy leads to improved postoperative visual recovery as well as improved anatomical outcomes with fewer complications.

Curative effect of 25G vitrectomy combined with different anti-VEGF drugs on proliferative diabetic retinopathy

Curative effect of 25G vitrectomy combined with different anti-VEGF drugs on proliferative diabetic retinopathy

An iris puncture technique for restoration of the anterior chamber in vitrectomy for pediatric vitreoretinopathies.

PurposeTo present a novel usage of iris puncture-assisted lensectomy with anterior vitrectomy or vitrectomy in pediatric patients with the absence of anterior chamber caused by various advanced vitreoretinopathies complicated with capsule-endothelial, iris-endothelial adhesion, and secondary glaucoma.DesignProspective study.Materials and methodsForty-one patients were enrolled in this consecutive, prospective study. The iris puncture was performed in all patients using a 20G Vitrectomy Microsurgical Knife, followed by the lensectomy with anterior vitrectomy or vitrectomy. Demographic information, the number of iris puncture times, surgical procedure, intraoperative and postoperative complications, therapy, and prognosis were collected. Patients were followed up for at least 6 months.ResultsA total of 18 female patients and 23 male patients were included, with a mean age of 9.5 ± 7.5 months. The formation of anterior chamber formation was achieved in 28 (68.3%) eyes, with only 1 initial episode of iris puncture, 11 (26.8%) patients required 2 episodes, and 3 episodes of iris puncture, with additional external drainage of subretinal fluid, were needed in the remaining 2 (4.9%) patients. Except for iris incarceration, which occurred in 7 (17%) eyes during operation, there was no iridodialysis or subretinal fluid overflow during operation. At the last visit (mean: 12.16 ± 5.38 months of follow-up), all eyes had a reconstructed anterior chamber with normal depth. No synechiae between the iris and the cornea occurred after surgery. The mean postoperative intraocular pressure was 6.23 ± 1.64 mmHg. A hazy cornea vanished in 31 out of 41 (75.6%) eyes, relieved in 8 out of 41 eyes (19.5%), and 2 out of 41 eyes (4.88%) did not change. In the 25 eyes accepting vitrectomy and lensectomy, 20 out of 25 (80%) achieved different degrees of reattachment.ConclusionThe innovative iris puncture technique is effective, simple, and safe management for the anterior chamber disappearance caused by various advanced pediatric vitreoretinopathies, which helped to lower the intraocular pressure and offers a chance for lensectomy with anterior vitrectomy or vitrectomy.

Хирургическое лечение дегенеративного ламеллярного макулярного разрыва с применением богатой тромбоцитами плазмы крови

Introduction. Surgical treatment of patients with degenerative lamellar macular hole (LMH) does not always improve visual acuity. One of the risk factors for such results is pronounced thinning of the retina in the area of the hole. In such cases, it was suggested to supplement the standard surgical technique with the application of autologous platelet-rich blood plasma (PRP) to the area of the hole. Purpose. To present a clinical case of surgical treatment of degenerative LMH with pronounced retinal thinning using PRP. Material and methods. Patient C., 68 years old, complained of distortion of objects contours and decreased vision in the right eye. His corrected visual acuity was 0.4. Optical coherence tomography revealed a degenerative LMH (Govetto A. et al. classification, 2016) of the right eye with significant retinal tissue defect, with ellipsoidal photoreceptor zone defect and minimal retinal thickness of 59 μm. A three-port subtotal 27G vitrectomy was performed with removal of the epiretinal membranes and internal limiting membrane, tamponade of the vitreal cavity with air, and application of autologous PRP to the hole area. Results. The dynamics of retinal recovery in terms of up to 9 months after surgery is described, the minimum retinal thickness increased from 59 to 238 μm; the maximum corrected visual acuity increased from 0.4 to 1.0. The formation of a hyperreflective zone similar in optical density to plexiform layers was noted in the area where the hole had previously occurred. The size of the hyperreflective zone decreased during observation. By 9 months after surgery, the ellipsoidal zone defect was virtually undetectable. Conclusion. The use of PRP resulted in not only closure of the hole but also normal retinal thickness in the foveal area which contributed to the restoration of the ellipsoidal zone of the photoreceptors and a significant increase of visual acuity. Presumably, PRP contributes to the speedy closure of the hole due to the formation of a glial scar of minimal size. Key words: degenerative lamellar macular hole, platelet-rich blood plasma, vitrectomy, hyperreflective zone, glial scar

Intraoperative Optical Coherence Tomography in Idiopathic Macular Epiretinal Membrane Surgery.

ObjectiveTo evaluate the feasibility and practicability of intraoperative optical coherence tomography (IOCT) in the surgery of idiopathic macular epiretinal membrane (IMM) without internal limiting membrane staining in all patients.MethodsPatients were selected from July 2018 to June 2020, and 32 patients (32 eyes) with IMM were operated with the use of IOCT. All patients underwent standard 23g vitrectomy. The internal limiting membrane was peeled off if there were obvious retinal folds. Intraoperative and postoperative complications, macular microstructural changes, and integrity of the detached membranes were recorded. The preoperative and postoperative best corrected visual acuity were compared.ResultsThe macular epiretinal membrane was completely removed in 75% (24 eyes) patients without internal limiting membrane staining, and in 15.6% (5 eyes) patients with combined internal limiting membrane stripping. The “starting point” of macular epiretinal membrane stripping was found in 75% (24 eyes), and the time required to find the best starting point ranged from 28s to 140s (mean 66 ± 15s). At 3 months after operation, 96.8% of the patients had stable or improved BCVA (p < 0.05). The central macular thickness of the affected eyes decreased significantly at 1 and 3 months after operation (p < 0.05).ConclusionIOCT can significantly reduce the use of internal limiting membrane staining in idiopathic macular epiretinal membrane surgery, and it is safe, feasible and practical in idiopathic macular epiretinal membrane surgery without internal limiting membrane staining in all patients.

Novel Technique of 23G Pars Planar Vitrectomy (TPPV) with Alcon Centurion Silver System Gravity -FMS (ACenSS) and ACenSS Vitrectomy Probe (23G) with an External Light Source in Teaching Hospital Rathnapura Sri Lanka

Dual pneumatic 23G vitrectomy cutters of both Alcon Constellation Vision System (AConsVS) and ACenSS have cut rates of 5000 cpm. Aims: To report a novel technique of using ACenSS 23G Vitrectomy cutter for trocar surgery with an external light source in Teaching hospital Rathnapura Sri Lanka from 01/03/2022 to 30/09/2022. Methods: 23G Alcon light probes were used with Retikare (ICON Medicare Tamil Nadu India) external light source for endoillumination. Infusion pressure was set at 65cmH2O (47.81 mmHg) and infusion line connected to eye through a 3 ways tap. ACenSS-GFMS aspiration line connected to aspiration line of vitrectomy probe. Cryopexy used to seal retinal tears as no endolaser facility. Volk surgical corneal lenses with Zeiss Lumera I microscope provided the viewing. ACenSS foot pedal was programmed to 3 modes of vitrectomy with navigation, cutter on/ off function and on/pause of continuous irrigation. A gravity driven another infusion line is used to keep the infusion when endo diathermy is used. Results: When working on maximum cut rate of the ACenSS GFMS (5000 cpm) for long duration machine automatically stops and a restart with reprime needed. Therefore, cut rates were set at a lower rate to work without interruption (core vitrectomy2000 cpm, peripheral trim- 3000cpm and for epinucleus removal 4000 cpm). No retinal traction or ridging of retina was observed at peripheral trim. Total of 210 TPPVs were performed with this technique. Conclusions: 23G TPPV with ACenSS using an external light source is a simple, safe and a cost-effective technique with equal outcome to AConsVS.

Оптимизация объема предоперационной диагностики у пациентов с персистирующей сосудистой фетальной сетью

Purpose. To optimize the scope of preoperative diagnostics in patients with persistent fetal vascular network. Material and methods. The Kaluga branch underwent surgical treatment of 30 patients with various manifestations of persistent fetal vascular network from 2015 to 2020. The age of the patients was from 3 months to 8.5 years. At the stage of preoperative diagnostics, additional research methods was used: fluorescence angiography (FAG), ultrasound color duplex scanning (UCDS), ultrasound biomicroscopy (UBM). Results. A complex of diagnostic measures made it possible to develop the most individualized plan for surgical treatment. In 16 patients, the anterior type of the disease was determined – phacoaspiration with IOL implantation was performed according to the standard technique, if necessary, a “dry vitrectomy” was carried out with the removal of the posterior lens capsule and adjacent parts of the vitreous body. In 11 patients (11 eyes) with a mixed type, phacoaspiration of the lens with IOL implantation and simultaneous 3-port 27g vitrectomy was performed according to the standard technique; tamponade of the vitreous cavity was not carried out. In 10 patients (30%) in the period from 6 months to 1.5 years after the first intervention the reoperation was required. In 27 patients (90%), the transparency of the optical surroundings was restored. Complete retinal attachment was observed in 22 patients (73%). For 3 to 6 months after surgery in 5 patients (17%), traction retinal attachment occurred. In 3 patients (10%), retinal attachment was not achieved despite repeated interventions. Conclusion. A differential approach to each patient based on preoperative multimodal diagnosis made it possible to expand the indications for surgical treatment and achieve satisfactory anatomical and functional results. Keywords: persistent vascular fetal network, complex of preoperative diagnostics, fluorescent angiography, ultrasound color duplex scanning, ultrasound biomicroscopy.