Outcomes Of Pars Plana Vitrectomy Research Articles

Pars plana vitrectomy combined with internal limiting membrane peeling for recurrent macular edema due to branch retinal vein occlusion after antivascular endothelial growth factor treatments

PurposeTo evaluate the anatomic and functional outcomes of pars plana vitrectomy combined with internal limiting membrane peeling for recurrent macular edema (ME) due to branch retinal vein occlusion (BRVO) after intravitreal injections of antivascular endothelial growth factor (anti-VEGF) agents.MethodsTwenty-four eyes of 24 patients with treatment-naive ME from BRVO were treated with intravitreal injections of anti-VEGF agents. Recurred ME was treated with pars plana vitrectomy combined with internal limiting membrane peeling.ResultsAfter the surgery, ME was significantly reduced at 1 month (P=0.031) and the reduction increased with time (P=0.007 at the final visit). With the reduction in ME, treated eyes showed a slow improvement in visual acuity (VA). At the final visit, improvement in VA was statistically significant compared with baseline (P=0.048). The initial presence of cystoid spaces, serous retinal detachment, or subretinal hemorrhage under the fovea, as well as retinal perfusion status, showed no association with VA improvement. However, the presence of epiretinal membrane showed a significant association with the visual recovery. Although eyes without epiretinal membrane showed visual improvement (−0.10±0.32 in logarithm of the minimum angle of resolution [logMAR]), eyes with epiretinal membrane showed greater visual improvement (−0.38±0.12 in logMAR, P=0.012).ConclusionFor recurrent ME due to BRVO after anti-VEGF treatment, particularly when accompanied by epiretinal membrane, pars plana vitrectomy combined with internal limiting membrane peeling might be a possible treatment option.

Inferior retinotomy and silicone oil tamponade for recurrent inferior retinal detachment and grade C PVR in eyes previously treated with pars plana vitrectomy or scleral buckle.

BackgroundOne of the most challenging problems in vitro-retinal surgery is the recurrence of retinal detachment in the context of high-grade proliferative vitreoretinopathy (PVR). The aim of our retrospective study was to assess the surgical outcomes of pars plana vitrectomy, 180° inferior retinotomy and silicone oil tamponade combined with phacoemulsification and IOL implantation for recurrent inferior retinal detachment with grade C PVR in phakic eyes. The study was carried out at tertiary referral centre - University Hospital of Rome “Tor Vergata”.MethodsRetrospective analysis of 33 eyes affected by recurrent inferior retinal detachment and grade C PVR after primary encircle scleral buckling (SB group – 12 eyes), or pars plana vitrectomy (PPV group – 21 eyes). All patients subsequently underwent PPV and silicone oil tamponade at our Institution. The first outcome measure was retinal reattachment, and second outcomes were reoperation rates, best-corrected visual acuity (BCVA) and postoperative complications.ResultsAll patients in the SB group and 19 (90 %) patients of the PPV group achieved retinal reattachment. Final BCVA was better in the SB group (p = 0.045). Two eyes in the PPV group required a third vitrectomy with heavy silicone oil tamponade. Postoperative complications included silicone oil in a deep anterior chamber (3 eyes in each group), untreatable hypotony in 1 eye in the PPV group (that led to enucleation due to phthisis bulbi), and elevated intraocular pressure in 3 patients (2 eyes in the PPV group).ConclusionsPhacoemulsification with IOL implant, PPV with silicone oil tamponade associated with 180° inferior retinotomy may lead to better anatomical success in patients who have previously undergone SB procedure for inferior retinal detachment repair compared with eyes that underwent a primary PPV.

Pars plana vitrectomy with juxtapapillary laser photocoagulation versus vitrectomy without juxtapapillary laser photocoagulation for the treatment of optic disc pit maculopathy: the results of the KKESH International Collaborative Retina Study Group

Background/aimsTo compare the functional and anatomic outcomes of pars plana vitrectomy (PPV) with juxtapapillary laser photocoagulation (JLP) versus vitrectomy without JLP in optic disc pit maculopathy.MethodsThis was a multicentre, retrospective...

Long-term Surgical Outcomes of Epiretinal Membrane in Patients with Retinitis Pigmentosa.

Macular complications such as an epiretinal membrane (ERM), a cystoid macular edema and a macular hole lead to unexpected central vision impairment especially for patients with retinitis pigmentosa (RP). To evaluate the long-term surgical outcomes of pars plana vitrectomy (PPV) for ERM in patients with RP, we retrospectively reviewed the charts of a consecutive series of 10 RP patients who underwent PPV for ERM at Kyushu University Hospital. Visual acuity (VA) testing, a fundus examination, and an optical coherence tomography (OCT) analysis were conducted. The standard PPV using three sclerotomies was performed for ERM. PPV was performed in 12 eyes of 10 patients. One eye was excluded from the outcome assessment due to short period observation (18 months). There was no significantly deleterious change from the baseline to final VA between the operation eyes and the fellow eyes (P = 0.19). Moreover, morphological improvement was obtained in 9 of 11 eyes based on OCT. Our present data suggest that PPV may be tolerable in the management for ERM in RP patients over the long-term. Furthermore, the appearance of the ellipsoid zone was an important factor in the prediction of visual outcome and determination of surgical indication.

Outcomes of Pars Plana Vitrectomy for Patients With Vitreomacular Traction.

To evaluate clinical and optical coherence tomography (OCT) outcomes of pars plana vitrectomy (PPV) for patients with vitreomacular traction (VMT). Noncomparative, interventional, consecutive case series from 2007 to 2014. Of the 37 study eyes, patients were grouped according to the extent of VMT evident on OCT. Group 1 (18 eyes) had intraretinal cysts on OCT. Group 2 (19 eyes) had both intraretinal cysts and subretinal fluid. Visual acuity (VA) improved at least one line or more in 76% of eyes postoperatively. Postoperative VA was not significantly different across the two groups (P > .36). Postoperatively, a macular hole developed in 4 eyes (10%). After reoperation, three of four eyes achieved macular hole closure. Patients with VMT achieve visual and OCT improvements after PPV. Postoperative macular hole formation is uncommon but can be successfully repaired with further surgery.

Visual outcomes of pars plana vitrectomy with epiretinal membrane peel in patients with uveitis.

To report the outcomes of pars plana vitrectomy with epiretinal membrane (ERM) peel, with or without internal limiting membrane peel, in patients with uveitis. Retrospective interventional case series of patients undergoing pars plana vitrectomy with ERM peel between January 2005 and March 2012. Sixteen consecutive patients (16 eyes) were identified, with a minimum postoperative follow-up of 6 months. Visual acuity, anatomical outcomes, perioperative control of inflammation, and complications were assessed. The mean age at surgery was 47.3 years (range, 14-68 years), with a mean duration of ERM at surgery of 21.3 months (3-84 months). At 6 months, visual acuity improved in 31.25% of eyes, stabilized in 31.25%, and was worse in 37.5%. The causes of reduced visual acuity postoperatively included severe preexisting macular pathology and unoperated cataract. Pars plana vitrectomy with ERM peel in eyes with uveitis may improve or stabilize visual acuity, especially in eyes with macular traction, but in the absence of traction, outcomes are variable and unpredictable. Prevention of ERM formation by aggressive control of inflammation is important.

Vitreoretinal surgery for advanced retinopathy of prematurity: Presentation and outcomes from a developing country

ObjectiveTo study the outcome of pars plana vitrectomy performed on patients with stage 4b and stage 5 retinopathy of prematurity and to examine differences in clinical presentation from developed countries. DesignObservational prospective case series. ParticipantsBabies with stage 4b or 5 retinopathy of prematurity who underwent vitrectomy. MethodsThe study was undertaken at a tertiary care ophthalmology centre in a developing country. Demographic variables, postnatal risk factors, and anatomic and visual status were noted preoperatively. Patients with stage 4b ROP underwent a 3-port lens-sparing vitrectomy. Those with stage 5 ROP additionally underwent lensectomy and retrolental membrane dissection. Patients were assessed on their last follow-up for anatomic, visual, and functional results. Statistical evaluation was performed using the nonparametric Wilcoxon rank sum test. ResultsThe results were evaluated by number of eyes treated, except for functional score. In 21 patients, 31 eyes underwent operation, of which 20 were stage 4b and 11 were stage 5. Anatomic success was achieved in 18 eyes (90%) with stage 4b. Mean vision in this anatomically successful group was 3.765, and the functional score was 5.36. In stage 5 eyes, anatomic success was achieved in 5 eyes (45.45%). Mean vision in this anatomically successful group was 1.833, and the functional score was 3. The visual results of stage 4b cases, compared with stage 5, were significantly better (p=0.0387). ConclusionsLarger, older babies and previously unablated eyes presented with retinopathy of prematurity for surgery compared with developed countries. Anatomic, visual, and (notably) functional recovery was found in a good percentage of eyes.

Burning bright or burning out?

Ophthalmology is a rapidly evolving field: Therapeutic models are constantly evolving and so are the drugs used. Striking examples of this would be the treatment of choice for age-related macular degeneration. A decade or so ago the treatment would have been different from what is advised today; refractive surgery too is another subspecialty where one has to be constantly updated with current research and techniques. The need to be constantly updated with one's profession can be an added source of stress to an already stressful life that a doctor leads. While it is only prudent that the patient himself or herself, weighs all options, evaluates the pros and cons of any treatment or surgery, and willfully consents for it, often times, we find ourselves in the unenviable position of being asked to make decisions on the patients’ behalf. Other factors such as unpredictable work hours, mental exhaustion, emotional fatigue, challenging patients, and workplace related issues can all contribute what is now becoming a significant issue – physician burnout. It is a state of mental exhaustion caused by the doctor's professional life, and is characterized by emotional exhaustion, depersonalization, and a reduced sense of accomplishment or success and it is largely an unrecognized entity.[1] Burnout can also affect professionalism, the quality of care offered, and even increase the risk for medical errors in addition to cause issues with personal lives as well.[2] Beyond the clinical aspect of practice, it is time to introspect, assess, and look into the quality of the lives, we ourselves are leading. It is time leaders in ophthalmology who make an attempt to tackle these issues. Staying on the same topic of life beyond the realm of clinical practice, Saurabh et al.[3] in their insightful study have attempted to assess the work-family balance and satisfaction among male and female ophthalmologists in India. This information is vital as work satisfaction directly affects the efficiency of health care delivery system of a country. While on one hand, it is reassuring to read that male and female ophthalmologists alike find the field equally rewarding, it is of concern to find that a significant number of female ophthalmologists reported having been subjected to physically uncomfortable gesture or being in physically uncomfortable position due to their gender at workplace. Only if the morale and job satisfaction levels of the entire work force are high can they be more productive; only if we are able to achieve good work-life balance can we lead fulfilling and gratifying lives and this applies to us, ophthalmologists as well. In this issue, we have a host of interesting articles: Raizada et al.[4] presented and discussed the management of nontractional diabetic macular edema comparing the outcomes of pars plana vitrectomy with three intravitreal injections of bevacizumab in a comparative study. Yadav et al.[5] have presented the outcomes of different techniques of pterygium excision with conjunctival autografting in a pediatric population. This issue also carries an article on a highly debated topic – comparison of cost effectiveness of small incision cataract surgery versus phacoemulsification and the quality-adjusted life years of subjects. This article by Dr. Amitava et al.[6] studies a sample of 52 subjects.

Minimal gauge vitrectomy for optic disc pit maculopathy: Our results.

The purpose of the study was to describe the surgical technique and clinical outcomes of pars plana vitrectomy without laser or gas tamponade in cases with optic disc pit maculopathy at our centre. Six eyes of six consecutive patients presenting with unilateral optic disc pit maculopathy were enrolled. Preoperative optical coherence tomography (OCT) was performed to determine the presence and extent of schisis and macular detachment. All eyes underwent 23-gauge pars plana vitrectomy with induction of posterior vitreous detachment (PVD) and internal limiting membrane (ILM) peeling and eyes were closed under fluid. Patients were followed up for at least 12 months post-surgery. Median age of patients was 22.5 years. Five of six eyes had neurosensory detachment (NSD) at the presentation; whereas, inner layer schisis was present in all patients. None of the patients had any evidence of vitreomacular or vitreopapillary adhesion or PVD either clinically or on OCT. Inner and outer retinal schisis resolved in all eyes after follow-up of at least 6 months. Resolution of subretinal fluid in eyes with NSD was seen in 4 of 5 eyes. There was a significant visual acuity improvement from mean preoperative visual acuity of 0.79 logarithm of the minimum angle of resolution (logMAR) units to 0.36 logMAR units at 12 months (P = 0.001). Thus, vitrectomy with ILM peeling and PVD induction alone could achieve good functional outcomes in cases with optic disc pit maculopathy.

Anatomical and Functional Outcomes of Pars Plana Vitrectomy for Lamellar Macular Defects.

The aim of this study is to investigate the anatomical and functional outcomes of surgical management of lamellar macular defects. This study is a retrospective observational case series. Overall, the records of 89 eyes of 78 consecutive patients with a clinical diagnosis of either lamellar macular hole, macular pseudohole, or foveal pseudocyst were reviewed. Twenty-one (23.6%) of the 89 eyes underwent pars plana vitrectomy by a single ophthalmologist. Preoperative and postoperative visual acuities (VAs) were compared, and the anatomical outcome of vitrectomy was examined by studying the restoration of the foveal contour on optical coherence tomography (OCT) scans. Comparisons of visual acuity and OCT measurements between vitrectomized and nonvitrectomized eyes were made. Comparisons were also made between the 3 different types of lamellar macular defects. Anatomical closure of the lamellar macular holes was achieved with a single surgical procedure in all vitrectomized eyes as confirmed by OCT. Visual acuity improved in 15 eyes (71%), from 0.39 ± 0.30 logMAR preoperatively to 0.26 ± 0.19 logMAR postoperatively (t20 = 2.425; P = 0.025). Macular pseudohole was associated with better presenting VA (F2,86 = 8.524; P < 0.001) and postoperative VA (F2,18 = 8.920; P = 0.002) than the other types of lamellar defects. Better postoperative VA was significantly correlated with better preoperative VA (r = 0.579; P = 0.006) and greater preoperative central foveal thickness (r = -0.535; P = 0.012). Pars plana vitrectomy provided a high success rate of anatomical and functional improvement for eyes with all types of lamellar macular defects.

Results of pars plana vitrectomy after complicated phacoemulsification surgery.

To identify the causes and outcomes of pars plana vitrectomy (PPV) in patients undergoing phacoemulsification with intraoperative complication and to analyze whether the interval between phacoemulsification and PPV interferes with best-corrected final visual acuity. This descriptive and retrospective analytical study was conducted in Paraná Eye Hospital in 2013. Data were collected from medical records of 38 patients who underwent complicated phacoemulsification and also required PPV. The most frequent complication as a result of phacoemulsification was posterior capsule rupture, observed in 35 patients (92.10%), followed by capsular bag detachment, in three patients (7.89%). Twenty-eight patients (73.68%) had cortical fragments that were removed during PPV. Twelve patients (31.57%) had their intraocular lens repositioned. PPV was performed on the same day of phacoemulsification in one patient (2.63%), within 1 week in 15 patients (39.47%), between 1 week and 1 month in 13 patients (34.21%), and 1 month after phacoemulsification in 9 patients (23.68%). This study is in agreement with worldwide literature, asserting that major complications of phacoemulsification are posterior capsule rupture and capsular bag detachment, and in addition, there is an improvement in the final visual acuity in almost half the cases, even when there are complications during modern cataract surgery, when complementary appropriate treatment is provided.

Long-term effectiveness of vitrectomy in diabetic cystoid macular edema.

The aim of this study is to assess whether the outcome of pars plana vitrectomy for the treatment of cystoid non-tractional diabetic macular edema is stable and durable. A prospective longitudinal analysis of central macular thickness and visual acuity was performed, using repeated-measures ANOVA, in 22 subjects with cystoid diabetic macular edema. Of the patients, 45.5 % met the criteria for surgical success at 6 months (achieving a reduction of central macular thickness of over 20 %, without associated loss of vision and central macular thickness less than 300 μm), of which 70 % remained stable at 1 year. A significant outcome of the intervention was found on central macular thickness (p < 0.01), but not on visual acuity (p = 0.159). This change occurred in the immediate postoperative period to remain stable thereafter. Vitreoretinal surgery can be an alternative treatment option in cases that do not respond to other types of treatment provided. Its expected benefit is observed in most cases in the immediate postoperative period, and is usually stable and sustained over 1-year follow-up.

Management of Thick Submacular Hemorrhage With Subretinal Tissue Plasminogen Activator and Pneumatic Displacement for Age-Related Macular Degeneration

To evaluate the outcome of pars plana vitrectomy, subretinal tissue plasminogen activator (t-PA) infusion and intraocular gas tamponade with and without postsurgical antivascular endothelial growth factor (VEGF) injection for thick submacular hemorrhage due to exudative age-related macular degeneration (AMD). Retrospective, comparative, interventional case series. setting: 2 retina referral centers. The patient population included 101 eyes of 101 patients with neovascular AMD and thick submacular hemorrhage who underwent surgical displacement of the hemorrhage with or without postoperative anti-VEGF injections. Main outcome measures included degree of blood displacement, best and final postoperative visual acuity (VA), and adverse events. Snellen acuity was converted to logMAR for statistical analysis. All patients were followed for a minimum of 3 months (mean, 15.3 months, range, 3-70 months). In 83 (82%) of 101 eyes, the procedure resulted in complete hemorrhage displacement from the fovea. Mean preoperative VA was 20/2255 (2.05 logMAR). The acuity significantly improved to 20/893 (1.65 logMAR) at month 1 (P < 0.001) at month 1; 20/678 (1.53 logMAR) at month 3 (P < 0.001), and 20/1150 (1.76 logMAR) at month 12 (P = 0.002). Best postoperative visual acuity improved by at least 1 line in 83 (82%) of 101 eyes, and 19.6% of eyes gained 3 lines or more at month 3. The visual acuity of the group of eyes that received postoperative anti-VEGF injection (n = 39) showed greater visual acuity improvement 6 months postoperatively compared to the group of eyes that did not receive postoperative anti-VEGF. Postoperative complications included vitreous hemorrhage in 2 eyes, rhegmatogenous retinal detachment in 4 eyes, and recurrent thick subretinal hemorrhage in 6 eyes. Vitrectomy with subretinal t-PA injection and gas tamponade was found to be relatively effective for displacement of thick submacular hemorrhage with a significant improvement in visual acuity. There is a loss of acuity over time; the addition of postoperative anti-VEGF therapy may help maintain the visual acuity gains.

Pars plana vitrectomy combined with focal endolaser photocoagulation for idiopathic macular telangiectasia.

Background. To report the outcome of pars plana vitrectomy (PPV) combined with intraoperative endolaser focal photocoagulation (PC) on eyes with idiopathic macular telangiectasis (MacTel) type 1. Methods. This was a retrospective study of two female patients with MacTel type 1 who were resistant to focal photocoagulation, sub-Tenon triamcinolone injection, and/or antiangiogenic drugs. The best-corrected visual acuity (BCVA) was determined, and fluorescein angiography (FA) and spectral domain optical coherence tomography (SD-OCT) were performed before and after surgery for up to 19 months. Results. After surgery, the BCVA gradually improved from 20/100 to 20/20 at 19 months in Case 1 and from 20/50 to 20/13 at 13 months in Case 2. Fluorescein angiography (FA) showed leakage at the late phase, and OCT showed that the cystoid macular edema was resolved and the fovea was considerably thinner postoperatively. Conclusion. Patients with MacTel type 1 who are refractory to the other types of treatments can benefit from PPV combined with intraoperative endolaser focal PC with functional and morphological improvements.

The outcomes of pars plana vitrectomy without endotamponade for tractional retinal detachment secondary to proliferative diabetic retinopathy.

To evaluate the outcomes of pars plana vitrectomy (PPV) without the use of an ocular tamponade in patients having tractional retinal detachment (TRD) secondary to proliferative diabetic retinopathy (PDR). It was an interventional study conducted at the Department of Ophthalmology, B.V. Hospital, Bahawalpur, Pakistan, from July 2011 to July 2012. A total of 75 patients (84 eyes) having TRD secondary to PDR were treated by PPV without using an ocular tamponade. All patients included in the study had a tractional retinal detachment secondary to proliferative diabetic retinopathy but didn't have or develop retinal breaks before or during the study period. The surgical procedure included a PPV combined with the removal of the tractional retinal membranes and the application of endolaser photocoagulation to the retina. The mean follow-up period was 12 months. Successful retinal reattachement was observed in 78 of the operated eyes (92.8%). In these patients, the retina remained attached till the end of the one year follow-up period. Improvement in best corrected visual acuity (BCVA) was seen in 63 eyes (75%). The visual acuity remained unchanged in 9 eyes (10.7%). Mean improvement in BCVA was 2.00+1.24 at baseline to 1.24+1.22 (P<0.05) at the end of the follow-up period. In the absence of the retinal breaks, a TRD secondary to PDR can be successfully treated by pars plana vitrectomy without the use of an ocular tamponade.

Pars plana vitrectomy to repair retinal detachment following brachytherapy for uveal melanoma

AimsRetinal detachment can develop following brachytherapy for uveal melanoma. This complication may result in substantial visual loss and poses a significant therapeutic dilemma due to the required surgical intervention for...

EFFICACY OF VITRECTOMY WITH TRIAMCINOLONE ASSISTANCE VERSUS INTERNAL LIMITING MEMBRANE PEELING FOR HIGHLY MYOPIC MACULAR HOLE RETINAL DETACHMENT

To compare the outcomes of pars plana vitrectomy (PPV) with or without the adjuvant surgical procedures: triamcinolone acetonide (TA) assistance and/or internal limiting membrane (ILM) peeling for the treatment of highly myopic macular hole retinal detachment (MHRD). Case-control study. Pars plana vitrectomy combined with 2 kinds of adjuvant surgical procedures were used on 96 highly myopic eyes with MHRD. These eyes were assigned to 4 groups randomly: Group 1, non-TA-assisted PPV and without ILM peeling; Group 2, non-TA-assisted PPV with ILM peeling; Group 3, TA-assisted PPV and without ILM peeling; Group 4, TA-assisted PPV with ILM peeling. Anatomical reattachment of the retina, macular hole closure, and best-corrected visual acuity were measured. The rates of both retinal reattachment and macular hole closure were higher in Group 2 (84.0 and 44.0%) and Group 3 (80.8 and 46.2%) than Group 1 (73.9 and 17.4%); however, there were no differences between Group 2 and Group 3 (P > 0.05). The rates of macular hole closure were extremely low in Group 1 and also in eyes with extreme long axial lengths (≥29.0 mm), "severe" chorioretinal atrophy, and posterior staphyloma. Pars plana vitrectomy with either TA assistance or ILM peeling was effective for the treatment of highly myopic MHRD. If you peel the ILM, adding TA does not affect closure rates; and if TA is used to visualize the vitreous, ILM peeling may not be necessary in MHRD. There was a lower anatomical success rate in MHRD with extreme long axial lengths, severe chorioretinal atrophy, and posterior staphyloma.

Efficacy of vitrectomy for moderate and extreme highly myopic macular hole retinal detachment

Objective To compare the outcome of pars plana vitrectomy (PPV) with triamcinolone (TA) assistance and internal limiting membrane (ILM) peeling for the treatment of moderate and extreme highly myopic macular hole retinal detachment (MHRD).Methods Fortyone highly myopic MHRD patients (41 eyes) who underwent PPV with TA assistance and ILM peeling were enrolled in this study.These eyes were divided into two groups according to different anatomic features:group A (24 eyes) had a consistent moderate long axial lengths (＜ 29 mm), mild retinal pigment epithelium (RPE) and chorioretinal atrophy,and posterior staphyloma (level 0-1 and depth ≤2 mm); while group B (17 eyes) had a consistent extreme long axial lengths (≥29 mm),severe RPE and chorioretinal atrophy,and posterior staphyloma (level 2 3 and depth＞2 mm).All the patients underwent C3F8 tamponade at the end of PPV.The anatomic reattachment of the retina,macular hole closure,and visual acuity were observed at 12 months after surgery.Results The rates of retinal reattachment and macular hole closure were 91.67％ and 58.33％ in group A,64.71％ and 17.65 ％ in group B in the first time of surgery.The differences of rates of retinal reattachment (P=0.049) and macular hole closure (x2 =6.787,P=0.009) between two groups were statistically significant.The rates of retinal reattachment and macular hole closure were 95.83％ and 58.33％ in group A,88.23％ and 29.53％ in group B in the second time of surgery.The difference of retinal reattachment rate between two groups was not statistically significant (P=0.560).The difference of macular hole closure rate between two groups was statistically significant (x2 =4.894,P=0.027).Twelve months after surgery,the vision acuity improved in 14 eyes,unchanged in nine eyes,and decreased in one eye in group A; the vision acuity improved in six eyes,unchanged in eight eyes,and decreased in three eyes in group B.The differences of vision result between two groups was not statistically significant (x2 =0.209,P=0.647).Conclusion After PPV with TA assistance and ILM peeling,the rates of retinal reattachment and macular hole closure in eyes with moderate highly myopic MHRD are higher than that in eyes with extreme highly myopic MHRD,but there is no difference in visual acuity. Key words: Myopia, degenerative/surgery; Retinal detachment/surgery; Retinal perforations/surgery; Vitrectomy

Influence of Pars Plana Vitrectomy on Macular Sensitivity and Morphology in Patients with Branch Retinal Vein Occlusion and Serous Retinal Detachment

To evaluate the influence of serous retinal detachment (SRD) on the outcome of pars plana vitrectomy (PPV) for macular edema in patients with branch retinal vein occlusion (BRVO). In an interventional case series, 20 patients (20 eyes) with BRVO and macular edema underwent PPV, including 12 patients with SRD and eight with cystoid macular edema (CME). Microperimetry of the macular region and optical coherence tomography were performed before and 6 months after PPV. In both the CME and SRD groups, the mean macular thickness and macular volume decreased significantly from baseline to 3 and 6 months after PPV (all P < .01), while visual acuity improved significantly in both groups (both P < .01). However, mean macular sensitivity only increased significantly in the SRD group (P < .05). PPV achieves greater improvement of macular sensitivity in BRVO patients with SRD than in those with CME.

Outcome of 20-gauge transconjunctival cannulated sutureless vitrectomy using silicone oil or air tamponade

BackgroundThe purpose of this study was to assess the outcome of pars plana vitrectomy using a 20-gauge transconjunctival cannulated sutureless system with air or silicone oil tamponade in cases of retinal detachment of different etiologies.MethodsA prospective study was performed in 60 eyes from consecutive 60 patients who underwent 20-gauge transconjunctival cannulated sutureless vitrectomy (30 eyes with air tamponade and 30 eyes with silicone oil tamponade), with the inclusion of a further 30 patients who underwent conventional 20-gauge vitrectomy and served as a control group. The main outcome measures were intraocular pressure, wound leakage, and comfort score.ResultsPreoperative intraocular pressure increased from 17.67 ± 5.6 mmHg preoperatively to 18.78 ± 6.1 mmHg on the first postoperative day in group A and decreased from 16.97 ± 4.9 mmHg to 15.88 ± 5.3 mmHg in group B. These changes were not statistically significant (P > 0.05). The comfort score ranged from 1 to 5 (1 = very bad, 2 = bad, 3 = good, 4 = very good, and 5 = excellent), with a mean of 4.4 ± 0.94 in group A and 4.35 ± 0.99 in group B on the first postoperative day, and no significant difference in scores between the groups at any follow-up visit. There was intraoperative wound leakage in two cases (6.7%) in group A which required suturing and one case (3.3%) in group B, but the difference was not statistically significant (P > 0.05). There was no wound leakage at follow-up in either group. No cases of hypotony, endophthalmitis, or unsealed sclerotomies were noted.ConclusionPars plana vitrectomy using a 20-gauge transconjunctival cannulated sutureless system combines the advantages of smaller-gauge vitrectomy systems with the economic advantage of not needing to purchase any additional handheld instruments. It can be used with both air and silicone oil tamponade in most cases of retinal detachment.