23-G Pars Plana Vitrectomy Research Articles

The efficacious combined treatment of rhegmatogenous retinal detachment (PVR ≤ C2) with inferior breaks using 25-gauge pars plana vitrectomy and air tamponade.

To examine the surgical results of 25-gauge (25-G) pars plana vitrectomy (PPV) with air tamponade for the repair of primary rhegmatogenous retinal detachment (RRD) with inferior retinal breaks. A retrospective consecutive study was conducted from March 2019 to February 2023 on 27 patients with primary RRD with inferior breaks who underwent 25-G PPV with air tamponade. Once the surgery was completed, the patients were monitored for a minimum of 6 months. Postoperative best-corrected visual acuity (BCVA), postoperative complications, and the rate of single surgery anatomical success were the primary outcome measures. The average age of the 12 female and 15 male study participants was 50.2 ± 12.8 years. The follow-up period was 10.3 ± 3.9 months on average. On average, the affected clock hours were 5.6 ± 2.1 hours, and the average number of retinal breaks was 2.2 ± 1.8. Moreover, the final anatomical success rate was 100%, compared to the estimated initial anatomical success rate of 96.30% following a single surgery. At 6 months, we also noticed a significant change in the mean BCVA, which went from 1.62 ± 0.71 logMAR (preoperative) to 0.89 ± 0.61 logMAR (postoperative) (P < .001). On the first day and the week following surgery, the mean intraocular pressure (IOP) was similar (all P > .05). One patient experienced postoperative complications such as retinal redetachment, which was addressed with the same procedure. After surgery, 2 patients had IOP of 35 and 28 mm Hg for 1 week. Two weeks following surgery, their IOP essentially returned to normal after receiving antihypertensive medication. No other notable postoperative complications were observed. According to this research, 25-G PPV with air tamponade has a satisfactory success rate in repairing primary RRD with inferior breaks. This procedure also produces quicker visual recovery and is linked to fewer complications.

Differential distribution of fibrovascular proliferative membranes in 25-gauge vitrectomy for proliferative diabetic retinopathy.

To analyze the distribution of fibrovascular proliferative membranes (FVPMs) in proliferative diabetic retinopathy (PDR) patients that treated with pars plana vitrectomy (PPV), and to evaluate the outcomes separately. This was a retrospective and cross-sectional study. Consecutive 25-gauge (25-G) PPV cases operated for PDR from May 2018 to April 2020. According to the FVPMs images outlined after operations, subjects were assigned into three groups: arcade type group, juxtapapillary type group, and central type group. All patients were followed up for over one year. General characteristics, operation-related variables, postoperative parameters and complications were recorded. Among 103 eyes recruited, the FVPMs distribution of nasotemporal and inferiosuperioral was significantly different (both P<0.01), with 95 (92.23%) FVPMs located in the nasal quadrants, and 74 (71.84%) in the inferior. The eyes with a central FVPM required the longest operation time, with silicon oil used in most patients, generally combined with tractional retinal detachment (RD) and rhegmatogenous RD, the worst postoperative best-corrected visual acuity (BCVA) and the highest rates of recurrent RD (all P<0.05). FVPM type, age of onset diabetes mellitus, preoperative BCVA, and combined with tractional RD and rhegmatogenous RD were significantly associated with BCVA improvement (all P<0.05). Compared with the central type group, the arcade type group had higher rates of BCVA improvement. FVPMs are more commonly found in the nasal and inferior mid-peripheral retina in addition to the area of arcade vessels. Performing 25-G PPV for treating PDR eyes with central FVPM have relatively worse prognosis.

SPONTANEOUS RESOLUTION OF SUBFOVEAL PERFLUOROCARBON: CASE REPORT AND REVIEW OF THE LITERATURE

Purpose: To report a case of spontaneous resolution of subfoveal perfluorocarbon liquid (sPFCL). Methods: A 72-year-old male presented with poor vision in the left eye for two months. Ophthalmic examination revealed a visual acuity of counting fingers at 40 cm, pseudophakia, and rhegmatogenous retinal detachment in the left eye. The patient underwent 23G pars plana vitrectomy associated with a scleral buckle and silicone oil. Postoperatively, a retained sPFCL bubble was observed on OCT image. Results: Postoperatively, the sPFCL bubbles disappeared spontaneously by a full-thickness macular hole. Four weeks after surgery, the macular hole was closed, and visual acuity improved with preservation of foveal depression. Conclusion: Because spontaneous resolution rarely occurs, retinal surgeons prefer early evacuation of sPFCL. Herein, we report a new case of spontaneously resolved sPFCL and discuss the mechanisms for its resolution reported in the literature.

Characteristics of fundus autofluorescence imaging at 795 nm and its correlations with postoperative outcomes for idiopathic macular hole.

Vitrectomy combined with internal limiting membrane (ILM) peeling or ILM inverted flap greatly improves hole closure and vision prognosis for idiopathic macular holes (IMH). The application of indocyanine green (ICG) in MH surgery increases the visibility of ILM and the safety of surgery. However, the area of ILM peeling and the state of the flap and a closed hole has not been well observed. Fundus autofluorescence at 7935nm can show the range of ILM peeling and the state of the hole site and ILM flap by monitoring residual ICG postoperatively. However, the characteristics of fundus autofluorescence especially the site of the closed hole, and its relationship with vision prognosis have not been explored. The aim of this project was to find the autofluorescence features of the closed hole and their relation with vision. To investigate the characteristics of fundus autofluorescence imaging after ICG-assisted vitrectomy for IMH and to evaluate the correlations of fluorescence patterns at the MH site with visual acuity and macular anatomic outcomes. We retrospectively evaluated 33 IMH patients (33 eyes) who underwent a 25G pars plana vitrectomy (follow-up, 6-14.5 months). ICG staining (2.5 mg/mL) was either used to remove the internal limiting membrane (ILM) or the inverted ILM flap was overlaid on the hole. After surgery, fluorescence imaging of the fundus was obtained using a scanning laser ophthalmoscope at 795 nm. On fluorescence imaging, the area of ILM peeling in all eyes showed hypofluorescence with no changes over time. The inverted ILM flap (performed in 18 eyes) was positioned on the inferior retina and exhibited early mild hyperfluorescence with blurred edges. This was gradually enhanced up to 3-6 months postoperatively and was then attenuated. MHs showed two distinct patterns on optical coherence tomography: granular (21 eyes) and patchy hyperfluorescence (12 eyes). Best-corrected visual acuity improved postoperatively in all cases (p<0.001, Z=-4.744). VA was worse in the patchy (vs. granular) hyperfluorescence cases (p=0.011, Z=-2.548). The status of the ILM peeling area, ILM flap, and closed MH can be clearly observed using autofluorescence imaging at 795 nm. Fluorescence may be due to ICG staining of the ILM and accumulation in retinal pigment epithelium cells during ICG-assisted surgery. Granular hyperfluorescence at the MH site may indicate good anatomic and visual prognoses.

Pars plana vitrectomy in patients aged 85 years and older: a single-centre, retrospective cohort study

PurposeTo describe the epidemiology, indications and surgical results of pars plana vitrectomy (PPV) in patients over 85 years of age.MethodsA retrospective cohort study was performed including all consecutive patients aged 85 years or older who underwent PPV between September 2018 and March 2022 in a single hospital in Madrid, Spain. Data on diagnosis, comorbidities, surgical indication, surgical details, surgical complications and surgical outcomes were collected from medical records.ResultsA total of 124 eyes of 119 patients (56 males, 47.1%) underwent PPV. Median age was 87 years (range 85–96). The most common surgical indications were complications of cataract surgery in 34 patients (28.6%), macular epiretinal membrane in 32 (26.9%), and rhegmatogenous retinal detachment (RRD) in 12 (10.1%). Mean preoperative best corrected visual acuity (BCVA) was 13.33 ± 42.34 ETDRS letters and improved to 40.05 ± 41.04 letters at 3 months (p < 0.001). BCVA had improved in 68.82% of patients at 3 months. Patients with chronic kidney disease (CKD; p < 0.001), RRD (p = 0.003), ocular trauma (p = 0.001) and age-related macular degeneration (AMD; p = 0.002) showed worse BCVA at 3 months from surgery. Patients with better preoperative BCVA (p < 0.001), and those who underwent 25G PPV (p = 0.041) showed better visual outcomes.ConclusionsPPV is an effective technique for improving visual acuity in patients aged 85 years and older with vitreoretinal diseases. Visual outcomes were better when patients had a better preoperative visual acuity and underwent 25G PPV. Patients with a previous diagnosis of AMD or CKD, and those undergoing surgery for ocular trauma or RRD had worse visual outcomes.

Management of Retinal Detachment With a Coexistent Macular Hole: Submacular Placement of Retinal Autograft Through a Macular Hole.

In this article, a submacular autologous neurosensory retinal transplantation technique is presented in patients with large macular hole (MH) accompanying retinal detachment. In the surgical procedure, 23-G pars plana vitrectomy and peripheral vitrectomy were performed. An autologous neurosensory retinal patch, which should be larger than the diameter of the MH, was released from a suitable quadrant. The retinal patch was grasped using a 23 gauge microforceps and then passed through the MH and placed under the macula. Liquid perfluorocarbon (PFCL) was injected, and the retina was reattached. A subfoveal autologous neurosensory retinal patch was repositioned in the center of the MH with gentle manipulation under fluid perfluorocarbon, if necessary. Laser retinopexy was applied to peripheral tears under PFCL Subsequently, a 5,000-cSt silicone oil-PFCL exchange was also performed. Four eyes of four patients were operated on using the technique described earlier. Silicone oil was removed from two patients, and the macular holes were closed in all patients at the last follow-up. This technique has been beneficial in refractory MHs and can improve the visual potential in eyes with MHs.

Pars Plana Vitrectomy in Tuberculous Endophthalmitis: A Case Report

Introduction: Ocular tuberculosis (TB) is an extrapulmonary mycobacterial disease with varied manifestations. Endophthalmitis is a severe manifestation with a rapid progression that may lead to intraocular tissue destruction and panophthalmitis. This study aimed to report a case of tuberculous endophthalmitis treated with pars plana vitrectomy (PPV).&#x0D; Case presentation: A 57-year-old male patient with TB endophthalmitis. The follow-up period was 6 months. The diagnosis was made on a clinical basis, and the specific etiology was confirmed by TST and IGRA tests. The diagnosis of ocular TB was delayed by one year. He had bilateral endophthalmitis with severe inflammation. The right eye (OD) was blind, and the left (OS) had best-corrected visual acuity (BCVA) of hand motion. Intraocular pressure (IOP) was elevated in both eyes. B-scan disclosed hyperreflective exudate, filling 1/3 of the vitreous cavity in OD, and vitritis and intravitreal hemorrhage in OS. We commenced triple antitubercular therapy. 23G PPV with silicone oil and phacoemulsification with IOL implantation were done. The intraocular inflammation in OS decreased postsurgically, and in one month, BCVA was 20/200 and IOP was within normal limits.&#x0D; Conclusion: Eendophthalmitis is an indication for therapeutic vitrectomy. The risks of surgery seem to be lower than the benefits, including a decent chance for visual improvement and avoidance of enucleation. In our case, 23G PPV with phacoemulsification seemed to be beneficial in decreasing the level of inflammation, improvement of visual acuity, reduction of IOP, and preservation of the eye.

Surgical Audit for the Outcome of Primary Rhegmatogenous Retinal Detachment Repair in the Kingdom of Bahrain.

The purpose of the study was to audit the primary and final success rate for primary rhegmatogenous retinal detachment (RRD) surgery performed between 2017 and 2022 at the Department of Ophthalmology in Salmanyia Medical Complex, the Kingdom of Bahrain. In addition, secondary outcomes for our study include assessments of risk factors for recurrence, final visual outcomes and complication rates. Prospective observational study showed data analysis of case series for 75 RRD patients operated during the study period. All patients who met the inclusion criteria were included in the study and evaluated by a specialized vitreoretinal surgeon before and after their operation. All patients were operated by the same surgeon (M.A) in the study period. Data collected from the hospital's electronic medical recording system (I-Seha) include macular state, pre- and postoperative best-corrected visual acuity, duration of symptoms, the presence of proliferative vitreoretinopathy (PVR), retinal breaks and their locations, any ocular comorbidities associated in the perioperative period such as increase in intraocular pressure or development of cataract, and operative notes related to the type of primary, secondary, and tertiary surgery if needed. A total number of 70 eyes from 70 patients with the majority of male patients (74.28%, n = 52) were included in the study. The mean age of the participants was 54.75 years (range: 11-91 years). Most of the patients 48.57% presented within 6 days of symptoms. Nearly 77.1% of the operated cases were macula off, whereas 22.85% were macula on. Thirty-six of the eyes (51.4%) had complex RRD with a combination of PVR (34.2%). Sixty-three of the eyes (51.4%) underwent standard 23G pars plana vitrectomy, while the combined surgery with a scleral buckle was performed on 9 eyes (12.8%). Five patients underwent pneumatic retinopexy and two patients had primary scleral buckles. Combined phacoemulsification with vitrectomy in selected cases was performed on 13 eyes (18.5%). Different tamponading agents were used 35 eyes (50%) silicon oil, 17 eyes (24%) C3F8, and 18 eyes (25%) SF6. The primary reattachment rate after one operation was 77.1% (54 eyes). The final reattachment rate following a second or third procedure was 95.7%. The mean postoperative visual acuity was 6/18 (range: 6/6 to hand motions). Thirty percent of the cohort of patients had a visual acuity of 6/12 or better. Sixteen out of the 70 eyes redetached (22.8%) and 10 of those eyes (62.5%) were classified as "complex" preoperatively which is thought to be a significant risk factor for failure. Our audit overall met international success rates despite the presence of some complex scenarios which required multiple surgical interventions. The primary use of gas or silicon oil did not influence reattachment rates but had a statistical significance when it came to final visual outcomes.

Safety and performance assessment of hyaluronic acid-based vitreous substitutes in patients with phthisis bulbi.

To assess the safety and performance of hyaluronic acid-based vitreous substitutes in phthitic eyes. In this retrospective interventional study a total of 21 eyes from 21 patients with phthisis bulbi were treated at the Eye Clinic Sulzbach between August 2011 and June 2021. Patients who underwent a 23G pars plana vitrectomy received a vitreous substitute composed of (I) a non-crosslinked hyaluronic acid (Healon GV), (II) a crosslinked hyaluronic acid-based hydrogel (UVHA), or (III) silicone oil (SO-5000). Main outcome measures were the intraocular pressure (IOP), the visual acuity and the structural integrity of the retina and choroid assessed by optical coherence tomography. An increase in IOP ≥ 5 mmHg was achieved with SO-5000 in 5/8 eyes (6/10 interventions, 60.0%) for 36.4 ± 39.5 days, with Healon GV in 4/8 eyes (7/11 interventions, 63.6%) for 82.6 ± 92.5 days and with UVHA in 4/5 eyes (5/6 interventions, 83.3%) for 93.6 ± 92.5 days. Visual acuity increased in 5/21 eyes (23.8%), remained constant in 12/21 eyes (57.1%) and decreased in 4/21 eyes (19.0%). No enucleations were required during the mean follow-up time of 192 ± 182 days. The OCT images indicated the preservation of retinal structures, while choroidal folds were only diminished in UVHA eyes. Hyaluronic acid-based hydrogels are biocompatible vitreous substitutes in humans and can increase and stabilize IOP in patients with phthisis bulbi for about 3 months.

The Short-Term Results of Autologous Platelet-Rich Plasma as an Adjuvant to Re-Intervention in the Treatment of Refractory Full-Thickness Macular Holes

The purpose of this study was to investigate the short-term efficacy and safety of autologous platelet-rich plasma (a-PRP) as an adjuvant to revisional vitrectomy for refractory full-thickness macular holes (rFTMHs). We conducted a prospective, non-randomized interventional study including patients with rFTMH after a pars plana vitrectomy (PPV) with internal limiting membrane peeling and gas tamponade. We included 28 eyes from 27 patients with rFTMHs: 12 rFTMHs in highly myopic eyes (axial length greater than 26.5 mm or a refractive error greater than -6D or both); 12 large rFTMHs (minimum hole width > 400 μm); and 4 rFTMHs secondary to the optic disc pit. All patients underwent 25-G PPV with a-PRP, a median time of 3.5 ± 1.8 months after the primary repair. At the six-month follow-up, the overall rFTMH closure rate was 92.9%, distributed as follows: 11 out of 12 eyes (91.7%) in the highly myopic group, 11 out of 12 eyes (91.7%) in the large rFTMH group, and 4 out of 4 eyes (100%) in the optic disc pit group. Median best-corrected visual acuity significantly improved in all groups, in particular from 1.00 (interquartile range: 0.85 to 1.30) to 0.70 (0.40 to 0.85) LogMAR in the highly myopic group (p = 0.016), from 0.90 (0.70 to 1.49) to 0.40 (0.35 to 0.70) LogMAR in the large rFTMH group (p = 0.005), and from 0.90 (0.75 to 1.00) to 0.50 (0.28 to 0.65) LogMAR in the optic disc pit group. No intraoperative or postoperative complications were reported. In conclusion, a-PRP can be an effective adjuvant to PPV in the management of rFTMHs.

23-Guage Vitrectomy with Internal Gas Tamponade for the Management of Rhegmatogenous Retinal Detachment

Purpose: To find out functional and anatomical outcomes of 23-G pars plana vitrectomy (PPV) with gas tamponade (C3F8/SF6) for Rhegmatogenous Retinal Detachment (RRD). Study Design: Quasi Experimental Study. Place and Duration of Study: Liaquat National Hospital Karachi Ophthalmology department, from October 2020 to April 2021. Methods: Fifty-five eyes of 55 patients with RRD were included in the study by convenient sampling. The patients underwent 23-G PPV with gas tamponade under general anesthesia. Anatomical and functional results were evaluated in the form of retinal attachment and change in the best corrected visual acuity (BCVA). Frequency of complications were also assessed. An average follow up period was 6 months. Results: Out of 55 patients, 32.7% were males and 67.3% were females. Mean age of the patients was 49.14 ± 17.11 years ranging from 17 years to 79 years. Four quadrants were involved in 36.4% of the patients. Among 55 eyes, 40% were phakic and 60% were pseudophakic. Only 4 (7.3%) patients needed redo procedure. Mean pre-operative and post-operative visual acuity was 2.52 ± 0.67 and 0.80 ± 0.66 with a significant mean difference of 1.71. Anatomical success was seen in 92.7% of patients. Conclusion: Anatomical success and improvement in the best corrected visual acuity (BCVA) is achievable with 23-G PPV with expansible gas used as internal tamponade in the treatment of RRD.

25-Gauge pars plana vitrectomy combined with air tamponade for primary rhegmatogenous retinal detachment

This study was performed to evaluate the outcomes of 25-gauge (25-G) pars plana vitrectomy (PPV) with air tamponade for primary rhegmatogenous retinal detachment (RRD). This retrospective consecutive case series included 126 eyes of 125 patients with primary RRD who underwent 25-G PPV with air tamponade. The patients were followed up for at least 6 months following surgery. The main outcome measures were the primary and final anatomical success rates and postoperative complications. The mean age of the 125 patients (80 men and 45 women) was 53.7 ± 10.0 years. The mean follow-up period was 8.3 ± 2.2 months (range, 6-18 months). Twenty-four eyes (19.0%) presented with high myopia, and 13 eyes (10.3%) were pseudophakic. Of the 126 eyes, 37 (29.4%) had inferior breaks, 2 (1.6%) had choroidal detachment, and 86 (68.3%) had macular detachment. The single- and final-operation success rates were 96.0% and 100%, respectively. Postoperative complications included macular hole formation in two eyes. During follow-up, secondary cataract surgery was performed in 27 (23.9%) of the 113 phakic eyes. 25-G PPV with air tamponade is effective and safe in treating selected patients with primary RRD with a high anatomical success rate.

Optimal timing of preoperative intravitreal anti-VEGF injection for proliferative diabetic retinopathy patients.

To analyze concentrations of vascular endothelial growth factor (VEGF) and fibrosis-related factors in vitreous fluid of proliferative diabetic retinopathy (PDR) patients pre-treated with intravitreal anti-VEGF injections (IVI) at different time periods prior to pars plana vitrectomy (PPV), and their correlation with the degree of vitreoretinal fibrosis and explore the optimal timing of preoperative IVI. The prospective case-control study from January 2019 to July 2020 included 31 eyes with PDR-related complications (PDR group) and 21 eyes with non-diabetic ocular disease (control group) requiring PPV. PDR eyes were divided into four groups based on timing of PPV: 3d after IVI (3-day group); 5d after IVI (5-day group); 7 or more days after IVI (≥7-day group); and no IVI. Vitreous fluid samples (0.5-1.0 mL) were collected prior to switching on the infusion before routine 23-G PPV. Concentrations of VEGF, basic fibroblast growth factor (bFGF), periostin (PN), interleukin (IL)-6, IL-8, and tumor necrosis factor (TNF)-α were measured by immunoassay, and concentration differences for each cytokine were compared among the groups. The degree of vitreoretinal fibrosis was graded intraoperatively, and the correlation between the changes in cytokine levels and the severity of vitreoretinal fibrosis was analyzed by univariate ordinal logistic regression analysis. PDR eyes without IVI had significantly higher VEGF, bFGF, PN, and IL-6 concentrations than non-diabetic eyes (all P<0.05), and had a significantly higher concentration of VEGF (P<0.05) and a significantly lower concentration of IL-8 (P<0.05) than PDR eyes with IVI. Statistically significant differences were also observed for concentrations of VEGF, bFGF, PN, IL-6, and IL-8 among 3-day, 5-day, and ≥7-day groups (all P<0.05); meanwhile there was no significant difference in TNF-α among groups (P=0.226). The 5-day group had the lowest concentration of VEGF and the ≥7-day group had the highest concentration of bFGF and PN. The degree of vitreoretinal fibrosis was significantly higher in the ≥7-day group compared to the 3-day (P=0.015) and 5-day group (P=0.039), and vitreoretinal fibrosis correlated significantly with concentrations of bFGF, PN, IL-6, and IL-8 (all P<0.05). Univariate ordinal logistic regression analysis showed that bFGF was an independent risk factor for the severity of vitreoretinal fibrosis in PDR patients pre-treated with IVI. The vitreous concentrations of VEGF, bFGF, PN, IL-6, and IL-8 change after pretreatment with IVI before PPV in PDR patients. The degree of vitreoretinal fibrosis is higher in patients with a longer time between IVI treatment and PPV, which may be related to the angio-fibrosis switch. The results suggest that PPV should be performed 5d after IVI administration in PDR patients.

Clinical observation of vitrectomy combined with endolaser photocoagulation at the edge of posterior scleral staphyloma for macular hole retinal detachment in high myopia.

To observe the clinical effect of pars plana vitrectomy (PPV) and silicone oil filling surgery combined with intraoperative posterior scleral staphyloma (PS) marginal retinal photocoagulation in the treatment of high myopic macular hole retinal detachment (MHRD) with PS. This was a retrospective clinical study. From May 2017 to March 2020, 62 MHRD patients with PS (62 eyes) were enrolled in the study. Patients were divided into 23G PPV combined with PS marginal retina intraoperative photocoagulation group (combined group) and conventional surgery group (conventional group), with 31 eyes in each. Triamcinolone acetonide and indocyanine green were used to remove the epiretinal membrane and the posterior macular inner limiting membrane (ILM). In the combined group, 2 to 3 rows of retinal photocoagulation were performed on the edge of the PS. The patients were followed up for an average of 8.34±3.21mo. The first retinal reattachment rate, macular hole closure rate, Duration of silicone oil tamponade, best corrected visual acuity (BCVA) and average number of operations were observed and compared between the two groups. The first retinal reattachment rates of the eyes in the combined group and the conventional group were 96.7% (29/31) and 67.7% (21/31), respectively (χ2 =6.613, P=0.010). The macular hole closure rates in the combined group and the conventional group were 74.2% (23/31) and 67.7% (21/31), respectively (χ2 =0.128, P=0.721). The Duration of silicone oil tamponade of the patients in the combined group was lower than that of the routine group (t=-41.962, P≤0.001). Postoperative logMAR BCVA values of patients in the combined group and the conventional group were 1.27±0.12 and 1.26±0.11, compared with the logMAR BCVA before surgery, each group was improved (t=19.947, t=-19.517, P≤0.001, P≤0.001). There was no significant difference in the logMAR BCVA between the eyes of the two groups (t=-0.394, P=0.695). The average numbers of operations on the eyes in the conventional group and the combined group were 2.39±0.62 and 2.06±0.25 times, the combined group had fewer operations on average (t=-2.705, P=0.009). Intraoperative PPV treatment of MHRD with PS combined with PS marginal endolaser photocoagulation can effectively increase the rate of retinal reattachment after the first operation, reduce the number of repeated operations, and reduce the postoperative duration of silicone oil tamponade.

Three-year results of combined pars plana vitrectomy and phacoemulsification in diabetic vitreous hemorrhage

Aim: The purpose of this study was to evaluate the efficacy and safety of complications following combined pars plana vitrectomy and phacoemulsification surgery of the eyes for the management of vitreous hemorrhage due to proliferative diabetic retinopathy as well as pronounced cataracts.&#x0D; Material and Method: Phacoemulsification and 23G pars plana vitrectomy procedures were performed for the management of vitreous hemorrhage and cataracts. Age, gender, best-corrected visual acuity before and after surgery, and intra- and post-operative complications were recorded in patients with cataracts who underwent surgery due to vitreous hemorrhage.&#x0D; Results: A total of 40 eyes of 40 patients, 22 females (55%) and 18 males, were included in the study. The mean age was 58.7±7.1 (44–76) years. Logmar visual acuity changed from a mean of 2.82±0.5 preoperatively to a mean of 0.7±0.6 postoperatively. Visual acuity increased in 38 eyes (95%) postoperatively. No reduction in visual acuity was observed in any eye. Complications associated with surgery included transient intraocular pressure increase (12 eyes), hyphema (2 eyes), posterior capsule rupture (1 eye), anterior chamber fibrin exudation (4 eyes), neovascular glaucoma (1 eye), vitreous hemorrhage (4 eyes), retinal detachment (1 eye), and posterior capsule opacification (2 eyes).&#x0D; Conclusion: It was found that combined phacoemulsification and PPV surgery was safe and effective in patients with proliferative diabetic retinopathy. Combined phaco-vitrectomy is a reliable method with a minimum complication profile and prevents the need for subsequent cataract surgery.

Prophylactic Laser Treatment Posterior to Pars Plana Vitrectomy Sclerotomy Wounds During Macular Surgery.

IntroductionSclerotomy related retinal breaks (SRRBs) are a risk factor for postoperative retinal detachment (RD). Endolaser posterior to sclerotomy wounds decreased the risk of SRRBs after 20G pars plana vitrectomy (PPV) for macular disease. However, similar data do not exist for 25G and 23G wounds.MethodsA retrospective cohort study of patients after 23G and 25G PPV for macular pathology was conducted between August 2017 and August 2020. The primary outcome was the postoperative rate of SRRBs or RDs. The secondary outcome was the postoperative rate of pupillary dysfunction and neurotrophic keratopathy. All participants had a minimum postoperative follow-up of one year.ResultsOne hundred seventeen patients were included in the study (62 in the laser group and 55 in the control group). Mean age was 65.4 ± 11.3 years (56.4% female and 43.6% male). Most of the laser group underwent 23G PPV (90%) while most of the control group underwent 25G PPV (96%). One patient in the control group developed RD secondary to a SRRB. No SRRBs or RDs developed in the laser group. None of the secondary outcomes developed in either group after one year.ConclusionsTo the best of the authors’ knowledge, this is the first report in the literature on prophylactic laser posterior to small gauge sclerotomies (25G and 23G) during macular surgery. Laser treatment posterior to small gauge sclerotomies (25G and 23G) had a similar incidence of SRRBs as with 20G sclerotomies. Larger prospective studies are needed to further understand the role of laser in lowering SRRB risk.

Outcomes from the Retrospective Multicenter Cross-Sectional Study on Lamellar Macular Hole Surgery.

PurposeTo analyze the functional and anatomical parameters of lamellar macular hole (LMH) surgery with internal limiting membrane peeling and determine which surgical technique provides the best visual outcome.MethodsThis is a retrospective multicenter cross-sectional study on patients who underwent pars plana vitrectomy (PPV) for LMH with or without combined phaco-vitrectomy, as well as gas-, air- or BSS-tamponade. Pre- and postoperative examination included best corrected visual acuity (BCVA) measurements for functional comparison and optical coherence tomography (OCT) scans to determine the contributing anatomical parameters.ResultsA total of 66 consecutive patients were included (age: 71.79 ± 8.52 years), of which 47 (71.2%) were diagnosed as tractional type LMH, and 19 patients (28.8%) as degenerative type. An epiretinal membrane (ERM) was present in 63 of the patients (95.5%), LMH-associated epiretinal proliferation (LHEP) was present in 19 patients (28.8%), and 16 patients (24.2%) had concomitant ERM and LHEP. In the group of tractional LMH, the mean central foveal thickness (CFT) was 81.1% thicker (P < 0.05) than in the degenerative group. Thirty-one patients (47.0%) underwent a combined phaco-vitrectomy procedure, while the rest underwent 23G, 25G or 27G PPV. Seventeen of the 66 patients received gas-tamponade (25.7%)-either SF6 or C3F8, 26 received air-tamponade (39.4%), while the remaining 23 patients received balanced salt solution (BSS)-tamponade (34.9%) during vitrectomy. The total BCVA showed significant improvement postoperatively (p < 0.001) and accordingly in the following groups: tractional LMH type (p < 0.001), degenerative type (p < 0.001), simple PPV (p < 0.001), phaco-vitrectomy (p < 0.001), BSS injection (p < 0.01), gas-tamponade (p < 0.05). None of the patients included in the study developed a full thickness macular hole postoperatively.ConclusionPPV provided a high success rate and functional improvement for treating LMH for both tractional and degenerative types, as well as combined phaco-vitrectomy treatment when cataract was present.

Air Tamponade for Rhegmatogenous Retinal Detachment With Inferior Breaks After 25-Gauge Pars Plana Vitrectomy: Technique and Outcome.

To evaluate the outcomes of 25-guage (G) pars plana vitrectomy (PPV) with air tamponade for rhegmatogenous retinal detachment (RRD) with inferior breaks. This retrospective consecutive case series included fifty-two eyes of fifty-two RRD patients with inferior breaks who underwent 25-G PPV with air tamponade. These patients were followed up for at least 6 months following surgery. Primary and final anatomical success rates and postoperative complications were the main outcome measures. The mean age of the patients (39 men and 13 women) was 51.8 ± 11.8 years. There were 49 primary RRDs (94.2%) and three recurrent RRDs (5.8%). The mean follow-up period was 8.2 ± 1.6 months (range: 6–13 months). Sixteen eyes (30.8%) presented with high myopia, and six eyes (11.5%) were pseudophakic. Proliferative vitreous retinopathy grade was C1 in four eyes (7.7%). Of the 52 eyes, two (3.8%) were complicated with choroidal detachment, and forty (76.9%) had the macula detached. The single- and final-operation success rates were 96.2% and 100%, respectively. During follow-up, secondary cataract surgery was performed in eight eyes (17.4%) of the 46 phakic eyes. 25-G PPV with air tamponade is effective in treating selected RRD patients with inferior breaks. Patients can benefit from early visual recovery and less complications.

Outcomes of early vitrectomy for endophthalmitis after cataract surgery in delta population, Egypt, 2015–2020

Purpose To evaluate the outcomes of early pars-plana vitrectomy (PPV) in the management of acute onset endophthalmitis after cataract surgery. Study design Retrospective observational study. Patients and methods We collected data from 11 patients who were diagnosed as acute infectious endophthalmitis within 6 weeks after cataract surgery, from January 2015 to December 2020 and had undergone early 23-G PPV and were followed up for 3 months. We analyzed factors that may affect prognosis and final visual outcomes. Results The mean age was 58±5 years, there was male predominance (72.7%). The mean axial length was 24.76±1.58 mm. The baseline best-corrected visual acuity was 2.3 logMAR and was improved to 1.2 logMAR at the third month (P&lt;0.001). Mixed air/fluid intraocular tamponade was used in 63.6% of patients. About half of the cases had positive cultures (54.5%), and the most frequent organism was Staphylococcus aureus (66.7%). Retinal detachment was reported in 36.4% of patients. The preoperative factors correlated with final best-corrected visual acuity were posterior vitreous detachment and intraocular tamponade. Conclusions Early PPV for acute-onset endophthalmitis after cataract surgery aided in improving final visual outcome and preserving structural and functional integrity of the globe, thus preventing late complications that could affect patients’ quality of life. Factors that influence the final visual outcome were intraocular tamponade and posterior vitreous detachment.

Pars Plana Vitrectomy Port Sizes: A Meta-Analysis of Randomized Controlled Trials.

The uptake of small-gauge (SG; ie, 23-gauge [23-G], 25-gauge [25-G], and 27-gauge [27-G]) pars plana vitrectomy (PPV) has grown. We aim to investigate the advantages and disadvantages of various PPV port sizes in a meta-analysis of randomized controlled trials (RCTs). A systematic literature search was performed for RCTs comparing PPV port sizes for any indication. Weighted mean differences (WMDs) and risk ratios (RRs) were calculated, and meta-analysis was performed with random-effects models. A total of 1,678 eyes from 22 RCTs were included. Risk-of-bias assessment found some concerns in 13 studies. Compared with 20-gauge PPV, there was no significant difference in the final or change in best-corrected visual acuity (BCVA; five studies analyzed each) relative to that of SG PPV. SG PPV was associated with a significantly greater incidence of hypotony (RR = 3.79; 95% confidence intervals [CI], 2.02 to 7.10; P < .0001; six studies) and choroidal detachment (RR = 5.65; 95% CI, 1.01 to 31.71; P = .05; three studies). Compared with 25-G PPV, there was no significant difference in BCVA at any time point with 23-G (two studies), and significantly more frequent port suturing was required with 23-G (RR = 0.46; 95% CI, 0.25 to 0.84; P = .01; two studies). Compared with 25-G PPV, 27-G was associated with a significantly better final BCVA (WMD = -0.06 logMAR; 95% CI, -0.11 to -0.01; P = .02; five studies) and a significantly lengthened surgery (WMD = 4.11 minutes; 95% CI, 0.18 to 8.05; P = .04; three studies). There was no significant difference in visual or surgical outcomes following 20-gauge PPV relative to SG PPV (Grading of Recommendations, Assessment, Development, and Evaluation recommendation: low certainty), and there was an increased risk of postoperative complications with SG PPV (moderate certainty). Compared with 25-G PPV, 23-G required more frequent port suturing (moderate certainty), whereas 27-G may be associated with a better final BCVA but longer surgery (low and moderate certainty, respectively). [Ophthalmic Surg Lasers Imaging Retina. 2022;53:152-158.].