Efficacy Of Pars Plana Vitrectomy Research Articles

Analysis of the therapeutic efficacy of pars plana vitrectomy without intraocular tamponade in the treatment of high myopic eyes with myopic foveoschisis and central foveal detachment

Objective: To investigate the efficacy of pars plana vitrectomy (PPV) without intraocular tamponade in the treatment of high myopic eyes with myopic foveoschisis (MF) accompanied by foveal detachment (FD). Methods: A retrospective case series study was conducted. The medical records of patients diagnosed with unilateral MF accompanied by FD at the Eye & ENT Hospital of Fudan University between May 2018 and December 2021 were collected. All patients underwent 23-gauge PPV with posterior vitreous cortex clearance, and no intraocular tamponade was applied. The cases were divided into groups based on whether the internal limiting membrane was peeled during surgery or retained. Follow-up was conducted for at least 12 months. The main outcome measures included postoperative best-corrected visual acuity (BCVA, converted to logarithm of the minimum angle of resolution), central foveal thickness (CFT), MF resolution, and complications. Statistical analyses were performed using t-tests, chi-square tests, Fisher's exact tests, and univariate and multivariate linear regression. Results: A total of 40 patients (40 eyes) with MF and FD were included in the study, with 30.0% being male and 70.0% female. The mean age was (56.9±11.7) years, and the axial length of the eyes was (29.1±1.9) mm. At 12 months postoperatively, BCVA improved from baseline 1.15±0.58 to 0.73±0.39 (t=6.11, P<0.001), and CFT decreased from baseline (610.1±207.2) μm to (155.9±104.1) μm (t=13.47, P<0.001). Complete resolution of MF with foveal reattachment was observed in 80.0% of eyes, with a median time of 6 (5, 8) months. There was no significant difference in BCVA and CFT between the internal limiting membrane peeled group and retained group [0.68±0.39 vs. 0.79±0.40, t=0.85, P=0.403; (148.3±63.8)vs.(164.3±137.2)um,t=0.48, P=0.634]. One eye experienced macular hole and another eye developed retinal detachment postoperatively. Correlation analysis showed a positive correlation between BCVA at 12 months postoperatively and baseline BCVA (β=0.433, P<0.001). Conclusions: Pars plana vitrectomy without intraocular tamponade is effective in treating MF accompanied by FD. The choice between internal limiting membrane peeling and retention does not significantly affect visual prognosis.

Pars Plana Vitrectomy for the Treatment of Diabetic Macular Edema with or without Internal Limiting Membrane Peeling: A Systematic Review and Meta-Analysis

Background Diabetic macular edema (DME) is defined as a retinal thickening in one-disc diameter (DD) of the centre of the macula. It is a number of microvascular retinal changes that lead to blood–retinal barrier (BRB) disruption, causing leakage of fluid and plasma components into the inner and outer plexiform layers. Aim of the Work The aim of the study was to conduct a systematic review and a meta-analysis estimating the efficacy of pars plana vitrectomy with and without internal limiting membrane peeling in treating non tractional refractory diabetic macular edema. Materials and Methods A comprehensive literature search was conducted using the databases Google scholar, PubMed, MEDS, web of science, EMBASE and Cochrane Library for published studies from 1 January 2000 to 1 August 2020. This meta-analysis included 14 studies. They were randomized controlled clinical trials (RCTs), and about 647 patients with DME (753 eyes) participated in these studies. Results This study demonstrated no statistically significant change in the mean of best corrected visual acuity (BCVA) improvement and central macular thickness (CMT) in both groups when comparing the baseline to one- and three-month follow-ups after the procedure, though with no statistically significant difference in the ILM compared to the non ILM group. Conclusion Pars plana vitrectomy with or without ILM peeling improves the long-term visual acuity of nontractional diabetic macular edema. Internal limiting membrane peeling, does not affect the postoperative best-corrected visual acuity significantly.

Long-term outcomes of autologous platelet treatment for optic disc pit maculopathy

PurposeOptic disc pits (ODPs) are rare congenital cavitary abnormalities of the optic nerve head, which can lead to serous macular detachments. The aim of this study was to evaluate the long-term efficacy of pars plana vitrectomy (PPV) combined with autologous platelet concentrate (APC) for the treatment of optic disc pit maculopathy (ODP-M).MethodsA retrospective analysis was performed on eleven eyes of ten patients with ODP-M, who received PPV combined with APC. Nine eyes operated primary, four of which had a repeat surgery also with injection of APC and two eyes underwent a rescue surgery, after they have been operated in another eye center without APC. Morphological and functional results were the main outcome parameters, determined by optical coherence tomography (OCT) and best-corrected visual acuity (BCVA), respectively.ResultsThe mean duration of visual loss before surgery was 4.7 ± 3.89 months (range 0–12 months). The mean BCVA increased significantly from 0.82 ± 0.33 logMAR (range 0.4–1.3) preoperatively to 0.51 ± 0.36 logMAR (range 0–1.2) at the last examination (p = 0.0022). A significant morphological improvement was also noticed with decrease of the mean foveal thickness from 935.82 ± 248.48 µm (range 559–1400 µm) preoperatively to 226.45 ± 76.09 µm (range 110–344 µm) at the final examination (p < 0.0001). The patients were followed-up for a mean 65.36 ± 48.81 months (range 1–144 months). Two eyes developed postoperatively a retinal detachment. Cataract surgery was performed in 5 eyes during the follow-up period.ConclusionOur study demonstrated that PPV with APC can improve functional and morphological outcomes, both as a primary and a rescue therapy, without any recurrence over a long follow-up period. To the best of our knowledge, this was the longest observation period regarding the use of APC in treatment of ODP-M.

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.

Pars plana vitrectomy for tractional diabetic macular edema with or without internal limiting membrane peeling.

The effectiveness of internal limiting membrane (ILM) peeling in the surgical treatment of tractional diabetic macular edema (DME), although widely examined, remains controversial. This study aimed to assess the efficacy of pars plana vitrectomy (PPV) in the management of tractional DME and to highlight any benefits of additional ILM peeling. This was an open-label, prospective, comparative, and interventional study that enrolled 50 eyes with tractional DME that underwent PPV and allocated each to one of two groups: group A consisted of 25 eyes that had no ILM peeling and group B consisted of 25 eyes that underwent ILM peeling. Postoperative assessments of best-corrected distance visual acuity (BCDVA) in the logarithm of minimal angle of resolution (logMAR) notation and central macular thickness (CMT) were performed at 1, 3, and 6 months postoperatively. At baseline, the two groups were comparable in terms of sex ratios, phakic status, insulin use, coexistence of hypertension, and mean (standard deviation [SD]) age, BCDVA, CMT, duration of diabetes mellitus, and glycosylated hemoglobin (HbA1c) levels. In group A, the mean (SD) BCDVA improved significantly from 0.89 (0.12) logMAR preoperatively to 0.64 (0.24) logMAR (P < 0.001), and the mean (SD) CMT declined significantly from 471.28 (80.83) µm to 228.20 (26.45) µm (P < 0.001), at the 6-month postoperative assessment. Likewise, in group B, the mean (SD) BCDVA improved significantly from 0.83 (0.10) logMAR preoperatively to 0.58 (0.24) logMAR (P < 0.001), and the mean (SD) CMT decreased significantly from 496.84 (89.82) µm to 226.20 (18.04) µm (P < 0.001), after 6 months. There were no significant differences between groups A and B in the changes in BCDVA (Delta BCDVA) or CMT (Delta CMT) at 1, 3, and 6 months postoperatively with respect to the baseline values (all P > 0.05). Postoperative complications were comparable between the two groups. A significant negative correlation was detected between the preoperative HbA1c level and BCDVA improvement in all participants (r = - 0.82; P < 0.001). PPV is an effective treatment for tractional DME. Additional ILM peeling was not significantly associated with functional and anatomical benefits over a short period. Long-term glycemic control plays a role in vision gain after vitrectomy in patients with diabetes. Further long-term studies are required to verify our findings.

The survival analysis and feasibility study of Pars Plana Vitrectomy (PPV) in the treatment of retinoblastoma.

To analyze the safety and efficacy of Pars Plana Vitrectomy (PPV) as a treatment for retinoblastoma patients and to evaluate the feasibility. We collected 342 eyes who had PPV after systemic chemotherapy in our retrospective study, then analyze the 5-year overall survival and 5-year event-free survival rate, recurrence rate, and metastasis rate. The above data were used to evaluate the feasibility of PPV in the treatment of retinoblastoma. The mean value of follow-up time was 62.9months from PPV. Of all 342 eyes, 18% eyes underwent enucleation of the eyeball. Excluding Non-PPV related deaths eyes, the 5-year overall survival rates and event-free survival were 95% and 80%; the tumor recurrence rate and metastasis rate were approximately 26% and 1.2%, respectively; the mortality was 3.9%. And the incidence of high-risk pathological factors of enucleated eyes after PPV was 32%. Our results suggest that Pars Plana Vitrectomy as a new approach to preserve the eyeball of RB children is feasible, especially for those patients who cannot be completely controlled by systemic chemotherapy or the tumors with vitreous seeds. Although the outcomes in our study are very optimistic, we also recommend an experienced eye surgeon to perform the operation and strictly control the indications for PPV surgery. And enough systemic chemotherapy is very important before and after surgery. Treatment study (Retrospective comparative study), III.

Efficacy of pars plana vitrectomy (PPV) for visually significant vitreous opacities.

Objective: To study the efficacy of pars plana vitrectomy (PPV) for visually significant vitreous opacities in improving visual function and quality of life. Study Design: Interventional study. Setting: Department of Vitreoretinal Clinic of Ophthalmology, Nishtar University Hospital Multan. Period: May 2017 to August 2019. Material &amp; Methods: A total of 50 patients of both genders, aged 35 to 65 years having lenticular status (Phakic or pseudophakic patients) and planned for PPV were enrolled for this study. All patients were examined on slit lamp bio microscope. Dilated fundus examination was performed with indirect ophthalmoscope using scleral indentation. Intraocular pressure was measured pre and postoperatively with Goldmann’s applanation tonometer under topical anaesthesia. Diagnosis was made on through clinical examination. All patients underwent 23 gauge PPV with or without silicon oil with endo laser. Best spectacle corrected visual acuity was recorded with help of Snellen chart. Results: There were 50 eyes of 50 patients in two groups, 40 phakic eyes (80%) and 10 pseudophakic eyes (20%) that underwent 3 PPV for visually significant opacities. There were 38 (76.0%) male and 12 (24.0%) female patients. Thirty four (68.0%) out of 50 patients showed improved best spectacle corrected visual acuity (BSCVA) and visual function while 18% had BCVA 6/24 – 6/18. Forty three (86.0%) patients reported quality of life and psychological feel improvement. Conclusion: Pars plana vitrectomy is a safe, effective and viable option for annoying vitreous floaters. There are risks of retinal breaks, rhegmatogenous retinal detachment and cataract. Surgeon must be ready for prompt handling of patient.

Management of Vasoproliferative Tumors of the Retina with Macular Complications by Pars Plana Vitrectomy Combined with Episcleral Cryotherapy.

Objective To evaluate the efficacy of pars plana vitrectomy (PPV) combined with episcleral cryotherapy in treating vasoproliferative tumors of the retina (VPTR) with macular complications. Methods In this retrospective noncomparative interventional case-series analysis, we included 11 eyes of ten patients diagnosed with VPTR. All patients underwent comprehensive ophthalmic examinations and were treated with PPV combined with episcleral cryotherapy. Best-corrected visual acuity (BCVA), tumor activity, retinal morphological structure, and postoperative complications were evaluated. Results Macular complications included epimacular membrane (n = 10), macular hole (n = 3), and macular edema (n = 1). Tumors were treated with triple freeze-thaw episcleral cryotherapy during PPV. The mean logarithm of minimal angle of resolution (logMAR) BCVA dropped from 0.62 ± 0.58 to 0.39 ± 0.46. The difference between the mean values of logMAR BCVA before and after treatment was statistically significant (t = 2.48, P=0.033). The tumor activity was controlled effectively in nine cases. Compared with preoperative tumor activity, tumor activity after treatment was significantly lower (P < 0.01). The increase of central retinal thickness and the disruption of retinal layers were associated with macular holes, macular edema, and retinal proliferative membrane. After the treatment, visual acuity improved in 91% of the cases, and 73% had no long-term complications. Conclusion PPV combined with episcleral cryotherapy promoted tumor regression, preserved retinal integrity, and improved visual acuity. Thus, the combination of PPV with episcleral cryotherapy can be considered effective and safe for the management of VPTR with macular complications.

Long-Term Outcome After Silicone Oil Removal in Eyes with Myopic Retinal Detachment Associated with Macular Hole

PurposeTo assess the efficacy of pars plana vitrectomy (PPV) and silicone oil tamponade for management of myopic retinal detachment associated with macular hole (MRDMH) and to assess the anatomical and functional outcomes of this technique and its long-term validity after silicone oil removal.MethodsRetrospective interventional non-comparative case series including consecutive patients who had PPV and silicone oil tamponade for MRDMH. All patients had an axial length ≥26 mm. Main outcome measures were retinal re-attachment and macular hole closure after silicone oil removal, improvement of best-corrected visual acuity (BCVA), and complications secondary to surgery. Chi square/Fisher’s exact test was used to analyze categorical variables, while One-way ANOVA/Kruskal–Wallis test was used to compare variables across the closure type and complications. Correlations between numerical variables were tested using Spearman correlation. Kaplan–Meier method was used to estimate the event-free survival. P value is significant at 0.05.ResultsThe study included 26 eyes of 26 patients. Retinal re-attachment rate after primary and secondary surgeries was 88.4% and 100%, respectively. W-type macular hole closure occurred in 58% of eyes. Vision improved in 58% of eyes. Mean final BCVA was 0.05 decimal units, p = 0.004. Cataract and glaucoma developed in 42% and 15% of eyes, respectively. Initial BCVA, axial length and duration of silicone oil tamponade did not correlate significantly with either the type of macular hole closure or the final BCVA.ConclusionPPV and silicone oil tamponade technique promotes successful anatomical and functional outcome in MRDMH. Long-term success is maintained after silicone oil removal. High incidence of silicone oil-induced complications mandate its removal from eyes with successful retinal re-attachment.

Efficacy of Pars Plana Vitrectomy with Internal Limiting Membrane Peeling for Treatment of Large Idiopathic Full-Thickness Macular Holes.

PurposeTo evaluate anatomical and visual outcomes of pars plana vitrectomy (PPV) with internal limiting membrane peeling (ILMP) in large idiopathic full-thickness macular holes (FTMH). Predictive factors also formed part of the study.Patients and MethodsA retrospective review of medical charts and optical coherence tomography images of patients with large idiopathic FTMH (≥400 µm) was conducted.ResultsOne hundred and fifty-eight eyes of 155 patients with a mean age of 62.94±7.50 years were included in the study. Mean preoperative visual acuity (VA) was 1.26±0.36 logMAR. Mean preoperative minimum linear diameter (MLD) and basal linear diameter (BLD) were 644.89±136.85 µm and 1208.11±307.14 µm, respectively. At 12 weeks postoperative follow-up, FTMH closure rate was 61.39% and mean postoperative BCVA was 0.92±0.36 logMAR. Multivariate logistic regression analyses showed the anatomical outcome was significantly associated with BLD ≤1200 µm, preoperative vitreomacular interface (VMI) disorder and extended ILMP (a radius of 2 disc diameters), whereas only postoperative ellipsoid loss ≤500 µm was significantly associated with visual outcome. In subgroup analyses, the large FTMH group (400–600 µm) had significantly better results in closure rate (70.97% vs 55.21%, P = 0.047) and visual results (P = 0.031) than the extra-large FTMH group (>600 µm).ConclusionPPV with conventional ILMP provided relatively low closure rate in large FTMH. Surgical success was significantly associated with BLD ≤1200 µm, no preoperative VMI abnormality, extended ILMP and postoperative ellipsoid defect ≤500 µm. Therefore, we suggest the extended ILMP if conventional ILMP technique is used. The large FTMH group had significantly better surgical outcomes than the extra-large group, so there is a need for reclassification of large FTMH.

Pars Plana Vitrectomy versus Intravitreal Injection of Ranibizumab in the Treatment of Diabetic Macular Edema Associated with Vitreomacular Interface Abnormalities.

Purpose To compare the efficacy of pars plana vitrectomy (PPV) versus intravitreal injection (IVI) of ranibizumab (RBZ) in the treatment of diabetic macular edema (DME) associated with vitreomacular interface abnormalities (VMIA). Methods The records of patients presenting with DME and VMIA throughout 2016 to 2018 were retrospectively analyzed. The patients were divided into 2 groups: group I received IVIs of RBZ and group II underwent PPV with internal limiting membrane peeling. The main outcome measures were the change in the LogMAR corrected distance visual acuity (CDVA) and central subfield thickness (CSFT) on optical coherence tomography over 6 months. Results At 6 months, mean CDVA improved by 0.22 ± 0.21 in group I patients (p < 0.001), while in group II, it improved only by 0.09 ± 0.22 (p < 0.115). Fifty-five percent of group I and 60% of group II patients had stable CDVA (within 2 lines from baseline) at 6 months. Significant improvement in vision (gain of 2 or more lines) was seen in 45% and 30%, respectively. Worsening of vision (loss of 2 or more lines) was seen only in 2 patients in group II, but none in group I. The mean CSFT improved significantly in both groups (by 162 µ and 216 µ, respectively; p < 0.001). The mean CSFT at 6 months was similar in both groups (354 µ and 311 µ, respectively; p=0.172). Conclusions Both treatments resulted in anatomical improvement of DME with concurrent VMIA. Visual improvement was more pronounced in the IVI group, although this may have been affected by other confounding factors.

Long-term evaluation of pars plana vitrectomy in children with Abusive head trauma.

To determine the efficacy of pars plana vitrectomy (PPV) in children with intraocular hemorrhage (IOH) secondary to Abusive head trauma (AHT). A long-term retrospective analysis evaluating epidemiology, management, safety, anatomical and functional results of PPV for IOH in children with AHT at tertiary referral center for children in the Czech Republic from 2004 to 2017. 18 children were identified with IOH due to AHT during observation period of 14 years. Overall incidence of IOH related to AHT was 29.6/100 000, in children under 1 year 22.2/100 000, in children 1 to 5 years 7.4/100 000. Mean age at the time of diagnosis was 13.7 (SD±20.53) months, median 5 months. IOH resolved in 56% of children, 64% eyes, spontaneously. 44% children, 36% eyes, underwent PPV. PPV was performed 30.5 (SD±16.98) days after established diagnosis on average. Postoperatively, 80% of eyes had anatomical improvement, 20% eyes had preexisting irreversible changes in the posterior pole. Vision of 50% eyes improved after surgery, vision of 20% eyes remained poor, 30% of eyes was not possible to test due to severe neurological impairment. Mean observational period was 33.4 (SD±38.21) months. Mortality rate of AHT in our group was 17%, all victims were younger 4 months. PPV is a safe and effective procedure to clear IOH in children with AHT. Ophthalmology outcomes are strongly associated with degree of neurological impairment. Best outcomes were achieved with PPV performed between 2 and 5 weeks after trauma. Opportunity to plan surgery within this time frame indicates a good neurological prospect and prevents deprivation amblyopia.

Inverted internal limiting membrane insertion versus standard internal limiting membrane peeling for macular hole retinal detachment in high myopia: one-year study.

The aim of this study was to investigate the efficacy of pars plana vitrectomy with inverted internal limiting membrane (ILM) insertion for macular hole retinal detachment (MHRD) in high myopia. We studied 49 eyes of 49 consecutive patients who underwent vitrectomy for MHRD and were followed for more than 12months postoperatively. Eyes that underwent vitrectomy with inverted ILM insertion from October 2013 to August 2015 were compared with eyes that underwent standard ILM peeling from October 2006 to September 2013. Macular hole closure rate, retinal reattachment, and postoperative visual acuity (VA) at 6 and12months were retrospectively evaluated. This series included 13 eyes in the inverted ILM insertion group and 36 eyes in the standard ILM peeling group. The MH closure rate was significantly better in the inverted ILM group (92 vs 39%) (P = 0.003). The initial and final retinal reattachment rates (92% vs. 86%, and 100% in both groups, respectively) did not differ significantly between groups. Although the mean preoperative VA did not differ significantly between the groups, postoperative VA tended to be better in the inverted ILM group at 12months (P = 0.059). The rate of visual improvement of three or more lines in the inverted ILM insertion group (85%) was higher than that in the standard ILM peeling group (47%) at 12months (P = 0.045). Compared to conventional ILM peeling, inverted ILM insertion has a higher MH closure rate and tendency of better postoperative VA in patients with MHRD.

Efficacy of vitrectomy combined with scleral buckling for rhegmatogenous retinal detachment with vitreous hemorrhage

Objective To evaluate the efficacy of pars plana vitrectomy (PPV) combined with minimal segmental scleral buckling (MSSB) without inert gas or silicone oil tamponade for the treatment of rhegmatogenous retinal detachment (RRD) with vitreous hemorrhage. Methods The data of 99 eyes of 99 cases with RRD with vitreous hemorrhage underwent PPV combined with MSSB from Mar. 2010 to May 2015 were collected and analyzed retrospectively. Results All eyes were localized no-proliferative RRD including 67 eyes with trauma history. The tears placed peripheral retina within a quadrant. Retinal tears were inferior in 73 eyes(73.74%). During operation, 21 eyes (21.21%) underwent air tamponade and 78 eyes (78.79%) received perfusate tamponade. The retinal reattachment rate of the first surgery was 92.93%. The final retinal reattachment rate was 100.00%. The postoperative visual acuity was improved (χ2=68.561, P=0.000). At the end of follow-up, the mean IOP increased from (14.55±3.81) mmHg (1 mmHg=0.133 kPa) to (17.92±2.45) mmHg (t=4.315, P=0.000). However, the IOP were in the normal range. No severe complication occurred during or after surgery. Conclusion PPV combined with MSSB without inert gas or silicone oil tamponade for the treatment of RRD with vitreous hemorrhage has high retinal reattachment rate and few complications. Key words: Vitrectomy, pars plana; Scleral buckling; Retinal detachment, rhegmatogenous

The necessity and optimal time for performing pars plana vitrectomy in acute retinal necrosis patients

BackgroundTo compare the efficacy of pars plana vitrectomy (PPV) at different time points to treat acute retinal necrosis (ARN) and to investigate the necessity of PPV for ARN.MethodsA retrospective review of the treatment options and outcomes of the ARN patients was performed. Thirty ARN patients (34 eyes) were included in this study. The eyes were divided into 3 groups depending on the treatment administered. In the medically treated group, there was no retinal detachment (RD) at the first visit. The routine group patients were treated with systemic antiviral medications, as well as with intravitreal antiviral injections. In the early PPV treatment group, there was no RD at the first visit. The early PPV treatment group patients were treated with systemic antiviral medications and PPV plus silicone oil tamponade and intravitreal injection. In the PPV group, there was RD at the first visit. The PPV group patients were treated with systemic antiviral medications and PPV plus silicone oil tamponade and intravitreal injection.ResultsIn the medically treated group, the mean baseline best corrected visual acuity (BCVA) (logMAR) was 1.38 ± 0.35. The BCVA was 1.21 ± 0.36 at the last visit for the medically treated group. In this group, one eye (12.5%) developed RD after 1 month of treatment. In the early PPV treatment group, the mean BCVA (logMAR) was 1.68 ± 0.26. The BCVA was 1.83 ± 0.21 at the last visit for the early PPV group. In this group, five eyes (29.4%) had recurrent RD before silicone oil removal. In the PPV group, the mean BCVA (logMAR) was 2.0 ± 0.35. The BCVA was 1.72 ± 0.34 at the last visit for the PPV group. In this group, one eye (11.1%) had recurrent RD before silicone oil removal. There were no significant differences among the three groups in the baseline BCVA and the BCVA at the last visit (p>0.05). There were no significant differences between the early PPV group and the PPV group in the recurrent RD rates (p = 0.38).ConclusionsProphylactic PPV showed no difference in recurrent RD rates or better BCVA. Therefore, prophylactic vitrectomy cannot prevent RD nor improve the prognosis of ARN based on our research.

Long-term results of pars plana vitrectomy as an anti-inflammatory therapy of pediatric intermediate uveitis resistant to standard medical treatment.

To evaluate the efficacy of pars plana vitrectomy (PPV) as an anti-inflammatory therapy in pediatric recurrent intermediate uveitis. A retrospective study evaluated the long-term results of PPV indicated for intermediate uveitis with a mean observation period of 10.3 years (range 7-15.6 years) in 6 children (mean age 8 years, range 6-12 years). Pars plana vitrectomy was performed on 10 eyes in the standard manner and was initiated by vitreous sampling for laboratory examination. Data recorded were perioperative or postoperative vitrectomy complications, anatomic and functional results of PPV, and preoperative and postoperative best-corrected Snellen visual acuity. No perioperative or postoperative complications were observed. Bacteriologic, virologic, mycotic, and cytologic analysis of the vitreous was negative in all tested children. Five eyes were subsequently operated on for posterior subcapsular cataracts. An average preoperative visual acuity of 0.32 improved to an average postoperative visual acuity of 0.8. In the case of systemic immunosuppressive treatment failure in pediatric uveitis, particularly in eyes with cystoid macular edema, we recommend PPV relatively early.

Efficacy of vitrectomy combined with selective retinal photocoagulation for diabetic retinopathy

Objective To observe the efficacy of pars plana vitrectomy (PPV) combined with selective retinal photocoagulation (SRP) in the treatment of proliferative diabetic retinopathy (PDR) with vitreous hemorrhage. Methods Two hundred eyes of 190 patients with PDR and vitreous hemorrhage were enrolled in this study.All patients were treated with 23-gauge PPV combined with retinal photocoagulation and intravitreal injection of Lucentis and triamcinolone acetonide.All patients were divided randomly into two groups: the contral group, 108 eyes of 102 cases, received panretinal photocoagulation(PRP) during surgery and the observation group, 92 eyes of 88 cases, received SRP during surgery. All patients were followed up for 6 months.The effect were compared between the two groups. Results BCVA of observation group was better than that of contral group at 1 week, 1 month and 3 months after surgery.The difference was statistically significant(P=0.000). The difference in BCVA was not statistically significant between the two groups at 6 months after surgery(P=0.094). The central macular thickness(CMT) of observation group was lower than that of contral group at 1 week and 1 month after surgery, the difference was statistically significant(P=0.000). The difference was not statistically significant at 3 months after surgery between the two groups(P=0.349). The number of times of retinal photocoagulation in observation group was more than that in contral group.The difference was statistically significant(P=0.000). The incidence of recurrent vitreous hemorrhage and neovascular glaucoma in observation group were higher than those in contral group.The difference were not statistically significant(P=0.526, 0.470). Conclusion Under the auxiliary of anti-vacular endothelial growth factor and triamcinoloneacetonide, microincision vitrectomy with SRP is better than microincision vitrectomy with PRP to treat patients with vitreous hemorrhage and PDR in reducing postoperative macular edema and improve the visual acuity. Key words: Retinopathy, diabetic, proliferative; Vitreous hemorrhage; Vitrectomy, 23-gauge; Photocoagulation, retinal, selective, pan

Efficacy of pars plana vitrectomy combined with endoscopic cyclophotocoagulation for refractory glaucoma

Objective To observe the efficacy of pars plana vitrectomy (PPV) combined with endoscopic cyclophotocoagulation (ECP) for refractory glaucoma. Methods Twenty-eight patients (30 eyes) diagnosed with refractory glaucoma were enrolled in this study. The intraocular pressure was ranged from 28 to 55 mmHg (1 mmHg=0.133 kPa), with the mean of (46.3±10.3) mmHg. There were 24 eyes with initial visual acuity 270° in 20 eyes. The follow-up ranged from 12 to 20 months, with the mean of 15.2 months. The intraocular pressure, vision and the mean number of intraocular pressure-decreased drugs before and after surgery were comparatively observed. The relationship between cyclophotocoagulation area and postoperative intraocular pressure was analyzed. Results At the final follow-up, the intraocular pressure ranged from 12 to 36 mmHg, with the mean of (18.5±4.4) mmHg, which decreased 49.4% compared with preoperative intraocular pressure (t=15.537, P 0.05). Compared with preoperative vision, the postoperative vision was improved in 8 eyes (26.7%), stabled in 15 eyes (50.0%), decreased in 7 eyes (23.3%). The mean number of intraocular pressure-decreased drugs was reduced from 4 to 1 (t=8.402, P<0.01). The cyclophotocoagulation area was positive related to postoperative intraocular pressure (r=4.160, P<0.05). There were no ocular and systemic complications during and after surgery except slight inflammation. Conclusion PPV combined with ECP for refractory glaucoma can reduce intraocular pressure, stabilize or improve the visual acuity. Key words: Glaucoma/surgery; Laser coagulation; Vitreoretinal surgery

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

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

Transconjunctival sutureless 20-G pars plana vitrectomy for the management of diabetic vitreous hemorrhage

ObjectiveThis study aimed to evaluate the short-term safety and efficacy of pars plana vitrectomy with a 20-G transconjunctival cannulated sutureless system for the management of diabetic vitreous hemorrhage.Patients and methodsThe study included 30 eyes of 30 patients with diabetic vitreous hemorrhage; 18 (60%) of the patients were women and 12 (40%) were men and their average age was 55 ± 9.3 years. All patients underwent surgery under general anesthesia. Using a 20-G MVR blade and a 15-20° entry angle, three limbus-radial, transconjunctival, pars plana sclerotomies were fashioned with an oblique intrascleral passage that was self-sealing (sutureless) at the end of surgery. The collected data included patients' age, sex, intraocular pressure, visual acuity, duration of surgery, and postoperative subjective pain; intraoperative or postoperative complications were also evaluated. Patients were evaluated postoperatively using the same preoperative tests. Visual acuity was measured at 1 week, 1 month, and 3 months postoperatively and also at all follow-up visits after that period.ResultsThe mean total operative time was 27.4 ± 4.5 min (range 20-35 min) and the mean time of vitrectomy was 13 ± 5.5 min. There was a significant improvement in visual acuity at 3 months of follow-up (P = 0.0001). The mean intraocular pressure changed from 15.2 ± 4 mmHg preoperatively to 15.4 ± 6 mmHg at 1 month; this was not statistically significant (P > 0.05). No serious complications such as endophthalmitis or retinal detachment were detected during the follow-up period. No patient developed sclerotomy-related complications.ConclusionThe transconjunctival sutureless 20-G vitrectomy leads to a short operative time, improved patient comfort, and rapid visual improvement with fewer postoperative complications and inflammation, in addition to the advantage of less expensive instruments. Further trials with contemporary equipment and a larger sample size are recommended.