Internal Tamponade Research Articles

Improved Outcomes with Heavy Silicone Oil in Complex Primary Retinal Detachment: A Large Multicenter Matched Cohort Study

PurposeTo establish whether Densiron® 68, a heavier-than-water endotamponade agent, is an effective alternative to conventional light silicone oil in primary rhegmatogenous retinal detachment surgery for eyes with inferior breaks in the detached retina and severe proliferative vitreoretinopathy. DesignCohort study of routinely collected data from the European Society of Retina Specialists (EURETINA) and British and Eire Association of Vitreoretinal Surgeons (BEAVRS) vitreoretinal database between 2015 and 2022. ParticipantsAll consecutive eyes that underwent primary rhegmatogenous retinal detachment surgery using either Densiron® 68 or light silicone oil as an internal tamponade agent. MethodsTo minimize confounding bias, we undertook 2:1 nearest neighbor matching on inferior breaks, large inferior rhegmatogenous retinal detachments, proliferative vitreoretinopathy, and, for visual analyses, baseline visual acuity between treatment groups. We fit regression models including prognostically relevant covariates, treatment-covariate interactions, and matching weights. We used g-computation with cluster-robust methods to estimate marginal effects. For nonlinear models, we calculated confidence intervals using bias-corrected cluster bootstrapping with 9 999 replications. Main Outcome MeasuresPresence of a fully attached retina and visual acuity at least two months after oil removal. ResultsOf 1061 eyes enrolled, 426 and 239 were included in our matched samples for anatomical and visual outcome analyses, respectively. The primary success rate was higher in the Densiron® 68 group (113 of 142; 80%) compared to the light silicone oil group (180 of 284; 63%), with an adjusted odds ratio of 1.90 (95% CI 1.63 to 2.23, P < 0.001). We also observed a significant improvement favoring Densiron® 68 of -0.26 logMAR in postoperative visual acuity between the two groups (95% CI -0.43 to -0.10, P = 0.002). The anatomical benefit of using Densiron® 68 in eyes with inferior retinal breaks and large detachments was more pronounced among eyes with proliferative vitreoretinopathy Grade C. We found no evidence of visual effect moderation by anatomical outcome or foveal attachment. ConclusionsDensiron achieved higher anatomical success rates and improved visual outcomes compared to conventional light silicone oil in eyes with inferior retinal pathology and severe proliferative vitreoretinopathy.

Predictors of visual outcome after pars plana vitrectomy secondary to proliferative diabetic retinopathy.

Objective: Advanced proliferative diabetic retinopathy can lead to serious ophthalmological complications, including blindness. This research aimed to determine visual outcomes after pars plana vitrectomy secondary to proliferative diabetic retinopathy, as well as to identify its predictors. Methods: This prospective clinical study was performed in the Ophthalmology Clinic of the Clinical Centre University of Sarajevo. 60 subjects (eyes) with performed pars plana vitrectomy secondary to proliferative diabetic retinopathy were included in the study. Results: After univariate linear regression analysis, glucose, HbA1c, vascular endothelial growth factor, previous pan-retinal laser photocoagulation, baseline best corrected visual acuity, gas injection, vitreous haemorrhage, iris rubeosis, and glaucoma were found to be statistically significant parameters associated with postoperative visual outcome (p<0.05). Multivariate linear regression analysis was performed to evaluate the association between factors and postoperative best corrected visual acuity. Only intravitreal vascular endothelial growth factor concentration, previous pan-retinal photocoagulation, and gas injection remained statistically significant associated with postoperative best corrected visual acuity (p<0.05). Conclusion: Vitrectomy is an effective treatment for advanced proliferative diabetic retinopathy. Factors correlated with the better visual outcome are good systemic control, previous pan-retinal photocoagulation, low intravitreal vascular endothelial growth factor concentration, younger age, intraoperative internal gas tamponade, combined phacoemulsification and pars plana vitrectomy surgery, and the absence of postoperative complications. Abbreviations: PDR = proliferative diabetic retinopathy, VEGF = vascular endothelial growth factor, TDR = tractional retinal detachment, BCVA = best corrected visual acuity, DR = diabetic retinopathy, RDD = rhegmatogenous retinal detachment, NVG = neovascular glaucoma, BRVO = branch retinal vein occlusion, CBC = complete blood count, DBT = differential blood count, ESR = erythrocyte sedimentation rate, HbA1c = glycosylated hemoglobin, PHACO = phacoemulsification, ILM = internal limiting membrane, PPV = pars plana vitrectomy, IOP = intraocular pressure, PRP = pan-retinal photocoagulation, ETDRS = Early treatment diabetic retinopathy study.

23-Guage Vitrectomy with Internal Gas Tamponade for the Management of Rhegmatogenous Retinal Detachment

Purpose: To find out functional and anatomical outcomes of 23-G pars plana vitrectomy (PPV) with gas tamponade (C3F8/SF6) for Rhegmatogenous Retinal Detachment (RRD). Study Design: Quasi Experimental Study. Place and Duration of Study: Liaquat National Hospital Karachi Ophthalmology department, from October 2020 to April 2021. Methods: Fifty-five eyes of 55 patients with RRD were included in the study by convenient sampling. The patients underwent 23-G PPV with gas tamponade under general anesthesia. Anatomical and functional results were evaluated in the form of retinal attachment and change in the best corrected visual acuity (BCVA). Frequency of complications were also assessed. An average follow up period was 6 months. Results: Out of 55 patients, 32.7% were males and 67.3% were females. Mean age of the patients was 49.14 ± 17.11 years ranging from 17 years to 79 years. Four quadrants were involved in 36.4% of the patients. Among 55 eyes, 40% were phakic and 60% were pseudophakic. Only 4 (7.3%) patients needed redo procedure. Mean pre-operative and post-operative visual acuity was 2.52 ± 0.67 and 0.80 ± 0.66 with a significant mean difference of 1.71. Anatomical success was seen in 92.7% of patients. Conclusion: Anatomical success and improvement in the best corrected visual acuity (BCVA) is achievable with 23-G PPV with expansible gas used as internal tamponade in the treatment of RRD.

Silicone oil complications in vitreoretinal surgery.

Objective: To illustrate the complications in subjects who experienced posterior vitrectomy and internal tamponade with silicone oil. Design: Prospective, observational, longitudinal, descriptive, series of cases. Material and methods: Patients who underwent posterior vitrectomy and internal tamponade with silicone oil of 1000 centistokes, from April to October 2021, were considered. All subjects included in the study had a complete ophthalmic examination pre and postoperatively on first day, first week and 1 to 6 months, and were assessed the best corrected visual acuity, ocular tension (raised > 21 mmHg, hypotony < 5 mmHg), emulsification, keratopathy, cataracts and posterior pole. Results: 40 eyes of 40 patients were considered; twenty women and 20 men, with an average age of 63 years (range 46 to 77 years). Conclusions: Complications are brief, treated medically or surgically, with better prognosis.

Artificial intelligence using deep learning to predict the anatomical outcome of rhegmatogenous retinal detachment surgery: a pilot study.

To develop and evaluate an automated deep learning model to predict the anatomical outcome of rhegmatogenous retinal detachment (RRD) surgery. Six thousand six hundred and sixty-one digital images of RRD treated by vitrectomy and internal tamponade were collected from the British and Eire Association of Vitreoretinal Surgeons database. Each image was classified as a primary surgical success or a primary surgical failure. The synthetic minority over-sampling technique was used to address class imbalance. We adopted the state-of-the-art deep convolutional neural network architecture Inception v3 to train, validate, and test deep learning models to predict the anatomical outcome of RRD surgery. The area under the curve (AUC), sensitivity, and specificity for predicting the outcome of RRD surgery was calculated for the best predictive deep learning model. The deep learning model was able to predict the anatomical outcome of RRD surgery with an AUC of 0.94, with a corresponding sensitivity of 73.3% and a specificity of 96%. A deep learning model is capable of accurately predicting the anatomical outcome of RRD surgery. This fully automated model has potential application in surgical care of patients with RRD.

When the savior becomes a demon: Silicon oil synechia-induced glaucoma.

Silicon oil is an important adjunct for achieving internal tamponade in the treatment of retinal detachment. Silicone oil tamponade often leads to narrowing of the angle and development of adhesions between the iris and anterior chamber angle structures, with consequential elevation of the intraocular pressure. The video showcases the management of these challenging scenarios. To highlight the management of early synechial closures due to silicon oil tamponade. The video highlights the management of early synechial closure following silicon oil tamponade. Surgical pupilloplasty has been demonstrated to break the peripheral anterior synechias on intraoperative gonioscopy as well as on anterior segment optical coherence tomography (AS-OCT). Performing pupilloplasty in the early phase of development of peripheral anterior synechias (PAS) helps to break the existing synechias and prevent angle closure and sequential deterioration of vision. Surgical pupilloplasty helps to relieve the post silicon oil-induced secondary angle closure glaucoma by breaking the peripheral anterior synechias and significantly opening the anterior chamber angles. https://youtu.be/xe2NGlhPBF4.

AIR VERSUS SULFUR HEXAFLUORIDE GAS TAMPONADE IN VITRECTOMY FOR UNCOMPLICATED RETINAL DETACHMENT WITH INFERIOR BREAKS

To compare surgical outcomes of filtered air and sulfur hexafluoride (SF6) as an internal tamponade in patients undergoing primary 25-gauge pars plana vitrectomy for uncomplicated rhegmatogenous retinal detachment with inferior breaks. Patients with uncomplicated rhegmatogenous retinal detachment associated with inferior breaks (between 4 and 8 o'clock positions) who were undergoing primary pars plana vitrectomy were enrolled. All eyes underwent pars plana vitrectomy and complete drainage of subretinal fluid, followed by filtered air or 20% SF6 tamponade. The main outcome measures included single-surgery anatomical success rates and final visual recovery. Overall, 116 eyes of 116 patients (81 men and 35 women with a mean age of 55.2 years) were assessed. Air was used in 52 eyes (air group) and gas in 64 eyes (gas group). Single-surgery anatomical success was achieved in 50 (96.2%) and 60 (93.8%) eyes in the air and gas groups, respectively (P = 0.69), and final anatomical success was achieved in all eyes. The mean final Snellen visual acuity was similar in the air (20/23) and gas groups (20/21; P = 0.13). No significant differences were observed in single-surgery anatomical success rates and final visual recovery when comparing air with SF6 gas tamponade in pars plana vitrectomy for primary uncomplicated rhegmatogenous retinal detachment with inferior breaks.

The Common Indications of Pars plana vitrectomy (PPV) for posterior Segment Ocular diseases in patients from a Private Retina Clinic

Purpose: To evaluate common indications and anatomical outcomes of PPV for posterior segment ocular diseases in patients presenting at private retina clinic in Lahore Study design: Cross sectional survey Methods and materials: Over the period of three years, from 1st April 2017 to 3oth April 2020, all patients fulfilling inclusion criterion, were included in study after approval from hospital ethical committee. After taking history and detailed ocular examination, diagnosis was confirmed by B scan or OCT, Hepatitis B &amp; C screening done. The patient age, gender, laterality of eye, lens status, macular status, type of retinal pathology, type of anesthesia, procedure done and type of vitreous tamponade if used were noted. All procedures were performed by a single surgical team and patients were followed for six months for anatomical success or any complication. Data was analyzed by SPSS 25. Results: Out of 266 total patients, 168 (63.2%) were males and 98 (36.8%) were females. Right eye was involved in 125 (47%) and left in 141 (53%). Age range was from 2 years to 83years, mean age for males was 47.30, for females 48.07 years, median age was 50 years, mean age for GA was 30.62 years and 51.71 for LA patients. The highest incidences of posterior segment ocular problems were observed in patients with age range 51 to 60 years. The commonest indication for posterior segment surgery were RRD seen in 107 (40.23%), ROSO in 51 (19.17%) and vitreous hemorrhage 33 (12.41%). Endophthalmitis was indication in 20 (7.52%), dropped nucleus in 11 (4.13%), Macular hole in 7 (2.63%) and ERM in 3 (1.13%). Asteroid hyalosis, intraocular IOFB and diagnostic vitrectomy were least common indication, each seen in 1 (0.5%) patient. Silicon oil was most commonly used Endo tamponade used in 138 (51.88%) patients. All patients were followed for 6 months with vision and retinal status. All patients who underwent pars plana vitrectomy surgery were stable with anatomical success rate till 6 months postoperatively except 10 (3.76%) who required re do operation for retinal detachment or some other complications. Conclusion: Current practice in ophthalmology shows increased frequencies of internal approach (PPV) for vitreoretinal diseases rather external approach (SB). Silicon oil was most common internal tamponade used. Diabetic retinopathy was important cause of vitreous hemorrhage and TRD. Patients should be educated regarding regular fundoscopy and good systemic control of diabetes. Higher incidence of retinal detachment among all age groups needs awareness and education about its warning ocular symptoms. Key words: PPV (Pars plana vitrectomy), RRD (Rhegmatogenous retinal detachment), SB (Scleral buckling), TRD (Tractional retinal detachment), ROSO (removal of silicon oil), GA (general anesthesia), LA (local anesthesia)

Outcomes of scleral buckle technique performed by trainee doctors in retinal detachment

AIM: To evaluate the outcomes of patients operated for retinal detachment by scleral buckle technique done by trainee doctors pursuing postgraduate course in ophthalmology. METHODS: This study was a non-comparative retrospective case series to evaluate the demography, clinical features and outcomes of patients underwent rhegmatogenous retinal detachment (RRD) repaired by scleral buckle technique from July 2017 to February 2018 at a tertiary care center in India. Records of all these patients were screened. Statistical analyses were performed and using Fisher's exact test, Mann-Whitney test and Nominal Logistic regression. RESULTS: Totally of 41 patients were included out of which, 32 (78.04%) were males and 9 (21.95%) were females. In our study primary anatomical success rate was 95.12%, with significant visual gain. Postoperative complications were raised intraocular pressure (n=2), new breaks (n=2) and re-detachment in 2 patients which was successfully managed by pars plana vitrectomy (PPV) with internal tamponade and laser. CONCLUSION: The study showed that scleral buckle surgeries done by trainee doctors under supervision can achieve a high success rate in patients of RRD both in terms of postoperative anatomical success, visual acuity and complication rates. Thus, scleral buckle surgery can be an acceptable primary procedure for trainee doctors for management of RRD in selected cases despite the various treatment options now available.

Management of Suprachoroidal Hemorrhage in a Patient With Boston Type I Keratoprosthesis.

Suprachoroidal hemorrhage (SCH) is a rare but vision-threatening complication in patients with keratoprosthesis devices (KPro), particularly in the setting of concurrent glaucoma tube shunts. Although there are many approaches to draining an SCH, surgery can be especially challenging in these patients because a crowded anterior chamber, and frequent anterior extension of the SCH. A case report is discussed. We describe a novel approach to surgical drainage of SCH in a 64-year-old monocular patient with a Type I Boston KPro, an Ahmed valve, and aphakia. Successful repair of appositional SCH in the context of KPro can be safely and effectively achieved by injecting viscoelastic through the backplate holes of the KPro, thereby providing internal tamponade within the vitreous compartment while liquefied hemorrhage is drained by sclerotomy.

ANATOMICAL AND VISUAL OUTCOME OF COMBINED PHACO-VITRECTOMY VS VITRECTOMY ALONE

Introduction&#x0D; Separation of Neurosensory retina from RPE(Retinal Pigment Epithelium) is described as retinal detachment. Recently Pars plana vitrectomy has emerged as a preferred surgical treatment for management of uncomplicated primary rhegmatogenous retinal detachment. Various studies have evaluated the results of combined phaco-vitrectomy, the combined approach allows faster visual recovery and has cost effectivity for patient. The rationale of this study is to compare the anatomical and visual outcome of combined phacoemulsification and vitrectomy vs vitrectomy alone&#x0D; Materials and methods&#x0D; This prospective randomized controlled trial was performed at Eye Unit II Mayo Hospital Lahore (tertiary care eye hospital in Lahore), Pakistan from August 2019 to February 2020. 36 patients full filling the inclusion criteria were divided into two groups 18 patients each. Group A was of combined Phaco-vitrectomy and Group B was of vitrectomy only. The Mann-whitney test as test of significance was applied and P≤0.05 was considered statistically significant.&#x0D; Results&#x0D; BCVA done Pre-operatively for Group A and B, P-value was &gt; 0.05 which was insignificant. Best corrected visual acuity at first week post operatively was significantly lower in patients in which we used gasses as internal tamponade as compared those in which we used silicon oil as tamponade. The BCVA at 1 month showed improvements in both groups, however the BCVA in group B was significantly lower than group A, P-value being &lt; 0.05. The BCVA at 3 month showed improvements in both groups, however the BCVA in group B was significantly lower than group A, P-value being &lt; 0.05.&#x0D; Anatomical Outcome was seen as weather retina was attached or detached. In Group A detachment was present in all follow-ups in 2/18 patients while in Group B detachment was present in all follow-ups in 3/18 patients. The P-value was &gt;0.05 and thus the difference between two groups was insignificant.&#x0D; Conclusion&#x0D; visual acuity did not differ among the two groups preoperatively and on first follow-up at 1 week. The P value being &gt;0.05 in both. However there was significant difference between the two group at 1 month and 3 months follow up, P value being &lt; 0.05 in each. The visual acuity was significantly better in Group A i.e combined phaco- vitrectomy.&#x0D; For anatomical outcome no difference was seen between the groups. The P value was &gt; 0.05. So the visual outcome of group A was significantly better than group B while the anatomical outcome was the same.&#x0D; &#x0D; Keywords&#x0D; Phacoemulsification, Three ports pars plana vitrectomy, best corrected visual acuity, retinal detachment.

Current Situation and Challenges in Vitreous Substitutes.

Vitreo-retinal disorders constitute a significant portion of treatable ocular diseases. These pathologies often require vitreo-retinal surgery and, as a consequence, the use of vitreous substitutes. Nowadays, the vitreous substitutes that are used in clinical practice are mainly divided into gases (air, SF6 , C2 F6 , C3 F8 ) and liquids (perfluorocarbon liquids, silicone oils, and heavy silicone oils). There are specific advantages and drawbacks to each of these, which determine their clinical indications. However, developing the ideal biomaterial for vitreous substitution continues to be one of the most important challenges in ophthalmology, and a multidisciplinary approach is required. In this sense, recent research has focused on the development of biocompatible, biodegradable, and injectable hydrogels (natural, synthetic, and smart), which also act as medium and long-term internal tamponade agents. This comprehensive review aims to cover the main characteristics and indications for use of the extensive range of vitreous substitutes that are currently used in clinical practice, before going on to describe the hydrogels that have been developed recently and which have emerged as promising biomaterials for vitreous substitution.

Evaluation of vitrectomycombined preoperative intravitreal ranibizumab and postoperative intravitreal triamcinolone acetonide for proliferative diabetic retinopathy.

To explore the treatment efficacy of the combination of preoperative intravitreal ranibizumab (IVR) and postoperative intravitreal triamcinolone acetonide (IVTA) in patients undergoing pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR). A retrospective comparative study was performed on 128 eyes of 128 patients who had PDR and underwent PPV. Patients who received a single PPV were assigned to Group A. Those who received PPV with preoperative IVR were assigned to Group B. Patients in Group C underwent PPV combined preoperative IVR and postoperative IVTA. Intraoperative findings, changes in mean best-corrected visual acuity (BCVA) and postoperative adverse events, were retrospectively evaluated at 6-month follow-up. The incidences of iatrogenic breaks, severe intraoperative bleeding, using long-term internal tamponade agents, recurrent vitreous hemorrhage (VH), and duration of surgery were statistically significantly less in Group B and Group C than in Group A. The postoperative BCVA was statistically significantly better in Groups B and Group C than in Group A, respectively, at 1month after surgery. The mean 3-month postoperative visual acuity was better in Group C. The incidence of high intraocular pressure (IOP) was significantly higher in Group C at the first postoperative week. There were no statistically significant differences in the incidence of exudative retinal detachment and choroidal detachment among the three groups. In patients undergoing PPV for PDR, preoperative IVR significantly reduced the occurrence of intraoperative and postoperative complications, and the combination of preoperative IVR and postoperative IVTA can better improve the postoperative visual outcome.

Surgical Outcomes of Combined Phacoemulsification and Silicone oil Removal in Post Retinal Detachment Surgery Patients

Purpose: To evaluate the surgical outcomes of Combined Phacoemulsification with IOL implantation and Silicone oil removal in patients with previous retinal surgery.&#x0D; Study Design: Interventional case series.&#x0D; Place and Duration of Study: Al-Ibrahim eye Hospital Karachi from January 2019 to December 2019.&#x0D; Methods: Total 30 eyes of 30 patients between ages of 25 to 65 years, who had retinal detachment surgery with silicone oil used as internal tamponade and later on developed cataract were re-operated once confirming that retinal was attached. The time interval between two surgeries was 8 to 10 months. Phacoemulsification with IOL implantationwas done followed by silicone oil removal by 23-gauge pars plana method. Postoperative follow-ups were done at day 1, 1 month and at 6 months to record visual acuity and retinal status.&#x0D; Results: Best corrected Visual acuity was recorded pre and post-operatively using Snellen chart. Preoperatively 12 patients had visual acuity of 6/60, 12 with vision 6/95 and 6 with 6/120. There was improvement of 2 lines of visual acuity post operatively as recorded by Snellen chart. Retina was attached in 28 (93.33%) patients and 2 (6.66%) had re-detached retina at the end of 6 months.&#x0D; Conclusion: Visual outcomes were found to be better with low rate of retinal re-detachment after 6 months follow-up of combined phacoemulsification with IOL implantation and silicone oil removal. Hence, Combined Phacoemulsification with Silicone oil removal is a method that is associated with better visual and anatomical outcomes as well as decrease the chances of patients undergoing third surgery for cataract extraction.&#x0D; Key Words: Retinal Detachment, Phacoemulsification, Silicon Oil.

Factors affecting visual recovery after successful repair of macula-off retinal detachments: findings from a large prospective UK cohort study.

To identify risk factors affecting visual outcomes in successfully re-attached macula-off rhegmatogenous retinal detachment (RD) surgery. A prospective study, using online databases, of visual outcomes for 2074 macula-off retinal detachments that were successfully re-attached by vitrectomy and internal tamponade. The database included detailed retinal diagrams of each detachment. The probability of achieving a post-operative visual acuity (VA) of ≤0.30 LogMAR (Snellen 6/12 or better). Male patients accounted for 64.9% of the sample and the median age was 63 years old. The median pre-operative VA was counting fingers (LogMAR 1.98); this improved to 0.41 LogMAR post-operatively. A post-operative VA of ≤0.30 LogMAR was achieved for 1012 (48.8%) eyes and the factors affecting this were the patient age and gender, pre-operative VA, duration of central vision loss, PVR grade, lens status, total RD and the presence of any ocular co-pathology where the model area under the receiver operator curve was 71.6%. From the identified risk factors that decrease the probability of achieving a post-operative visual acuity of ≤0.30 LogMAR, the most important modifiable risk factor was the duration of central vision loss. Recent macula-off retinal detachments should be repaired within 72 h of the loss of central vision.

Air vs Gas Tamponade During Macular Hole Repair Surgery.

This work investigates the visual and anatomical outcomes of full-thickness macular hole (FTMH) repair surgery using air in comparison to gas tamponade. A retrospective consecutive review of medical records was undertaken of all patients undergoing pars plana vitrectomy for idiopathic FTMH at an academic practice from January 2010 to May 2017. Each operative report was reviewed to investigate the agent used for tamponade at the end of the surgery. Preoperative hole duration and size as measured using optical coherence tomography as well as successful postoperative hole closure were recorded. Use of gas or air was not randomized and was instilled at surgeon discretion. The final analysis included 211 eyes. Gas was used as the tamponade agent in 171 of the 211 eyes; most of these eyes (144 of 171) received sulfur hexafluoride (SF6) and the remainder received perfluoropropane (C3F8). Forty eyes underwent only a complete fluid-air exchange without any gas placement following vitrectomy. There was no statistically significant difference between the 2 groups in mean preoperative macular hole size (P = .43). Nine of the 171 macular holes receiving gas tamponade failed to close (5.3%). One of the 40 macular holes receiving only air failed to close (2.5%). There was no statistically significant difference in hole closure rates between the 2 groups (P = .45). Air served as an equally efficacious internal tamponade agent in comparison to nonexpansile gas following idiopathic FTMH repair surgery.

Outcome and Distal Access Patency in Subintimal Arterial Flossing with Antegrade-Retrograde Intervention for Chronic Total Occlusions in Lower Extremity Critical Limb Ischemia

PurposeTo report the outcome and distal access patency of the Subintimal Arterial Flossing with Antegrade-Retrograde Intervention (SAFARI) technique for chronic total occlusion (CTO) in critical limb ischemia (CLI). Materials and MethodsFrom January 2009 to June 2015, 220 SAFARI procedures were performed for 200 limbs in 191 patients (108 males [56.5%]; median age, 70 years old; range, 36 to 97 years old) with CLI (9.4% were Fontaine classification 3; and 90.6% were Fontaine classification 4). Distal access was obtained from the distal superficial femoral artery (n = 6), popliteal artery (n = 49), anterior tibial artery (n = 56), dorsalis pedis (n = 51), peroneal artery (n = 12), posterior tibial artery (n = 45), and lateral plantar artery (n = 1). Distal access hemostasis was obtained with internal balloon tamponade in 71.4% (n = 157). Outcome measurements were technical success, freedom from major amputation and complications. Preprocedural angiograms of clinically driven repeat interventions were reviewed in 73 cases for distal access patency. ResultsTechnical success was achieved in 80.5% (n = 177). Reasons for technical failure include inability to obtain distal access (n = 3), cross the occlusion retrogradely (n = 16), re-enter the true lumen (n = 9), and achieve antegrade blood flow after the procedure (n = 15). Freedom from major amputation for technically successful procedures was 84.7%, 82.9%, and 81.9% at 6, 12, and 24 months, respectively. There were 3 cases of distal access bleeding with 1case that required coil embolization. The distal access remained patent in 80.8% of observable cases with repeated endovascular intervention. ConclusionsDistal retrograde arterial access (SAFARI) technique is safe and effective in the treatment of CTOs in the context of CLI, after failure of antegrade revascularization.

SURGICAL OUTCOMES OF 25-GAUGE PARS PLANA VITRECTOMY USING AIR AS AN INTERNAL TAMPONADE FOR PRIMARY RHEGMATOGENOUS RETINAL DETACHMENT.

To report surgical outcomes of 25-gauge pars plana vitrectomy using air as an internal tamponade for patients with primary rhegmatogenous retinal detachment (RRD). A retrospective clinical study of 59 eyes of 59 consecutive patients presented with primary RRD at the Beijing Tongren Eye Center in China. From August 2016 to May 2018, medical records of the patients who underwent 25-gauge pars plana vitrectomy with air tamponade for RRD were reviewed. The main outcome measures were primary and final anatomical success (retinal re-attachment) rates, and postoperative complications. Of the 59 patients, aged 54.47 ± 11.81 years, 31 (52.5%) were men. Vitrectomy was performed 3 to 40 (averaged 16.98 ± 10.17) days after the onset of symptoms, and the mean follow-up period was 12.90 ± 5.92 months (ranging 6.07-26.10 months). Forty-two eyes (71.2%) had RRD with retinal breaks in the superior half of the retina, and the mean number of retinal breaks was 1.75 ± 0.94. Three eyes (5.1%) had RRD with giant retinal tears. Of the 59 eyes, 35 (59.3%) had RRD with inferior quadrants involved. Proliferative vitreoretinopathy (PVR) gradings were C1 in 2 (3.4%) eyes and B or below in 57 (96.6%) eyes. The primary and final anatomical success rates were 94.9% (56/59) and 98.3% (58/59), respectively. Of the three eyes which developed re-detachment of the retina, one eye had postoperative progression of PVR and two eyes were RRD associated with macular hole in high myopia. Postoperative complications included 5 eyes (8.5%) with serous choroidal detachment within 3 days after surgery and 4 eyes (6.8%) with macular epiretinal membrane formation 1 to 8 months after surgery. Secondary cataract surgery was performed in 13 of the 53 phakic eyes (24.5%) during follow-up. Small-gauge pars plana vitrectomy with air tamponade may be effective in treating selected cases of relatively simple primary RRD. Additional studies are needed to verify the efficacy of this surgical approach for more complicated cases such as those with giant retinal tears.

Intravitreal bevacizumab versus intravitreal triamcinolone in the prevention of intraoperative bleeding in diabetic vitrectomy; a randomized clinical trial

Diabetic retinopathy is a diabetes complication that affects eyes. It's caused by damage to the blood vessels of the light-sensitive tissue at the back of the eye. So, the aim of this study was to compare the effects of intravitreal injection of TA and bevacizumabon intraoperative bleeding in eyes candidate for diabetic vitrectomy. Consecutive patients undergoing primary pars plana vitrectomy for complications of active PDR were recruited for this prospective study. The indications for vitrectomy included non-clearing vitreous hemorrhage, tractional retinal detachment, or active fibrovascular proliferation with or without TRD. Patients undergoing vitrectomy due to diabetic macular edema were not included. Patients were divided into two groups using a randomizing table; the first group received an intravitreal injection of bevacizumab 1.25 mg, and the second group received an intravitreal injection of triamcinolone 2 mg before surgery. After the operations, the attending surgeon completed a study questionnaire. All statistical analyses were performed by SPSS version 21. The P-value less than 0.05 was considered statistically significant. In this study, 141 eyes of 141 diabetic patients with an average age of 54 ± 10 were included. Of them, 74 and 67 were allocated to the IVB and IVT groups, respectively. There was no statistical difference between the groups regarding demographic and preoperative characteristics. We also did not notice any difference in the intraoperative data between the groups except for the uses of PFCL and internal tamponade that were significantly higher in the IVB group. Intraoperative bleeding occurs in 53 (71.6%) and 46 (68.7%) of the eyes in the IVB and IVT groups, respectively. The ATE based on the results of the AIPW model for the two groups in terms of intraoperative bleeding was 1.3% which failed to show a statistically significant difference. Our study demonstrated that preoperative IVT injection could at least be as effective as preoperative IVB injection as far as intraoperative bleeding in diabetic vitrectomy is concerned.

Outcome of pars plana vitrectomy in patients with retinal detachments secondary to retinal vasculitis

Purpose:Retinal detachments (RD) secondary to retinal vasculitis are highly complex. We report the clinical profile and outcome of vitrectomy in RDs secondary to retinal vasculitis in terms of intraoperative findings, final anatomical, and functional outcome.Methods:In a retrospective review of 68 patients (6 with bilateral RD; 74 eyes) undergoing pars plana vitrectomy (PPV) between 2000 and 2015 for vasculitic RD, tractional RD was present in 50 (67.57%) eyes and combined RD in 24 (32.43%) eyes.Results:The mean age was 31.54 ± 9.95 years (62 males, 6 females). Fibrovascular proliferations (FVPs) involved major vascular arcades (22.98%), optic disc (10.81%), both arcades and disc (20.27%), peripheral retina (32.43%), and arcades with peripheral retina (13.51%). A total of 14 (18.92%) eyes had retinal folds, of which 9 had macular drag. Of 24 eyes with combined RD, 3 (12.5%) eyes had macular hole, 15 (62.5%) eyes had the primary retinal break anterior to equator, and 6 (25%) eyes had the primary break posterior to equator. Twenty-one (28.38%) eyes had iatrogenic retinal breaks. Thirty-eight (51.35%) eyes required an internal tamponade [gas in 31 (81.57%) eyes and silicon oil in seven (18.42%) eyes]. A scleral buckle was additionally required in 26 (35.14%) eyes. Postoperative complications included vitreous hemorrhage (27.03%), re-RD (12.16%), and iris neovascularization (9.46%). The median follow-up was 18 months (range 6-122 months). Sixty-eight (91.9%) eyes achieved final anatomical success. Fifty-two (70.27%) eyes had ≥2 lines visual improvement.Conclusion:Vasculitic RDs are complicated by tractional/combined RDs, peripherally located FVPs, retinal folds and iatrogenic retinal breaks, and carry a moderate prognosis.