C3F8 Gas Tamponade Research Articles

Primary rhegmatogenous retinal detachment with inferior retinal breaks postoperative prone positioning results: 1\xa0day versus 7\xa0days

BackgroundTo compare the primary anatomical outcome of pars plana vitrectomy, 360° peripheral endolaser, and 15% octafluoropropane C3F8 gas tamponade in patients with uncomplicated rhegmatogenous detachment and inferior retinal breaks, after 24-h postoperative prone positioning to similar patients with 1 week postoperative prone positioning.MethodsRecords of 5500 patients who underwent pars plana vitrectomy between 2008 and 2015 were retrieved. Collected data included age, gender, number of retinal quadrants with retinal breaks, number of retinal breaks, macula status on presentation (attached or detached), phakic status (phakic, pseudophakic, or aphakic), and primary anatomical outcome (at 1 and 3 months post-operative).Results270 patients met the study inclusion criteria (78 females, and 192 males). In the 24-h positioning arm (183 patients), the overall anatomical success rate was 96.2% at 1 month and 83.6% at 3 months. In the 1-week positioning group (87 patients), the overall anatomical success rate was 93% at 1 month and 79% at 3 months. Both positioning groups did not show statistical difference in outcome at 1 month (p-value = 0.7) or at 3 months (p-value = 0.39). Logistic regression analysis found that the number of retinal breaks correlates with the postoperative anatomical success at 3 months (odd ratio 0.8, p-value = 0.016).ConclusionThis short term retrospective study demonstrated that patients with uncomplicated rhegmatogenous retinal detachment due to inferior retinal breaks, who underwent pars plana vitrectomy, 360° endolaser, 15% C3F8 gas, and limited (24-h) prone positioning did not show statistical difference in the anatomical outcome (at 1, and 3 months) when compared with 1 week postoperative positioning. Larger prospective studies are warranted to further elucidate positioning role.

Clinical efficacy of vitrectomy combined with internal limiting membrane tamping on macular hole and retinal detachment in high myopia

Objective To evaluate the safety and effectiveness of vitrectomy combined with internal limiting membrane (ILM) tamping on macular hole and retinal detachment (MHRD) in highly myopic eyes. Methods 23 patients (23 eyes) were retrospectively reviewed, who were diagnosed as MHRD through examination of the ocular fundus, optic coherence tomography (OCT) and B-mode ultrasonography. There were 5 males (5 eyes) and 18 females (18 eyes). The mean age was (62.35±8.28) years. The mean course of disease was 1.1 months. The logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) was 2.31±0.72. The mean axial length was (28.66±1.99) mm. All patients underwent 23G microincision vitrectomy. After vitreous gel and cortex were gently resected, the ILM around the edges of the macular hole was stained with indocyanine green, and was folded and pushed to fill the macular hole gently. Then silicone oil or C3F8 gas tamponade was applied in 18 eyes and 5 eyes, respectively. The silicone oil was removed after 3 months. The follow-up was 6 months. The BCVA, macular hole closure, retinal anatomical reattachment were retrospectively observed, and were used to evaluate the safety and effectiveness of the surgery. Results At the 6 months after surgery, the logMAR BCVA was improved to 1.13±0.38, the difference was significant (t=15.33, P=0.00). The postoperative macular hole closure rate and retinal anatomical reattachment rate were 100%. There were no ocular or systemic adverse events observed in all patients. Conclusion Vitrectomy combined with ILM tamping is an effective and safe treatment for the high myopic eyes with MHRD. Key words: Retinal perforations/surgery; Retinal detachment/surgery; Myopia, degenerative/complications; Vitreoretinal surgery

Comparison on clinical efficacy of surgical treatment and conservative treatment for traumatic macular hole

Objective To compare the clinical efficacy of surgical and conservative therapy in patients with traumatic macular hole. Methods The data of 56 eyes of 56 cases with traumatic macular hole were retrospectively analysed. Thirty cases were rondomly selected as surgical group, and treated with vitrectomy, internal limiting membrane peeling and C3F8 gas tamponade. Twenty-six cases of the same period were used as control group, and treated with conservative therapy. The visual acuity and macular hole diameter after treatment between the two groups were compared and analyzed. Results All patients were followed up for 3-6 months, average (4.6±0.5). The hole closed in 26 cases (86.7%), visual acuity improved in 15 cases (50%) at the last follow-up time in surgical group. The control group were 11 cases (39.3%) and 12 cases (46.2%) accordingly. The closure rate of macular hole in the surgical group was better than that of the conservative group (χ2=10.327, P=0.001), but there was no significant difference in visual acuity between two groups. Conclusion Surgical treatment is helpful to improve the closure rate of traumatic macular hole, but the improvement of visual acuity is not obvious. Key words: Macular hole, traumatic; Surgery; Drug therapy; Visual acuity

The efficacy of different surgical methods for secondary macular epiretinal membrane

Objective To observe the efficacy of different surgical methods for secondary macular epiretinal membrane(SEM). Methods Clinical data of 52 eyes of 52 cases with SEM who underwent surgical treatment were retrospectively analysed. Patients in group A (26 eyes) underwent pars plana vitrectomy+ membrane peeling + intravitreal injection of luncentis(0.5 mg/ 0.05 ml) .Patients in group B (26 eyes) underwent pars plana vitrectomy+ membrane peeling + fluid-air exchange + C3F8(20%) gas tamponade. Postoperative changes in best corrected visual acuity (BCVA), macular morphology and the complications were observed. Results The follow-up time was 4-14 months. In group A, the BCVA improved in 20 eyes after the operation, it was unchanged in 5 eyes and decreased in 1 eye, the post-operative BCVA improved comparing with the preoperative one (t=4.125, P=0.00035). In group B, the BCVA improved in 18 eyes after the operation, unchanged in 6 eyes and decreased in 2 eyes, the post-operative BCVA improved comparing with the preoperative one(t=3.817, P=0.00052). The difference in vision improvement between the two groups was not statistically significant(z=0.661, P=0.24). The thickness of neuroepithelium in the central macular area ( CMT) was statistically improved after the surgery in both the two groups. But the improvement of CMT was faster in group A. In group A, small amount of retinal hemorrhage happened in 6 eyes during the surgery, and vitreous hemorrhage occurred in 1 eye after the surgery. Prepheral retinal hole occurred in 3 eyes , in which one eye was cured by laser treatment, and the other two eyes needed secondary surgery. In group B, small amount of retinal hemorrhage happened in 8 eyes during the surgery, and vitreous hemorrhage occurred in 4 eyes after the surgery. Prepheral retinal hole occurred in 3 eyes, and were cured in all 3 eyes by laser treatment. Epiretinal membrane(EM)was seen in 2 eyes during follow-up time in group B, which ocurred after vitreous hemorrhage absorption. Conclusion Both the two kinds of operation can cure SEM effectively. The surgical method of group A can improve the CMT faster, reduce the risk of vitreous hemorrhage and epiretinal membrane recurrence. The surgical method of group B can cure the tractional retinal hole effectively. Key words: Macular epiretinal membrane, secondary; Surgery; Thickness, neuroepithelium, central macular area; Complications

LONG-TERM OUTCOMES FOR OPTIC DISK PIT MACULOPATHY AFTER VITRECTOMY.

To evaluate the efficacy of pars plana vitrectomy for congenital optic disk pit maculopathy with various adjuvant techniques, including gas tamponade, internal limiting membrane peel, and temporal optic disk endolaser in a multicenter study with long-term follow-up. A retrospective chart review was performed to identify eyes that underwent surgical repair for congenital optic disk pits and serous macular detachment with or without macular retinoschisis from four retinal centers across Canada from 2003 to 2013. Data collected included surgeries performed, preoperative and postoperative vision, central retinal thickness, and presence or absence of subretinal fluid. Optical coherence tomography was used to define anatomical success (i.e., foveal reattachment). Thirty-two eyes of 32 patients with optic disk pits and serous macular detachments were identified that had undergone surgical repair. All eyes underwent pars plana vitrectomy and induction of posterior vitreous detachment if one was not present. Additional procedures performed on occasion included internal limiting membrane peel (n = 8), temporal optic disk pits endolaser (n = 7), and gas tamponade (air, C3F8 or SF6; n = 31). After vitrectomy surgery, foveal attachment was achieved in 26 of 32 eyes (81.3%). The average number of surgeries required was 1.4 ± 0.6, with a maximum of 3 vitrectomies (n = 2). Mean change in best-corrected visual acuity was -0.47 ± 0.54 logMAR units, which corresponds to approximately 5 lines of visual improvement (P < 0.001). Median time to reattachment was 416 days. Preoperative vision, preoperative symptom days, and age were not associated with postoperative reattachment. Similarly, internal limiting membrane peel and temporal endolaser were not associated with postoperative reattachment, nor was there a difference between air and SF6 and C3F8 gas tamponade. Elevated preoperative central retinal thickness was associated with a lower chance of postoperative reattachment (P = 0.007) and was also the best prognostic indicator of success (P = 0.039). Vitrectomy for macular detachment due to optic disk pit has good long-term success and results in an improvement in visual acuity. However, adjuvant techniques such as internal limiting membrane peel and temporal endolaser may not improve outcomes, nor does there seem to be a difference between short- and long-acting gases. Patients should be made aware that it can take more than a year and multiple surgeries to achieve foveal reattachment and that increased baseline central retinal thickness is a poor prognostic sign.

LONG-TERM OUTCOMES OF 23-GAUGE PARS PLANA VITRECTOMY WITH INTERNAL LIMITING MEMBRANE PEELING AND GAS TAMPONADE FOR MYOPIC TRACTION MACULOPATHY: A Prospective Study.

To investigate the long-term safety and efficacy of microincisional 23-gauge pars plana vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade in the treatment of myopic traction maculopathy. A prospective nonrandomized multicenter study was designed. Patients with myopic traction maculopathy without macular hole and retinal detachment were included in the study between January 2009 and May 2012. All patients underwent microincisional 23-gauge pars plana vitrectomy with ILM peeling and 12% C3F8 gas tamponade. In all cases, brilliant blue G staining of the ILM was performed. All patients were prospectively evaluated. The evolution of best-corrected visual acuity (BCVA) and macular thickness were recorded. Myopic traction maculopathy resolved in 28 of the 30 patients (93%) included. Mean follow-up was 33.8 ± 13 months (range, 24-60 months). Mean time of myopic traction maculopathy resolution after surgery was 2.65 ± 1.4 months. At 1 month after surgery, one patient developed a macular hole and another one a rhegmatogenous retinal detachment. After 2 years, another patient developed a retinal detachment. Statistically significant improvements in macular thickness compared with baseline were found at all follow-up visits (P < 0.001, Student's t-test). At final visit, BCVA improved significantly compared with baseline (P = 0.044, Wilcoxon's test). However, a statistically significant improvement in visual acuity was achieved only in eyes with a preoperative Snellen visual acuity ≥ 20/63 (P = 0.027). In contrast, the final BCVA of eyes with worse preoperative visual acuity (<20/63) did not improve significantly (P = 0.41, Wilcoxon's test). Microincisional 23-gauge pars plana vitrectomy with ILM peeling and gas tamponade is effective in the treatment of myopic traction maculopathy, with low postoperative complications. Globally, both BCVA and macular thickness improved significantly during the follow-up period. However, greater visual acuity improvements were only seen in eyes with preoperative BCVA equal to or better than 20/63 Snellen equivalent. Some concerns remain about the risk of macular hole formation after ILM peeling. Further studies are necessary to investigate this issue.

Combined anterior and posterior segment surgery in the treatment of penetrating eye injuries with small intraocular foreign body

Objective To investigate the clinical efficacy of combined anterior and posterior segment surgery in early treatment of penetrating eye injuries with small intraocular foreign body. Methods Twenty-two eyes of 22 patients suffered penetrating eye injuries with small intraocular foreign bodies underwent the combined operations of anterior and posterior eye segment 2-4 days after emergent debridement and suturing and according to their conditions different surgical procedures were preformed. Anterior segment surgery included anterior chamber forming, iris suture laceration, cataract extraction and intraocular lens implantation and posterior segment surgery included vitrectomy, foreign body removal, retinal laser photocoagulation around the injury site and C3F8 gas or silicone oil tamponade. The surgery efficacy and the complications were analyzed from 3months to 12 months. Silicone oil was removed 4-5month after operation. Results Intraocular foreign bodies were removed in once operation in all cases. All the patients got the intraocular lens implantation at the same time during the surgery. No serious complication happened, such as endophthalmitis, intraocular lens shift, uveitis, retinal detachment, choroidal detachment or secondary glaucoma. All the cases got the best corrected visual acuity improved from light perception -0.1 before operation to 0.05-0.8. Conclusion Combined anterior and posterior segment surgery in early treatment of penetrating eye injury with small intraocular foreign body can achieve good clinical efficacy. Key words: Foreign body, intraocular; Injury, ocular, penetrating; Cataract, traumatic; Lens, intraocular; Vitrectomy

Vitrectomy combined with intraviteal injection of half-dose triamcinolone acetonide for proliferative diabetic retinopathy

Objective To investigate the efficacy and safety of pars plana vitrectomy (PPV) combined with intraviteal injection of half-dose triamcinolone acetonide (TA) for proliferative diabetic retinopathy (PDR). Methods Thirty-nine eyes of 32 patients with PDR accepted PPV combined with intraviteal injection of half-dose TA (2 mg/0.05 ml). And membrane peeling, retinal photocoagulation, scleral cryocoagulation, silicone oil or C3F8 gas tamponade were applied according to particular situation respectively. The visual acuity, intraocular pressure (IOP), inflammatory reaction of anterior chamber, lens opacification, vitreoretinal hemorrhage and detachment of retina were observed and analyzed after the procedure. Results Postoperative following up was 3~18 months, with average (7.81±4.52) months. The visual acuity was improved in 36 eyes (92.31%), and the difference was statistically significant between the preoperative one and the postoperative one (Z=-5.539, P=3.03×10-8). The difference between the preoperative IOP and the postoperative IOP 3rd month postoperatively was not statistically significant (t=-0.204, P=0.84). Transient postoperative elevated IOP occurred in 8 eyes(20.51%) in two weeks after surgery. All cases had mild inflammatory reaction of anterior chamber. Cataract appeared in 8 eyes (20.51%). And retinal detachment occurred in 2 eyes (5.13%). Conclusion PPV combined with intraviteal injection of half-dose TA is safe and effective for the treatment of PDR. It could control inflammation and improve visual acuity with few serious complications. Key words: Retinopathy, diabetic, proliferative; Vitrectomy; Triamcinolone acetonide, half-dose

Risk factors for posterior synechiae of the iris after 23-gauge phacovitrectomy.

To identify risk factors for the development of posterior synechiae of the iris (PSI) after 23-gauge phacovitrectomy. A retrospective chart review was performed in consecutive Asian patients treated with 23-gauge phacovitrectomy with a 3-piece intraocular lens (IOL) or a single-piece 4 haptics IOL. A total of 263 eyes from 242 patients were included in the study. Postoperative PSI was identified in 16 (6.1%) eyes. In multivariate analysis, C3F8 gas tamponade, oil tamponade, and long operation time were significantly associated with PSI formation. There was no difference in the incidence of PSI between the groups using two different types of IOL (P=0.779). C3F8 gas or oil tamponade and long operation time increased the incidence of PSI after 23-gauge phacovitrectomy. The single-piece 4 haptics IOL, in lieu of a 3-piece IOL, may be inserted into the capsular bag with a comparable incidence of PSI.

Non-Descemet Stripping Descemet Membrane Endothelial Keratoplasty

To report a case of non-Descemet stripping Descemet membrane endothelial keratoplasty (nDMEK) in a patient with pseudophakic bullous keratopathy. A 70-year-old man underwent an nDMEK in his right eye, which suffered from pseudophakic bullous keratopathy after a complicated cataract surgery was performed. Under local anesthesia, an 8-mm sized round Descemet membrane and endothelial cell graft (DMEK graft), harvested from an 85-year-old male donor cornea, were transplanted without stripping the recipient's Descemet membrane. The patient was examined at 1 week, 2 weeks, 3 weeks, 4 weeks, 2 months, 4 months, and 6 months after the surgery took place. Optical coherence tomography, Scheimpflug imaging (Pentacam, Oculus), and specular microscopy were performed. Graft detachment was observed at 1 and 2 weeks after the surgery, but this was successfully resolved with C3F8 gas tamponade in the anterior chamber. Thereafter, no graft detachment was observed, and the cornea remained clear 6 months after the surgery. The best-spectacle corrected visual acuity was improved from 20/100 to 20/25, and central corneal pachymetry was improved from 713 to 570 µm. No ocular complication was detected at the final visit. An nDMEK was successfully performed in a patient with pseudophakic bullous keratopathy and resulted in a good visual outcome.

Clinical features and outcomes of vitrectomy for diabetic retinopathy with central retinal vein occlusion

Objective To observe the clinical features and outcomes of vitrectomy for diabetic retinopathy (DR) with central retinal vein occlusion (CRVO) in type 2 diabetes mellitus (T2DM).Methods A total of 192 patients (241 eyes) with proliferative DR (PDR) who underwent vitrectomy were enrolled in this study.All the patients were diagnosed as vitreous hemorrhage (VH) because of suddenly decreased vision.There were 93 eyes with tractional retinal detachment (TRD) and six eyes with neovascularization of iris (NVI).The patients were divided into PDR with CRVO group (group A,41 eyes) and PDR group (group B,200 eyes) according to the results of fundus examination.All patients received vitrectomy with silicone oil and C3F8 gas tamponade.There were 138 eyes with silicone oil tamponade which including 30 eyes in group A and 108 eyes in group B.The difference of number in silicone oil-filled eyes in two groups was statistically significant (x2=5.110,P＜0.05).There were 38 eyes with C3F8 gas tamponade which including six eyes in group A and 32 eyes in group B.There was no difference in C3F8 gas-filled eyes numbers in two groups (x2 =0.048,P＞0.05).The follow-up ranged from one to 60 months,with the mean of (28.69± 17.28) months.The corrected vision,retinal reattachment,persisting macular edema (ME),neovascular glaucoma (NVG) and repeated VH after surgery were comparatively analyzed.Results Of 241 eyes,there were 41 eyes (17.0％) with CRVO.Before surgery,the differences of corrected vision (Z=-0.138),intraocular pressure (t=0.966),whether there was TRDor not (x2=0.412),whether underwent panretinal photocoagulation or not (x2 =1.416) were not statistically significant (P＞0.05),but the difference of whether NVI were present or not was statistically significant (x2=31.724,P＜0.05)between two groups.After surgery,the corrected vision improved in both two groups (Z=2.319,4.589;P＜0.05).There was no difference of corrected vision after surgery between two groups (Z=0.782,P＞0.05).Postoperative complications occurred in 94 eyes,including 26 eyes in group A and 68 eyes in group B.The differences of incidence of reoperation (x2 =0.498),retinal reattachment (x2 =0.818),persisting ME (x2 =2.722) between two groups after surgery were not statistically significant (P ＞ 0.05).The incidence of repeated VH (x2 =5.737) and NVG (x2 =6.604) in group A were higher than those in group B (P＜ 0.05).Conclusions CRVO is commonly found to coexist with DR in T2DM patients with VH.Combined with CRVO patients are more likely to suffer NVI.Vitrectomy can improve the visual function in PDR with CRVO patients. Key words: Diabetic retinopathy/surgery; Retinal vein occlusion/therapy; Disease attributes; Vitrectomy

Long-term outcomes of pars plana vitrectomy without internal limiting membrane peeling for optic disc pit maculopathy

To evaluate the results of surgical treatment of maculopathy secondary to congenital optic pit anomaly with pars plana vitrectomy (PPV), endolaser to the temporal edge of the optic disc and C3F8 tamponade without internal limiting membrane (ILM) peeling. Thirteen eyes of 12 patients with serous macular detachment and/or macular retinoschisis secondary to congenital optic disc pit (ODP) were included in the study. All eyes underwent PPV, posterior hyaloid removal, endolaser photocoagulation on the temporal margin of the optic disc and 12% C3F8 gas tamponade. Anatomic success and functional outcome determined retrospectively by optical coherence tomography and measurement of best corrected visual acuity (BCVA), respectively were the main outcome parameters. Two lines or more improvement in BCVA was obtained in 11 eyes and 6 of these eyes had 20/40 or better BCVA at the final visit. Subretinal or intraretinal fluid was completely resorbed postoperatively in 12 eyes but a little intraretinal fluid persisted in one eye at the 16-month follow-up. Better visual improvement was observed in patients treated by earlier surgical intervention. PPV, C3F8 gas tamponade and endolaser to the optic disc margin without ILM peeling may yield favourable results in the treatment of ODP maculopathy.

Revisiting Autologous Platelets as an Adjuvant in Macular Hole Repair: Chronic Macular Holes Without Prone Positioning

Chronic macular hole and inability to maintain prone positioning remain poor prognostic markers for successful macular hole closure. The authors revisited the role of autologous platelets as an adjunct to internal limiting membrane (ILM) peeling of chronic macular holes in patients unable to maintain prone positioning. A retrospective case study was conducted on 13 eyes of 13 patients with full-thickness chronic macular hole (> 24 months). Each patient was unable to maintain prone positioning due to medical and physical comorbidities. Each eye was treated with pars plana vitrectomy, ILM peeling, autologous platelets, and C(3)F(8) gas tamponade. No positioning was advised postoperatively. All patients had complete ophthalmic examinations preoperatively and 1 day and 1, 3, and 6 months postoperatively with optical coherence tomography. Outcome measures were anatomic closure based on Tornambe classification, final best-corrected visual acuity, and improvement of quality of vision. All 13 patients completed 6 months' follow-up. Macular hole duration ranged from 2 to 5 years. There was a 100% macular hole closure rate at 1 and 6 months postoperatively. All patients reported subjective improvement in visual acuity as an improvement of an absolute central scotoma. At 6 months postoperatively, 38% of patients reported improved best-corrected visual acuity. There were no recurrences. Autologous platelets and ILM peeling may function synergistically to enhance chronic macular hole closure in patients unable to maintain prone positioning.

Efficacy of vitreoretinal surgery for X-linked retinoschisis and its complications

Objective To evaluated the efficacy of vitreoretinal surgery for X-linked retinoschisis (XLRS) and its complications.Methods Twenty-one XLRS patients (27 eyes) with retinal detachment or vitreous hemorrhage who were treated by vitreoretinal surgery were enrolled in this study. There were microcystis-like splitting in all the eyes.The mean visual acuity was 0.11 ± 0.09 and the mean area of macular splitting was (1.09±0.56) mm2.Among the eyes,there were 12 eyes with rhegmatogenous retinal detachment,five eye with traction retinal detachment,six eyes with vitreous hemorrhage and four eyes with retinal detachment and vitreous hemorrhage.All the patients underwent a standard three-port pars plana vitrectomy.Internal limiting membrane peeling,laser photocoagulation,and C3F8 gas or silicone oil tamponade were carried out in different condition.The follow-up was 9 - 122 months (average 51 months).The preoperative visual acuity and anatomic structure of retina were observed.Results The mean visual acuity at last visit was increased to 0.26±0.15,the difference was significant (t=-6.320,P=0.000).It improved in 20 eyes (74.1％ ),remained unchanged in seven eyes (25.9 ％).The retina remained attached in 27 eyes.The mean area of macular splitting was decreased to (0.29 ±0.21) mm2,the difference was significant (t=10.358,P=0.000).The complications were found in four eyes (14.8％) which including two eyes with proliferative vitroretinopathy and traction retinal detachment six and eight months after surgery,one eye with cataract four months after surgery,and one eye with vitreous hemorrhage 15 months after surgery.The retina remained attached in these four eyes after reoperation.Conclusion Vitreoretinal surgery can significantly improve visual acuity,resume the anatomic structure of retina. Key words: Retinoschisis/congenital; Retinoschisis/surgery; Vitrectomy/methods; Treatment outcome

Long term result of silicone oil versus gas tamponade in the treatment of traumatic macular holes

PurposeTo compare the effectiveness of pars plana vitrectomy (PPV) with either silicone oil or gas tamponade for the treatment of traumatic macular holes.MethodsA retrospective comparative study included 22 patients who were operated on by PPV for repair of traumatic macular holes with either silicone oil tamponade (nine patients) or perfluoropropane (C3F8) gas tamponade (13 patients).ResultsTwenty-two cases were reviewed to assess the anatomical and visual outcomes of surgery with silicone oil tamponade in nine cases (40.9%) vs 14% C3F8 gas tamponade in 13 cases (59.1%). The age of the silicone oil-treated patients ranged from 10 to 40 years (mean 27.4 ± 11.3 years), while that of the gas-treated patients ranged from 19 to 35 years (mean 26.54 ± 5.68 years). Female patients accounted for 33.3% of the silicone oil group and 30.77% of the gas-treated group. The minimal follow-up time for the silicone oil-treated group was 13 months, with a maximum of 18 months after silicone oil removal. The minimal follow-up time for the gas-treated group was 12 months and the maximum was 24 months. The rate of hole closure after the primary operation with oil tamponade was significantly lower than that with gas tamponade (66.67% vs 92.3%; P = 0.022). With re-operations, the final rate of hole closure was higher in the gas group (100%) than in the silicone oil group (77.8%). The final postoperative decimal visual acuity for the gas group was significantly better than for the oil group (0.433 vs 0.245; P = 0.047).ConclusionsC3F8 gas was a more effective tamponade than silicone oil in achieving initial closure of traumatic macular holes. Eyes receiving an oil tamponade required significantly more re-operations to achieve hole closure than did eyes undergoing a gas tamponade. Final visual acuity was better for gas-treated eyes than for silicone oil-treated eyes.

Macular hole surgery with short-acting gas and short-duration face-down positioning

PurposeTo report on the outcomes of vitrectomy and sulfur hexafluoride (SF6) gas tamponade for idiopathic macular holes with 2 days of face-down positioning.Patients and methodsThis was a prospective, nonrandomized, observational sequential case-series study on 23 consecutive patients receiving macular hole surgery using 20% SF6 and advised to stay in a face-down position for 2 days postoperatively (SF6 group). These patients were compared to 23 consecutive patients who had previously undergone macular hole surgery, had received 14% C3F8, and were advised to maintain a face-down position for 2 days (C3F8 group). Patients in both groups underwent vitrectomy, internal limiting membrane peeling, and fluid gas exchange using either SF6 or C3F8. Preoperative and postoperative data included best corrected visual acuity recorded in LogMAR units, slit-lamp biomicroscopy, and optical coherence tomography.ResultsAt a 6-month follow-up, macular hole closure was noted in 23/23 eyes (100%) and in 22/23 eyes (96%) in the SF6 and C3F8 groups, respectively. The improvement in visual acuity (measured through Snellen acuity lines both preoperatively until 6 months postoperatively) was 4.08 ± 2.31 (95% confidence interval [CI]: 3.08–5.08) for the SF6 group and 2.87 ± 2.30 (95% CI: 1.87–3.86) for the C3F8 group; this difference was not statistically significant (P = 0.06).ConclusionVitrectomy with internal limiting membrane peeling and a short-acting gas tamponade using SF6 with posture limitation for 2 days may give a high success rate in macular hole surgery.

Macular holes after retinal detachment surgery

AbstractPurpose To study the incidence, characteristics and management of Macular Holes (M.H.) developing after retinal detachment repair.Methods The records of 4 patients with M.H. following retinal detachment were reviwed. All patients underwent three‐port pars plana vitrectomy, internal limiting membrane removal, 14% C3F8 gas tamponade with post‐operative face down positioning for two days.Results Macular holes were diagnosed from 1 to 9 months post‐operatively. Macular hole closure was achieved in all patients. Functional improvement was compromised by pre‐existing macular pathology.Conclusion Macular holes may develop after retinal detachment repair and they can be managed with conventional M.H. surgery.

Conjunctival pigmentation after 23-gauge microincisional vitrectomy surgery

To investigate cases with conjunctival pigmentation originating from sclerotomy sites after 23-gauge microincisional vitrectomy surgery (MIVS). This is a retrospective study comprised of 185 eyes from 185 consecutive patients who underwent 23-gauge MIVS. The authors investigated the incidence and the clinical factors associated with conjunctival pigmentation, including indication of vitrectomy and surgical procedures. Eight eyes (4.3%) from 185 eyes showed conjunctival pigmentation after surgery within 7 days postoperatively. Light microscopic examination of excised tissue showed infiltration of abundant dark brownish colored melanophages with surrounding scattered, finely granular, melanin pigments. C3F8 gas tamponade (OR, 9.4; 95% CI, 1.9-44.5; P=0.005) was significantly associated with conjunctival pigmentation. The mean surface area (21.26±2.21 mm(2)) of three eyes with C3F8 tamponade was significantly larger than that of five eyes (2.51±0.73 mm(2)) without tamponade (P=0.025). Neither leakage nor hypotony was found. Intraocular melanin pigments could prolapse through the sclerotomy site and cause conjunctival pigmentation after 23-gauge MIVS. Thus, preoperative warning is necessary in patients with 23-gauge MIVS.

Surgical treatment of an enlarging retinal cyst associated with a choroidal coloboma.

The purpose of this study was to describe a case of an enlarging retinal cyst associated with a choroidal coloboma, which was treated surgically in a child. A retrospective case report. A funduscopic examination of a 5-year-old boy revealed a retinal cyst in the inferonasal area of the right fundus. The corrected visual acuity at initial examination was 20/40. During the follow-up period, the retinal cyst waxed and waned spontaneously. Seven years after the first examination, the visual acuity decreased to 20/1000 due to an enlarged retinal cyst, which obscured the macula and did not recover. At the 9-year follow-up, barrier laser around the retinal cyst and pars plana vitrectomy with retinectomy, internal drainage of the cyst, and 14% C3F8 gas tamponade were performed. There was a colobomatous choroidal defect at the base of the retinal cyst. The patient's visual acuity improved to 20/25, and the retina remained flat at the 2-year follow-up postoperatively. We managed a very rare case of a retinal cyst associated with a choroidal coloboma. During the 9-year follow-up, the retinal cyst waxed and waned spontaneously. The enlarging retinal cyst that caused visual impairment was treated successfully by barrier laser and vitreous surgery. The visual acuity recovered completely.

Macular hole formation after vitrectomy for retinal detachment

Editor, E arlier theories of macular hole (MH) formation include the suggestions that its development is caused by tangential vitreomacular traction (Gass 1995) or cystoid degeneration of foveal inner retinal layers. Further studies using optical coherence tomography (OCT) suggest that vitreofoveal traction plays a major role in the pathogenesis of MH (Haouchine et al. 2001). The primary purpose of vitrectomy is to relieve vitreous traction at the macula; hence, MH formation in an eye that has previously undergone vitrectomy remains a conundrum. We describe five cases of full-thickness MH formation in eyes that had previously undergone vitrectomy performed by five different surgeons (Table 1). The mean age of the patients was 59.6 years and all were male. Four patients initially presented with a macula-off rhegmatogenous retinal detachment (RD) and one with a macula-on tractional RD. They underwent RD repair with uncomplicated three-port pars plana vitrectomy (PPV), cryotherapy to the breaks and gas tamponade (20% SF6 or 14% C3F8). Macular hole was diagnosed 12 days to 4 months postoperatively (Fig. 1A) and confirmed by Stratus OCT (Carl Zeiss Meditec AG, Jena, Germany) (Fig. 1B). Four patients opted for further three-port PPV, internal limiting membrane (ILM) peel and 14% C3F8 gas tamponade with postoperative facedown posturing. In all cases, the retina remained flat after RD repair and the MH T a b le 1 . P a ti en t d et a il s.