Combined Pars Plana Vitrectomy Research Articles

Duration after Macular Hole Surgery for Stabilisation of Visual Acuity: A Long-term Retrospective Review

The purpose of the study is to determine the median duration for visual recovery to achieve visual stability and visual acuity gain after macular hole surgery in our local population. This was a retrospective study. Patients with full-thickness macular holes (FTMH) from surgical logs were included between January 2009 and December 2019. The patients' medical records were reviewed for pre-, intra-, and post-operative data collection. Patients who fulfilled the inclusion and exclusion criteria were recruited and analysed. Data collected from the medical record pre-operatively, which included baseline best corrected visual acuity (BCVA), interval of symptoms development to surgery, any ocular co-morbidities, optical coherence tomography (OCT) for size and stage of macular hole and central subfield thickness (CST). Intra-operative notes included whether vitrectomy with or without phacoemulsification and with the internal limiting membrane (ILM) peel or ILM flaps, types of dye, and tamponade agent used. Post-operative data included BCVA and CST on each visit, types of macular hole closure, or any complications. Data were analysed using SPSS.Thirty-one patients were diagnosed with FTMH. Sixteen patients who underwent pars plana vitrectomy (PPV) were included and analysed. Fifteen patients (93.75%) achieved successful macular hole closure after the primary operation. The median duration BCVA reached at stability was 19.5 months (IQR 9 – 26.25), and visual acuity gained by 0.44 LogMAR (IQR 0.165 – 0.565). Ten patients (62.5%) underwent combined PPV with phacoemulsification. CST showed improvement from baseline, 444 (IQR 347.5 – 519.75) to 273 (IQR 232 -285.5), 230 (IQR 221.5-255), and 270 (IQR 254-322) at the period interval of 0 to 3 months, 3 to 6 months, and 6 to 12 months respectively. Gas C3F8 and membrane blue were commonly used as tamponade agents and dyes, and PPV with ILM peel was the common surgery performed. Six patients (40%) achieved type 1 macular hole closure within 12 months of follow-up. Despite the small sample size, our study provided practical information regarding patient’s expectations of when their vision can become stable after macula hole surgery in our local population.

Comparison of pars plana vitrectomy and combined pars plana vitrectomy with phacoemulsification for proliferative diabetic retinopathy: A retrospective study about 120 eyes.

To compare the outcomes of pars plana vitrectomy (PPV) and combined PPV with phacoemulsification (PPVCE) surgeries for proliferative diabetic retinopathy (PDR) and cataract treatment. Retrospective analysis of 120 diabetic patients who underwent PPV or PPVCE. The key outcome indicators were best-corrected visual acuity (BCVA) and post-operative complications. The PPVCE group had an average age of 53 years, with 50% females and 50% males. The initial visual acuity (VA) was 1.84 log MAR. In this group, BCVA remained stable or increased in 61 eyes (74%). Regarding the PPV group, the average age was 43 years; 65% were men while 34% were women. The initial VA was 1.83 log MAR; in this group, the VA increased or remained stable in 28 eyes (73%). The evolution of the VA was rather symmetric in the two groups without a significant difference (P = 0.9). Similarly, the occurrence of postoperative complications was comparable for the main complications studied, namely the inflammatory reaction (P = 0.809), ocular hypertension (P = 0.344), corneal edema (P = 0.07), and neovascular glaucoma (P = 0.413). However, there was a decrease in BCVA (three lines) in the PPV group after 6 months of follow-up (P = 0.05) in patients with a clear lens preoperatively and who developed a clinically evident cataract. According to this study, for diabetic patients with severe cataracts and vitreoretinal disease requiring vitrectomy, combining vitrectomy with phacoemulsification as a single surgical intervention may be a suitable therapeutic choice. This approach does not significantly increase the risk of visual impairment or retinopathy development.

The Role of Preoperative Case Selection in the Training of Surgical Repair of Primary Rhegmatogenous Retinal Detachment.

To analyse single-operation anatomical success (SOAS) of primary rhegmatogenous retinal detachment (RRD) repair by junior vitreoretinal surgeons guided by preoperative individual case selection by an experienced mentor vitreoretinal surgeon. Retrospective, single institute, observational study, included all patients who underwent standard pars plana vitrectomy (PPV) or combined encircling band (CB) and PPV and gas tamponade in the treatment of RRD from November 2021 to December 2022 were included. Preoperative selection for the surgery decision, whether standard PPV or combined CB & PPV was undertaken through the senior surgeon; according to the location and extensions of the RRD, number of retinal tears (RT) and lens status. We excluded patients with tractional retinal detachment, RD with proliferative vitreoretinopathy stage C, giant tears, trauma, previous scleral buckle, schisis RD and RD requiring silicone oil. The primary outcome measure was to evaluate the single-operation anatomic success (SOAS). Secondary outcome measures evaluated whether there was a statistical significant difference between both procedures. Eighty-two eyes were included in the study. Forty-five eyes were selected for combined CB&PPV and 37 eyes for standard PPV. SOAS was achieved in 40 eyes (88.8%) in combined group and 35 eyes (94.5%) in standard PPV group. There was no statistically significant difference in the success rate between both operations, p = 0.65. Structured preoperative selection of standardized surgical techniques according to the degree of complexity of RD together with close supervision enables junior vitreoretinal surgeons in training to achieve re-attachment rates of more than 80% with both types of surgeries.

Combination phacoemulsification and pars plana vitrectomy for retinal reattachment surgery in the Siberian Husky breed.

To report the success rate and complications of combined phacoemulsification and pars plana vitrectomy (PPV) for treatment of cataracts and retinal detachment in the Siberian Husky breed. Client-owned Siberian Husky dogs that underwent combined phacoemulsification and PPV at two veterinary referral centers. Retrospective study of 16 Siberian Husky dogs that underwent combined phacoemulsification and PPV with a minimum 3-month postoperative follow-up. Signalment and preoperative ophthalmic examination findings, intraoperative findings, and postoperative visual status and complications were recorded. Functional success was defined as the maintenance or restoration of vision. Seventeen eyes of 16 dogs were evaluated. Immediate postoperative anatomic success was achieved in all 17 eyes (100%), with functional success through the last known follow-up examination achieved in 88.2% of operated eyes (15/17). The most common postoperative complication was silicone oil migration into the anterior chamber (AC-SiO migration), occurring in 47.1% of eyes (8/17), followed by corneal endothelial decompensation and glaucoma each occurring in 17.6% of eyes (3/17). Combined phacoemulsification and PPV is a viable option in Siberian Husky dogs with cataracts and preoperative retinal detachment. Visual success was achieved in 88.2% of eyes, with the most common postoperative complication being AC-SiO migration.

Scleral sutured toric intraocular lens with pars plana vitrectomy for the correction of corneal astigmatism without capsular support.

To describe the repair of a patient with bilateral subluxed cataract and corneal astigmatism in the setting of a coloboma of the iris, zonules, lens, and retina. Pre-operatively his best corrected acuity was 20/500 OD and 20/200 OS. His pre-operative refraction was -7.25 +1.00 at 080 OD and -7.75 +3.00 at 040 OS. On corneal topography, he had 1.95D and 1.45D of regular astigmatism in the right and left eye respectively. This technique involves pars plana vitrectomy in combination with the placement of a MX60 toric intraocular lens fixated to the sclera using 8-0 Gore-Tex in line with the axis of steep corneal astigmatism. The lens is affixed through two pair of nasal and temporal sclerotomies, with each pair located 3 mm posterior to the limbus and 5 mm apart, centered along the axis of steep astigmatism. Post-operatively the patient was 20/25 uncorrected OD and 20/20 uncorrected OS with a refraction of -0.75 +0.50 at 180 in the OD and -0.75 +1.00 at 180 in the OS. Scleral sutured toric intraocular lens placement and pars plana vitrectomy is a viable solution for patients with regular corneal astigmatism and cataract repair in the absence of zonular support.

Primary Retinal Detachment Repair in Eyes Deemed High Risk for Proliferative Vitreoretinopathy: Surgical Outcomes in 389 Eyes

To evaluate surgical outcomes in eyes with primary rhegmatogenous retinal detachment (RRD) deemed at high risk for postoperative proliferative vitreoretinopathy (PVR). Retrospective, consecutive case cohort study. Eyes undergoing primary RRD repair with pars plana vitrectomy (PPV) or combined PPV with scleral buckling (PPV/SB) between January 1, 2016 and December 30, 2017 at Wills Eye Hospital. Eyes were defined as 'high risk' if at least one of the following risk factors for PVR was present on pre-operative exam: pre-operative PVR grade A or B, vitreous hemorrhage, RRD involving 50% or more of retinal area, presence of 3 or more retinal breaks, history of prior cryotherapy, presence of choroidal detachment, and/or duration of RRD greater than 2 weeks. Surgical failure was defined as an additional intervention required for the retinal reattachment. Single surgery attachment success (SSAS) rate 3 months after first surgical intervention for primary RRD. Of 2053 reviewed charts, a total of 389 eyes (18.9%) met the definition of high risk and were included in the analysis. Mean patient age was 63.5 years. PPV/SB was performed in 125 (32.1%) eyes and PPV alone in 264 (67.9%) eyes. The SSAS rate for the overall cohort was 71.5% at 3 months. SSAS rate was significantly higher in eyes treated with PPV/SBP compared to PPV (80.8% versus 67%, respectively, p=0.006). On multivariate analysis, use of PPV/SB was the only feature associated with SSAS (OR 2.04, 95% CI 1.12 - 3.69, p=0.019). In eyes with primary RRD and risk factors for PVR, overall SSAS was 71.5% after primary repair. In this cohort, use of PPV/SB was associated with a significantly higher SSAS compared to PPV alone.

Evaluation of a New Monofocal Intraocular Lens in Patients Undergoing Cataract and Vitrectomy Surgery for Idiopathic Macular Hole

Purpose To evaluate the usefulness of a newly generated monofocal intraocular lens (IOL) in patients who underwent combined cataract and pars plana vitrectomy (PPV) surgery for idiopathic macular hole (MH). Methods A prospective study was conducted on 89 eyes of 89 patients who underwent combined cataract and PPV surgery for MH. The patients were divided into two groups: Eyhance ICB00 and Tecnis ZCB00. Pre-operative characteristics, post-operative visual outcomes, contrast sensitivity, and complications were compared between the two groups. A univariate regression analysis was performed to identify the factors that may affect the postoperative visual outcomes. Results Both groups showed significant improvement in mean corrected distance visual acuity (CDVA) six months post-operation (p < 0.001). There was no significant difference in pre-operative characteristics or complications between the two groups. However, the Eyhance ICB00 group showed a significantly higher uncorrected intermediate visual acuity (UCIVA) value at 6 months after surgery than the Tecnis ZCB00 group (p = 0.014). Contrast sensitivity values were not significantly different between the two groups. The univariate regression analysis revealed a significant correlation between preoperative CDVA and minimum linear diameter of MH with postoperative UCIVA in the Eyhance ICB00 group. Conclusions The newly generated Eyhance ICB00 IOL showed promising results in terms of post-operative UCIVA, with no significant difference in complications or contrast sensitivity values compared to the Tecnis ZCB00 IOL. These findings suggest that the Eyhance ICB00 IOL may be a useful option for patients who undergo combined cataract and PPV surgery for idiopathic MH, particularly for those who require intermediate visual acuity.

Choroidal structural changes following vitrectomy performed with phacoemulsification in unilateral idiopathic epiretinal membrane

BackgroundThis study aims to determine the influence of vitrectomy combined with macular epiretinal membrane dissection and internal limiting membrane (ILM) peeling and phacoemulsification on choroidal vasculature in patients with unilateral idiopathic epiretinal membrane (IERM) and concurrent cataract using optical coherence tomography (OCT).MethodsThis retrospective study included 26 eyes of 26 patients (8 males and 18 females) with unilateral IERM without vitreomacular traction (VMT) (group 1) and the patients’ fellow eyes (n = 26, group 2). Three-port 25-G pars plana vitrectomy (PPV) combined with macular epiretinal membrane dissection and ILM peeling and phacoemulsification was performed on all patients. The comprehensive ophthalmologic examinations of all patients involved OCT measurements at every visit before and after surgery, and the choroidal thickness (CT), central macular thickness (CMT) and choroidal vascularity index (CVI) were calculated.ResultsThe mean age of the IERM patients was 66.58 ± 7.06 years. Postoperatively, best corrected visual acuity (BCVA) was significantly greater than baseline (P = 0.023). The CVI of the IERM eyes was significantly lower (P < 0.01) than that of the fellow eyes at baseline. The subfoveal CT in the IERM eyes was lower than that in the fellow eyes (P = 0.023), but there was, no significant difference in the average CT between the two groups at baseline (P = 0.071). In eyes with IERM, the CVI significantly increased at 1 week, 1 month (P < 0.001), and 3 months (P = 0.049) postoperatively, the subfoveal CT was markedly thickened 1 month after surgery (P = 0.001), the temporal 3 mm and nasal CT significantly increased at 1 week and 1 month postoperatively (P = 0.041, P = 0.022 for temporal 3 mm; P < 0.001, P = 0.047 for nasal 1.5 mm; P = 0.01, P = 0.001 for nasal 3 mm), and only the temporal 3 mm CT increased significantly at 3 months postoperatively (P = 0.017). The baseline CMT of the IERM eyes was significantly thicker than that of the fellow eyes (P < 0.001). CMT significantly decreased at 3 months postoperatively in IERM eyes(P = 0.033).ConclusionsThe increase in the CVI in the IERM eyes without VMT after combined PPV with ILM peeling and phacoemulsification persists for at least 3 months.

Pars plana vitrectomy and subretinal tissue plasminogen activator for large exudative submacular hemorrhage: a case series

BackgroundTo evaluate anatomical and functional outcomes of patients with large submacular hemorrhage (SMH) who treated by pars plana vitrectomy (PPV) in combination with subretinal tissue plasminogen activator (TPA) injection, intraocular gas tamponade, and with additional post-operative interventions.MethodsMedical records of 9 patients who presented with large SMH secondary to age-related macular degeneration (AMD) and underwent PPV, subretinal TPA injection, and gas tamponade at Chiang Mai university hospital between January 2012 and January 2020 were reviewed. Collected data included preoperative visual acuity (VA), SMH extent and duration, intraoperation and post-operation complications, post-operative anatomical and VA responses, and the need for administer post-operation additional treatments.ResultsOverall, five patients were male and four patients were female with a mean (SD) age of 66.9 (7.7) years and a mean (SD) follow-up of 21.1 (16.1) months. A mean (SD) duration of SMH was 15.1 (10.9) days with a mean (SD) extent of SMH was 6.2 (3.4) disc diameters. At 1-month post-operation, complete SMH displacement was noted in eight (88.9%) patients. The mean (SD) VA significantly improved from LogMAR 1.9 (0.4) to 1.1 (0.4), (P = 0.004). During follow-up, eight patients (88.9%) were given additional therapy (anti-vascular endothelial growth factor (anti-VEGF) monotherapy, photodynamic therapy, or in combination). At final follow-up, a mean (SD) LogMAR VA of 0.9 (0.4) was significantly improved compared to baseline (P = 0.004). For intra- and post-operation complications, none developed intraoperative retinal break and retinal detachment.ConclusionsVitrectomy with subretinal TPA injection, intraocular gas tamponade, and additional post-operation treatments provide benefit for anatomical and visual outcomes for patients with large SMH. It may consider as one of effective treatment in this group of patients.

Combined Pars Plana Vitrectomy, Phacoemulsification and Intraocular Lens Implantation: A review on the Advantages and Limitations of Phacovitrectomy

When vitreoretinal and anterior segment surgeons collaborate to perform concomitant cataract-vitreoretinal surgery (also known as phacovitrectomy) in the appropriate clinical setting, combined surgery can expedite visual recovery, improve the view and surgical access to the retina in cases with significant cataract, avoid multiple rounds of anaesthesia and reduce the financial burden on the patient. While combined surgery overcomes several limitations of sequential surgery, it is important to understand that phacovitrectomy may be associated with increased postoperative inflammation and less predictable refractive outcomes. We typically recommend combined phacovitrectomy in patients with significant cataract and vitreoretinal pathology, especially if the cataract impairs the view to the retina or if the patient is too ill to undergo several rounds of anaesthesia. In patients with high refractive expectations who have an early cataract or mild retinal pathology, combined surgery is not likely to be a viable or reasonable management option.

Efficacy of Intravitreal Dexamethasone After Combined Phacoemulsification and Pars Plana Vitrectomy for Diabetic Tractional Retinal Detachments.

Purpose: To evaluate the efficacy and complications of intravitreal dexamethasone with simultaneous silicone tamponade after combined phacoemulsification and pars plana vitrectomy (PPV) in severe diabetic tractional retinal detachments (TRDs). Methods: In this single center, prospective, randomized, and open labeled 2 parallel group study, patients who applied to our clinic due to diabetic TRD involving the macula with grade-3 and 4 cataracts were randomized to receive either simultaneous silicone tamponade and intravitreal dexamethasone (Group-1) or only silicone tamponade (Group-2). Primary outcome measurements were the incidence rate of retinal re-detachment and, proliferative vitreoretinopathy (PVR) at sixth month, and anterior segment inflammation and posterior iris synechia at first and at sixth months. Results: We operated 22 eyes of 22 patients in Group-1 (PPV with dexamethasone implant) and 21 eyes of 21 patients in Group-2 (PPV without dexamethasone implant). The rate of re-detachment and PVR were significantly higher in the Group-2 compared with in Group-1 at sixth month (Group-1, 0/22, Group-2, 6/21 28.6%, P = 0.038). Anterior chamber fibrin exudation at first month was significantly superior in the Group-2 (Group-1, 0/22, Group-2, 8/21 38.0%, P = 0.021). Posterior iris synechia was more observed in the Group-2 at sixth month (Group-1, 0/22, Group-2, 7/21 33.3%, P = 0.029). Conclusions: Dexamethasone implant at the end of combined phacoemulsification and PPV with silicon oil tamponade in patients with diabetic TRD reduces retinal re-detachment, anterior chamber fibrin exudation and posterior iris synechia. This approach can be an alternative option in the treatment of diabetic TRD with coexisting cataracts.

Vitrectomy versus Combined Vitrectomy and Scleral Buckle for Repair of Primary Rhegmatogenous Retinal Detachment with Vitreous Hemorrhage

To compare pars plana vitrectomy (PPV) with combined PPV and scleral buckle (PPV/SB) for repair of primary rhegmatogenous retinal detachment (RRD) with associated vitreous hemorrhage (VH). Retrospective, observational study. Patients with RRD and associated VH who underwent PPV or PPV/SB from January 1, 2010, through August 31, 2020, were analyzed. We performed a single-institution, retrospective, observational study of 224 eyes with RRD and VH at the time of detachment. We excluded eyes with <6 months of follow-up, a prior history of retinal detachment (RD) repair with vitrectomy or SB, VH that resolved before surgical intervention, and tractional or combined tractional and rhegmatogenous detachments. Single-surgery anatomic success (SSAS) at 6 months, defined as no recurrent RD requiring surgical intervention. Pars plana vitrectomy and PPV/SB were performed on 138 eyes (62%) and 85 eyes (38%), respectively. The mean age of the PPV and PPV/SB patients was 61.9 and 60.2 years, respectively. Single-surgery anatomic success was achieved in 107 of 138 eyes (77.5%) that underwent PPV and 78 of 85 eyes (91.7%) that underwent PPV/SB. The difference in SSAS between types of treatment was significant (P= 0.006). Mean visual acuity improvement in the PPV/SB group was 0.54 logMAR units greater than that in the PPV group (P= 0.126). The incidence of postoperative proliferative vitreoretinopathy in the PPV/SB group (11.7%) was lower than that in the PPV group (19.5%; P= 0.128). The rate of repeat PPV for non-RD reasons was similar for both the groups (P= 0.437). Final reattachment status was achieved in 137 of the 138 and 84 of the 85 eyes in the PPV and PPV/SB groups, respectively. Final visual acuity improvement was significantly better in eyes with PPV/SB than in eyes with PPV alone (logMAR 2.12 vs. 1.26, respectively; P= 0.011). In patients with RRD and VH, SSAS was superior in patients treated with PPV/SB compared with those treated with PPV alone. Although not significantly different, the PPV/SB group had better visual outcomes and a lower postoperative proliferative vitreoretinopathy rate.

Vitrectomy in Serous Macular Detachment Associated with Optic Pit

Optic disc pit is a rare congenital anomaly of the optic disc and may be complicated by maculopathy with progressive vision loss. Optical disc pits are generally unilateral and sporadic, and the pathogenesis of maculopathy is not clear. Optical disc maculopathy (ODP-M) is a condition characterized by intraretinal, subretinal fluid, and retinal layers dissociation (retinoschisis). The origin of the subretinal fluid is controversial, and it is thought to be caused by liquefied vitreous, cerebrospinal fluid (CSF), leakage of the blood vessels in the base of the pit, and choroid. Although there is no consensus on its treatment, pars plana vitrectomy (PPV) alone or combined PPV, juxtapapillary laser photocoagulation, gas tamponade injection are the most frequently used methods in recent years. In this article, literature research was conducted on the possible mechanisms of the optic disc pit and the treatment modalities used.

Combined Pars Plana Vitrectomy and Segmental Scleral Buckle for Rhegmatogenous Retinal Detachment with Inferior Retinal Breaks.

PurposeTo describe a variation of the traditional segmental scleral buckle (SB) without an encircling band combined with 23-gauge pars plana vitrectomy (PPV) for the management of rhegmatogenous retinal detachment (RRD) with inferior retinal breaks.Patients and MethodsThis is a single-center, retrospective, consecutive review of all RRDs with inferior retinal breaks that were treated with PPV and segmental SB without an encircling band between May 2019 and February 2020.ResultsA total of 12 eyes of 12 patients were included in the study. All patients had at least 1 inferior retinal break and more than 2 clock hours of retinal detachment. Eight eyes had RRD with macular involvement at presentation. Seven eyes had a persistent RRD following previous pneumatic retinopexy (C3F8). All eyes were treated by PPV combined with a segmental #510 sponge without an encircling band. Surgery anatomical success was 100%. Mean logMAR visual acuity was 1 (SD 0.6; 20/160) and 0.5 (SD 0.4; 20/60) at 3 months and last follow-ups, respectively. No scleral buckle-related complications were noted over the 4.1 (SD 0.8) month follow-up period.ConclusionThe combined segmental buckling technique is a safe and effective adjunct to PPV in treatment of inferior RRD.

Incidence of Clinically Significant Aniseikonia Following Encircling Scleral Buckle Surgery: An Evaluation of Refractive and Axial Length Changes Requiring Intervention

To evaluate the incidence of symptomatic anisometropia and aniseikonia requiring intervention following surgery with combined pars plana vitrectomy (PPV) and broad 276 style encircling scleral buckle (ESB) for the repair of rhegmatogenous retinal detachments (RRD) and to report axial length (AL) and keratometry changes, a retrospective review of consecutive RRD patients treated with combined PPV and ESB between June 2016 until September 2019 was performed. All patients with symptomatic optically induced aniseikonia requiring additional interventions or surgical procedures including clear lens exchanges, secondary intraocular lens implants or contact lenses were documented. Keratometry and AL measurements were recorded for each eye and changes calculated. In total, 100 patients underwent combined PPV, ESB and endotamponade with mean age of 59.47 years (SD 11.49). AL was significantly increased (25.39 mm [SD 1.27] to 26.54 mm [SD 1.16], p = 0.0001), with a mean change of 1.15 mm (SD 0.67). Mean corneal astigmatism increased by –0.95 D (SD 0.51) in control eyes preoperatively and –1.33 (SD 0.87) postoperatively (p = 0.03). Over half of phakic patients (39/61; 64%) developed a visually significant cataract, subsequently undergoing surgery. Six of 100 patients developed symptomatic anisometropia with aniseikonia postoperatively (6%). Four proceeded with clear lens exchange despite absence of visually significant cataract (4%). Two of these initially trialled contact lenses (2%). One was intolerant, while the other decided to proceed with clear lens exchange for convenience. Only one patient (1%), being pseudophakic in both eyes, had persistent anisometropia/aniseikonia. AL and keratometry changes induced by encirclement with broad solid silicone rubber buckles are acceptable and similar to those reported previously using narrow encircling components, being unlikely to induce troublesome symptomatic anisometropia/aniseikonia. Many patients are phakic and develop visually significant cataracts, allowing correction of changes induced with the aim of visual restoration. A minority require more prolonged methods of visual rehabilitation, such as contact lens wear or clear lens exchanges. Caution and appropriate consent should be made in patients that are pseudophakic in both eyes at presentation.

Outcomes of Rhegmatogenous Retinal Detachment

Purpose: To study demographic characteristics and treatment outcomes of Rhegmatogenous retinal detachment in a private Vitreo-retinal setup of Lahore.&#x0D; Study Design: Cross sectional Observational study.&#x0D; Place and Duration of Study: Private Vitreo-retinal setup, from March 2017 to April 2019.&#x0D; Methods: Total 102 patients with Rhegmatogenous retinal detachment (RRD) were included. Patients with retinal detachment other than RRD were excluded. Detailed history and ocular examination was performed. Type of break, procedure adopted for RRD repair and type of endo-tamponade were also recorded. These patients had either 23 G pars plana vitrectomy (PPV) or scleral buckling (SB) procedures or combined sclera buckling with PPV. Patients were followed-up for six months.&#x0D; Results: Out of 102 total RRD cases, 63.70% were males and 36.30%were females. Mean age was 47.44 ± 18.44. Macula was on in 48% and off in 52%. Phakic patients were 46.50%, pseudophakic 48.50% and 5.10% were aphakic. Position of break in RRD was superotemporal in 39.2%, inferotemporal in 30.4% and inferonasal in 2.9%. Total RD was observed in 27.5% patients. One or more breaks were identified in 82.4% patients and giant tear in 4.9%. Three ports 23 G PPV was done in 64.7%, PPV with IOL in 18.6%, scleral buckling in 10.8% and combined PPV + SB in 5.9% patients. The anatomical success rate was observed in 96.07%, 3.9% needed second surgery to get anatomical success in six months follow-up.&#x0D; Conclusion: Anatomical success rates in retinal attachment surgeries in experienced hands is comparable with more developed retinal centers of the world.&#x0D; Key Words: Rhegmatogenous retinal detachment, Pars plana vitrectomy, Scleral buckling, Silicon oil.

Anatomical outcome of retinal detachment surgery comparing different surgical approach

To describe the outcome of retinal detachment surgery in a population affected by rhegmatogenous retinal detachment (RRD) in southern Sweden 2011-2013. All primary retinal detachments that underwent surgery at the Skåne University Hospital were registered during the period of 2011-2013. Age, sex, lens status and the different surgical methods including type of tamponade were recorded. For outcome assessment, no reoperation within 6months was considered as primary success with one surgery except silicone oil removal. In total, 918 primary retinal detachments were recorded during the 3-year period. Pars plana vitrectomy (PPV) alone was used in 618 eyes (67.3%), whereas an external approach with scleral buckling (SB) was used in 184 cases (20.0%) and a combination of PPV+SB in 116 eyes (12.6%). Pars plana vitrectomy (PPV) in combination with phacoemulsification and IOL implantation was performed in 169 eyes (18.4%), which was 43.6% of the phakic eyes having a PPV procedure. A total of 346 eyes (37.7%) were pseudophakic preoperatively. The success rate of one surgery was 86.9% for the entire cohort. In 120 eyes (13.1%), there was a re-detachment during the 6-month follow-up time. Higher age at the primary surgery turned out to be correlated to an increased risk of primary failure (p=0.018) but gender was not (p=0.84). Preoperative lens status did not affect the risk of re-detachment (p=0.36), and there were no differences in outcome between surgeons (p=0.27). No surgical procedure - alone or in combination - showed superior outcome as primary surgical approach. There were no significant differences in anatomical outcome between the various surgical procedures in this large cohort of 918 RRD cases.

Outcomes of Pars Plana Vitrectomy Alone versus Combined Scleral Buckling plus Pars Plana Vitrectomy for Primary Retinal Detachment

We compared the outcomes of primary uncomplicated rhegmatogenous retinal detachment (RRD) repair using pars plana vitrectomy (PPV) alone versus combined scleral buckling plus PPV (SB+PPV). Retrospective, observational study. Patients with primary RRD who underwent PPV or SB+PPV from June 1, 2014, through December 31,2017. We performed a single-institution, retrospective, observational study of 488 consecutive patients with primary RRD repaired via PPV alone or SB+PPV and gas tamponade. We excluded patients younger than 18 years and those with advanced proliferative vitreoretinopathy, giant retinal tear, trauma, or secondary forms of RRD. We performed logistic regression and Cox proportional hazard regression analyses to identify potential risk factors associated with a retinal redetachment. Single-operation anatomic success (SOAS), defined as adequate retinal reattachment achieved with only 1 procedure. The mean follow-up interval was 14.3 months. Single-operation anatomic success and final anatomic success were achieved in 425 eyes (87.1%) and 487 eyes (99.8%), respectively. Single-operation anatomic success was achieved in 90 of 111 eyes (81.1%) with PPV alone compared with 345 of 374 eyes (92.2%) with SB+PPV (P= 0.0010). Scleral buckling plus PPV showed greater SOAS than PPV alone in phakic eyes (P < 0.0001), but not in eyes with a posterior chamber intraocular lens (PCIOL). Retinal redetachments occurred on average at 1.5 and 9 months after the initial surgery. Significant best-corrected visual acuity improvement was associated with SOAS (P < 0.0001). Scleral buckling plus PPV resulted in greater SOAS outcomes than PPV alone for primary RRD repair. Phakic eyes achieved greater surgical success with SB+PPV, whereas eyes with a PCIOL achieved similar results with both methods. Most retinal redetachments occurred within the initial postoperative 3-month period. Single-operation anatomic success was associated with statistically significant visual improvement.

External Drainage Alone Versus External Drainage With Vitrectomy in Advanced Coats Disease

To evaluate the efficacy of transscleral drainage of subretinal fluid (TDSRF) with and without pars plana vitrectomy (PPV), which are performed as an adjunct to ablative therapies in advanced Coats disease. Retrospective, comparative case series. A total of 31 eyes from 31 consecutive patients with advanced Coats disease at an average age of 47.8 ± 34.2 (2-156) months at the time of the surgery, who underwent TDSRF alone or in combination with PPV. Main outcome measurements were LogMAR visual acuity values, anterior and posterior segment findings, need for further surgery, laser photocoagulation, and anti-vascular endothelial growth factor (anti-VEGF) treatment. Anatomical success was defined as the maintenance of retinal reattachment without any further surgery during follow-up. Sixteen patients underwent TDSRF alone, and 15 patients underwent combined TDSRF and PPV. Mean follow-up time was 34.8 ± 32.9months (6-128). Anatomical success rate of combined TDSRF and PPV was higher than that of TDSRF alone (93.8% vs 75%, respectively). The incidence of epiretinal membrane formation, number of laser photocoagulation procedures, and anti-VEGF treatments were statistically significantly higher in the group that underwent TDSRF alone than in those who had combined TDSRF and PPV in the long term. There was an improvement in vision in only 4 eyes (12.9%) (all >3 years old at presentation) during the follow-up. Combined TDSRF and PPV appears to be more effective in controlling the disease than TDSRF alone, as an adjunct to ablative procedures for the treatment of advanced Coats disease. The need for additional treatment is much less with the addition of PPV.

ENDOPHTHALMITIS AFTER TRANSCONJUNCTIVAL PARS PLANA VITRECTOMY: A 6-year Experience Without Prophylactic Intraoperative Subconjunctival Antibiotics.

This study aimed to investigate the incidence and risk factors of endophthalmitis after transconjunctival pars plana vitrectomy (PPV) without intraoperative subconjunctival antibiotics. Retrospective, consecutive case series at a single institution. Consecutive cases of transconjunctival 25-gauge PPV without intraoperative subconjunctival antibiotics performed by three retina surgeons at a single surgical site at the Dean McGee Eye Institute from 2012 to 2018 were reviewed. Of 4,263 cases of PPV without intraoperative subconjunctival antibiotics, five cases (0.117%, 5/4,263) of post-PPV endophthalmitis were identified. Of these five cases, four cases (80%, 4/5) received combined cataract extraction or secondary intraocular lens implantation at the time of PPV. The incidence of endophthalmitis in isolated PPV was 0.027% (1/3,606 cases), whereas the incidence in combined PPV with anterior segment procedures was 0.608% (4/657 cases). Risk factors for endophthalmitis included diabetes mellitus, which was present in 80% of patients with endophthalmitis (4/5 cases). Causative organisms were identified in four of the five cases (80%), including Staphylococcus epidermidis (N = 3) and Propionibacterium acnes (N = 1). Performing transconjunctival PPV alone with standard preparation using povidone-iodine and postoperative topical antibiotics for 1 week without intraoperative subconjunctival antibiotics did not lead to an increase in incidence of postoperative endophthalmitis (1 per 3,606 cases).