Iatrogenic Retinal Breaks Research Articles

Clinical efficacy of minimally invasive vitreous surgery for special rhegmatogenous retinal detachment in children and adolescents

Objective To observe the clinical efficacy of minimally invasive vitreous surgery (MIVS) for special rhegmatogenous retinal detachment (RRD) in children and adolescents. Methods A retrospective clinical comparative study. Fourteen eyes with special type of RRD in 14 children and adolescents who received the MIVS treatment from January 2014 to January 2019 in Ophthalmology Department of The First Affiliated Hospital Ophthalmology of Air Force Military Medical University, were included in this study. Among them, 8 eyes from 8 males and 6 eyes from 6 females. The age of them ranged from 5 to 17, with the mean age of 12.64±4.11 years. The course of disease was ranged from 1 d to 1 year, and the average of it was 30 d. All the eyes developed the special type RRD, including pseudophakic and aphakic retinal detachment, giant retinal tear with retinal detachment, choroidal detachment associated with retinal detachment, and RRD with ocular dysplasia. In the 14 eyes, there was 2 eyes with retinal detachment in 1 quadrant, 4 eyes in 2 quadrants, 1 eye in 3 quadrants and 7 eyes in total 4 quadrants. All the eyes were treated with 23G or 25G MIVS and filled with irrigation solution, air and silicone oil. In addition, 10.4 months' follow-up for average after surgery were taken to observe the occurrence of retinal reattachment, BCVA and related complications in the eyes. Results In the 14 eyes, 13 (92.9%) of them attained retinal reattachment and 1 eye (7.1%) got a poor retinal reattachment after one operation. At the last follow-up, all the 14 eyes (100.0%) attained retinal reattachment and 5 of them at the filling state of silicone oil. The vision of 8 eyes (57.1%) were improved, 4 eyes (28.6%) have no notable changes and 2 eyes decreased (14.3%). During the operation, iatrogenic retinal breaks were occurred in 1 eye, and silicone oil entered underneath the retina in 1 eye. After the operation, 1 eye suffered a relapse of retinal detachment after the removal of silicone oil and then were filled with it again. Conclusions MIVS is a safe and effective way to treat the special type RRD among the children and adolescents. The rate of retinal reattachment is 92.9% after one surgery and 100.0% at the last follow-up. Therefore, MIVS can help most of eyes with special type RRD to get a stable and improved vision. Key words: Retinal detachment/surgery; Vitreoretinal surgery; Child; Adolescent

Outcomes of 23G vitrectomy and internal limiting membrane peeling with brilliant blue in patients with myopic foveoschisis from a retrospective cohort study.

The aim of the present study was to investigate whether internal limiting membrane (ILM) peeling in patients with myopic foveoschisis (MF) treated with 23-gauge (23G) vitrectomy improved the anatomical and visual outcomes. In this retrospective cohort study, from March 2014 to August 2017 at the Department of Ophthalmology, The Second Affiliated Hospital of Nanchang University (Nanchang, China), 60 patients (60 eyes) with MF underwent 23G vitrectomy. The patients were grouped according to whether they underwent brilliant blue-assisted ILM peeling (peeling group) or not (non-peeling group). Best-corrected visual acuity (BCVA) and central macular thickness (CMT) on optical coherence tomography were measured. There were 30 eyes in each group and the baseline characteristics were similar (all P>0.05). BCVA improved in 24 eyes (80%) in the peeling group and 25 eyes (83.3%) in the non-peeling group (P=0.922). Preoperative CMT was not significantly different between the peeling and non-peeling group (458±62.2 vs. 460±61.1 µm, respectively, P=0.229). However, postoperative CMT was significantly different between the peeling and non-peeling group (269.3±67.7 vs. 294.4±60.5 µm, respectively; P=0.015). In the peeling group, MF was completely resolved in all 30 eyes, but only in 26 eyes in the non-peeling group (P=0.038). Postoperative Amsler testing was positive in five eyes in the peeling group and 13 eyes in the non-peeling group (P=0.024). Complications were similar in both groups; postoperatively, there were one and two cases of iatrogenic peripheral retinal break, three and two cases of macular hole, and one and one case of retinal detachment in the peeling and non-peeling groups, respectively.23G vitrectomy combined with brilliant blue-assisted ILM peeling resulted in better visual and anatomical effects compared with 23G vitrectomy alone in patients with MF.

Preoperative Bevacizumab for Tractional Retinal Detachment in Proliferative Diabetic Retinopathy: A Prospective Randomized Clinical Trial

To assess the effectiveness and safety of an intravitreal injection of 1.25mg bevacizumab (IVB) as a preoperative adjunct to small-gauge pars plana vitrectomy (PPV) compared with PPV alone in eyes with tractional retinal detachment secondary to proliferative diabetic retinopathy. This prospective, double-masked, randomized, multicenter, active-controlled clinical trial enrolled 224 eyes of 224 patients between November 2013 and July 2015. All eyes underwent a baseline examination including best-corrected visual acuity, color photos, optical coherence tomography, and fluorescein angiography. Data were collected on intraoperative bleeding, total surgical time, early (<1month) postoperative vitreous hemorrhage, and mean change in best-corrected visual acuity at 12months. P < .05 was considered statistically significant. A total of 214 patients (214 eyes) were randomized in a 1:1 ratio to PPV plus IVB ([study group] 102 eyes) or PPV plus sham ([control] 112 eyes). Iatrogenic retinal breaks were noted intraoperatively in 35 eyes (34.3%) in the study group, and 66 eyes (58.9%) in the control group (P= .001). Grade 2 intraoperative bleeding was noted in 32 (31.3%) eyes in the study group and 58 (51.7 %) eyes in the control group (P= .001). Endodiathermy was necessary in 28 (27.4 %) eyes in the study group, compared with 75 (66.9%) eyes in the control group (P= .0001). Mean surgical time was 71.3 ± 32.1minutes in the study group and 83.6 ±38.7minutes in the control group (P= .061). Preoperative IVB seems to reduce intraoperative bleeding, improving surgical field visualization, and reducing intraoperative and postoperative complications. NOTE: Publication of this article is sponsored bythe American Ophthalmological Society.

The Incidence of Retinal Breaks Induced by Posterior Hyaloid Separation During 27-Gauge Pars Plana Vitrectomy

Purpose: As advances are made in smaller-gauge vitrectomy, it is important to characterize the associated risks. This allows the surgeon to anticipate complications and appropriately counsel patients. The incidence of iatrogenic retinal breaks in 25- and 23-gauge (G) vitrectomy is known, but no studies exist looking at the incidence in 27G vitrectomy with an attached posterior hyaloid face (PHF). This study set out to characterize the incidence. Methods: A retrospective, consecutive, observational study of patients undergoing 27G transconjunctival sutureless vitrectomy for macular pathology or floaters was conducted. This was a single-surgeon series conducted between 2015 and 2017 at Calderdale Royal Hospital, United Kingdom. Inclusion criteria included only those with an attached PHF at the disc, identified intraoperatively. Results: Data were collected and analyzed in 94 patients. Preoperative diagnosis frequency was as follows: epiretinal membrane 24 (25.5%), macular hole 47 (50.0%), vitreomacular traction 11 (11.7%), and floaters 12 (12.8%). In 82 out of 94 patients (89.1%), 27G vitrectomy was combined with 2.2 mm microincisional phacoemulsification with lens implantation. The incidence of iatrogenic retinal breaks associated with PHF separation during 27G PPV was 17% (16 cases). Conclusions: This is the first study to report the incidence of peripheral retinal breaks induced by PHF separation during 27G vitrectomy. Our single-surgeon case series of 27G PPV for all elective vitreoretinal indications, in eyes with attached vitreous, yielded an iatrogenic break rate of 17%. However, no postoperative retinal detachments followed. Statistical analysis revealed no specific risk factors to be significantly associated with outcome (incidence of retinal tear).

Preoperative intravitreal bevacizumab for proliferative diabetic retinopathy patients undergoing vitrectomy - First update.

This Living FRISBEE (Living FRIendly Summary of the Body of Evidence using Epistemonikos) is an update of the summary published in December 2014. Proliferative diabetic retinopathy can cause severe vision loss and even blindness if left untreated. Vitrectomy is often required in the treatment of more severe cases. Preoperative administration of bevacizumab, a humanized anti-vascular endothelial growth factor would improve intraoperative variables that facilitate surgery and improve postoperative course. We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. We identified five systematic reviews including 16 studies overall, of which 14 were randomized trials. We concluded the preoperative use of intravitreal bevacizumab reduces the rate of vitreous hemorrhage in the early postoperative period, and probably also in the late postoperative period, but its effect on visual acuity is not clear. Furthermore, it probably decreases the surgical time and may decrease the incidence of iatrogenic retinal breaks. Although we are uncertain whether preoperative bevacizumab decreases intraoperative bleeding, it may reduce the need for endodiathermy.

Conbercept and Ranibizumab Pretreatments in Vitrectomy with Silicone Oil Infusion for Severe Diabetic Retinopathy.

We compared the efficacies of intravitreal ranibizumab (IVR) and intravitreal conbercept (IVC) as the adjuvant pretreatments for vitrectomy with silicone oil infusion for tractional retinal detachment (TRD) secondary to proliferative diabetic retinopathy. This retrospective study comprised 74 patients (79 eyes) who underwent vitrectomy with silicone oil tamponade for diabetic TRD. They received IVC (37 eyes) or IVR (42 eyes) at standard doses 3-5 days preoperatively and were followed up for ∼6 months. Anatomic success rate, intra- and postoperative complications, and visual outcomes were compared between both groups. Initial (IVC vs. IVR: 97% vs. 98%) and final anatomic success rates (100% in each group) and mean visual acuity changes were not significantly different (P = 0.46). Intraoperative complications [iatrogenic retinal breaks (P = 0.58) and intraoperative bleeding (P = 0.66)], postoperative complications [fibrin formation (P = 0.51), postoperative preretinal bleeding (P = 0.88), progressing or persistent neovascular glaucoma (P = 0.63), progressive fibrovascular proliferation (P = 0.93), and recurrent retinal detachment (P = 0.93)], and surgical variables [surgical time (P = 0.53)] were similar between both groups. Conbercept and ranibizumab are equally effective surgical adjuvants for vitrectomy with silicone oil infusion in patients with diabetic TRD.

Internal Limiting Membrane Flap in the Management of Retinal Detachment due to Paracentral Retinal Breaks

Purpose To describe the technique and outcomes of using either inverted or free internal limiting membrane flap in the management of retinal detachment due to paracentral retinal breaks. Methods This retrospective observational case series includes nine patients who received surgery for retinal detachment due to paracentral retinal breaks developed either from primary rhegmatogenous origin, or secondary iatrogenic retinal breaks after prior membrane peeling, or during surgery for tractional retinal detachment. Either inverted or free internal limiting membrane flaps were inserted in the identified breaks, followed by air fluid exchange and gas tamponade. Visual acuity and structural changes were evaluated. Results Nine eyes were included. One had primary rhegmatogenous retinal detachment, one had highly myopic eye with peripapillary atrophic hole, three had secondary retinal detachment after membrane peeling for foveoschisis or macular pucker, one had recurrent retinal detachment due to proliferative vitreoretinopathy, one had combination of tractional and rhegmatogenous retinal detachment, and two had iatrogenic breaks during surgery. The retinal breaks of all eyes were sealed with retina attached postoperatively. Visual acuity in logarithm of minimal angle of resolution improved from 1.18 ± 0.55 preoperatively to 0.74 ± 0.47 postoperatively (p=0.04). Conclusion Internal limiting membrane flap technique can be a surgical approach selectively for retinal detachment due to paracentral retinal breaks with difficulty for laser application. The retina can be attached successfully and achieve good visual outcome without major complication. This trial is registered with NCT03707015.

Panretinal photocoagulation versus intravitreal injection of bevacizumab as a preoperative adjuvant before vitrectomy in the management of proliferative diabetic retinopathy

Background Proliferative diabetic retinopathy (PDR) characterized by neovascularization of the optic disk, retina, and/or iris may be an aberrant attempt to alleviate hypoxia in eyes with severe capillary closure or other retinal ischemia. The new vessels grow perpendicular to the plane of the retina into the scaffolding provided by the vitreous cortex, typically from venules at the junction of the perfused and nonperfused retina. Objective This work aims to study the effect of panretinal photocoagulation (PRP) versus intravitreal injection of bevacizumab (Avastin) before vitrectomy in the management of PDR. Patients and methods Our clinical study was conducted on 60 eyes in 40 patients with PDR with indications of vitrectomy (vitreous hemorrhage, tractional retinal detachment involving or threatening the macula, combined tractional/rhegmatogenous retinal detachment and fibrovascular membranes covering and distorting the macula, persistent macular edema with viteromacular traction) managed by parsplana vitrectomy after preoperative preparation by intravitreal injection of bevacizumab (Avastin) or PRP used as an adjunct was grouped into two groups: group A and group B; FFA was done previtrectomy for all cases. Results Intraoperative using of endodiathermy is reported as once in eight cases, twice in 15 cases, three times in seven cases in group A, while once in 14 cases, twice in six cases, and not used in 10 cases in group B. Intraoperative use of endolaser is reported as less than 1500 shoots in seven cases, and more than 1500 shoots in 23 cases in group A, while less than 1500 shoots in 29 cases, and more than 1500 shoots in one case in group B. Therefore, bevacizumab or PRP induces regression of active fibrovascular proliferation decreasing the extent of bleeding during tissue segmentation and delamination. The lesser intraoperative bleeding makes visualization of the surgical plane better, which in turn facilitates a precise separation of the proliferative tissue from the retina and helps avoid accidental retinal vascular damage and iatrogenic retinal breaks and make the surgery and the results better than conventional surgery (without using any adjuvants). Conclusion Use of both adjuvants before vitrectomy enhances the outcome of vitrectomy when best indicated rather than without using. The shorter time of surgery and less use of endodiathermy or endolaser is with the PRP group, although postoperative best-corrected visual acuity gaining is not significant. So, accurate clinical differences between two adjuvants need more researches.

Efficacy and safety of vitrectomy with internal limiting membrane peeling for diabetic macular edema: a Meta-analysis.

To evaluate the efficacy and safety of vitrectomy with internal limiting membrane (ILM) peeling for diabetic macular edema (DME). The PubMed, Embase, Web of Science, Cochrane, SionMed, ClinicalTrials.gov, CNKI databases and Wanfang databases, published until Oct. 2017, were searched to identify studies comparing the clinical outcomes following vitrectomy with and without ILM peeling, for treating DME. Pooled results were expressed as odds ratios (ORs) with corresponding 95% confidence intervals (CI) for vitrectomy with and without ILM peeling with regard to best corrected visual acuity (BCVA), central macular thickness (CMT), and complication incidents. A total of 14 studies involving 857 eyes were included of which three studies were Chinese and the rests were English literatures. Meta-analysis indicated that compared with vitrectomy alone, vitrectomy with ILM peeling could improve BCVA more obviously (OR=1.66, 95%CI: 1.12-2.46, P=0.01) and had higher rate of CMT reduction (OR=3.89, 95%CI: 1.37-11.11, P=0.01). There were significant statistical differences between the two surgical methods for both BCVA and CMT (P<0.05). For the incidence of intraoperative and postoperative complications, the incidence of epiretinal membrane (ERM) was slightly lower in the ILM peeling group than the group without ILM peeling (OR=0.38, 95%CI: 0.07-2.00, P=0.25), although insignificant statistically. Other incidences of overall complications, iatrogenic peripheral retinal break and increased intraocular pressure indicated no significant difference between two groups (OR=1.19, 95%CI: 0.82-1.73, P=0.36; OR=1.21, 95%CI: 0.66-2.21, P=0.53; OR=1.34, 95%CI: 0.75-2.40, P=0.32). Vitrectomy is effective for DME and the effect can be improved by additional ILM peeling, especially for anatomical efficacy, without increasing the incidence of intraoperative and postoperative complications. However, it is imperative to gain more evaluation in the future due to the paucity of prospective randomized study.

Internal Limiting Membrane Peeling for Diffuse Tractional Diabetic Macular Oedema

Aim: To determine the efficacy of internal limiting membrane (ILM) peeling vitrectomy for diffuse tractional diabetic macular oedema. Patients and methods: A prospective non –randomized interventional study was carried out at Nour- EL–Hayaha Eye Center (Cairo) between March, 2015 and March, 2017. 40 eyes of 31 patients with symptomatic marked diminution of vision and tractional diabetic macular oedema were enrolled in this study. Ocular examinations included measurements of best corrected visual acuity (BCVA) at a distance using a logarithm of the minimum angle of resolution (logMAR) scale, refractive status using an autorefractometer (KR-8100; Topcon corporation, Tokyo, Japan), IOP was measured by Goldman applanation tonometry (CT-80; Topcon corporation, Tokyo, Japan), and fundus evaluation using an indirect ophthalmoscope were obtained. 23-gauge vitrectomy with internal limiting membrane peeling assisted by staining by brilliant blue G stain(BBG) were performed for all patients with a follow –up period at least 6 months. Spectral domain optical coherent tomography (SD OCT) images were obtained at the follow –up visits to determine the presence of an epiretinal membrane (ERM). Results: At 6 months there was a median 200µ decrease from baseline in the central subfield thickness (P<0.005).Mean change in the central subfield macular thickness was -150µ (SD± 130.56).There was 7 (17.5%) cases developed iatrogenic retinal break during removal of posterior vitreous and treated by endodiathermy, of greatest importance, 3(7.5%) eyes developed a vitreous hemorrhage treated by conservative treatment after B scan evaluation, and 1(2.5%) eye developed a retinal detachment. All complications were successfully managed. 23 out of 40 eyes (57.5%) underwent cataract surgery with IOL implantation within 6 months of pars plana vitrectomy. Transient elevation of IOP was developed in 7(17.5%) eyes and managed carefully with antiglucomatous drugs. One eye developed persistent elevation of IOP that required maintenance anti glaucomatous drug. Also macular hole developed in one eye and epiretinal membrane developed in one eye. Conclusion: ILM peeling achieved higher anatomic success with a reduced need for additional surgical interventions and or event postoperative ERM formation that might result in subsequent visual loss.

Retrospective Comparison of 27-Gauge and 25-Gauge Microincision Vitrectomy Surgery with Silicone Oil for the Treatment of Primary Rhegmatogenous Retinal Detachment

Aim To retrospectively compare the safety and effectiveness of 27-gauge (27G) microincision vitrectomy surgery (MIVS) with 25-guage (25G) MIVS for the treatment of primary rhegmatogenous retinal detachment (RRD) with silicone oil tamponade. Methods Ninety-two patients with RRD who underwent MIVS from May 1, 2015, to June 30, 2017, were included in this study. Fifty-eight eyes underwent 25G MIVS and 34 eyes underwent 27G MIVS. We analyzed the characteristics of the patients, surgical time, main clinical outcomes, and rate of complications. Results The mean surgical time was 56.7 ± 35.9 min for the 25G MIVS and 55.7 ± 36.1 min for the 27G MIVS, and there was no significant difference (P=0.894) between the two groups. The primary anatomical success rate after a single operation was 94.8% for 25G MIVS and 91.2% for 27G MIVS (P=0.666). Baseline and final visit best-corrected visual acuity (BCVA) were 1.9 ± 1.1 and 1.0 ± 0.8 in the 25G group, and 1.7 ± 1.0 and 1.1 ± 0.8 in the 27G group. Last visit BCVA increased significantly in both groups (P < 0.001). However, there were no significant differences in terms of visual improvement ratio (>0.2 logMAR) between the two groups (P=0.173). No severe intraoperative complication was observed. Iatrogenic retinal breaks occurred in 2 eyes (3.4%) in the 25G group and 1 eye (2.9%) in the 27G group during the peripheral vitreous base shaving. The transient ocular hypertension (>25 mmHg) within postoperative week 1 was 25.9% in the 25G group and 11.8% in the 27G group (P=0.120). Conclusions This study found no significant anatomical or functional difference between 27G and 25G MIVS in the treatment of primary RRD. Therefore, 27G vitrectomy appears to be a safe and effective surgery for the treatment of primary RRD.

INTRAOPERATIVE AND POSTOPERATIVE COMPLICATIONS IN PHACOVITRECTOMY FOR EPIRETINAL MEMBRANE AND MACULAR HOLE: A Clinical Audit of 1,000 Consecutive Eyes.

The aim of this study was to report the intraoperative and postoperative complications of phacovitrectomy for epiretinal membrane (ERM) and macular hole (MH). This was a retrospective audit of 1,052 phacovitrectomy operations (410 for ERM and 642 for MH) by the same surgical team between 1998 and 2017. Outcome measures included rates of intraoperative anterior segment and posterior segment complications such as posterior capsule rupture and retinal breaks. A subgroup analysis of 189 procedures in which postoperative complications were rigorously recorded was also undertaken. The rate of posterior capsule rupture was 2.2%, with no difference between ERM and MH (1.7 vs. 2.5%; P = 0.40). Iatrogenic retinal tears were more common in MH than in ERM surgery (15.6 vs. 6.8%; P < 0.001). The chance of one or more anterior segment or posterior segment intraoperative complications occurring (excluding iatrogenic retinal breaks) was not associated with: indication for surgery, grade of surgeon, gauge of surgery, surgical machine, diabetic status, patient sex, or patient age. Subgroup analysis showed postoperative events as follows: posterior capsular opacification 10.6% (20/189), posterior synechiae 4.2% (8/189), uveitis 2.1% (4/189), angle closure glaucoma 1.6% (3/189), and rhegmatogenous retinal detachment 1.1% (2/189). Phacovitrectomy seems to be safe in phakic patients with ERM or MH, performed either by fellows or consultants. It avoids the requirement for repeat surgery and is more cost and resource efficient.

Efficacy and Safety of Intravitreal Conbercept, Ranibizumab, and Triamcinolone on 23-Gauge Vitrectomy for Patients with Proliferative Diabetic Retinopathy.

Introduction To compare the effect and safety of intravitreal conbercept (IVC), intravitreal ranibizumab (IVR), or intravitreal triamcinolone acetonide (IVTA) injection on 23-gauge (23-G) pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR). Methods Fifty patients (60 eyes) of varying degrees of PDR were randomly grouped into 3 groups (1 : 1 : 1) (n = 20 in each group). The 23-G PPV was performed with intravitreal conbercept or ranibizumab injection 3–7 days before surgery or intravitreal TA injection during surgery. The experiment was randomized controlled, with a noninferiority limit of five letters. Main outcome measures included BCVA, operation time, incidence of iatrogenic retinal breaks, endodiathermy rate, and silicone oil tamponade. Results At 6 months after surgery, there were no significant differences of BCVA improvements, operation time, incidence of iatrogenic retinal breaks, endodiathermy rate, silicone oil tamponade, vitreous clear-up time, and the incidence of intraoperative bleeding between the IVC and IVR groups (all P values ≥ 0.05), but they were significantly different from the IVTA group (all P values < 0.05). IOP increases did not show significant differences between the IVC and IVR groups, but both were significantly different with the IVTA group. More patients had higher postoperative IOP in the IVTA group. Conclusions The intravitreal injection of conbercept, ranibizumab, or TA for PDR had a significant different effect on outcomes of 23-G PPV surgery. Conbercept and ranibizumab can reduce difficulty of the operation, improve the success rate of PPV surgery, and decrease the incidence of postoperative complications.

PARS PLANA VITRECTOMY AND LENSECTOMY FOR ECTOPIA LENTIS WITH AND WITHOUT THE INDUCTION OF A POSTERIOR VITREOUS DETACHMENT.

Posterior hyaloid removal during pars plana vitrectomy and lensectomy for ectopia lentis is commonly performed, but may increase the risk of intraoperative retinal breaks and postoperative retinal detachment. This study evaluated outcomes after pars plana vitrectomy and lensectomy with or without posterior hyaloid removal. This retrospective observational cohort study included ectopia lentis cases that underwent pars plana vitrectomy and lensectomy (2005-2014), with or without intraoperative induction of a posterior vitreous detachment (PVD). The primary outcome was postoperative retinal detachment. The secondary outcomes were the incidence of iatrogenic retinal breaks, and change in visual acuity. Twenty-six cases were included. The posterior hyaloid was preserved intraoperatively in 11 cases (non-PVD group). In the remainder (15 cases), the vitreous was removed completely (PVD group). Postoperative retinal detachment occurred in 2 cases in each group (18.2% non-PVD vs.13.3% PVD, P = 0.7). Intraoperative breaks occurred more frequently in the PVD group (2 vs. 9 cases; P = 0.03). There was no difference in mean improvement in visual acuity (7 [PVD] vs. 3 [non-PVD] ETDRS lines; P = 0.2). The preservation of posterior hyaloid attachment during vitreolensectomy for ectopia lentis was associated with fewer iatrogenic retinal breaks. Postoperative retinal detachment did not seem to be influenced by the choice of surgical technique.

Surgical outcomes of 27-gauge vitrectomy for rhegmatogenous retinal detachment with air tamponade

Objective To evaluate the efficacy and safety of 27-gauge sutureless vitrectomy with air tamponade for rhegmatogenous retinal detachment (RRD). Methods The clinical data of 35 consecutive eyes with primary RRD from 35 patients who received 27-gauge vitrectomy with intraocular air tamponade in Zhongshan Eye Center from April 2016 to January 2017 were retrospectively analyzed.The mean follow-up duration was 8.6 months.Best corrected visual acuity (BCVA) (LogMAR) and intraocular pressure (IOP) were examined before surgery, 1 week and 3 months after surgery.The operative duration, sclerotomy sites, retinal reattachment rate, intraoperative and postoperative complications were recorded. Results The mean duration of vitreous removal was (15.3±3.6) minutes, and the mean duration of operation was (34.5±4.8) minutes.No suturing process was performed at sclerotomy sites in all eyes.The retinal reattachment rate following a single procedure was 100%.The mean BCVA was significantly different among before surgery, 1 week and 3 months after surgery (F=64.12, P<0.01), and the BCVA at 1 week and 3 months after surgery was evidently improved in comparison with before surgery (0.82±0.31 vs. 1.01±0.40; 0.68±0.30 vs.1.01±0.40) (both at P<0.05). The mean IOP was (14.69±3.66), (17.37±2.32) and (16.69±2.45)mmHg (1 mmHg =0.133 kPa) before surgery, 1 week and 3 months after surgery, showing a significant difference among them (F=14.82, P<0.01), and the IOP 1 week and 3 months after surgery was evidently higher than that before surgery (both at P<0.05). The complications included intraoperative iatrogenic retinal breaks in 2 eyes, postoperative hypotony in 1 eye and hypertension in 5 eyes.These complications were curable. Conclusions 27-Gauge vitrectomy and air tamponade for RRD is an effective and safe approach. Key words: Vitrectomy/instrumentation; Vitrectomy/methods; Intraocular air tamponade; Rhegmatogenous retinal detachment/surgery; Treatment outcome; Complications; Retrospective studies

Special considerations for pediatric vitreoretinal surgery.

In this review, the authors present special considerations a vitreoretinal surgeon should take into account before embarking on surgery in a pediatric eye. First, the anatomy of a pediatric eye is different from an adult and changes as the child grows. This is important especially in relation to the placement of transconjunctival ports. The structural characteristics of the sclera are also different, with lower scleral rigidity found in pediatric eyes. When considering vitrectomy, a posterior pars plicata lens-sparing technique should be considered. However, this may not be possible in complicated total detachments where anterior translimbal vitrectomy may be the method of choice. Scleral buckles are preferred for certain cases, and division of the encirclage is advocated in children below the age of 2 years, once the retina has stabilized. Enzymatic vitreolysis has been described as a preoperative adjunct to enhance complete detachment of the posterior hyaloid and reduce iatrogenic retinal breaks. However, its use in pediatric eyes has been limited, and larger studies are warranted. Finally, postoperative visual rehabilitation and treatment of amblyopia are key to maximizing functional outcomes in the pediatric patient. Co-management with a pediatric ophthalmologist and enlisting the co-operation of the parents are essential.

Antivascular endothelial growth factor agents pretreatment before vitrectomy for complicated proliferative diabetic retinopathy: a meta-analysis of randomised controlled trials

Background/aimsTo evaluate the efficacy of antivascular endothelial growth factor (anti-VEGF) agents pretreatment before vitrectomy for patients with complicated proliferative diabetic retinopathy (PDR).MethodsThe PubMed, Embase and the Cochrane Central Register of...

Clinical effect of vitreoretinal surgery combined with intravitreal injection of conbercept or ranibizumab on severe proliferative diabetic retinopathy

Background Vitreoretinal surgery (VRS) is the main treatment of severe proliferative diabetic retinopathy (PDR), intravitreal injection of anti-VEGF drugs before VRS on severe PDR has been widely used in clinic, but the auxiliary effect of different anti-VEGF drugs on VRS is unclear. Objective This study was to observe the efficacy of preoperative intravitreal injection of anti-VEGF drugs for the treatment of severe PDR, and to compare the efficacy of intravitreal conbercept (IVC) versus intravitreal ranibizumab (IVR) before VRS. Methods A retrospective, comparative study was performed.Niety-six severe PDR patients (98 eyes) who experienced VRS were collected in Tianjin Eye Institute from October 2014 to January 2016.There were 32 eyes in the preoperative IVC group, 31 eyes in the preoperative IVR group and 35 eyes in the simple VRS group.The intravitreal injection was performed 3 days prior to VRS in the preoperative IVC group and preoperative IVR group.All operations were conducted by the same physician.The duration of VRS, number of endodiathermy, incidence of severe hemorrhage and iatrogenic retinal breaks were recorded.The follow-up visit ranged from 3 to 6 months with an average of (3.51±0.59) months, the changes of best corrected visual acuity (BCVA) and incidence of postoperative complications were compared among the three groups. Results The average operation duration was (84.84±11.03) minutes and (83.45±14.24) minutes in the preoperative IVC group and preoperative IVR group respectively, which were significantly shorter than (104.57±13.42) minutes in the simple VRS group, with significant differences between them (t=6.622, 6.604, both at P 0.05). The mean BCVAs were significantly different among the 3 groups of different timepoints (Fgroup=4.077, P=0.020; Ftime=100.937, P=0.000). The postoperative mean BCVA at 3 months after surgery was (0.80±0.37), (0.82±0.32) and (1.03±0.52) in the preoperative IVC group, preoperative IVR group and simple VRS group respectively, which was significantly improved compared with preoperative results (all at P<0.01). The postoperative BCVAs were improved in preoperative IVC group and preoperative IVR group compared with the simple VRS group, with significant differences between them(both at P<0.05). Conclusions The preoperative intravitreal injection of anti-VEGF drugs combined with VRS is conductive to shorten the average operation time, reduce the rate of intraoperative hemorrhage, endodiathermy as well as improve the BCVA.Conbercept and ranibizumab had the similar auxiliary effect for VRS for the treatment of severe PDR. Key words: Proliferative diabetic retinopathy; Vascular endothelial growth factor; Conbercept; Ranibizumab; Vitreoretinal surgery

Clinical observation on 25G+ vitrectomy under Resight non-contact wide angle lenses for proliferative diabetic retinopathy

Objective To observe the efficacy and complications of 25G+ vitrectomy under Resight non-contact wide angle lenses for the treatment of proliferative diabetic retinopathy (PDR). Methods The data of 69 eyes of 60 cases with PDR treated by 25G+ vitrectomy under Resight non-contact wide angle lenses were collected and retrospectively analyzed. Results All cases received vitrectomy successfully .The operation time was 30-100 min, mean(61.00± 28.17)min.Obvious hemorrhage occurred in 6 eyes during operation, iatrogenic retinal breaks happened in 7 eyes and silicone oil tamponade in 9 eyes. The BCVA improved in 57 eyes(82.61 %)1 week after surgery.The IOP>30mmHg (1 mmHg=0.133 kPa) was in 2 eyes, IOP recovered to normal 3 days after drugs treatment.Two eyes with recurrent hemorrhage improved after drugs treatment. BCVA improved with different extents was in 66 eyes(95.65%)1 month postoperatively, unchanged in 3 eyes.Among 2 eyes with recurrent hemorrhage, hemorrhage absorbed was in 1 eye , the other eye improved after vitreous cavity lavaged. BCVA improved in 64 eyes(92.75%)3 month postoperatively. Between preoperative and 1, 3 months after surgery, the difference of BCVA were statistically significant(χ2 =30.804, P=0.000; χ2=34.166, P=0.000). Conclusion The 25G+ vitrectomy under Resight non-contact wide angle lenses for the treatmlent of PDR can shorten operation time, reduce iatrogenic injury incidence , decrease complications and increase visual acuity obviously. Key words: Non-contact wide angle lenses , Resight; Vitrectomy, 25G+; Retinopathy , diabetic , proliferative; Visual acuity; Complications

25G intraocular illumination aided scleral buckling for treatment of rhegmatogenous retinal detachment

Objective To evaluate the effectiveness and safety of 25G illumination aided scleral buckling surgery for treatment of rhegmatogenous retinal detachment (RRD). Methods This is a retrospective case control study. Fifty-seven RRD patients (57 eyes) were enrolled in this study. There were 35 males (35 eyes) and 22 females (22 eyes). The patients were randomly divided into ophthalmoscope group (29 patients, 29 eyes) and illumination group (28 patients, 28 eyes). There was no differences in the data of gender, age, onset time, logarithm of the minimum angle of resolution (logMAR) best corrected visual acuity(BCVA) and information of retinal tears between the two groups (P>0.050). The patients in the ophthalmoscope group received operation of conventional scleral buckling with binocular indirect ophthalmoscope. The patients in the illumination group received scleral buckling surgery with the aid of intraocular illumination and noncontact wide-angle viewing system. The follow-up was ranged from 6 to 12 months. The BCVA, intraocular pressure, fundus examination and complications were observed and recorded. Results The difference of operation time between two groups was significant (t=2.124, P=0.031). In the ophthalmoscope group, 26 eyes (89.7%) achieved retinal reattachment, 3 eyes (10.3%) failed in retinal reattachment. In the illumination group, 26 eyes (92.8%) achieved retinal reattachment, 2 eyes (7.2%) failed in retinal reattachment. There was no difference of retinal reattachment rate (P=1.000). Five eyes failed in retinal reattachment, 3 eyes received sclera buckling surgery, 2 eyes received vitrectomy with silicone oil tamponade. The final reattachment ratios were both 100%. BCVA increased in both groups compared with pre-surgery BCVA (t=4.529, 5.108; P<0.001). The difference of BCVA between two groups was not significant (t=0.559, P=0.458). There was no significant difference of intraocular pressure and complications before and after surgery in both two groups (t=−1.386, −1.437; P=0.163, 0.149). The difference of intraocular pressure between two groups was not significant (t=0.277, P=0.730). Subretinal hemorrhage occurred in 1 eye in the ophthalmoscope group. There was no iatrogenic retinal break, choroidal hemorrhage and endophthalmitis in the two groups. Conclusion 25G intraocular illumination aided buckling surgery for treatment of RRD is fast, safe and effective. Key words: Retinal detachment/surgery; Scleral buckling