Core Vitrectomy Research Articles

Endogenous fungal endophthalmitis caused by Cladophialophora devriesii: report of a case and literature review

PurposeTo report a case of endogenous endophthalmitis caused by the dematiaceous fungus Cladophialophora devriesii.MethodsObservational case report and literature review.Case presentationA 73-year-old female with a history of chronic obstructive pulmonary disease presented with a red and painful left eye. Examination revealed anterior segment inflammation and vitritis, indicative of endophthalmitis. She underwent core vitrectomy and intravitreal injection of vancomycin and amphotericin B. The vitreous sample showed inflammatory cells and fungal hyphae, and systemic amphotericin B and itraconazole were commenced for fungal endophthalmitis. Targeted amplification of the sample for bacterial DNA (V2-V3 region of 16 S rDNA) was negative, but fungal DNA targets (ITS1 and ITS2) were present, and their sequences were consistent with Cladophialophora devriesii. Phenotypic characterisation and sequencing of ITS1 and ITS2, carried out on cultured fungus from the sample, also revealed Cladophialophora devriesii. She received repeated intravitreal injections of voriconazole, and based on the antifungal susceptibility results, her systemic medication was changed to posaconazole. After 12 months, the eye showed no signs of inflammation, and posaconazole therapy was discontinued. After 3 months without antifungal medication, the inflammation recurred, and she was restarted on antifungal therapy for an additional 20 months. Another recurrence occurred 3 months after discontinuation of treatment, and a repeat vitreous sample confirmed the presence of Cladophialophora devriesii. She was started on isavuconazole, but developed seclusio pupillae and painful secondary glaucoma. Due to the duration and severity of the infection, the eye was enucleated. Histopathology revealed persistent fungal elements at the ciliary processes and the posterior lens surface.ConclusionsThis second reported case of endogenous endophthalmitis caused by Cladophialophora devriesii illustrates the role of vitreous sampling and molecular methods in diagnosis and treatment of fungal endophthalmitis. Despite early diagnosis and prolonged local and systemic antifungal therapy, it was not possible to achieve long-term control of the fungal infection.

High-speed Beveled Tip Versus Standard Tip Vitrectomy Probe: A Prospective Randomized Clinical Trial.

To compare the efficiency of the advanced ultravit beveled vitrector probe (10,000 cuts per minute) to the current standard ultravit highspeed (7500 cuts per minute) vitrector probe. A prospective, randomized controlled trial was conducted on patients undergoing routine vitrectomy surgery for epiretinal membrane, full-thickness macular hole, and vitreous opacities. Patients were randomly assigned to undergo PPV with the ultravit highspeed probe (Probe 1) or the advanced ultravit beveled probe (Probe 2). The main outcome measure was time to completion of core vitrectomy and vitreous base shave. Forty patients were enrolled in this study, 20 in each cohort. The average time to completion of core vitrectomy was 10.4 +/- 1.8 min in the Probe 1 cohort compared to 9.7 +/- 2 min in the Probe 2 cohort (P = 0.21). The average time to completion of vitreous base shave was 9.6 +/- 2.7 min in the Probe 1 cohort compared to 9.4 +/- 1.8 min in the Probe 2 cohort (P = 0.39). In the current study, the advanced ultravit beveled probe was noninferior to the ultravit highspeed vitrectomy probe when looking at the time to completion of core vitrectomy and vitreous base shave. The increased cut rate did not affect the efficiency of vitreous removal.

Fibrinous nodular anterior segment membrane as a presentation of chronic postoperative Aspergillus endophthalmitis

A 63-year-old lady, with over-the-counter steroid use, presented with a gradual progressive diminution of vision 6 months after uncomplicated cataract surgery. On examination, the vision was hand movements and the anterior chamber (AC) showed a thick, irregular fibrinous membrane over the iris and pupil and a fixed hypopyon, and B-scan revealed vitritis. AC membrane and vitreous biopsy was done along with intracameral and intravitreal Amphotericin-B. Owing to the poor response and microbiological tests suggestive of Aspergillus, core vitrectomy with intravitreal Voriconazole injection was done. Significant improvement in vision and inflammation was noted, after 1 month. Fungal etiology must be suspected in the presentation of endophthalmitis as a fibrinous and nodular membrane, and all such patients must be reviewed for systemic immunosuppression.

Use of a Backflush Needle with a Silicone Tip Cannula to Embed Lamellar Hole-Associated Epiretinal Proliferation.

For the treatment of lamellar macular hole, the recent development of a lamellar hole-associated epiretinal proliferation (LHEP) embedding technique is likely to improve functional and anatomical results. However, the peeling of LHEP is often technically challenging. We have developed a new technique using a backflush needle with a silicone tip cannula that seems safer and more effective for use in LHEP embedding. A 25-gauge vitrectomy system with an enhancing visual acuity system (D.O.R.C., Zuidland, Netherlands) was used in all cases. After core vitrectomy, triamcinolone acetonide (Wakamoto Pharmaceutical Co., Ltd., Tokyo, Japan) was used to visualize the membrane. A 25-gauge backflush needle with a silicone tip cannula was used to remove the thin preretinal membrane centripetally, leaving an LHEP on the edge of the hole. Brilliant Blue G (internal limiting membrane Blue; D.O.R.C.) was then used to stain the internal limiting membrane. This technique was used in six eyes with lamellar macular holes. In all cases, peeling and embedding of the LHEP was effectively performed without damaging the internal limiting membrane or causing retinal hemorrhage. No other intraoperative or postoperative complications were experienced. Using a silicone-tipped backflush needle with passive aspiration was a simple and effective technique for peeling and embedding of LHEPs in this small series.

Dry eye parameters measured with an ocular surface analyzer in eyes after vitrectomy for vitreomacular interface disorders.

Dry eye disease (DED) might be caused by multiple ocular surgical interventions. The aim of the study was to estimate the extent of DED in patients undergoing core vitrectomy for vitreoretinal interface disorders. In this prospective observational study, we included patients with 12 months of follow-up after vitrectomy. The following data were collected as controls: age, sex, best-corrected visual acuity before and after surgery, and phakic status. In OSA (ocular surface analysis), the following parameters were evaluated: NIBUT (non-invasive tear break-up time), sltDear (thickness of the lipid layer), Meibomian gland (MGD) loss, and the height of tear meniscus. Shapiro-Wilk test, Wilcoxon rank-sum test, and Mann-Whitney U tests were used for statistical analysis. We evaluated 48 eyes of 24 patients (10 men, 14 women; 64.63 ± 14.10 years) 1 year after vitrectomy. From the analyzed ocular surface parameters, NIBUT was significantly lower in operated versus non-operated eyes (P = 0.048). The higher the level of difference in MGD loss between both eyes, the higher the level of difference in NIBUT between both eyes (rs = 0.47, P = 0.032). NIBUT levels were still decreased 12 months after vitrectomy. Patients with more pronounced MGD loss or decreased NIBUT levels in the fellow eye were more likely to experience such disorders. The tear meniscus height was lower in patients undergoing surgery for retinal detachment than in those with vitreoretinal disorders. This might allow the suggestion to include artificial tears in pre- and post-operative care in vitrectomized eyes.

Image sharpening algorithms improve clarity of surgical field during 3D heads-up surgery

BackgroundImage-sharpening algorithms with color adjustments enable real-time processing of the surgical field with a delay of 4 msec for heads-up surgery using digital three-dimensional displays. The aim of this study was to investigate the usefulness of the algorithms with the Artevo 800® digital microscope.MethodsSeven vitreoretinal surgeons evaluated the effects of image-sharpening processing on the clarity of the surgical field with the Artevo 800® system that is used for cataract and vitreous surgeries. The scorings were made on a 10-point scale for anterior capsulotomy, phacoemulsification, cortex aspiration, core vitrectomy, and peeling of an epiretinal membrane or an internal limiting membrane. In addition, the images during the internal limiting membrane peeling were processed with or without color adjustments. We also evaluated the skewness (asymmetry in the distribution of the pixels) and kurtosis (sharpness in the distribution of the pixel) of the images to evaluate the contrast with each intensity of image-sharpening.ResultsOur results showed that the mean visibility score increased significantly from 4.9 ± 0.5 at 0% (original image) to 6.6 ± 0.5 at 25% intensity of the image-sharpening algorithm (P < 0.01). The visibility scores of the internal limiting membrane increased significantly from 0% (6.8 ± 0.3, no color adjustments) to 50% after the color adjustments (7.4 ± 0.4, P = 0.012). The mean skewness decreased significantly from 0.83 ± 2.02 at 0% (original source) to 0.55 ± 1.36 at 25% intensity of the image-sharpening algorithm (P = 0.01). The mean kurtosis decreased significantly from 0.93 ± 2.14 at 0% (original image) to 0.60 ± 1.44 at 25% intensity of the image-sharpening algorithm (P = 0.02).ConclusionsWe conclude that the image-sharpening algorithms can improve the clarity of the surgical field during 3D heads-up surgery by decreasing the skewness and kurtosis.Trial registrationThis was a prospective clinical study performed at a single academic institution, and the procedures used were approved by the Institutional Review Committee of the Kyorin University School of Medicine (reference number, 1904). The procedures also conformed to the tenets of the Declaration of Helsinki.

Perfluorocarbon liquid-assisted vitreo-dissection in eyes with firmly adherent posterior hyaloid

BackgroundInduction of posterior vitreous detachment (PVD) is a critical step during pars plana vitrectomy. Multiple techniques and utilities have been proposed for assistance with this step with no consensus on the safest and most effective means, especially in eyes with firmly adherent posterior hyaloid. Viscodissection or the utilization of perfluorocarbon liquid (PFCL) can be used to dissect the posterior hyaloid and widely adherent epiretinal membranes.MethodsA technique of PFCL dissection of the posterior hyaloid in eyes with abnormal adhesion of the posterior hyaloid. After core vitrectomy, breaking into the posterior hyaloid face is made via active aspiration and cutting or a sharp dissection. This is followed by active and slow injection of PFCL into the potential space between the posterior cortical vitreous and the neurosensory retina. A wave of PFCL propagates anteriorly causing “vitreo-dissection” of the peripheral cortical vitreous.ResultsThe technique was effective and safe in 8 successive cases, 4 cases with vitreoretinal traction syndrome and 4 with diabetic tractional membranes.ConclusionThe technique can be considered in cases with abnormal firmly adherent posterior hyaloid when induction of PVD proves difficult.

EVALUATION OF THE RETINAL HAZARD WITH 3D DIGITALLY ASSISTED VISUALIZATION SYSTEM AND CONVENTIONAL MICROSCOPE IN MACULAR SURGERIES.

To investigate the retinal light hazard during macular surgery using a digital three-dimensional visualization system (3D) and a conventional microscope (CM). Experimental study and retrospective evaluation of a case-control study. A total of 20 and 10 patients who underwent pars plana vitrectomy for epiretinal membrane using 3D and CM, respectively. Spectral irradiances of endoilluminators were measured for representative settings used during core vitrectomy and macular manipulations with 3D and CM. From the medical record of the patients, time needed for core vitrectomy and macular manipulations was extracted. The total retinal light hazard index and the macular hazard index were calculated based on the spectral irradiances weighted by the standard functions. Total retinal light hazard index, macular hazard index, and the number of cases that exceeded the maximum permissible radiant power exposure were compared between the two groups. The spectral irradiance were 1.6 and 3.9 mW/cm 2 for core vitrectomy and 3.4 and 8.1 mW/cm 2 for macular manipulations using typical settings for 3D and CM groups, respectively. The total retinal light hazard index ranged from 4.31 kJ/m 2 to 17.37 kJ/m 2 for 3D and 11.09 kJ/m 2 to 27.70 kJ/m 2 for CM groups, respectively, whereas the macular hazard index ranged from 2.93 kJ/m 2 to 14.58 kJ/m 2 for 3D and from 6.84 kJ/m 2 to 23.55 kJ/m 2 for CM, respectively ( P < 0.001). One (5%) and 6 (60%) pars plana vitrectomy cases exceeded the threshold limits with 3D and CM groups, respectively ( P < 0.05, chi-square test). The 3D digitally assisted visualization system offers significantly safer macular surgery compared with the CM, considering the potential retinal hazard.

Metallic intraocular foreign body removal assisted through the extrusion line

AbstractPurpose: To describe an alternative vitreoretinal surgical manoeuvre, to remove metallic intraocular foreign bodies.Methods: Two patients, at different time lines, underwent vitrectomy to remove a metallic intraocular foreign body (IOFB). A 3‐port vitrectomy was performed, a 23‐G constellation vitrectomy equipment was used in both procedures, careful core vitrectomy was first done, vitreous adhesions and vitreous detachment was carefully done, retina was partially detached at the IOFB location, vitreous adhesions were cut and released gently not to increase the retinal detachment. Liquid prefluorocarbon was placed on the macula. As the vitreous adherences were cut, the IOFB was free from all potential tractional forces, the soft silicone tip cannula was held on to its surface, and at maximal vacuum aspiration, the IOFB was brought up to the anterior chamber, switching the light pipe for forceps in the other hand, and removed out of the eye. A complete as possible vitrectomy was performed, intraocular laser around the retinal brakes was performed, an intraocular lens was placed in the ciliary sulcus with the optic within the anterior capsule, and silicone oil was used as tamponade.Results: No signs of intraocular inflammation were recorded postoperatively. Intraocular silicone oil removal was done at the third post‐operative month in both cases, retina remained attached through follow up, both patients had over 9 months follow‐up visits, visual acuity improved from initial presentation, and also improved after the silicone oil tamponade removal.Conclusions: Active aspiration through the soft silicon tip cannula can be used to reach, and assist removal of metallic intraocular foreign bodies, being this manoeuvre safe, reproducible, possibly time‐saving, and also it could potentially avoid the risk of IOFB mobilization, avoiding further damage to the retina.

Electroretinographic Assessments of Macular Function after Brilliant Blue G Staining for Inner Limiting Membrane Peeling.

The purpose of this study was to determine the effect of brilliant blue G (BBG) staining of the inner limiting membrane (ILM) on macular function. Fourteen eyes of 14 patients consisting of 9 men and 5 women who underwent vitreous surgery with ILM peeling were studied. The mean age of the patients was 68.8 ± 9.14 years. Three eyes had a macular hole and eleven eyes had an epiretinal membrane. The ILM was made more visible by spraying 0.25% BBG into the vitreous cavity. The macular function was assessed by recording intraoperative focal macular electroretinograms (iFMERGs) before and after the intravitreal spraying of the BBG dye. The iFMERGs were recorded three times after core vitrectomy. The first recording was performed before the BBG injection (Phase 1, baseline), the second recording was performed after the spraying of the BBG and washing out the excess BBG (Phase 2), and the third recording was performed after the ILM peeling (Phase 3). All recordings were performed after 5 min of light-adaptation and stabilization of the intraocular conditions. The iFMERGs were recorded twice at each phase. The implicit times and amplitudes of the a- and b-wave, the PhNR, and the d-wave were measured. Wilcoxon signed-rank test were used to determine the significance of differences of the findings at Phase 2 vs. Phase 1 and Phase 3 vs. Phase 1. A p value &lt; 0.05 was taken to be statistically significant. The average implicit times of the a-wave, b-wave, PhNR, and d-wave were not significantly different in Phase 1, 2, and 3. The average a-wave, b-wave, PhNR, and d-wave amplitudes at Phase 1 did not differ significantly from that at Phase 2 and at Phase 3. The results indicated that the intravitreal injection of BBG does not alter the physiology of the macula, and we conclude that BBG is safe. We also conclude that iFMERGs can be used to monitor the macular function safely during intraocular surgery.

Late surgery for unilateral persistent fetal vasculature: long-term visual and anatomic outcomes

BackgroundPersistent fetal vasculature (PFV) is a congenital anomaly caused by failure of the ocular vasculature to regress. We report the visual and anatomic outcomes in patients who underwent surgery for PFV between 7-48 months of age. MethodsThe medical records of patients who underwent lensectomy and anterior or core vitrectomy for unilateral PFV, with or without intraocular lens implantation, were reviewed retrospectively. Inclusion criteria were surgery between 7-48 months of age and at least 12 months of follow-up. Patients with severe posterior segment involvement were excluded. The primary outcome was the final visual acuity using age-appropriate tests converted to logMAR. Secondary outcomes included the rate of adverse events and number of subsequent intraocular procedures. ResultsA total of 20 patients with a mean age at surgery of 19.3 ± 10.5 months and mean follow-up of 73.7 ± 46.7 months were included. Sixteen patients had delayed surgery due to late presentation; the remaining 4 were managed initially with refractive correction and occlusion. Eight patients (40%) achieved a final visual acuity better than 1.0 logMAR. Four eyes had adverse events, including one retinal detachment. No patient developed glaucoma. Four eyes underwent subsequent procedures. ConclusionsIn our study cohort, surgery for unilateral PFV between 7-48 months of age achieved functional visual acuity in over one-third of patients. This is comparable to results achieved with surgery before 7 months of age, but with fewer adverse events. Differences in disease severity could account for later PFV presentation and surgery as well as outcomes.▪

Feature Tracking and Segmentation in Real Time via Deep Learning in Vitreoretinal Surgery: A Platform for Artificial Intelligence-Mediated Surgical Guidance

This study investigated whether a deep-learning neural network can detect and segment surgical instrumentation and relevant tissue boundaries and landmarks within the retina using imaging acquired from a surgical microscope in real time, with the goal of providing image-guided vitreoretinal (VR) microsurgery. Retrospective analysis via a prospective, single-center study. One hundred and one patients undergoing VR surgery, inclusive of core vitrectomy, membrane peeling, and endolaser application, in a university-based ophthalmology department between July 1, 2020, and September 1,2021. A dataset composed of 606 surgical image frames was annotated by 3 VR surgeons. Annotation consisted of identifying the location and area of the following features, when present in-frame: vitrector-, forceps-, and endolaser tooltips, optic disc, fovea, retinal tears, retinal detachment, fibrovascular proliferation, endolaser spots, area where endolaser was applied, and macular hole. An instance segmentation fully convolutional neural network (YOLACT++) was adapted and trained, and fivefold cross-validation was employed to generate metrics for accuracy. Area under the precision-recall curve (AUPR) for the detection of elements tracked and segmented in the final test dataset; the frames per second (FPS) for the assessment of suitability for real-time performance of the model. The platform detected and classified the vitrector tooltip with a mean AUPR of 0.972 ± 0.009. The segmentation of target tissues, such as the optic disc, fovea, and macular hole reached mean AUPR values of 0.928 ± 0.013, 0.844 ± 0.039, and 0.916 ± 0.021, respectively. The postprocessed image was rendered at a full high-definition resolution of 1920× 1080 pixels at 38.77 ± 1.52 FPS when attached to a surgical visualization system, reaching up to 87.44 ± 3.8 FPS. Neural Networks can localize, classify, and segment tissues and instruments during VR procedures in real time. We propose a framework for developing surgical guidance and assessment platform that may guide surgical decision-making and help in formulating tools for systematic analyses of VR surgery. Potential applications include collision avoidance to prevent unintended instrument-tissue interactions and the extraction of spatial localization and movement of surgical instruments for surgical data science research. Proprietary or commercial disclosure may be found after the references.

Evaluating the therapeutic response of intra-vitreal moxifloxacin in acute post-operative (cataract) endophthalmitis.

Objective: To assess the effectiveness and side effects of injecting intra-vitreal moxifloxacin (IV-M) in the treatment of acute post‑operative (cataract) endophthalmitis having visual acuity ≥ hand movements. Study Design: Prospective, Interventional Case Series study. Setting: Eye Department of Qazi Hussain Ahmad Medical Complex, Nowshera. Period: 2018 to Jan. 2021. Material &amp; Methods: Thirty (30) patients with post‑op endophthalmitis who presented within 4 weeks with visual acuity (VA) ≥ hand movements (HM) received two IV-M injection. at 24 hr. interval at an Eye department. Patients with prior history of ocular diseases or intra-vitreals were excluded. Patients were followed up to 12 weeks either for improvement or deterioration of endophthalmitis. No. of patients who attained VA ≥ 6/12 and 6/60 at the 12th week visit were compared with the no. of patients at presentation, by performing statistical analysis. In addition, pre-therapy VA converted into logarithm of minimum angle of resolution (Log MAR) at the time of presentation was compared with post-therapy VA at end of 12th week by using repeated measure ANOVA test. Results: Twenty five (83.3%) patients completely resolved while two patients underwent core vitrectomy. 14 (46.66%) and 22 (73.34%) patients achieved VA ≥ 6/12 and 6/60, respectively at 12th week visit as compared to 04 (13.33%) and 08 (26.66%) patients respectively at the time of presentation (p = 0.043). In the same way, mean Log MAR VA pre-intervention was 0.811 which improved to 0.344 at the 12th week (P &lt; 0.05). We didn’t observe any toxicity to IV-M. Conclusion: Intra-vitreal moxifloxacin was efficacious and safe in the treatment of post-operative (cataract) endophthalmitis.

Minimal surgery for tractional retinal detachment secondary to branch retinal vein occlusion: a case report

BackgroundTractional retinal detachment secondary to retinal vein occlusion is a complex entity that can be extremely difficult to manage due to an intricate association of the retinal tissue with the fibrovascular proliferation, making vitreous dissection an extraordinarily difficult procedure. Minimal surgery without endo-tamponade can reduce recovery time and avoid complications of surgery, which in some cases can lead to blindness and even phthisis.Case presentationA 64-year-old Indian woman presented with progressive worsening of vision (right eye) due to fovea involving tractional retinal detachment secondary to supero-temporal branch retinal vein occlusion. After anterior, core and peripheral vitrectomy, the epicenter of the fibrous bridge causing foveal split was identified and released. The corrected distance visual acuity improved from 6/60 pre-operatively to 6/12 post-operatively. At the 5-year follow-up, the patient remains stable both anatomically and visually.ConclusionsThis case illustrates how careful identification of the epicenter of traction helps maximize visual gain in patients with minimal risk of iatrogenic retinal tears and eliminates the need for endo-tamponade with either gas or silicone oil. Minimal surgery for tractional detachment provides excellent visual gains with minimal risks in select cases.

Intraocular Temperature Distribution in Eyes Undergoing Different Types of Surgical Procedures during Vitreous Surgery.

Vitreous temperature has been reported to vary during intraocular surgery. We measured the temperature at three intraocular sites, just posterior to the crystalline lens (BL), mid-vitreous (MV), and just anterior to the optic disc (OD), and investigated temperature changes before and after different types of surgical procedures in 78 eyes. The mean temperature at the beginning was 30.1 ± 1.70 °C in the anterior chamber, 32.4 ± 1.41 °C at the BL, 33.8 ± 0.95 °C at the MV, and 34.7 ± 0.95 °C at the OD. It was lowest at the BL, and highest at the OD. The mean temperature after cataract surgery was slightly lower especially at an anterior location. Thus, the temperature gradient became slightly flatter. The mean temperature after core vitrectomy was even lower at all sites and a gradient of the temperature was not present. The mean temperature after membrane peeling was significantly higher than that after core vitrectomy, and there was no gradient. The mean temperature after fluid/air exchange was lower at the BL and higher at the MV and at the OD. Thus, a gradient of higher temperatures at the OD appeared. The intraocular temperature distribution is different depending on the surgical procedure which can then change the temperature gradient. The temperature changes at the different intraocular sites and the gradients should be further investigated because they may affect the physiology of the retina and the recovery process.

Two Surgical Approaches for Intraocular Lens Dislocation: Pars Plana Vitrectomy Versus Core Vitrectomy with Lens Exchange.

To compare the efficacy and safety of core vitrectomy and pars plana vitrectomy for lens exchange in patients with intraocular lens dislocation. This is a retrospective study conducted at one eye center in Zurich, Switzerland. We reviewed 124 eyes with dislocated intraocular lens undergoing lens exchange carried out by two surgeons between 03/2016 and 12/2019 (45 months). Intraocular pressure (IOP) and best-corrected visual acuity (BCVA) were analyzed preoperatively and at 5 time points up to 12 months after lens exchange. Data on postoperative complications were collected. There were 124 eyes with intraocular lens dislocation that were referred for lens exchange. Of these eyes, 59 (48%) received core vitrectomy and 65 (52%) received pars plana vitrectomy with lens exchange. Glaucoma was more frequent in the core vitrectomy group (78%) than in the pars plana vitrectomy group (32%; p < 0.001). In the core vitrectomy group, 19 (32%) eyes presented with visual impairment, 17(29%) eyes presented with high IOP alone, and 23 (39%) eyes presented with both at the same time prior to surgery. Mean preoperative IOP in the core vitrectomy group decreased from 22.4 ± 9.2 mmHg to 14.7 ± 3.1 mmHg 12months after surgery (p < 0.001). Mean BCVA changed from 0.40 ± 0.41 logMAR preoperatively to 0.32 ± 0.37 logMAR at 12 months postoperatively (p = 0.598) in the core vitrectomy group. In the pars plana vitrectomy group, 44(68%) eyes presented with a change in vision, 7 (11%) eyes presented with high IOP alone, and 14 (22%) eyes presented with pressure elevation and visual impairment at the visit prior to surgery. Mean preoperative IOP in the pars plana vitrectomy group decreased from 20.9 ± 8.3 mmHg to 15.1 ± 3.5 mmHg at 12 months after lens exchange (p < 0.001). Mean BCVA in the pars plana vitrectomy group was 0.57 ± 0.62 logMAR preoperatively and 0.22 ± 0.35 logMAR 12months postoperatively (p < 0.001). Postoperative pressure decompensation occurred more frequently in the core vitrectomy group (20%) than in the pars plana vitrectomy group (6%; p = 0.018). There was no statistically significant difference for postoperative cystoid macular edema (p = 0.055), anisometropia (p = 0.986), and high astigmatism (p = 0.362). Core vitrectomy and pars plana vitrectomy with lens exchange are equally efficient and safe in the management of intraocular lens dislocation.

Clinical outcomes of a beveled tip, ultra-high speed, 25-gauge pars plana vitrectomy system

ObjectiveTo report the clinical outcomes of a 25-gauge, beveled-tip, 10,000 cuts-per-minute (cpm) microincisional vitrectomy surgery (MIVS) system.MethodsProspective case series of eyes undergoing primary pars plana vitrectomy (PPV) for common vitreoretinal indications. Main outcome measures were: rate of achieving surgical objectives, operative times, number of surgical steps, use of ancillary instruments, corrected distance visual acuity (CDVA), and adverse events (AE).ResultsThe surgical objectives were achieved in all eyes. Mean total operative time (TOT), core, shave and total vitrectomy times were 1891 ± 890, 204 ± 120, 330 ± 320, 534 ± 389 s, respectively. Mean number of surgical steps was 4.3 ± 1.5. Mean number of ancillary instruments used was 4.5 ± 1.9. Mean CDVA improved by 0.53 ± 0.56 logMAR units (P < 0.001) 3 months postoperatively. AE included elevated IOP (8%), hypotony (6%), and re-detachment (2%). Majority (82%) had no postoperative discomfort. The number of surgical steps demonstrated a positive correlation with TOT (p < 0.05), number of ancillary instruments used (p < 0.05), and postoperative Day 1 IOP (p < 0.05). The number of times ancillary instrumentation was used demonstrated a positive correlation with TOT (p < 0.05).ConclusionBeveled-tip, 10,000 cpm MIVS system effectively and safely performs common VR procedures of varying complexity and may reduce operative times and use of ancillary instrumentation.

Achoo - God bless you!

Background:“Achoo” is the sound that is correlated with sneezing. A sneeze, in rare occasions, it can cause Valsalva retinopathy. Usually, small bleeding gets absorbed with time. But if the haemorrhage stays for a longer period of time, it can lead to de-hemoglobinization of blood which can cause damage to the photoreceptors. If such a damage occurs over the macula, it can cause irreversible visual loss. Hence, prompt and meticulous treatment is indicated in such cases. One such case is described here where a lady suffered from a sudden bout of sneezing and presented to us after a month later. A large sub-internal limiting membrane (ILM) bleed was noted over the macula. Hence a vitrectomy with ILM peeling with drainage of blood was advised. She recovered 20/40 visual acuity one month following surgery.Purpose:This video emphasizes on diagnosis of sub-ILM hemorrhage and the technique in which the sub-ILM bleed can be drained in the modern era of microincision vitreoretinal surgeries.Synposis:A key aspect in such cases is to distinguish sub-ILM from sub-hyaloid bleed. Subtle differentiating points on imaging are described in the video. In cases of sub-ILM hemorrhage, the most important surgical step after performing a core vitrectomy is a good posterior vitreous detachment (PVD) induction. After that, ILM peeling is carried out with the help of finesse loop and ILM peeling forceps. Using proportional vacuum and aspiration alternatively from the cutter, the hemorrhage is displaced and drained. This step can prevent damage to the underlying retinal tissue. After the macula hemorrhage is completely cleared, an air-fluid exchange is done.Highlights:Teaching points include: 1. Diagnostic markers for sub-ILM hemorrhage; 2.The method of PVD induction in cases of Sub ILM hemorrhage; and 3.Technique of drainage of sub-ILM hemorrhage using proportional vacuum and aspiration function of the cutter.Video link: https://youtu.be/hBhfLDy9o-Y

The use of Online Videos for Vitreoretinal Surgery Training: A Comprehensive Analysis.

Objectives:The current study aimed to test the quality and educational utility of the videos of retinal detachment surgery available on YouTube.Methods:YouTube was searched using the keywords “retinal detachment, retinal detachment surgery” in October 2019. The steps of pars plana vitrectomy surgery were standardized according to the literature. The videos were evaluated in a blinded fashion by two retina specialists with the use of the Modified DISCERN, Health on the Net Foundation (HON)code, the Journal of American Medical Association (JAMA) checklist, and the Global Quality Score (GQS).Results:A total of 125 videos were reviewed. The total surgery score was 3.11 (2.16–3.67 IQR), and the most commonly shown surgical stages were photocoagulation and core vitrectomy (n = 99 [79.2%] and n = 97 [77.6%], respectively). In the multivariate linear regression model, the duration of video (minutes) (β- Coefficient 0.033, p<0.001), the HONcode score (β-Coefficient 0.310, p=0.005), and GQS (β-Coefficient 0.768, p<0.001) were associated with better educational content, whereas JAMA and Modified DISCERN scores were not.Conclusion:So far, the educational value of YouTube videos has been unsatisfactory. Assessing the videos using tools such as HONcode, video duration and GQS may provide better educational perspective to ophthalmology trainees.

Clinical profile, visual outcome and root cause analysis of post-operative cluster endophthalmitis due to Burkholderia cepacia complex.

Purpose:To present varied clinical presentations, surveillance reports, and final visual outcomes of a rare outbreak of cluster endophthalmitis caused by gram-negative, opportunistic bacilli, Burkholderia cepacia complex (Bcc).Methods:Details of five patients who developed postoperative cluster endophthalmitis were collected. For each patient, an undiluted vitreous sample was collected during vitreous tap. Bacterial culture from the vitreous sample in each case had grown Bcc. Surveillance investigations for root cause analysis (RCA) were performed in the operating room (OR), admission, and day-care wards to localize the source.Results:Four patients had undergone phacoemulsification surgery, and one patient had undergone penetrating keratoplasty. Each patient received an initial dose of empiric intravitreal ceftazidime and vancomycin. The organism isolated in each case was sensitive to ceftazidime, cotrimoxazole, and meropenem and resistant to other antibiotics. Core vitrectomy was done after 48–60 hours in four patients along with intravitreal imipenem injection. One patient did not provide consent for core vitrectomy and subsequently developed phthisis bulbi. Three patients had subsequent recurrences. Two patients had a final BCVA of 20/60, two had BCVA better than 20/200, while one patient had no perception of light. None of the surveillance samples from the OR complex could isolate Burkholderia.Conclusion:Extensive OR surveillance should be done to identify the potential source of infection. However, the source may not be identifiable in few instances like in our case. Longer follow-up is recommended in cases of Bcc endophthalmitis due to the persistent nature of the infection.