Effect Of Pars Plana Vitrectomy Research Articles

Clinical outcomes of radial optic neurotomy versus pars plana vitrectomy in recent onset non-arteritic anterior ischemic optic neuropathy.

This study investigated the effect of pars plana vitrectomy (VIT) versus pars plana vitrectomy combined with radial optic neurotomy (RON) on recent onset non-arteritic anterior ischemic optic neuropathy (NAION). In this prospective interventional case series, individuals with recent-onset NAION, lower than one month and low vision (lower than 20/200) were recruited. Patients randomly underwent either VIT, or RON. 34 eyes of 34 patients were included in this study. 10, 9, and 15 eyes were randomly included in VIT, RON, and control groups, respectively. The BCVA of the VIT group improved significantly from 1.84 ± 0.5 logMAR at baseline to 1.29 ± 0.67, 0.93 ± 0.53, and 0.77 ± 0.47 logMAR at 1, 3, and 6 months, respectively (Ps < 0.05). The corresponding values for RON group were 1.73 ± 0.53 logMAR at baseline, which improved to 1.04 ± 0.65, 0.64 ± 0.28, and 0.61 ± 0.26 logMAR at the same follow-up visit times (P < 0.05).The corresponding values for the control group were 1.6 ± 0.58 log MAR at baseline, which improved to 1.03 ± 0.29, 1.00 ± 0.32, and 0.32 ± 0.83 log MAR at the same follow-up visit times. There was no significant statistical difference in BCVA between the three groups. However, both interventions resulted in statistically significant improvement in mean deviation (MD) of visual field (VF) compared with the control group at the end of 6 months (VIT P = 0.006, RON P = 0.043). RNFLT decreased from baseline 235.3 ± 44.01 to 75.6 ± 17.68 at 1 month in the VIT group (P < 0.001), from baseline 268.22 ± 65.9 to 76.67 ± 10.59 at 1 month in RON (P < 0.001), while it decreased from baseline 179.48 ± 39.02 to 112.92 ± 44.51 at 1 month in the control group. VIT and RON showed promising results in terms of MD of VF, and optic disc edema resolved faster in these groups compared to the control group in recent onset NAION. A larger sample size study is deemed necessary to generalize the results of this study.

Evaluating the efficacy of pars plana vitrectomy in the management of endophthalmitis after following the endophthalmitis vitrectomy study: A systematic review and meta-analysis.

Endophthalmitis is a devastating eye complication that requires prompt and effective treatment. A pivotal study in the field of endophthalmitis treatment is the endophthalmitis vitrectomy study (EVS), conducted over a decade ago. The primary objective of this study was to assess the effectiveness of pars plana vitrectomy (PPV) as a treatment option for endophthalmitis following the EVS study. We conducted a comprehensive search across three databases: PubMed, EBSCO host, and ProQuest. Reference lists of published articles were searched. Our study encompassed research conducted between January 2013 and January 2023 to ensure the most up-to-date findings. The best-corrected visual acuity (BCVA) in logMar, causative agents, and predicting factors for visual outcome were evaluated. Nine studies involving 351 eyes were included in the study; however, only eight were included in the meta-analysis. We observed a significant BCVA improvement compared to baseline at 1 month, >1-3 months, >3-6 months, and ≥12-month follow-up, with mean differences of 1.06 (P < 0.001), 1.25 (P < 0.001), 1.41 (P < 0.001), and 1.01 (P < 0.001), respectively. A causative organism was cultured in 61.4% of cases, and the majority of them were Coagulase-negative Streptococcus, Staphylococcus aureus, and Streptococcus sp. Factor associated with better visual acuity includes a younger age, lower intraocular pressure, and culture-negative endophthalmitis. Meanwhile, culture-positive endophthalmitis particularly Streptococcus sp., lower baseline vision, and presence of retinal detachment at initial presentation were identified as a prognostic for poorer visual outcome. PPV demonstrated a significant visual gain in patients with endophthalmitis in the 1st, 3rd, and 6th months. However, caution is warranted in drawing a definitive conclusion.

Pars Plana Vitrectomy with or without Internal Limiting Membrane Peel for Epiretinal Membrane: A Systematic Review and Meta-Analysis

Background: The safety and effectiveness of pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling remains poorly understood for the treatment of epiretinal membrane (ERM). Objectives: Our study aims to compare the safety and effectiveness of PPV with and without ILM peeling for ERM. Methods: A systematic literature search was conducted on Ovid MEDLINE, Embase, Cochrane Library, and Google Scholar from January 2000 to January 2023 for comparative studies reporting visual and anatomical outcomes for patients with ERM that received PPV with or without ILM peeling. Primary outcomes included best-corrected visual acuity (BCVA) at last study observation and change in BCVA from baseline. Secondary outcomes included retinal thickness (RT) at last study observation, change in RT from baseline, risk of ERM recurrence, and adverse events. A random-effects meta-analysis was performed. Risk of bias of randomized controlled trials was assessed using the Risk of Bias 2 tool of observational studies using the Risk of Bias in Non-randomized Studies of Interventions-I tool. The certainty of evidence of outcomes was evaluated using Grading of Recommendations, Assessment, Development and Evaluation criteria. Results: Nineteen studies reporting on 1,291 eyes at baseline were included. PPV with and without ILM peel achieved a similar BCVA at last study observation (p = 0.68) and change in BCVA from baseline (p = 0.79). These findings remained consistent irrespective of whether simultaneous phacoemulsification was performed. PPV with ILM peel achieved a significantly lower incidence of ERM recurrence (risk ratio [RR] = 0.26, 95% CI = [0.13, 0.51], p < 0.0001) and additional surgery (RR = 0.17, 95% CI = [0.04, 0.74], p = 0.02) compared to PPV without ILM peel. Conclusion: PPV with and without ILM peel achieved a similar BCVA at last study observation in ERM patients. Patients treated with PPV and ILM peel also had a reduced risk of ERM recurrence and lower reoperation risk. These conclusions are associated with a moderate certainty of evidence and potential for bias from multiple non-randomized studies.

Effect of Pars Plana Vitrectomy on Central Corneal Thickness and Its Influence onIntraocular Pressure

Purpose: To determine the effect of Pars Plana Vitrectomy on the central corneal thickness(CCT)and its influence on intraocular pressure(IOP). Study Design: Interventional case series. Place and Duration of Study: This research was conducted at Ibrahim Eye Hospital, Karachi, Pakistan, from October 2022 to March 2023. Methods: Forty-one patients of either sexpresenting with posterior segment disease and planned for Pars Plana vitrectomy (PPV) were selected after written informed consent. Pre and post-operative comparison of CCT and IOP was done using paired t-test. Follow-up of readings was done by repeated measures ANOVA test. BCVA measurements were based on the Snellen chart and were converted to the logarithm of the minimum angle of resolution (logMAR) scale for statistical analysis. Results: CCT and IOP of the affected eyes were increased considerably in the first post-operative week (CCT=591 ± 1.5,IOP=28 ± 1.5)and decreased significantly in the 3rd month(CCT=527 ± 1.34, IOP=13 ± 2.5). The change was insignificant at 6thmonth follow-up. BCVA was improved in first week (626 ± 1.34) and remained same throughout the follow-up period. Maximum change in CCT (ΔCCT)was found in age &lt;15 years and in aphakic eyes (119 ± 0.09). Conclusion: Pars Plana vitrectomy causes significant change in CCTwhich can influenceIOP. This change should be kept in mind to prevent false diagnosis of glaucoma in the early post-operative period of PPV. Young patients and Aphakic eyes are more prone to the corneal changes.

Long-Term Safety and Efficacy of Pars Plana Vitrectomy for Uveitis: Experience of a Tertiary Referral Centre in the United Kingdom.

To evaluate the effectiveness of pars plana vitrectomy (PPV) without macular intervention on uveitis eyes with persistent vitreous inflammation/opacities in terms of visual acuity (VA), intraocular inflammation and macular profile. We carried out a single-center retrospective study of patients with uveitic eyes that underwent PPV without intervention on the macula due to persistent vitreous inflammation/opacities. The primary outcome measures were best-corrected visual acuity (BCVA), intraocular inflammation and macular profile at 3, 12 and 24 months after surgery. Twenty-seven eyes of twenty-six patients were analyzed. Overall, 77.8% had an improvement of VA (55% by 0.3 LogMAR or more); 62.5% of patients had no intraocular inflammation, and the number of patients on systemic steroids and second-line immunosuppressives was reduced by 26% at 12 months; 87.5% of patients had resolution of macular oedema at 12 months. PPV for persistent vitreous inflammation/opacities is safe and effective, showing beneficial outcomes in terms of improvement of BCVA and the reduction in inflammation.

Vitrectomy for Macular Hole with Macular Foveoschisis in Myopic Tractional Maculopathy PPV for MH-MFS

Background: Macular Hole with Macular Foveoschisis (MH-MFS) represents one of the end stages of Myopic Traction Maculopathy (MTM). This study demonstrates the effectiveness of Pars Plana Vitrectomy (PPV) with appropriate Internal Limiting Membrane (ILM) peeling and use of an ILM flap without the conventional use of macular buckle for resolving this condition. Methods: Twelve highly myopic eyes with MH-MFS underwent PPV in a single institution. Careful fovea sparing Inner Limiting Membrane (ILM) peeling with inverted flap under repeated re-staining with brilliant blue was performed. Best Corrected Visual Acuity (BCVA) and rate of Macular Hole (MH) closure, as measured by Optic Coherence Tomography. Results: Primary MH closure was obtained in 90.9% of the cases. Best Corrected Visual Acuity (BCVA) improved in 9 patients (75%) from a baseline BCVA of 0.59 ± 0.26 log MAR (20/77) to a post-operatory BCVA of 0.35 ± 0.25 log MAR (20/44) with statistical significance (p=0.004). Foveoschisis resolution occurred as follows: 6 cases within the first month, and 9 cases by the first year. Partial resolution was achieved in 2 cases, while one failed to resolve during follow-up. Conclusions: PPV with ILM peeling and inverted flap is a safe and effective method for managing MH-MFS. Careful identification of ILM and a thorough understanding of the vitreomacular interface abnormalities is key to surgical success.

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

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

Evaluation of corneal hysteresis after pars plana vitrectomy combined phacoemulsification and intraocular lens implantation

We evaluated the early effects of pars plana vitrectomy (PPV) on corneal biomechanics by comparing corneal hysteresis (CH) after cataract surgery (phacoemulsification and aspiration with intraocular lens implantation; PEA + IOL) alone and PPV combined with cataract surgery. This study included 20 eyes (18 patients), who underwent cataract surgery alone (PEA + IOL group), and 28 eyes (27 patients) who underwent PPV combined with cataract surgery (PPV triple group). The CH was 11.1 ± 1.1, 10.4 ± 1.1, and 11.0 ± 1.0 mmHg in the PEA + IOL group and 11.0 ± 1.4, 9.8 ± 1.4, and 10.6 ± 1.6 mmHg in the PPV triple group, preoperatively, at 2 weeks, and 3 months after surgery, respectively. The CH was not significantly different after surgery in the PEA + IOL group, but decreased significantly in the PPV triple group 2 weeks following surgery (p < 0.01). Intraocular pressure (IOP) and central corneal thickness (CCT) did not change significantly after surgery in either group. Preoperatively, there was a positive correlation between CH and CCT in the PPV triple group, but the correlation disappeared postoperatively. In PPV combined with cataract surgery, CH temporarily decreased postoperatively, independent of IOP and CCT. Removal of the vitreous may reduce the elasticity and rigidity of the entire eye.

Reduction of Foveal Avascular Zone After Vitrectomy Demonstrated by Optical Coherence Tomography Angiography.

Purpose: To investigate the effect of pars plana vitrectomy on foveal circulation, and in particular the foveal avascular zone (FAZ), using optical coherence tomography angiography (OCTA).Methods: This was a prospective, non-randomized, comparative case series of patients that underwent vitrectomy. Twenty-six eyes of 26 patients that underwent vitrectomy were studied postoperatively by OCTA. Our patients underwent 23 or 25G pars plana vitrectomy (PPV) for any posterior segment pathology. Three-dimensional OCTAs (DRI Triton Swept Source OCT; Topcon) of the capillary plexus were obtained three months post-operatively. The FAZ measurements of the fellow eyes were used as controls.Main outcome measures: Change in FAZ area between vitrectomized eyes and controls.Results: From a total of 26 patients, 17 underwent vitrectomy due to retinal detachment (RD). Almost all patients demonstrated a statistically significant reduction in FAZ size based on the OCTA measurements. Τhe mean difference in FAZ size for the superficial capillary plexus (SCP) was -93.77 ± 71.73 μm and for the deep capillary plexus (DCP) -88.87 ± 75.41 μm, both statistically significant (p=0.000), while the amount of reduction in μm was the same for both SCP and DCP.Conclusion: The foveal avascular zone seems to be reduced following vitrectomy as shown by optical coherence tomography angiography. It is postulated that this may be the result of changes in the physiology of the vitrectomized eye, and that this change should be attributed to the removal of the vitreous itself rather than other structures such as the internal limiting membrane.

Surgical outcomes in patients with optic disc pit maculopathy: does peeling the ILM lead to better outcomes?

PurposeOptic disc pits (ODPs) are rare congenital anomalies. Several patients develop optic disc pit maculopathy (ODP-M): visual impairment caused by intra- and/or subretinal fluid. Treatment mode remains controversial. This study was designed to investigate the effectiveness of pars plana vitrectomy (PPV) and gas tamponade with or without internal limiting membrane (ILM)-peeling in improving visual acuity and reducing subretinal fluid in ODP-M patients.MethodsWe retrospectively reviewed the charts of 16 patients who underwent surgery for ODP-M from 2002–2015. Six patients underwent PPV with gas tamponade (group 1); ten patients additionally received ILM-peeling (group 2). Pre- and postoperative visual acuity and central retinal thickness (CRT) were compared between groups, as well as retinal morphology and the number of secondary vitrectomies and complications.ResultsMedian visual acuity improved by 2 ETDRS lines in both groups (p = 0.713, Mann–Whitney U test). Median CRT decreased by 426.5 µm and 460 µm (p = 0.931). One patient in group 1 underwent repeat vitrectomy for persistent retinoschisis. Three patients in group 2 required repeat vitrectomy: two to treat a macular hole, one for peripheral retinal holes with retinal detachment.ConclusionIn our cohort, PPV with gas tamponade proved to be an effective first-line treatment for ODP-M. Additional ILM-peeling did not give a significant benefit in this study.

Anatomic and functional results of idiopathic macular epiretinal membrane surgery.

To assess the impact of macular surgery on the functional and anatomic outcomes in patients with grade 2 epiretinal membrane (ERM), and the effect of internal limiting membrane (ILM) peeling on visual acuity and to analyze the long-term effect of pars plana vitrectomy (PPV) on intraocular pressure (IOP). Pseudophakic eyes (62 eyes) diagnosed as idiopathic grade 2 ERM with at least 6mo postoperative follow-up were included in this retrospective study. The fellow eye was nonvitrectomized. Patients were divided into two groups: group 1 (29 eyes) treated with ERM and ILM peeling and group 2 (33 eyes) with only ERM peeling. Preoperative and postoperative best corrected visual acuity (BCVA), slit-lamp, and a dilated fundus examination was performed. IOP was measured with Goldman applanation tonometer before, day 1 and first week and each visit after surgery. The incidence of significant IOP elevation was compared between vitrectomized eyes and nonvitrectomized fellow eyes. Visual improvement was statistically significant and similar in both groups (P=0.008 in group 1, P=0.002 in group 2, P=0.09 inter-group). The amount of decrease in central macular thickness was statistically significant and similar in both groups (P=0.005 group 1, P=0.008 group 2, P=0.37 intergroup). At the final follow-up (14.1±9.6mo) the incidence of significant IOP elevation was 4% in vitrectomized eyes (three eyes) and 3% (two eyes) in the nonvitrectomized fellow eyes (P=0.12). Four eyes (12.1%) had recurrent ERM after a mean follow-up of 8.6±1.1mo in group 2, there was no recurrence in group 1 (P=0.01). Recurrence of ERM may be decreased by ILM peeling during ERM surgery. However, it seems that ILM peeling do not affect the functional outcome and 23-gauge PPV alone do not have a significant effect on IOP.

Immune modulator therapy compared with vitrectomy for management of complicated intermediate uveitis: a prospective, randomized clinical study.

To compare the benefits and side effects of pars plana vitrectomy with those of systemic immune modulator therapy for patients with complicated intermediate uveitis. This prospective clinical trial enrolled patients with recurrent intermediate uveitis who exhibited minimal improvement of visual acuity, despite injections of periocular steroids. Twenty patients were randomized to the pars plana vitrectomy group or oral steroid and cyclosporine-A group (10 eyes of 10 patients per group). Follow-up was performed for 24 months to study changes in visual acuity, binocular indirect ophthalmoscopy score, fluorescein angiography, and optical coherence tomography findings. Visual acuity (logarithm of the minimal angle of resolution) significantly improved from 0.71 to 0.42 (p=0.001) in the surgical group, whereas it improved from 0.68 to 0.43 (p=0.001) in the immune modulator therapy group. Seven patients (70%) in the surgical group gained ≥2 lines, and six patients (60%) in the immune modulator therapy group gained ≥2 lines (p=0.970). Fluorescein angiography and optical coherence tomography studies showed that six of seven pars plana vitrectomy patients who had cystoid macular edema experienced improvement, whereas two patients with diffuse macular edema did not experience improvement. In the immune modulator therapy group, three of six patients with cystoid macular edema did not experience improvement, whereas two patients with diffuse macular edema experienced improvement. Pars plana vitrectomy and immune modulator therapy resulted in significant improvement in visual function in patients with persistent inflammation secondary to chronic intermediate uveitis. Despite this success, there remains a need for the determination of optimal indications for the use of each modality. Immune modulator therapy was successful for the treatment of diffuse macular edema associated with chronic intermediate uveitis, whereas pars plana vitrectomy was not.

Effect of Pars Plana Vitrectomy With or Without Cataract Surgery in Patients with Diabetes: A Systematic Review and Meta-Analysis.

IntroductionPars plana vitrectomy (PPV) is considered to be an essential and effective surgical approach for the management of complications of diabetic retinopathy. Given the high rate of accelerated cataract progression after PPV, PPV combined with cataract surgery appears to be an attractive treatment option for patients with diabetes. However, this combined surgical approach remains controversial in terms of effectiveness and safety. We have therefore conducted a meta-analysis to evaluate the treatment outcome of PPV with or without cataract surgery.MethodsA systematic search of three electronic databases (PubMed, Web of Science, and the Cochrane Library) was performed to identify relevant articles, using the key words “pars plana vitrectomy,” “cataract,” and “diabetic retinopathy.” Main outcome measures included the final visual acuity and postoperative complications. The incidence of postoperative complications was pooled using odds ratio (OR) with 95% confidence intervals in a random effect model.ResultsUltimately, one randomized controlled trial (RCT) and four high-quality retrospective studies met the inclusion criteria and were included in the meta-analysis. In four of these studies, final visual acuity did not vary significantly between patients undergoing PPV alone and those undergoing PPV combined with cataract surgery (combined surgery). Only one study reported better visual improvement in the combined treatment group. Our analysis also showed that most phakic eyes after PPV had cataract progression with varying degrees. In addition, patients receiving PPV alone had a lower risk of neovascular glaucoma (OR 0.36; P < 0.05), iris synechias to anterior capsule (OR 0.36; P < 0.05), and iris rubeosis (OR 0.26; P < 0.05) compared with those receiving combined surgery.ConclusionOverall, our findings show that PPV combined with cataract surgery achieved good outcomes without a substantial increased risk to visual acuity or most complications. Given the high rates of cataract progression after PPV, combined surgery may be the more appropriate treatment for patients with diabetes and coexistent visually significant cataract.

Retinoschisis: A Predictive Factor in Vitrectomy for Lamellar Macular Holes in Highly Myopic Eyes

Purpose: To evaluate the effect of pars plana vitrectomy (PPV) and internal limiting membrane (ILM) peeling for lamellar macular hole (LMH) with or without macular retinoschisis in highly myopic eyes. Methods: In this retrospective, consecutive case-control study, 21 highly myopic patients (22 eyes) with LMH were divided into two groups based on preoperative optical coherence tomography (OCT): the “flat group” had no macular retinoschisis (n = 10), and the “retinoschisis group” had macular retinoschisis (n = 12). The average follow-up time was 17.2 ± 12.6 months. Outcomes were based on 6-month postoperative best-corrected visual acuity (BCVA), integrity of the ellipsoid zone (EZ), external limiting membrane (ELM), and residual foveal thickness (RFT). Results: The appearance of the macula on OCT was normalized in 19 eyes (86.3%) at the final follow-up visit. Compared to the flat group, the retinoschisis group presented a significantly higher incidence of epiretinal membrane (p = 0.046) and lower refractive error (p = 0.033), shorter axial length (p = 0.0009), better integrity of ELM and EZ (p = 0.005 and p = 0.005, respectively), and better preoperative and postoperative BCVAs (p = 0.015). Conclusions: PPV is an effective method to achieve a high anatomical success, improve postoperative vision, and prevent foveal thinning in highly myopic eyes with LMH. In these eyes, the presence of retinoschisis strongly indicates the need for vitrectomy.

Anatomic and Functional Effects of Pars Plana Vitrectomy in Patients with Diabetic Tractional Retinal Detachment

Anatomic and Functional Effects of Pars Plana Vitrectomy in Patients with Diabetic Tractional Retinal Detachment

Functional and Morphological Effects of Pars Plana Vitrectomy with Internal Limiting Membrane Peeling in Patients with Diabetic Macular Edema Refractory to Laser Photocoagulation

Functional and Morphological Effects of Pars Plana Vitrectomy with Internal Limiting Membrane Peeling in Patients with Diabetic Macular Edema Refractory to Laser Photocoagulation

Macular choroidal thickness after vitreoretinal surgery: Long-term effect of pars plana vitrectomy with and without encircling scleral buckling surgery

Abstract Purpose To evaluate the macular choroidal thickness (CT) of eyes subjected to pars plana vitrectomy (PPV) whether or not combined with encircling scleral buckling (ESB) surgery for primary rhegmatogenous retinal detachment repair at 6 months or more after surgery. Methods This observational study included: 15 eyes (15 patients) submitted to combined ESB + PPV; 15 eyes submitted to PPV and their respective 30 normal fellow eyes (FE). Two 6 mm lineal perpendicular optical coherence tomography B-scans centered on the fovea with enhanced depth imaging were performed on each eye. CT was measured at several macular locations: subfoveal (SF-CT) and at a radius of 1, 2, and 3 mm from the fovea. CTs of the eyes in the CE + PPV group were compared to CT in the PPV group and the CTs of all operated eyes were compared to the CTs of their FE. Results SF-CT of the eyes in the ESB + PPV group was significantly increased compared to their FE (p = 0.001). CT at a radius of 1, 2, and 3 mm from the fovea of the ESB + PPV group were significantly increased (p = 0.001, p = 0.005, and p = 0.001, respectively). The SF-CT of the PPV group was similar to their FE (p = 0.691). The SF-CT of the ESB + PPV group was significantly increased compared to SF-CT of the PPV group (p = 0.019). Conclusions The CT of the eyes subjected to combined ESB and PPV was significantly increased at 6 months or more after surgery compared to the CT of their FE and to the CT of the eyes subjected to PPV alone, which could be explained by a venous engorgement caused by the ESB.

The efficacy of vitrectomy combined with internal limiting membrane peeling to treat high myopia macular hole with macular retinoschisis and it affecting factors

Objective To observe the clinical effects of pars plana vitrectomy (PPV) combined with internal limiting membrane peeling (ILMP) for macular hole (MH) and macular retinoschisis in high myopic eyes, and to analyze factors affecting the MH closure rate. Methods This is a retrospective case study. 21 high myopic patients (22 eyes) with MH and macular retinoschisis were enrolled in this study. All eyes were examined for best corrected visual acuity (BCVA), intraocular pressure, slit lamp microscope, indirect ophthalmoscope, A and/or B-scan ultrasound, optical coherence tomography and visual electrophysiological examination. The BCVA was ranged from finger counting to 0.2. The axial length (AL) was ranged from 26.00 to 31.00 mm, with an average of 27.47 mm. Among 22 eyes, AL was between 26.00 mm to 27.00 mm in 9 eyes, 27.10 mm to 28.00 mm in 5 eyes, 28.10 mm to 29.00 mm in 3 eyes, 29.10 mm to 30.00 mm in 3 eyes, and longer than 30.00 mm in 2 eyes. The diameter of MH was ranged from 227 µm to 597 µm and with an average of 432 µm. Among them, the minimum diameter was between 200 µm to 400 µm in 4 eyes, 401 µm to 450 µm in 13 eyes, 451 µm to 500 µm in 3 eyes, 501 µm to 600 µm in 2 eyes. All the eyes were treated with PPV combined with ILMP surgery. The average follow-up time was 17 months after surgery. The efficacy was determined at the final follow up, including the MH closure, the state of macular retinoschisis and the BCVA. MH closure rate with different MH diameters and different AL were compared and analyzed. Results During the final follow- up, MH were fully closed in 17 eyes (77.3%), bridge-closed in 4 eyes (18.2%) and not closed in 1 eye (4.5%). Retinoschisis was resolved in 19 eyes (86.4%), partially resolved in 2 eyes (9.1%) and not changed in 1 eye (4.4%). MH with smaller diameter had higher MH closure rate (χ2=12.036, P=0.032). MH with longer AL had lower MH closure rate (χ2=16.095, P=0.003).The final BCVA was ranged from finger counting to 0.25. Among 22 eyes, BCVA or metamorphopsia were improved in 9 eyes (40.9%), stable in 8 eyes (36.4%). BCVA was reduced and metamorphopsia was more severe in 5 eyes (22.7%). Conclusions PPV combined with ILMP is a safe and effective surgical treatment for MH (with minimum diameter ≤600 μm) and macular retinoschisis in high myopic eyes. After surgery, MH was closed and retinoschisis was resolved in most patients. The major factors affect the MH closure were the minimum diameter of MH and AL. Key words: Retinal perforations/surgery; Retinoschisis/surgery; Myopia, degenerative/ complications; Vitrectomy

Change in central corneal thickness, corneal endothelial cell density, anterior chamber depth and axial length after repair of rhegmatogenous retinal detachment.

Objective:To compare the effects of Pars Plana Vitrectomy (PPV) and Scleral Buckling (SB) with reference to Central Corneal Thickness (CCT), Corneal Endothelial-Cell Density (CED), Anterior Chamber Depth (ACD) and Axial Length (AL) in repair of Rhegmatogenous Retinal Detachment (RRD).Methods:This comparative cross sectional analytical study was conducted at Armed Forces Institute of Ophthalmology (AFIO), Rawalpindi from July 2013 to July 2015. A total of 69 eyes of 69 patients which underwent repair of RRD by either PPV or SB were analyzed to compare mean change in CCT, CED, ACD and AL between two groups.Results:Mean age of patients was 56.23±5.22 years. Mean pre-operative CCT, CED, ACD and AL in PPV group was 533.06±13.28µm, 2231.67±164.57Cells/mm2, 3.37±0.18mm and 23.66±0.76mm respectively. Mean post-operative CCT, CED, ACD and AL in PPV group was 534.81±11.83µm, 2037.19±167.83 Cells/mm2, 3.24±0.13mm and 23.88±0.80mm respectively. Change in CED, ACD and AL from pre-operative value after PPV was statistically significant (p<0.001). Mean pre-operative CCT, CED, ACD and AL in SB group was 530.73±12.59 µm, 2161.79±161.96 Cells/mm2, 3.343±0.14mm and 23.67±0.82mm respectively. Mean post-operative CCT, CED, ACD and AL in SB group was 532.76±7.74 µm, 2158.27±156.58 Cells/mm2, 3.24±0.10mmand 25.71±0.86mm respectively. Change in ACD and AL from pre-operative value after SB was statistically significant (p<0.001). Mean change of CED, ACD and AL between two groups was also statistically significant (p<0.001).Conclusion:Rhegmatogenous retinal detachment repair causes ocular changes, with significantly more decrease in corneal endothelial cell density after pars plana vitrectomy, and more increase in anterior chamber depth and axial length after scleral buckling.

增殖性糖尿病视网膜病变围手术期玻璃体腔内注射康柏西普的疗效研究

目的：对比观察单行玻璃体切除术(Pars Plana vitrectomy, PPV)与玻璃体腔内注射康柏西普联合玻璃体切除术治疗增殖性糖尿病视网膜病变(Proliferative diabetic retinopathy, PDR)的临床效果。方法：选取我院2014-12/2015-12收治的PDR患者23例26眼，随机分为两组。单行PPV治疗的患者为对照组(11例12眼)，在行PPV术前行康柏西普玻璃体腔内注射的患者为试验组(12例14眼)。术后随访1年，观察两组患者手术情况及治疗效果。结果：试验组的平均手术时间、术中严重出血率均少于对照组。两组患者术前CMT、BCVA差异无统计学意义，术后试验组明显优于对照组，且差异具有统计学意义。结论：行PPV前玻璃体腔内注射康柏西普可以有效的缩短手术时间，减少术中出血，降低医源性裂孔的发生率，减轻黄斑水肿，提高患者的最佳矫正视力。 AIM: To compare the effects of pars plana vitrectomy (PPV) with or without conbercept intravitreal injection of proliferative diabetic retinopathy (PDR). METHODS: 23 patients (26 eyes) with PDR in our hospital from December 2014 to December 2015 were recruited, and were randomly divided into two groups. 11 cases (12 eyes) in control group were received single vitrectomy. In ex-perimental group, 12 cases (14 eyes) were injected by drug therapy of conbercept and received vitrectomy. In the postoperative follow-up of 1 year, the general situation of operation and thera-peutic effect between the two groups were analyzed. RESULTS: The average operation time, bleeding during operation of the experimental group were lower than that of the control group; they were significantly different. There was no statistically significant difference between two groups on CMT & BCVA before operation, but the experimental group had better effect than control group at 4mo. CONCLUSION: Intravitreal injection of conbercept before vitrectomy can decrease the operation time, reduce active neovascularization, minimize the incidence of intraoperative haemorrhage and iatrogenic retinal breaks incidence, alleviate macular edema and improve BCVA of patients in the treatment of PDR.