Iatrogenic Retinal Tears Research Articles

Phacofragmentation of Posteriorly Dislocated Lens Fragments: Limbal versus Pars Plana Approach

ABSTRACT Purpose To assess intra-operative complications and feasibility of removing crystalline lens fragments from the vitreous cavity through a limbal incision compared to a pars plana approach. Design Retrospective cohort study. Subjects 16 eyes underwent phacofragmentation via a limbal approach (Group A) and 9 eyes through a pars plana approach (Group B) at an academic center over a 10-year period. Methods We collected pre-operative, intra-operative, and post-operative data. We compared rates of intraoperative complications, including corneal wound burn, iris or capsular damage, retinal tears, and hemorrhage, and recorded post-operative BCVA and IOP measurements at the one-month post-operative appointment. We also compared rates of post-operative complications, including corneal edema, choroidal detachment, or retinal detachment. Main Outcome Measures Primary outcomes of the study were the rates of intraoperative complications and the feasibility of crystalline lens removal with the limbal approach. We defined the latter outcome as the ability to complete lens removal without switching to the pars plana route. Results Mean BCVA for group A was 1.6, and for group B was 2.0 (p = .19). There was no significant difference between the two groups in the incidence of intraoperative complications, including corneal wound burn, iris damage, anterior capsular tear, iatrogenic retinal tear, or suprachoroidal hemorrhage (p > .99). There was no significant difference in the incidence of intra-operative vitreous hemorrhage (p = .36). Additionally, there was no significant difference in post-operative corneal edema (p = .27), choroidal detachment (p = .52), or retinal detachment (p > .99). The mean post-operative BCVA was 1.0 in group A and 1.0 in group B (p = .75). We completed all cases in group A using the limbal approach without switching to the pars plana route. Conclusion Phacofragmentation through a limbal incision provides a feasible option for dropped nuclear fragment removal and is not associated with a higher risk of complications than the pars plana route.

Optimized design of surgical steps in pars plana vitrectomy for macular hole retinal detachment in pathological myopia decreases rate of iatrogenic retinal break and shortens length of operation

BackgroundTo investigate the effect of surgical steps optimization in pars plana vitrectomy (PPV) with internal limiting membrane (ILM) flap for macular hole retinal detachment (MHRD) in pathological myopia.MethodsA retrospective, consecutive, nonrandomized comparative study. High myopic eyes diagnosed with MHRD receiving PPV with ILM flap from March 2019 to June 2020 in Department of Ophthalmology, Xiangya Hospital, Central South University were included in the study. Patients were included into two groups based on different design of surgical steps. In the routine group, extension of posterior vitreous detachment (PVD) towards periphery was performed right after induction of PVD. In the experiment group, the retina was reattached with drainage of subretinal fluid through macular hole before peripheral vitreous was dealt with. Complete ophthalmic examinations were performed before and after surgery. The follow-up time was at least 6 months. The rate of iatrogenic retinal break and length of operation were compared between the two groups.ResultsThirty-one eyes from 31 patients were included in the study with 15 in the experiment group and 16 in the routine group. Demographics showed no statistically significant difference between the two groups. Post-op BCVA, rate of macular hole closure and rate of retinal reattachment were similar in the two groups. The rate of iatrogenic retinal break in the experiment group was significantly lower than that in the routine group (6.7% vs. 37.5%, P < 0.05). The average length of operation was 78.6 ± 18.8 min in the routine group and 64.0 ± 12.1 min in the experiment group (P < 0.05).ConclusionsOptimized design of surgical steps in PPV for MHRD could effectively decrease the rate of iatrogenic retinal tear and shorten the length of operation.

Chandelier-assisted pars plana vitrectomy decreases the rate of retinal re-detachment following silicone oil removal

Background Recurrent retinal detachment is one of the major complications after silicone oil (SO) removal. Therefore, finding ways to decrease its incidence would be of great significance. Purpose The aim of this study was to compare the rate of retinal re-detachment following SO removal in eyes that underwent scleral self-indentation during chandelier-assisted vitreous base shaving compared to the eyes that underwent scleral indentation by an assistant. Patients and methods This is a retrospective study that included 381 eyes of 381 consecutive patients who underwent SO removal between December 2017 and December 2021, after a successful pars plana vitrectomy for primary rhegmatogenous retinal detachment. Scleral self-indentation (group A) was performed in 186 eyes, while scleral indentation by an assistant (group B) was performed in 195 eyes. The primary outcome measure was the rate of retinal re-detachment after SO removal. The secondary outcome measures were the rate of iatrogenic peripheral retinal tears and intraoperative complications. Results Retinal re-detachment occurred in 21 (11.29%) eyes in group A compared to 38 (19.49%) eyes in group B, with a statistically significant difference (P=0.027). Iatrogenic retinal tear during vitreous base shaving occurred in two (1.08%) eyes in group A compared with 17 (8.71%) eyes in group B, with a statistically significant difference (P=0.001). Slipped infusion cannula during indentation occurred in two (1.02%) eyes in group B and resulted in serous choroidal detachment in one eye, a complication that was not reported in group A. Lens touch occurred in three (1.61%) eyes in group A versus eight (4.1%) eyes in group B, a statistically nonsignificant difference (P=0.065). Conclusion Scleral self-indentation during chandelier-assisted vitrectomy facilitated safe and satisfactory vitreous base shaving with a lower risk of retinal re-detachment after SO removal. It was also associated with a lower rate of iatrogenic retinal breaks and intraoperative complications.

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

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

Vitreous Opacity Vitrectomy (VOV): Safest Possible Removal of "Floaters".

PurposePrimary opacities that develop in the aging vitreous, commonly termed “floaters,” were once considered merely a nuisance, not justifying any risk of surgical removal. However, vitreoretinal specialists are increasingly recognizing that extensive symptomatic vitreous opacities (SVO) that substantially interfere with activities that critically depend on vision (daily visual activities, DVA), constituting degenerative vitreous syndrome (DVS, see http://floaterstories.com), warrant removal albeit with minimal risk - but no description of how to reduce vitrectomy risks to least possible has been forthcoming. We here describe such a method.Patients and MethodsThe safest possible removal of extensive SVO as described herein was attained by an operation specifically designed for DVS treatment (vitreous opacity vitrectomy, VOV), rather than as only a means of achieving subsequent retinal surgery in the same procedure, as is usually the case. We retrospectively reviewed the outcomes of 100 consecutive VOV operations (in 81 patients, average age 66) performed with ultra-high speed, 27-gauge vitrectomy probes.ResultsAll eyes rapidly achieved continuously clear vision, and no eye developed a clinically significant complication during a year of follow-up. Three small, existent retinal breaks were discovered prior to peripheral vitrectomy and one apparently iatrogenic retinal tear was found at VOV completion, when each was treated. In the eyes that were not pseudophakic, postoperative nuclear sclerosis progression was successfully managed by subsequent cataract extraction.ConclusionThe goals of VOV for DVS are to safely restore continuously clear vision by performing tractionless vitreous removal with respect to the retina and to reduce the lifetime risk of retinal detachment, both by such vitreous removal and by microscopic examination of the peripheral retina under anesthesia (MEPRUA), guiding appropriate prophylactic retinopexy. The otherwise healthy DVS eyes so treated warrant this specific form of vitrectomy, continually focused on achieving least possible risk, to maintain an acceptable risk/benefit ratio.

The Clinical and Safety Outcomes of 27 Gauge Pars Plana Vitrectomy in Eyes With Macular Hole.

ObjectiveTo report the clinical, visual, and safety outcomes of 27 gauge pars plana vitrectomy (27G PPV) in eyes with full thickness and lamellar macular hole (MH). MethodologyThis retrospective cross-sectional study, conducted at the ophthalmology department of Shifa International Hospital, Islamabad, was done on 89 eyes of 85 patients who underwent 27G PPV for full-thickness and lamellar MH with a postoperative follow-up period of six months. ResultsThe mean age was 61.9 ± 17.3 years with 57.3% being males. Most of the eyes had idiopathic stage III full-thickness MH (n=34, 38.2 %). The total mean operating time was 42.5 ± 19.8 minutes. During surgery, 48 (53.9%) eyes had concurrent phacoemulsification. Hexafluoroethane was the most commonly used tamponade agent (n=81, 91%). Postoperatively, the primary closure rate was 93.2% (n=83) while the final closure rate was 100% (n=6) either by prolonged posturing (n=3, 3.3%) or by an additional procedure involving autologous internal limiting membrane (ILM) transplant (n=3, 3.3%). The complication rate was 2.2% including iatrogenic retinal tear (n=1, 1.1%) and raised IOP (n=1, 1.1%). The overall best-corrected visual acuity (BCVA) improved significantly from 1.20 ± 0.67 to 0.31 ±0.17 (p=<0.001).ConclusionAs per this study, 27G PPV is a practical and efficient surgical system with substantial anatomical success, minimal complication, and considerable visual recovery rates in eyes with full thickness and lamellar MH. We suggest 27G PPV with ILM peeling and medium-acting intraocular gas as the standard procedure for MH.

Сравнительная оценка эффективности комбинированного метода хирургического лечения регматогенной отслойки сетчатки

Purpose. To optimize the technology of surgical treatment of rhegmatogenous retinal detachment by a combination of vitrectomy of the base of the vitreous body in air with 360° peripheral endolaser retinopexy and to evaluate its clinical and functional effectiveness. Material and methods. The control group included 25 patients (25 eyes) with peripheral vitrectomy under the fluid (BSS) with laser restriction of the retinal tear only. The study group included 25 patients (25 eyes) with peripheral vitrectomy under air in combination with 360° laser retinopexy. Groups were compared in terms of visual acuity, duration of retinal detachment, presence of proliferative vitreoretinopathy, macular condition, number of retinal tears, lens condition (phakic/pseudophakic), and recurrent retinal detachment. The frequency of intraoperative iatrogenic retinal tears that occurred during peripheral vitrectomy was also assessed. Results. In the main group, in one case, an atorogenic rupture was detected during surgery. In the control group, there were 3 cases of touching the periphery of the retina with the appearance of a rupture during vitrectomy in the “shave” mode. There are no statistically significant differences in visual acuity after 3-6 months. During the observation period, no retinal detachment recurrence was detected in the main group in any case. Whereas in the control group there were 2 relapses. Conclusions. The advantage of air vitrectomy is a greater view of the periphery of the retina during surgery, which in many cases does not require additional sclerocompression for better visualization. Also residual vitreous body between tissue-air environments is very well identified. 360° endolaser coagulation is a prophylactic procedure to prevent recurrence of retinal detachment. In addition, in our study, we found that peripheral air vitrectomy combined with 360° laser retinopexy had comparable results to fluid vitrectomy in shave mode, with laser limited only around tears. Keywords: rhegmatogenous retinal detachment, vitrectomy, endolaser coagulation

Outcomes of 27gauge pars plana vitrectomy for a variety of posterior segment diseases.

To report outcomes of 27 gauge pars plana vitrectomy for the management of a variety of simple to complex posterior segment disorders. This retrospective cohort study was conducted at the Shifa International Hospital, Islamabad, Pakistan, and comprised data of all patients who underwent 27 gauge pars plana vitrectomy between July 1, 2015, and June 30, 2019, for a variety of indications. Data noted included age, gender, laterality, diagnosis, pre-operative visual acuity, date of surgery and surgical details, including operating time and complications. Best corrected visual acuity at 3 months was also recorded. Data was analysed using SPSS 21. Of the 574 patients, 355(62%) were males and 219(38%) were females. The overall mean age was 55±16.9 years. There were total 665 eyes as 91(15.8%) patients underwent bilateral surgeries. The most common surgical indications were diabetic tractional retinal detachment 196(29.5%) and vitreous haemorrhage 191(28.7%). Mean operating time was 62± 37 minutes. With the exception of 0.34% cases where 20 gauge fragmatome was used, no case required conversion to 20 gauge system, while 25 gauge trocar was used for silicon oil injection. Per-operative complications included iatrogenic retinal tear 2(0.3%) eyes and supra choroidal silicon oil migration 1(0.15%) eye. Post-operative complications were raised intraocular pressure 7(1.05%), endophthalmitis 1(0.15%) eye, haemorrhagic occlusive retinal vasculitis 1(0.15%) eye and rhegmatogenous retinal detachment 2(0.3%) eyes. Mean best corrected visual acuity improved from 1.62± 0.68 to 0.4± 0.38 logarithm of minimum angle of resolution (p<0.001). The 27 gauge pars plana vitrectomy was found to be a safe and effective procedure for both simple and complex retinal pathologies requiring significant surgical manipulation.

Ab-interno surgical technique for the implantation of a wireless subretinal prosthesis in mini-pigs

We sought to describe the surgical techniques required in the ab-interno method to implant subretinal prostheses in mini-pigs and suggest tips to facilitate optimal outcomes. During vitrectomy, the use of valved trocar cannulas was essential to stabilize the detached retina and implanted chip. As a first step in retinal detachment, a 23-gauge cannula with very small amount of viscoelastic material was used to establish the retinal hole and promote retinal detachment. Then, balanced salt solution was applied to increase the retinal detachment and diathermy was used to make opening for subretinal prosthesis. For easy positioning of the subretinal prosthesis, a curved laser probe was adopted when handling the subretinal prosthesis under the retina. After surgery, the sclerotomy sites were tightly sutured to prevent silicone oil leakage. Without special equipment, such as a 41-gauge tip, retinal detachment could be induced easily, while the prosthesis was also successfully inserted and manipulated under the retina without an iatrogenic retinal tear. Two weeks after the operation, the oil fully occupied the intraocular volume without leakage. The subretinal prosthesis remained stable without complication. Understanding the principle of the ab-interno method and considering several tips for improving surgical access may help to enhance surgical success rates of subretinal prostheses implantation.

Limited Vitrectomy versus Complete Vitrectomy for Epiretinal Membranes: A Comparative Multicenter Trial.

Purpose To evaluate whether limited vitrectomy is as effective as complete vitrectomy in eyes with epiretinal membrane (ERM) and to compare the surgical times and rates of complications. Methods In this multicentre European study, data of eyes with ERM that underwent vitrectomy from January 2017 to July 2018 were analyzed retrospectively. In the limited vitrectomy group, a posterior vitreous detachment (PVD) was induced up till the equator as opposed to complete PVD induction till the vitreous base in the comparison group. Incidence of iatrogenic retinal breaks, retinal detachment, surgical time, and visual outcomes were compared between groups. Results We included 139 eyes in the analysis with a mean age being 72.2 ± 6.9 years. In this, sixty-five eyes (47%) underwent limited vitrectomy and 74 eyes (53%) underwent complete vitrectomy. Iatrogenic retinal tears were seen in both groups (5% in limited vitrectomy versus 7% in complete vitrectomy, p=0.49). Retinal detachment occurred in 2 eyes in the limited vitrectomy group (3%) compared to none in the complete vitrectomy group (p=0.22). Best-corrected visual acuity (BCVA) and central macular thickness improved significantly with no intergroup differences (p=0.18). Surgical time was significantly shorter in the limited vitrectomy group with 91% surgeries taking less than 1 hour compared to 71% in the complete vitrectomy group (p < 0.001). Conclusion A limited vitrectomy is a time-efficient and effective surgical procedure for removal of epiretinal membrane with no additional complications.

Novel probabilistic model of core vitreous traction using microsurgical vitrectomy tools.

Traction exerted on the vitreous base during vitrectomy poses a risk for retinal tears. We aimed to quantify core vitreous traction during vitrectomy using spring return and pneumatic cutters. Juvenile porcine vitreous was vacuum held in a vitreous bath while traction was measured using precision force gauge during vitrectomy. The parameters included were aspiration rate, cut-rate, cutter size, and machine types. An empirical probabilistic model was developed. The traction was proportional to the aspiration rate but insignificantly dependent on the cut-rate. The traction probability was inversely proportional to the exponential function of the traction (p < 0.05). The traction was < 0.003N for 99% of the time using either 23- or 25-gauge cutters. The tractions measured were considered similar to the causative forces of an iatrogenic retinal tear during a pars plana vitrectomy. The results provide a safety reference matrix of instrumental parameters during vitrectomy.

Retinal Detachment after Vitrectomy; Risk Factors, Pathogenesis, Clinic, and Management

Intraoperative iatrogenic retinal tears leading to postoperative retinal detachments secondary to vitrectomy are an important sight-threatening complication of pars plana vitrectomy. Peripheral vitreous traction and retinal tears that incompletely removed, surgical instruments causing shrinkage on the basis of vitreous and incarceration of the vitreous to the entry points of the surgical instruments during entry and exit can be counted among the main causes of tears. In addition, small ruptures that may have been missed before the operation may cause retinal detachment after PPV. In order to reduce postoperative RD, it is based on the principle of detecting and treating the retinal breaks, if it is formed. Removing the peripheral vitreous completely without traction during PPV is important in preventing the formation of new tears.

Outcome of Bimanual 23G, 5-Ports Versus 3-Ports Pars Plana Vitrectomy for Advanced Diabetic Eye Disease

Purpose: Evaluation of efficacy and safety of 23 – guage five ports vitrectomy versus 23 – guage three portspars plana vitrectomy (PPV) in diabetic tractional retinal detachment.Study Design: Prospective Interventional case series.Place and Duration of Study: Mayo hospital and Services hospital, Lahore, from February 2018 to December2018.Material and Methods: Forty eyes of forty patients were equally divided into two groups. One group whichunderwent five ports PPV and the other group had three ports PPV. Patients with tractional retinal detachment(TRD) with fibrovascular membranes were included and patients who had undergone previous ocular surgery(except cataract surgery) or having TRD due to other ocular diseases were excluded. Preoperative work-upincluded visual acuity, intra ocular pressure measurement and slit lamp examination of anterior and posteriorsegment. Gender, age, pre-operative and post-operative BCVA and intraocular pressure presented by calculatingfrequency and percentages.Results: Pre-operative BCVA improved from 1.11 ± 0.5 to 0.66 ± 0.5 in 3-port groups and from 1.7 ± 0.9 to 0.87± 0.8 in 5-port groups. Duration of surgery was 74.40 ± 5.4 and 53.40 ± 2.5 minutes in 3 ports and 5-ports grouprespectively. Iatrogenic retinal tear developed in two patients in each group. Per-operative vitreous hemorrhagedeveloped in three patients in 3-ports group and in two patients in 5-ports group. Two patients in each groupdeveloped post vitrectomy cavity hemorrhage.Conclusion: Bimanual 5- ports 23-guage vitrectomy is a faster procedure than three ports 23 – guage vitrectomyin diabetic tractional retinal detachment.

International multi-center study of iatrogenic retinal tears in pars plana vitrectomy

To study and compare the effect of different surgical settings on the development of iatrogenic retinal tears (IRT) in conventional (20-gauge) and microincisional vitrectomy. An international retrospective comparative study of 394 patients who had simple vitrectomy at three tertiary centers. Surgeries were performed by four retina surgeons using different viewing systems. Two groups of eyes were compared: microincisional vitrectomy (327 eyes) and conventional (67 eyes) vitrectomy. An iatrogenic tear was defined as the occurrence of one or more peripheral retinal tears during surgery or at any visit in the first 6wk postoperatively. Mean age was 67±12y and 55% were female. Iatrogenic tears occurred in 11/394 (2.8%) of eyes. The rate of tears was similar among different surgeons and viewing systems (P=0.93 and P=0.76, respectively). Surgical indication, preexisting pseudophakia/aphakia, induction of posterior vitreous detachment (PVD) during surgery, and the use triamcinolone acetonide didn't significantly affect the rate of tears (P>0.1 for all factors). A higher rate of tears was found in the conventional group compared to the microincisional group (respectively, 7.5%, 1.8%, P=0.02). The rate of IRT in vitrectomy is not significantly affected by surgical indication, preexisting PVD or pseudophakia, or use of triamcinolone or different viewing systems but is significantly higher in conventional vitrectomy. Microincisional platforms improve the safety of vitrectomy regardless of the viewing system used.

Chandelier-assisted scleral buckling using wide angle viewing contact lens for pseudophakic retinal detachment repair.

To evaluate a modified technique for scleral buckling (SB) in pseudophakic retinal detachment (RD). A retrospective non-comparative study included 21 consecutive eyes with uncomplicated pseudophakic RD that was repaired by chandelier assisted SB using wide angle viewing (WAV) contact lens. Segmental tire alone was used in 5 eyes (23.81%), and combined with encircling band in 7 eyes (33.33%). Radial sponge alone was used in 3 eyes (14.29%) and combined with encircling band in 6 eyes (28.57%). Primary success rate was (90.48%). External drainage of subretinal fluid was performed in 8 eyes (38.1%). Intraoperative complications included vitreous prolapse at chandelier sclerotomy site in 4 eyes (19.05%) and localized subretinal hemorrhage at drainage site in one eye (4.76%). No case of intraocular lens (IOL) displacement, retinal incarceration or iatrogenic retinal tear was detected. Postoperative complications included choroidal detachment in one eye (4.76%), elevated intraocular pressure in 2 eyes (9.52%), epiretinal membrane formation in one eye (4.76%) and proliferative vitreoretinopathy in 3 eyes (14.29%). Mean postoperative corrected distance visual acuity was 0.7±0.3 logMAR units. Chandelier-assisted SB using WAV contact lens is a reliable technique for repairing selected cases of simple pseudophakic RD.

Visual Outcome of Pars Plana Vitrectomy for Treatment of Premacular Hemorrhage

Background: premacular hemorrhage can lead to painless loss of central vision. Several modalities of treatment have been described in previous reports. Purpose: to evaluate the visual outcome after pars plan vitrectomy (PPV) for treatment of premacular hemorrhage of different etiology. Patients and methods: A series of retrospective study 17 eyes of 17 patients presented with premacular hemorrhage due to different pathologies. Complete ophthalmic evaluation was done including visual acuity (VA), intraocular pressure (IOP), anterior segment examination, slit lamp biomicroscopy, fundus photography± fluorescein angiography (FA), and ocular ultrasound ± biometry. PPV was performed using 23gauge system with proper tamponade ± Phaco with PCIOL.No intraoperative lens touch or iatrogenic retinal tear has been recorded. Results: BCVA was improved from CF 50 cm in2 cases, hand movement (HM) in 15 cases to 0.1 (Log MAR) in 2 eyes (11.76%), 0.3 in one eye (5.88%), 0.4 in 5 eyes (29.41%), 0.6 in 3 eyes (17.64%), 1.00 in 3 eyes (17.64%), (3/60) in 2 eyes (11.67%), CF (1/60) in one eye (5.88%). No serious complications weredetected. Conclusion: PPV is a beneficial surgical treatment for premacular hemorrhage of different pathologies ensuring rapid visual recovery. The visual outcome is an encouraging and the complications are comparable to other studies.

Parameters affecting postoperative success of surgery for stage 4A/4B ROP

PurposeTo describe the long-term anatomical and functional results of surgery for retinal detachment (RD) associated with stage 4 retinopathy of prematurity (ROP) and patient and surgery-related factors affecting postoperative success.DesignRetrospective...

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.

Observation on the efficacy of vitrectomy at posterior pole and minimal gas tamponade for the treatment of idiopathic macular hole

Objective To observe the efficacy of localized vitrectomy at posterior pole and minimal C3F8 gas tamponade for the treatment of idiopathic macular hole. Methods The data of 40 eyes of 40 cases with idiopathic macular hole from Aug. 2013 to Jun. 2015 were collected and analyzed retrospectively. All cases underwent 25-gauge localized vitrectomy at posterior pole, internal limiting membrane peeling without staining and C3F8 gas tamponade (0.3-0.4 ml). After surgery all cases were required face-down position for 2 weeks. The visual acuity, intraocular pressure and macular structure was observed. Results No iatrogenic retinal tear occurred during surgery. After 6 months follow-up, the macular hole was closed in 37 eyes (92.50%), and visual acuity was improved in 35 eyes (87.50%). The average best corrected visual acuity (logMAR) after surgery was increased from 0.90±0.46 to 0.62±0.33, the difference was statistically significant (t=3.055, P=0.001). Conclusion The localized vitrectomy at posterior pole and minimal C3F8 gas tamponade is an effective method for idiopathic macular hole, with less traumatic and less time. Key words: Vitrectomy; Macular hole, idiopathic; Internal limiting membrane peeling; Tamponade, C3F8

Efficacy of 23-gauge minimally invasive vitrectomy for exogenous endophthalmitis

Objective To analyze the efficacy of 23 G minimally invasive vitrectomy for exogenous endophthalmitis. Methods A retrospective case series study. The data of 105 eyes of 105 patients with exogenous infectious endophthalmitis from May 2008 to May 2016 were analyzed. All cases received local and systemic sufficient antibiotics treatment, intravitreal injection or 23 G minimally invasive vitrectomy. Follow-up time was 1-6 months after treatment. The efficacy and complications of 23 G vitrectomy were analyzed. Results Among 105 cases, endophthalmitis were cured in 97 cases(92.38%), in which vitrectomy combined with antibiotics adjuvant therapy were received in 57 cases, accounting for 54.29%. No iatrogenic retinal tear occurred. At the end of follow-up, BCVA were improved after surgery, the difference was statistically significant between before and after surgery(P 0.05). Conclusion The 23-gauge minimally invasive vitrectomy is safe and effective for exogenous endophthalmitis. Key words: Endophthalmitis , exogenous; Vitrectomy, minimally invasive