Pars Plana Vitrectomy For Complications Research Articles

Anti-vascular endothelial growth factors in combination with vitrectomy for complications of proliferative diabetic retinopathy.

Anti-vascular endothelial growth factors in combination with vitrectomy for complications of proliferative diabetic retinopathy.

Effect of Intravitreal Conbercept Injection on Complications of Pars Plana Vitrectomy in Patients with Proliferative Diabetic Retinopathy.

The effect of intravitreal conbercept (IVC) before pars plana vitrectomy (PPV) on surgical complications in patients with proliferative diabetic retinopathy (PDR) was observed. A total of 152 patients with PDR operated on in Jiangsu Provincial People's Hospital from November 2019 to November 2020 were divided into two groups: 124 patients in the preoperative intravitreal conbercept injection + PPV group (IVC group) and 28 patients in the PPV only group (No-IVC group). Vitreous samples were collected in all eyes of patients who underwent vitrectomy, and the content of VEGF-A was measured by Luminex. The effect of conbercept on intraoperative and postoperative complications of PDR was assessed. The content of VEGF in the vitreous of the IVC group was significantly lower than that in the No-IVC group (64.50 ± 58.40 pg/mL vs. 805.17 ± 417.60 pg/mL, p < 0.001). During postoperative follow-up, early postoperative vitreous hemorrhage (VH) occurred in 13 of 142 eyes (9.15%). Compared with the No-IVC group, PDR patients with VH and fibrovascular membrane (FVM) or high complexity in the IVC group had lower intraoperative bleeding rates (p < 0.05). The early postoperative hemorrhage rate in the IVC group was lower than in the No-IVC group (6.03% vs. 23.08%, p < 0.05). The number of intraoperative electrocoagulation and iatrogenic retinal holes in the IVC group was significantly lower than in the No-IVC group (p < 0.05). There were no significant differences in intraocular hypertension and NVG numbers between the two groups. Visual acuity in both groups improved after PPV surgery, reaching the highest level in the 3rd month after the operation. IVC before PPV can reduce the level of VEGF-A in the vitreous body and reduce surgical complications.

Outcomes and complications of primary rhegmatogenous retinal detachment repair with pars plana vitrectomy in young adults

BackgroundScleral buckling has been the standard for rhegmatogenous retinal detachment repair in young patients given the typical lack of posterior vitreous detachment, phakic status, and lower risk of proliferative vitreoretinopathy. In older patients, pars plana vitrectomy alone is typically used for rhegmatogenous retinal detachment repair. We report the outcomes and complications of pars plana vitrectomy for rhegmatogenous retinal detachment in young eyes.MethodsRetrospective, single-center cohort study. Medical records of patients between 15 to 45 years of age undergoing primary pars plana vitrectomy for rhegmatogenous retinal detachment repair between 2010 and 2020 were carefully reviewed. All analyses were performed using the Kruskal–Wallis tests for numeric covariates between age groups.ResultsEyes were stratified by age: 15–24 (group 1, n = 10), 25–34 (group 2, n = 14), and 35–45 (group 3, n = 38). The average number of surgeries were 1.9, 1.4, and 1.1 in groups 1, 2, and 3, respectively (p = 0.004). Single surgery success rates were 50%, 64%, and 92% in groups 1, 2 and 3, respectively (p = 0.005). Final reattachment rates were 80%, 93%, 100% in groups 1, 2, and 3, respectively (p = 0.568). Proliferative vitreoretinopathy developed in 50%, 7%, and 8% of eyes in groups 1, 2, and 3, respectively (p < 0.001).ConclusionWhile the final reattachment rates were excellent in all groups, the higher rates of proliferative vitreoretinopathy and lower single surgery success rate in younger patients may suggest that primary pars plana vitrectomy may not be the optimal repair method in these age groups.

Outcomes and Complications of Pars Plana Vitrectomy for Tractional Retinal Detachment in People With Diabetes

Tractional retinal detachment (TRD) occurs in approximately 5% of people with proliferative diabetic retinopathy and poses a threat to vision. Pars plana vitrectomy (PPV) is the treatment of choice for TRD. To determine anatomic and functional outcomes of PPV for the treatment of TRD in people with diabetes (dTRD). MEDLINE and Embase were searched systematically from January 1, 2000, to February 20, 2022. In addition, a reference list of eligible studies were screened. Eligible studies were those published in English, those reporting outcomes of PPV for dTRD, and those that included more than 25 eyes and with a minimum follow-up of 3 months. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines for data extraction/synthesis were followed, and the National Institute for Health quality assessment tool was used to assess risk of bias. Study eligibility was determined independently by 2 reviewers; data extraction was conducted by 1 reviewer and entries checked for accuracy by another. Data were pooled using a random-effects model. Main outcomes included rate of failure of retinal reattachment following 1 surgery and final visual acuity (VA). The association of baseline patient characteristics and surgical maneuvers with postoperative surgical outcomes was investigated. Of the 406 studies identified, 38 (3839 eyes) were eligible and included for analysis. Patients had a median (IQR) age of 52.2 (49.6-55.7) years. In the studies reporting patient sex (31 of 38 studies), 1441 were female individuals (50.1%). The overall failure rate of retinal reattachment after 1 surgery was 5.9% (95% CI, 1.4%-8.3%), and the mean final VA was 0.94 (95% CI, 0.82-1.05) logMAR (approximate Snellen equivalent, 6/53; 95% CI, 6/39-6/71). People with higher preoperative VA achieved higher postoperative vision (0.66 logMAR worse final vision; 95% CI, 0.39-0.84 per 1.0 logMAR worse at baseline; P <.001). On multivariable analysis, no other patient characteristics or surgical variables had a statistically significant association with outcomes. Results of this systematic review and meta-analysis suggest that PPV was an effective strategy to achieve retinal reattachment in people with dTRD. Given that higher preoperative VA was the only factor associated with higher postoperative vision, early intervention should be considered and discussed in detail with patients. Overall, final postoperative VA remains low, and patients should be counseled on the guarded prognosis of dTRD.

Outcomes of Pars Plana Vitrectomy and 4-Point Sutured Scleral Fixation of Akreos AO60 Intraocular Lens in Clinical Settings: A Case Series

To determine the long-term anatomic outcomes and surgical complications of pars plana vitrectomy (PPV) and 4-point Gore-Tex-sutured Akreos AO60 intraocular lens (IOL) scleral fixation. Retrospective, multicenter, multisurgeon case series. Ninety-seven patients in tertiary eye care centers. The patients underwent PPV and intraocular fixation of the Akreos AO60 IOL using Gore-Tex CV-8 sutures between January 2015 and April 2020. The inclusion criteria were aphakia, no capsular support, and a minimal 1 year of follow-up. Uncorrected visual acuity (VA), complication rates or types, and refraction. Data from 101 eyes of the 97 patients were analyzed (mean follow-up duration, 33.4 months; range, 12-62 months). The mean ± standard deviation uncorrected logarithm of the minimum angle of resolution VA improved from 1.04 ± 0.73 (20/200 Snellen equivalent) before surgery to 0.66 ± 0.65 (20/80) at 6 months after surgery (P < 0.001). The most prevalent complications included hypotony (12.9%), ocular hypertension (12.9%), corneal edema (8.9%), cystoid macular edema (6.9%), and vitreous hemorrhage (5.9%). Refraction was measured between 3 and 6 months after surgery, and 61.8% of the patients had spherical equivalent of ± 2.0 diopters. Most complications occurred in the first postoperative month and resolved spontaneously or with medical treatment. The results demonstrated that this surgical technique is well tolerated by the eyes, with a low complication rate in the long term. The rates of IOL opacification were infrequent for up to 62 months of follow-up.

A comparison of using digitally assisted vitreoretinal surgery during repair of rhegmatogenous retinal detachments to the conventional analog microscope: A prospective interventional study.

To compare outcomes and complications of pars plana vitrectomy (PPV) using a three-dimensional heads-up visualisation system (digitally assisted vitreoretinal system, DAVS) versus conventional analog microscope (CAM) in primary rhegmatogenous retinal detachment (RRD). This prospective interventional institutional study evaluated 60 eyes of 60 subjects with primary RRD undergoing PPV between September 2017 and February 2018. Subjects were randomly put into DAVS and CAM group and pre-operative ocular characteristics and final outcomes recorded at each visit. All subjects were followed up for a duration of 6months. Main outcome measures recorded were post-operative retinal status, visual acuity (VA), intraocular pressure (IOP) and surgical complications. Overall final retinal attachment at 6months was 91.7% (90% in DAVS eyes and 93.3% in CAM eyes; p = 0.999). Final VA improved significantly from baseline in both groups (p < 0.001). Overall, VA improved to > = 20/40 in 18.3% eyes (6 DAVS, 5 CAM). Median duration of silicone oil endotamponade was 3.5months (3.5months in DAVS, 3months in CAM). Redetachment rate in the series was 25% (20% in DAVS, 30% in CAM). Post-operative proliferative vitreoretinopathy grade C and more was present in 15% ofeyes (10% in DAVS, 20% in CAM). Average duration of surgery was 37 ± 6.2min in DAVS groupand 39.8 ± 6.6min in CAM group (p = 0.09). All steps of vitrectomy could be performed with relative ease and comfort with the DAVS platform. Anatomical and functional outcomes of RRD were favourable with DAVS and comparable to that with conventional microscope surgery.

Proposal for the management of myopic traction maculopathy based on the new MTM staging system.

To propose the Myopic Traction Maculopathy (MTM) management Table, based on the MTM Staging System (MSS). A retrospective review of 157 eyes affected by MTM, operated with pars plana vitrectomy (PPV), or macular buckle (MB) or combined surgery (MB + PPV). Each case was classified according to the MSS. Anatomical results were evaluated with OCT at an intermediate follow-up (3-6 months) and at a final follow-up (2-8 years), considering changes both in the foveal and in the retinal pattern. The number and type of operations needed were noted. The surgical complications were reported. Primary surgery was MB for 83 eyes (52%), PPV for 36 (23%) and MB + PPV for 38 (24%). At intermediate follow-up, the retinal pattern was restored in 55.41% and foveal in 42.68%.Further surgery was indicated as PPV in 25.48%, MB in 14.65%. At the final follow-up, the retinal pattern was restored in 96.16% and the foveal pattern in 87.90%.BCVA improved at the final follow-up (p < 0.05). The complications of MB were not sight-threatening. The complications of PPV were FTMH in 67% cases in stages 2, 3, and 4. Cataract developed in 60% of phakic eyes. The complications of combined MB+PPV were cataract (56%) and PVR (5%). Both PPV and MB may be used to treat MTM. PPV addresses the changes in the foveal pattern while MB addresses the changes in the retinal pattern. The MTM management table offers a proposal for the choice of type and timing of treatment customized per each stage of MTM.

Safety of intracameral cefuroxime in pars plana vitrectomy.

Postoperative endophthalmitis is a rare, but serious complication of pars plana vitrectomy (PPV). Subconjunctival cefuroxime injection has been the traditional choice for post vitrectomy endophthalmitis prophylaxis. Its effectiveness and safety in this context are however poorly understood and cases of retinal toxicity have been reported. The traditional standard subconjunctival antibiotic prophylaxis has been superceded in cataract surgery by intracameral antibiotic prophylaxis. The primary aim of this three centre non-randomised retrospective database cohort study of 7,532 PPV procedures was to identify the rate of endophthalmitis in cohorts of patients treated with intracameral or subconjunctival cefuroxime. A secondary aim was to estimate the achieved intraocular antibiotic concentrations of cefuroxime in eyes with intracameral versus subconjunctival administration using mathematical modelling. The overall incidence of postoperative endophthalmitis was 0.07% (5/7532). There were no cases of endophthalmitis in eyes receiving intracameral cefuroxime alone or in combination with subconjunctival cefuroxime (0/5586). Patients receiving subconjunctival cefuroxime alone had a higher incidence of endophthalmitis (0.22%, 4/1835), and there was one case of endophthalmitis in eyes not receiving any perioperative antibiotics (0.9%, 1/111). No cases of cefuroxime toxicity were identified. With subconjunctival cefuroxime, in the presence of a sclerotomy leak, we estimated the vitreous drug concentration to be higher than that for intracameral cefuroxime and potentially toxic. Intracameral cefuroxime appears to be a safe and efficient choice for prophylaxis against endophthalmitis after PPV. Small eyes with intraocular tamponade seem to be at particular risk of drug toxicity if cefuroxime is administered via the subconjunctival route.

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.

Randomised controlled trial on vitreoretinal surgery with and without oral anticoagulants: surgical complications, visual results and perioperative thromboembolic events

BackgroundVitreoretinal surgery in anticoagulated patients is a challenging situation for vitreoretinal surgeons, who have to choose between being faced with the systemic thromboembolic risks that the interruption of anticoagulation involves, or the intra- and postoperative haemorrhagic risks associated with maintenance of this therapy. So far, no trial has compared, in a prospective and randomized manner, perioperative complications and the visual results associated with continuation or interruption of oral anticoagulant therapy before pars plana vitrectomy (PPV) under retrobulbar anaesthesia. The main objective of this trial is to compare haemostasis-related perioperative complications of PPV in patients maintaining anticoagulant therapy before surgery compared to patients with an interruption in this therapy before surgery.MethodsNinety-six patients will be randomly assigned to either the control group, in whom oral anticoagulant therapy will be interrupted and substituted with subcutaneous heparin according to local clinical practice, or the intervention group in whom oral anticoagulant therapy will not be interrupted before surgery. Patients will be stratified according to the oral anticoagulant they were taking (direct or indirect anticoagulation). They will be followed up for 12 weeks, and the primary outcome, and haemorrhagic complications until 15 days after surgery, will be evaluated.DiscussionThis trial will provide novel information on the possibility of continuing anticoagulant therapy during PPV. The benefits expected from the change in the current surgical management paradigm for anticoagulated patients would be a decreased risk in the incidence of perioperative thromboembolic events and the possibility of performing surgery without delay and without the need for patients to change their usual anticoagulation protocol to the more complex and less safe substitutive therapy.Trial registrationClinical Trials Register EudraCT, 2018–000753-45. Registered on 11 November 2018.

Nucleus Drop or Intraocular Lens Drop Underwent Pars Plana Vitrectomy due to Complication of Cataract Surgery

Abstract&#x0D; Background: The incidence of nucleus drop or intraocular lens (IOL) drop as the complication of phacoemulsification increases due to the increased frequency of phacoemulsification. Pars plana vitrectomy (PPV) followed by endofragmentation and secondary IOL implantation is the choice of procedure for management. This study aims to determine the frequency, outcomes, and complication of PPV in the case of nucleus drop or IOL drop in the Department of Ophthalmology, Fakultas Kedokteran Universitas Indonesia – Rumah Sakit Cipto Mangunkusumo (FKUI-RSCM)&#x0D; Methods: This study is a retrospective descriptive study conducted in the Vitreoretinal Division of the Department of Ophthalmology, FKUI - RSCM. Research data was taken from the medical records of all nucleus drop or IOL drop patients underwent PPV in January 2017-December 2017.&#x0D; Results: There were 19 cases studied. The incidence of nucleus drop occurred in phacoemulsification surgery techniques (94.7%) and ECCE techniques (5.3%). Vitrectomy surgery was performed ≤2 weeks in 31.6% and &gt;2 weeks in 68.4% after the patient first arrived at the vitreoretinal clinic. Most pre-PPV visual acuity was 1/60-6/60 (47.1%). In the final follow-up, visual acuity improved from 6/45 to 6/6 occurred in 42.2% of cases. Complication after PPV and secondary IOL implantation include elevated IOP (10.5%), IOL decentration (5.3%), corneal decompensation (5.3%), macular edema (5.3%), and retinal detachment (5.3%).&#x0D; Conclusion: Nucleus drop or IOL drop generally occurs in phacoemulsification cataract surgery techniques. Improved visual acuity was achieved after PPV and secondary IOL implantation at the end of the follow-up period. Most common post-PPV complication is elevated IOP.&#x0D;

Adjunctive Intravitreal Bevacizumab with Vitrectomy for Diabetic Vitreous Hemorrhage

Background: Postoperative vitreous hemorrhage (VH) following pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR) is a common event, with a reported incidence of 29% to 75%.This complication delays visual rehabilitation, interferes with fundus examination, and may necessitate additional surgical procedures. Vascular endothelial growth factor (VEGF) is an angiogenic mitogen, and the involvement of VEGF in PDR has been suggested by studies that have demonstrated that VEGF concentrations were markedly elevated in both vitreous and aqueous fluids of patients with active PDR compared with samples from patients without diabetes, with NPDR, or with quiescent PDR. Bevacizumab (Avastin®, Genentech, Inc., South San Francisco, CA) is a full-length recombinant humanized monoclonal antibody that binds to all isoforms of VEGF. Aim of the Work: to evaluate the safety and efficacy of intravitreal bevacizumab (IVB) at the end of vitrectomy operation for prevention of postoperative rebleeding in patients with diabetic vitreous hemorrhage. Patients and Methods: The study included 20 eyes of 20 patients undergoing PPV for severe non-clearing vitreous hemorrhage for more than 1 month. Eligible eyes were randomly assigned to one of two groups: Group A (10 eyes) did not receive any intravitreal injection and Group B (10 eyes) received 1.25 mg IVB injection at the end of surgery. All patients were subjected to complete history taking and full ophthalmic examination including best-corrected visual acuity, anterior segment examination, fundus examination and B-scan ultrasonography was performed. All patients underwent three-port pars plana vitrectomy using 23-gauge instrumentation under local anesthesia. At the end of surgery, fluid-air exchange was performed and the intraocular air is left as tamponade in selected cases. The follow up period occurred over 1 week, 1 month and 3 months. The main outcome measures were occurrence of vitreous hemorrhage and BCVA. Results: At 1 month after surgery, the incidence of early postoperative VH was 30% and 20% in Group A and B, respectively (p = 0.641). Mild vitreous hemorrhage (grade 1) was the major component of early VH at 1 month (20% of 30% and 10% of 20%, in Group A and B, respectively). Analysis of changes in the mean BCVA at 1 month after surgery showed significant improvement from the preoperative BCVA in all study groups, the mean differences between pre-BCVA (Log MAR) and post BCVA (Log MAR) among the studied groups was 0.865 ± 0.351 with statistically significant difference between the two groups (p = 0.000).the mean differences between pre-BCVA (Log MAR) and post BCVA (Log MAR) among the studied groups was 0.865 ± 0.351 with statistically significant difference between the two groups (p = 0.000). At 3 months after surgery, the incidence of late postoperative VH was 20.0% and 0.00% in Group A and B, respectively, with no significant difference between the two groups(P=0. 237). Again, analysis of changes in the mean BCVA at 3 months after surgery showed significant improvement to 1.080 ± 0.2098 and 0.870 ± 0.17767 in Group A and B, respectively, with statistically significant difference between the two groups (p >0.027). Conclusion: The incidence of late postoperative vitreous hemorrhage is lower than that of early postoperative vitreous hemorrhage and is not affected by intraoperative intravitreal bevacizumab injection and Adjunctive use of intravitreal bevacizumab with pars plana vitrectomy for complications of PDR is safe and well-tolerated with no serious ocular or systemic adverse events.

Adjunctive Intravitreal Bevacizumab with Vitrectomy for Diabetic Vitreous Hemorrhage

Background: Postoperative vitreous hemorrhage (VH) following pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR) is a common event, with a reported incidence of 29% to 75%.This complication delays visual rehabilitation, interferes with fundus examination, and may necessitate additional surgical procedures. Vascular endothelial growth factor (VEGF) is an angiogenic mitogen, and the involvement of VEGF in PDR has been suggested by studies that have demonstrated that VEGF concentrations were markedly elevated in both vitreous and aqueous fluids of patients with active PDR compared with samples from patients without diabetes, with NPDR, or with quiescent PDR. Bevacizumab (Avastin®, Genentech, Inc., South San Francisco, CA) is a full-length recombinant humanized monoclonal antibody that binds to all isoforms of VEGF. Aim of the Work: to evaluate the safety and efficacy of intravitreal bevacizumab (IVB) at the end of vitrectomy operation for prevention of postoperative rebleeding in patients with diabetic vitreous hemorrhage. Patients and Methods: The study included 20 eyes of 20 patients undergoing PPV for severe non-clearing vitreous hemorrhage for more than 1 month. Eligible eyes were randomly assigned to one of two groups: Group A (10 eyes) did not receive any intravitreal injection and Group B (10 eyes) received 1.25 mg IVB injection at the end of surgery. All patients were subjected to complete history taking and full ophthalmic examination including best-corrected visual acuity, anterior segment examination, fundus examination and B-scan ultrasonography was performed. All patients underwent three-port pars plana vitrectomy using 23-gauge instrumentation under local anesthesia. At the end of surgery, fluid-air exchange was performed and the intraocular air is left as tamponade in selected cases. The follow up period occurred over 1 week, 1 month and 3 months. The main outcome measures were occurrence of vitreous hemorrhage and BCVA. Results: At 1 month after surgery, the incidence of early postoperative VH was 30% and 20% in Group A and B, respectively (p = 0.641). Mild vitreous hemorrhage (grade 1) was the major component of early VH at 1 month (20% of 30% and 10% of 20%, in Group A and B, respectively). Analysis of changes in the mean BCVA at 1 month after surgery showed significant improvement from the preoperative BCVA in all study groups, the mean differences between pre-BCVA (Log MAR) and post BCVA (Log MAR) among the studied groups was 0.865 ± 0.351 with statistically significant difference between the two groups (p = 0.000).the mean differences between pre-BCVA (Log MAR) and post BCVA (Log MAR) among the studied groups was 0.865 ± 0.351 with statistically significant difference between the two groups (p = 0.000). At 3 months after surgery, the incidence of late postoperative VH was 20.0% and 0.00% in Group A and B, respectively, with no significant difference between the two groups(P=0. 237). Again, analysis of changes in the mean BCVA at 3 months after surgery showed significant improvement to 1.080 ± 0.2098 and 0.870 ± 0.17767 in Group A and B, respectively, with statistically significant difference between the two groups (p >0.027). Conclusion: The incidence of late postoperative vitreous hemorrhage is lower than that of early postoperative vitreous hemorrhage and is not affected by intraoperative intravitreal bevacizumab injection and Adjunctive use of intravitreal bevacizumab with pars plana vitrectomy for complications of PDR is safe and well-tolerated with no serious ocular or systemic adverse events.

Postoperative Complications of Pars Plana Vitrectomy for Diabetic Retinal Disease

ABSTRACTDespite recent advances in the medical management of diabetic retinal disease, there remain established indications for vitreoretinal surgery in the treatment of severe proliferative diabetic retinopathy. These include non-clearing vitreous hemorrhage and tractional retinal detachment. Advances in surgical instrumentation, technique, and experience have led to improved visual outcomes, as well as a corresponding decrease in the incidence of postoperative complications. However, the presence of systemic and ocular factors in diabetic patients increases the risk of adverse events compared to non-diabetic individuals. This review will focus on the most important postoperative complications following pars plana vitrectomy, with specific considerations for the diabetic patient.

Venous Air Embolism During Pars Plana Vitrectomy: A Case Report and Review of the Literature

Purpose: Presumed venous air embolism (PVAE) is a rare and potentially fatal complication of pars plana vitrectomy that is poorly described and understood but requires improved awareness among ophthalmologists and vitreoretinal surgeons. Methods: A case report is presented along with a systematic review of published reports of PVAE during ocular surgery. Results: An otherwise healthy adult male undergoing retinal detachment repair under local anesthesia with monitored anesthesia care died from a PVAE. Literature search yielded 2 experimental models, 6 individual case reports, and several editorials. Review of existing reports reveals that PVAE can affect patients of any age or gender with no medical predilection and occurs in cases of trauma, endoresection, or retinal detachment repair. It is typically associated with a drop in end-tidal carbon dioxide during fluid–air exchange and can present similar to a hemorrhagic choroidal detachment. Analysis suggests that venous air embolism can be prevented by ensuring full engagement of the infusion cannula into the vitreous cavity prior to fluid–air exchange. Conclusion: Presumed venous air embolism is a potentially fatal complication of ocular surgery and in some cases may be recognized by ophthalmologists as a choroidal detachment during fluid–air exchange in pars plana vitrectomy. It is imperative to immediately stop the air infusion line if venous air embolism is suspected.

OUTCOMES OF PARS PLANA VITRECTOMY IN THE MANAGEMENT OF REFRACTORY AQUEOUS MISDIRECTION SYNDROME.

To determine the efficacy and complications of pars plana vitrectomy (PPV) and adjunct surgeries for aqueous misdirection refractory to medical therapy. A retrospective review of consecutive eyes with refractory aqueous misdirection at the King Khaled Eye Specialist Hospital between 2002 and 2010. Patients underwent two-port and three-port pars plana vitrectomy (PPV) with adjunct procedures including pars plana lensectomy combined with posterior capsulectomy, hyaloido-zonulo-iridectomy, and synechiolysis. Main outcome measures included anatomical success, functional success, and factors associated with the outcomes. Sixty-nine eyes were evaluated over a mean follow-up period of 17.6 ± 3.8 months (3-156 months). Anatomical success was achieved in 62 eyes (90%) and functional success in 54 eyes (78%) that underwent PPV as a primary surgery. The factors associated with the altering misdirected aqueous flow and reducing intraocular pressure significantly associated with a two-line improvement of best-corrected visual acuity included surgical treatment within 4 weeks of presentation (P = 0.004) and preoperative intraocular pressure (P = 0.001). The success of two-port PPV and standard three-port PPV was similar (P = 0.7). The intraoperative and postoperative complications included retinal detachment in two eyes and endophthalmitis in one eye. The PPV was effective for managing aqueous misdirection refractory to medical therapy. Two-port or three-port PPV did not change the success rate but early surgery improved both anatomical and functional outcomes.

The Safest Approach to Idiopathic Epiretinal Membrane Removal

A case of symptomatic epiretinal membrane (ERM) is presented. The discussion revolves around key questions: 1. What do we know about this disease entity? 2. What is the traditional approach to symptomatic ERM? 3. What are the major complications of pars plana vitrectomy (PPV)? 4. Is there any technical solution available for increased safety during vitrectomy? 5. What are the advantages of wide-angle light probes? 6. How can dye-related chemotoxicity be reduced? 7. How non-contact wide-angle viewing systems could help during vitrectomy? 8. What were the results of a safe standardized approach to symptomatic ERM?

OUTCOMES AFTER PARS PLANA VITRECTOMY FOR EPIRETINAL MEMBRANES ASSOCIATED WITH TOXOPLASMOSIS

To evaluate outcomes and complications of pars plana vitrectomy in patients with epiretinal membrane secondary to toxoplasmic retinochoroiditis. Retrospective evaluation of the records of 14 patients who underwent pars plana vitrectomy for epiretinal membrane secondary to toxoplasmic retinochoroiditis. The best-corrected visual acuity, intraoperative and postoperative complications, and macular optical coherence tomography were analysed. All patients received postoperative prophylactic treatment with trimethoprim/sulfamethoxazole. Fourteen patients, 5 men and 9 women, were included. Mean follow-up period after surgery was 6.07 ± 2.64 months. Preoperative mean best-corrected visual acuity was 20/200, and postoperative mean best-corrected visual acuity was 20/60. There were no intraoperative complications. Three patients developed posterior capsule opacification, and one patient developed cataract. Pars plana vitrectomy is a safe and effective procedure in patients with epiretinal membrane secondary to toxoplasmic retinochoroiditis, improving both visual acuity and anatomical result on macular optical coherence tomography. The most frequent postoperative complications were posterior capsule opacification and cataract. No recurrences of the disease were recorded.

Analysis on the macular edema after pars plana vitrectomy

Objective To analyze the incidence, risk factors and visual outcome of macular edema after pars plana vitrectomy (PPV). Methods Fifiy-five eyes of 55 patients who underwent PPV were examined.The visual outcome and the macular thickness which was quantitatively measured by optical coherence tomography (OCT) was compared.The best corrected visual acuity, the central macular thickness, the edge macular thickness and the macular volume before and after operation were recorded. Results The average best corrected visual acuity (BCVA, logMAR) improved from 0.93±0.62 to 0.62±0.49 (t=8.67, P=0.000) at 1 month after surgery. The incidence rate of postoperative macular edema was 67.27%.The central macular thickness(t=-2.22, P=0.03), macular edge thickness(t=-2.25, P=0.03)and total macular volume(t=4.17, P=0.0001)of patients with an inflammation level under 2 were significantly reduced compared with those of patients with more than 3 inflammation level. Conclusion Postoperative macular edema is a common complication of PPV, and it affects the visual outcome. Minimizing the inflammation after the surgery might help to reduce the incidence rate of postoperative macular edema. Key words: Pars plana vitrectomy; Macular edema; Optical coherence tomography

SURGICAL OUTCOME OF LATE IN-THE-BAG INTRAOCULAR LENS DISLOCATION TREATED WITH PARS PLANA VITRECTOMY.

To present the visual outcome and postoperative complications of pars plana vitrectomy and intraocular lenses (IOL) removal with or without IOL exchange of late in-the-bag IOL dislocation after uneventful cataract surgery. Retrospective analysis of a consecutive series of 83 eyes with late in-the-bag dislocated IOL treated with pars plana vitrectomy and anterior chamber IOL (25 eyes), transscleral suture-fixated posterior chamber IOL (38 eyes), or aphakia (20 eyes). High myopia was the major predisposing factor (40%). The interval between cataract surgery and the dislocation was 10.9 years. The complication rate after the second surgery was 43%; being transient hypotony (19%) and hypertension (15%) the most frequent. Postoperative best-corrected visual acuity improvement was statistically significant (P < 0.001), with a mean of 3 Snellen lines. This improvement was also significant in 2 subgroups, patients with sutured posterior chamber IOL (20/80-20/40; P < 0.001) and in patients with anterior chamber IOL (20/125-20/40; P < 0.001). However, best-corrected visual acuity did not improve in aphakic patients (20/63-20/63; P = 0.13). Postoperative astigmatism increased significantly (P < 0.001), with a mean of -1 D. Mean follow-up was 24 months. The major predisposing factor for late in-the-bag IOL dislocation is myopia. Despite a complication rate of 43%, mostly minor and transient, IOL exchange surgery is an effective procedure with a good visual outcome (mean 3 Snellen lines improvement). There were no statistically significant differences in the final best-corrected visual acuity or complication rate between anterior chamber IOL and sutured posterior chamber IOL, thus, both surgical techniques may be considered to treat this condition.