Pars Plana Vitrectomy In Eyes Research Articles

A 10-year review of the visual outcomes of early versus late pars plana vitrectomy in eyes with dropped lens fragment or nucleus during phacoemulsification

Background: Pars plana vitrectomy (PPV) is a routine surgical option for the removal of dropped lens fragment or nucleus in the vitreous cavity due to complicated cataract surgery; however, its optimal timing is controversial. Therefore, we aimed to determine the visual outcomes of early versus late PPV in eyes with dropped lens fragment or nucleus due to complicated phacoemulsification cataract surgery.
 Methods: This descriptive-analytical retrospective study collected data of patients who underwent early (less than or equal to 1 week) versus late (> 1 week) PPV for the management of dropped lens fragment or nucleus resulting from complicated phacoemulsification cataract surgery over a 10-year period at Imam Khomeini Tertiary Referral Hospital, Ahvaz, Iran. Demographic characteristics, the interval between complicated phacoemulsification and PPV, pre- and postoperative intraocular pressures, best-corrected distance visual acuity (BCDVA), and postoperative complications were extracted from each patient’s record.
 Results: Fifty-one eyes of 51 patients with a mean (standard deviation [SD]) age of 64.66 (6.54) years and a male-to-female ratio of 33 (64.7%) to 18 (35.3%) were included over 10 years. The mean (SD) BCDVA before PPV was 1.87 (0.53) logarithm of the minimum angle of resolution (logMAR), which improved significantly to 0.54 (0.46) logMAR at the final postoperative visit (P < 0.001). The mean (SD) BCDVA was significantly better after early PPV than after late PPV (0.41 [0.30] versus 0.62 [0.52] logMAR; P < 0.05). There was no significant difference in the final BCDVAs among the three methods of lens fragment removal (P > 0.05). The rates of post-PPV complications were as follows: 29 (56.9%) eyes with corneal edema, 16 (31.4%) eyes with uveitis, 10 (19.6%) eyes with cystoid macular edema, 8 (15.7%) eyes with rhegmatogenous retinal detachment, and 8 (15.7%) eyes with other complications (optic nerve atrophy, choroidal neovascularization, vitreous hemorrhage, or epiretinal membrane formation). No significant differences were observed in the rates of complications according to the time interval between complicated phacoemulsification and PPV (all P > 0.05). The frequency of corneal edema was significantly higher when removing lens fragments using the trans-limbal method than using the other methods (P < 0.05), yet the rates of other complications were comparable among the three methods of lens fragment removal (all P > 0.05).
 Conclusions: Early PPV and removal of a dropped lens fragment or nucleus resulting from complicated phacoemulsification cataract surgery are recommended to achieve better visual outcomes. Future studies with longer follow-up, greater sample sizes, and analysis of other parameters of visual function, such as contrast sensitivity, visual field, color vision, and stereopsis, could provide more conclusive results and help verify our preliminary findings.

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

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

Comparison of pars plana vitrectomy for retinal detachment after failed pneumatic retinopexy and primary pars plana vitrectomy

To compare secondary pars plana vitrectomy (PPV) after failed pneumatic retinopexy (PR) (Group 1) with primary PPV (Group 2) for repair of rhegmatogenous retinal detachment (RRD), with respect to single-procedure reattachment rate and visual outcome. A consecutive series of RRD patients treated with PPV following failed PR (n=42) were compared with a selected group of RRD patients who were initially treated with PPV (n=29) with a similar location and distribution of retinal breaks. Main outcomes studied were retinal reattachment rate with single PPV in eyes treated with PPV and gas tamponade or after silicone oil removal in eyes with PPV and SO tamponade, as well as visual acuity at 1-year. The retinal reattachment rate was 90.5% and 93.1% in Group 1 and Group 2, respectively. There was no statistically significant difference in retinal reattachment between groups (P=0.69). Final anatomical reattachment rates after reoperations were 100% in each group. Visual acuity (logarithm of the minimum angle of resolution) improved from 1.95±0.84 at baseline to 0.67±0.35 in Group 1, and from 1.99±1.01 at baseline to 0.65±0.32 in Group 2. Both groups had a significant visual acuity improvement at 1-year compared to baseline (P<0.001 in each of them). Retinal reattachment rate was not associated with lens status (phakic vs pseudophakic) or intraocular tamponade (gas vs silicone oil). Visual outcomes were correlated with macular status at baseline and the number of reoperations. This study demonstrates that PPV after failed PR and primary PPV in patients with RRD caused by superiorly located retinal breaks have a similar rate of retinal reattachment along with an improved final VA. Initial success of PPV and macular status may be important predictors of final visual outcomes.

RESULTS OF RETINAL DETACHMENT SURGERY IN EYES WITH OSTEO-KERATOPROSTHESIS.

To evaluate the anatomical and functional results of pars plana vitrectomy in eyes with osteo-keratoprosthesis, who have suffered retinal detachment. An observational, retrospective study of 18 eyes which underwent pars plana vitrectomy for retinal detachment after an implantation of an osteo-keratoprosthesis, with a minimum of 1-year follow-up. A descriptive study and a Kaplan-Meier survival analysis for anatomical and functional success were performed. Anatomical success was defined as an attached retina at the end of vitreoretinal surgery with no redetachment during the follow-up. Functional success was defined as a postoperative visual acuity of more than or equal to 20/400. The overall rate of anatomical success was 56%, and the anatomical survival rates were 67% and 53% at 6 months and 12 months, respectively, maintaining this last value at 24 months after pars plana vitrectomy. The overall rate of functional success was 17%, and the functional survival rates were 83%, 39%, and 14% at 6 months, 12 months, and 24 months after pars plana vitrectomy, respectively. The most frequent complication after retinal surgery was retroprosthetic membrane (33%). Despite the reserved prognosis and the severe complications, vitrectomy represents a valid method for treating retinal detachment in patients with osteo-keratoprosthesis, with good anatomical results but poor visual acuity.

Surgical Results in Ocriplasmin Candidates With Symptomatic Vitreomacular Traction Syndrome

ABSTRACTPurpose: To report surgical outcomes in a series of cases with symptomatic vitreomacular traction that met MIVI-TRUST (Microplasmin for intravitreous injection-traction release without surgical treatment) criteria for ocriplasmin use who underwent primary 25-gauge vitrectomy.Materials and Methods: A single-center retrospective chart review study was performed in patients who underwent primary 25-gauge vitrectomy for symptomatic vitreomacular traction (VTM) from January 2013 through January 2016. Pre- and postoperative visual acuity (measured by the early treatment diabetic retinopathy acuity test), and posterior hyaloid focal attachment to the macula (demonstrated by high-definition optical coherence tomography) were analyzed. In addition, intra- and postoperative complications were obtained from medical records.Results: Fifteen consecutive cases of symptomatic VMT traction that underwent primary 25-gauge vitrectomy were included. All met the MIVI-TRUST criteria for ocriplasmin use. In all cases, VMT resolution, macular hole closure, and improvement in best corrected visual acuity (BCVA) were observed. Mean visual acuity improved from 56.53 ± 16.04 letters at baseline to 73.13 ± 7.46 letters at 24 weeks of follow-up. The mean BCVA improvement from baseline was 16.60 letters (range 6–44), which was statistically significant (P < 0.0001). Ten of fifteen patients (66.6%) showed significant improvement of their BCVA to 20/40 or better (70 or more in ETDRS visual acuity test). No significant intra- or postoperative complications were documented.Conclusions: Primary 25-gauge pars plana vitrectomy in eyes with symptomatic vitreomacular traction is able to efficiently resolve VMT and macular holes, improving vision in candidates for intravitreal injection of ocriplasmin. This well-tolerated surgical procedure may be a reliable and predictable alternative for resolving VMT pathology.

Risk factors associated with neovascular glaucoma after vitrectomy in eyes with proliferative diabetic retinopathy

Objective To investigate the risk factors associated with neovascular glaucoma (NVG) after pars plana vitrectomy (PPV) in eyes with proliferative diabetic retinopathy (PDR). Methods Retrospective study. One hundred and thirty-seven patients (137 eyes) with PDR who underwent PPV were recruited. There were 85 males and 52 females. The average age was (60.1±8.8) years old. The duration of diabetes was (10.2±3.6) years. There were 49 patients with ipsilateral carotid artery stenosis. Fifty-three eyes underwent intravitreal ranibizumab or conbercept injection before PPV. All eyes were treated with 23G standard three-port PPV. The average follow-up time after PPV was 11.5 months. Fundus fluorescein angiography (FFA) was conducted in postoperative 4-6 weeks to observe non-perfused retinal areas. Risk factors, such as ipsilateral carotid artery stenosis, the presence of non-perfusion in retina after PPV and the application of anti-vascular endothelial growth factor (VEGF) drugs before PPV, were identified by logistic regression. Results Twenty of 137 patients (14.6%) developed postoperative NVG after PPV. Ipsilateral carotid artery stenosis [odds ratio (OR) = 5.048, 95% confidence interval (CI) 2.057-12.389, P=0.000] and the presence of non-perfusion in retina after PPV (OR =4.274, 95%CI 1.426-12.809, P=0.009) were significant risk factors for postoperative NVG, while the application of anti-VEGF drugs was not (OR=1.426, 95%CI 0.463-4.395, P=0.536). But the time from PPV to the onset of NVG varies significantly between the two groups of injection of anti-VEGF drugs or not (t=-4.370, P=0.000). Conclusions Risk factors associated with NVG after PPV in eyes with PDR included ipsilateral carotid artery stenosis and the presence of non-perfusion in retina after PPV. The application of anti-VEGF drugs before PPV can delay the onset of NVG in PDR eyes after vitrectomy. Key words: Glaucoma, neovascular/etiology; Diabetic retinopathy/surgery; Vitrectomy; Root cause analysis

Clinical outcomes of 25-gauge vitrectomy surgery for vitreoretinal diseases: comparison of vitrectomy alone and phaco-vitrectomy.

To compare the clinical outcomes of combined 25-gauge pars plana vitrectomy (PPV) and phacoemulsification/posterior chamber intraocular lens (PC-IOL) implantation with vitrectomy alone surgery in patients with various vitreoretinal diseases. A total of 306 eyes (145 with PPV alone and 161 with phaco-vitrectomy) were enrolled in this retrospective analysis. The surgical approach was 25-gauge PPV combined with phacoemulsification and PC-IOL implantation at the same time in eyes in phaco-vitrectomy group and only PPV in eyes in vitrectomy alone surgery group. The main outcome measures were postoperative clinical outcomes included anterior chamber inflammation, changes in intraocular pressure (IOP) and best corrected visual acuity (BCVA). The most common postoperative complication was anterior chamber reaction which has higher incidence in phaco-vitrectomy group (P<0.001). The mean postoperative 1(st) day IOP of vitrectomy alone group was significantly lower than that of phaco-vitrectomy group (16.3±5.8 mm Hg vs 17.8±8.1 mm Hg, respectively, P=0.02). Hypotony (IOP≤8 mm Hg) was not different between groups in the postoperative 1(st) day (P>0.05). The mean preoperative visual acuity was not different between groups (1.6±0.9 logMAR vs 1.8±0.9 logMAR, respectively, P>0.05). However, the mean visual acuity was decreased in vitrectomy alone group at the final visit compared to phaco-vitrectomy group (1.2±0.8 logMAR, 0.9±0.7 logMAR, respectively P<0.05). Twenty-five gauge PPV combined with phacoemulsification surgery is a safe and efficient procedure, which can be preferred in phacic patients with a variety of vitreoretinal diseases compared to vitrectomy alone. Despite improved outcomes, this approach is not free of limitations as anterior chamber complications especially with combined surgery.

MODIFIED CURVED ASPIRATION CANNULAS AND END-GRIPPING FORCEPS FOR 25-GAUGE VITRECTOMY ON HIGHLY MYOPIC EYES.

Pars plana vitrectomy in highly myopic eyes with an axial length (AL) of over 27.00 mm using instruments with the standard length is more challenging than surgery on eyes with an average length of 22.00 mm to 24.00 mm.1 One of the most difficult maneuvers is to reach the posterior pole of the eye, especially in the case of posterior staphyloma. To reach the posterior retina, the long AL of myopic eyes necessitates positioning vitrector or vitreoretinal instruments at a sharper angle to the visual axis of the viewing system than for emmetropic eyes. In addition, because of an insufficient length of the instrumentation, a slight depression may be created on the eye wall in an attempt to reach the posterior pole. An inadequate length can also result in the instruments or the surgeon's fingers coming in contact with the distal lens of the viewing system or contact macular lens, which obscures or displaces the microscopic view making further manipulations more complicated. This can lead to prolonging the time of the surgical procedure or even rendering it insufficient. Previous data have indicated the possibility of using curved instruments in vitreoretinal surgery.2–5 The use of sliding curved laser probes is well known.5 Extra-long straight cannulas and long-shaft forceps for highly myopic eyes to reach the posterior pole are already commercially available.6 The purpose of this work is to report the use of modified aspiration cannulas and end-gripping forceps to improve access to posterior pole during pars plana vitrectomy in eyes with a large AL.

Safety of Pars Plana Vitrectomy in Eyes With Plaque-Irradiated Posterior Uveal Melanoma

To determine the long-term safety of pars plana vitrectomy (PPV) in eyes with plaque-irradiated posterior uveal melanoma. In this retrospective case series, patients with plaque-irradiated posterior uveal melanoma subsequently underwent PPV for vitreous hemorrhage. The main outcome measures are the rates of intraocular melanoma dissemination, extrascleral extension of melanoma, local melanoma recurrence, and systemic melanoma metastasis after PPV. Forty-seven eyes of 47 patients underwent PPV for vitreous hemorrhage after iodine 125-labeled plaque radiotherapy for choroidal melanoma. The mean interval between the onset of vitreous hemorrhage and PPV was 13 (median, 10; range, 0-52) months. The mean time from PPV to last follow-up was 5 (range, 0.5-16) years. There were no cases of intraocular melanoma dissemination or extrascleral extension of melanoma. One patient (2%) developed local choroidal melanoma recurrence (2 years after PPV and 5 years after initial plaque radiotherapy) and was successfully managed with transpupillary thermotherapy. Systemic melanoma metastasis occurred in 4 patients (9%) during a mean interval of 5 years after plaque radiotherapy. During follow-up, 43 patients (91%) were alive without systemic metastasis and 4 patients (9%) were alive with metastasis. Management of vitreous hemorrhage by PPV in eyes with previously irradiated uveal melanoma appears to be safe and without increased risk for intraocular, local, orbital, or systemic dissemination of the tumor.

VITRECTOMY FOR EXUDATIVE AGE-RELATED MACULAR DEGENERATION WITH VITREOUS HEMORRHAGE

The purpose of this study was to study the effect of pars plana vitrectomy (PPV) for age-related macular degeneration with vitreous hemorrhage on choroidal neo-vascularization (CNV). A retrospective interventional case series in which 92 eyes with age-related macular degeneration with vitreous hemorrhage that received PPV were studied. Among them, 60 eyes without pre- or posttreatment other than PPV were selected. Choroidal neovascularization was expressed as the incidence of bleeding 6 months before and after PPV. The status of CNV after PPV was compared and classified as worsened, remained, regressed, disappeared, or unclassified. The influence of posterior vitreous detachment was examined. The incidence of bleeding was reduced dramatically after PPV (1.11 +/- 0.44 in preoperative 6 months vs. 0.03 +/- 0.18 in postoperative 6 months, P < 0.0001). The status of CNV improved in most cases; 40 of 54 classifiable eyes (74.1%) were categorized as "regressed" or "disappeared." Postoperative visual acuity was significantly better than preoperative visual acuity (P < 0.0001). The status of CNV subsided more in those eyes without posterior vitreous detachment than in those with posterior vitreous detachment (odds ratio, 1.02; 95% confidence interval, -0.01-2.08; P = 0.054). The activity of CNV was reduced after PPV in eyes with age-related macular degeneration with vitreous hemorrhage. Visual acuity significantly improved, with only rare severe complications. The involvement of vitreomacular traction in the patho-physiology of CNV in age-related macular degeneration is possible.

Clinical Complications of Combined Phacoemulsification and Vitrectomy for Eyes with Coexisting Cataract and Vitreoretinal Diseases

To discuss the intraoperative and postoperative complications of combining phacoemulsification and foldable intraocular lens (IOL) implantation with pars plana vitrectomy in eyes with significant cataract and coexisting vitreoretinal diseases. This retrospective study consisted of 186 eyes of 149 patients with various vitreoretinal abnormalities and visually significant cataracts. Vitreoretinal surgery was combined with clear corneal phacoemulsification and foldable IOL implantation. Main outcome measures were the intraoperative and postoperative complications at from 6 to 56 months. The most common intraoperative complication was iatrogenic retinal hole (5.3%), transient corneal edema (3.2%), and posterior capsule break (2.1%). The most common postoperative complication was posterior capsule opacification (21.5%) and elevated intraocular pressure (9.7%), macular edema (8.1%), fibrinous reaction (6.9%), vitreous hemorrhage (3.7%), posterior synechiae (3.7%), and recurrent retinal detachment (3.2%). Postoperatively, in 162 eyes (87.1%), visual acuity improved by 3 lines or more on the Snellen chart. In 14 eyes (7.5%), vision remained within 3 lines of preoperative levels and in 10 eyes (5.3%), vision had decreased at the last follow-up. Postoperative complications did not increase significantly in the combined phacoemulsification and vitreoretinal surgery. Combined vitreoretinal surgery and phacoemulsification with foldable IOL implantation is safe and effective in treating vitreoretinal abnormalities coexisting with cataract. Based on extensive experience with the combined procedure, the authors suggest that combined surgery is recommended in select patients having simultaneous vitreoretinal pathologic changes and cataract.

PARS PLANA VITRECTOMY IN EYES TREATED FOR RETINOBLASTOMA

As conservative treatments for retinoblastoma become more prevalent, there will be a greater number of ocular complications developing in eyes that previously would have been enucleated. Pars plana vitrectomy (PPV) is needed to manage some of these complications. The authors evaluated three consecutive cases of PPV in eyes that were successfully treated for retinoblastoma from the Retina Service of the Massachusetts Eye and Ear Infirmary (MEEI) performed between 1989 and 2004. A review of the literature to date regarding PPV after treatment for retinoblastoma was also performed. There was no tumor reactivation in the three cases at MEEI. Vision was maintained at light perception in one case, and there was improvement in vision from hand motions to 20/80 and 20/400 to 20/160 in two cases. Twelve of the 24 cases reviewed in the literature were found to have significant complications of recurrent tumor, need for enucleation, and/or systemic metastasis. PPV is associated with significant risks in eyes previously treated for retinoblastoma and should be reserved for monocular patients with no other alternative for retaining visual function. Areas that may influence outcome include different treatment modalities and length of time of documented tumor inactivity before PPV.

Combined phacoemulsification and pars plana vitrectomy for macular hole treatment

To assess the outcome of simultaneous phacoemulsification, pars plana vitrectomy and intraocular lens (IOL) implantation in eyes with macular hole. A retrospective study was conducted in 38 eyes (36 patients) after combined phacoemulsification, insertion of a posterior capsule IOL and pars plana vitrectomy. The macular hole was successfully closed in 32 of the 38 eyes (84%). In six eyes (16%) the hole failed to close and one eye underwent a second operation. Vision improved by two or more Snellen lines in 29 eyes (73%), there was no change in seven eyes (18%), and visual acuity decreased in two eyes (5%). Intraoperative and postoperative complications included retinal tears in nine eyes (24%), posterior capsule rupture in two eyes (5%), transient postoperative increase of intraocular pressure in eight eyes (21%), and posterior capsule opacification in five eyes (13%). Combining phacoemulsification, IOL insertion and pars plana vitrectomy for macular hole repair can reduce the need for cataract surgery in the future, decrease costs, shorten postoperative recovery time and allow for clearer intraoperative visualization, making the procedure safer and more effective.

The Use of Viscoelastics During Pars Plana Vitrectomy in Eyes With an Anterior Chamber Intraocular Lens

Pars plana vitrectomy in eyes with an anterior chamber intraocular lens poses several challenges. This becomes more obvious during fluid-air exchange. The use of viscoelastics during the surgery to overcome these problems is described. This technique allows better visibility intraoperatively, provides a stable anterior chamber, and maintains corneal clarity.

Pars plana vitrectomy in eyes containing a treated posterior uveal melanoma

Purpose To determine the safety of pars plana vitrectomy in eyes containing a treated posterior uveal melanoma. Design Interventional case series. Methods Retrospective case series of patients with posterior uveal melanoma who underwent pars plana vitrectomy. Complications, vitreous cytology, local tumor control, and metastasis were assessed. Results Nine patients met study criteria. Tumors were treated with 125I plaque radiotherapy (seven patients) or transpupillary thermotherapy (two patients). Vitrectomy was performed for vitreous hemorrhage (five patients), macular pucker (two patients), macular hole (one patient), and rhegmatogenous retinal detachment (one patient). Vitrectomy was performed at a mean of 24.7 months (range, 7–47 months) after melanoma treatment. Dispersion of tumor cells at vitrectomy was not observed in any patients. Melanoma cells were detected in the vitreous aspirate in one of seven cases examined cytologically. This patient had intratumoral and vitreous hemorrhage before plaque radiotherapy, underwent combined vitrectomy/cataract extraction, and developed intraocular tumor dissemination 56 months after vitrectomy. No other patients developed intraocular tumor dissemination. At mean follow-up of 24 months (range, 3–63 months) after vitrectomy, none of the nine patients developed systemic metastasis. Conclusions Pars plana vitrectomy rarely may lead to intraocular tumor dissemination, although the risk of this complication is probably low if the tumor has been treated and has responded to therapy before vitrectomy. Vitrectomy should be approached with caution if a vitreous hemorrhage is present, especially if the hemorrhage occurred before tumor treatment, as this may seed tumor cells into the vitreous cavity.

Combined phacoemulsification, intraocular lens implantation, and vitrectomy for eyes with coexisting cataract and vitreoretinal pathology

PurposeTo report the preoperative, intraoperative, and postoperative outcomes of combining phacoemulsification and posterior chamber intraocular lens (IOL) implantation with pars plana vitrectomy in eyes with significant cataract and coexisting vitreoretinal pathology. DesignRetrospective, consecutive, interventional case series. MethodsCharts of patients undergoing combined procedures at the Wilmer Ophthalmologic Institute between March 1995 and May 2000 were reviewed. ResultsIn all, 122 eyes of 111 patients were identified. Patient ages ranged from 27 to 89 years (mean 65). Forty-three eyes had diabetic retinopathy; 11 had undergone vitrectomy previously. Macular pathology (hole, membrane, choridal neovascularization) was present in 69 eyes. The most common indications for surgery were diabetic vitreous hemorrhage, macular hole, epiretinal membrane, and retinal detachment. In all cases, phacoemulsification and IOL implantation were performed before vitreoretinal surgery. Preoperative vision ranged from 20/30 to light perception and postoperative vision ranged from 20/20 to no light perception. In 105 patients vision improved, in 7 there was no change, and in 10 vision decreased. Postoperative complications included opacification of the posterior capsule, increased intraocular pressure, corneal epithelial defects, vitreous hemorrhage, retinal detachment and iris capture by the IOL. ConclusionsCombined surgery is a reasonable alternative in selected patients. Techniques that may simplify surgery and reduce complications include: careful, limited, curvilinear capsulorhexis; in-the-bag placement of IOLs; use of IOLs with larger optics; suturing of cataract wounds before vitrectomy; use of miotics and avoidance of long-acting dilating drops in patients with intravitreal gas; and use of wide-field viewing systems.

Diagnostic yield of vitrectomy in eyes with suspected posterior segment infection or malignancy

Purpose To determine the yield of diagnostic pars plana vitrectomy in eyes with suspected posterior segment inflammation or malignancy when clinical examination and systemic laboratory testing did not yield a specific diagnosis. Design Noncomparative interventional case series Participants Eighty-seven consecutive patients (90 eyes) who underwent diagnostic pars plana vitrectomy from 1989 through 1999. Interventions Vitreous samples were analyzed in a directed manner based on the preoperative clinical examination and systemic laboratory testing. Main outcome measures Diagnosis from each test performed on the vitreous samples. Results Diagnostic vitrectomy was performed alone in 6 eyes (7%) and as part of a therapeutic procedure in the remaining 84 eyes. The diagnostic tests performed most frequently included cytopathology (83%), microbiologic culture and sensitivity (43%), polymerase chain reaction (PCR) (36%), and intraocular antibody levels for T. canis (14%). Of these, intraocular antibody testing and PCR had the highest positive yield, 46% and 39%, respectively. Overall, directed vitreous analysis identified a specific cause in 35 eyes (39%). Of the 65 cases in which an underlying infection was suspected preoperatively, the procedure yielded a specific diagnosis in 27 (42%). When intraocular malignancy was considered preoperatively (71 eyes), a diagnosis of intraocular lymphoma was obtained in seven (10%). This difference between these diagnostic yields was significant ( P = 0.02, Fisher’s exact test). Conclusions Diagnostic vitrectomy with directed vitreous fluid analysis yields a specific cause and guides subsequent therapy in a high percentage of cases. This procedure is a valuable adjunct in cases that cannot be diagnosed by less invasive methods.

Evaluation of primary surgical procedures for retinal detachment with macular hole in highly myopic eyes: A randomized comparison of vitrectomy versus posterior episcleral buckling surgery

Purpose To evaluate postoperative outcomes between pars plana vitrectomy (PPV) and posterior episcleral buckle procedure (PEBP) in myopic eyes with retinal detachment (RD) and macular hole (MH). Design Retrospective nonrandomized comparative interventional trial. Participants and intervention The study included 30 phakic, highly myopic eyes (from 19–30 negative diopters) of 30 patients with an RD and MH. The patients were divided into two groups: They were assigned to PPV (15 eyes, group A) or to PEBP (15 eyes, group B). No significant ( P > 0.01) differences in preoperative visual acuity (VA) between group A and group B eyes were found. Follow-up was 12 months. Main outcome measures Anatomic attachment of the retina was determined, and VA was measured. Results Retinal reattachment was obtained on 11 of 15 (73.3%) eyes of group A and on 14 of 15 (93.3%) eyes of group B. In group A eyes the VA was substantially unmodified after surgical treatment, whereas in group B eyes the VA observed after surgical treatment increased significantly ( P < 0.001) with respect to the preoperative values. Conclusions PEBP resulted in better postoperative anatomic and functional results compared with PPV in eyes with extreme degrees of myopia, pronounced posterior staphyloma, and posterior vitreous schisis affected with RD caused by MH.

Ciliary body endophotocoagulation during pars plana vitrectomy for pediatric patients with vitreoretinal disorders and glaucoma

PURPOSE: To investigate the efficacy of ciliary body endophotocoagulation during pars plana vitrectomy in eyes of pediatric patients with medically uncontrolled glaucoma. METHOD: We compared preoperative and postoperative intraocular pressure and visual acuity in five eyes of five patients aged between 10 months and 14.5 years who had 180 degrees of ciliary body endophotocoagulation with pars plana vitrectomy. RESULTS: Preoperative intraocular pressure on medical therapy for glaucoma ranged from 30 to 55 mm Hg (median, 35 mm Hg). Postoperative follow-up ranged from 12 to 24 months, with a median of 16 months. Postoperative intraocular pressure on medical therapy ranged from 12 to 35 mm Hg (median, 25 mm Hg) at 6 weeks, from 12 to 33 mm Hg (median, 29 mm Hg) at 6 months, and from 12 to 29 mm Hg (median, 27 mm Hg) at 12 months. Twelve months after surgery, mean intraocular pressure reduction of 20 mm Hg was statistically significant ( P = .020). CONCLUSION: Ciliary body endophotocoagulation during pars plana vitrectomy may be an effective treatment for pediatric patients with simultaneous uncontrolled glaucoma and vitreoretinal disorders.

An Infusion Temporary Keratoprosthesis for Pars Plana Vitrectomy

To develop a temporary keratoprosthesis with integrated infusion cannula to minimize retinal complications during pars plana vitrectomy in eyes with an opaque cornea. The wide-field temporary keratoprosthesis has been modified to include an integrated infusion cannula. The 20-gauge cannula runs from the periphery of the corneal flange, bends 90 degrees, and enters the eye after passing through the periphery of the corneal cylinder. The infusion wide-field temporary keratoprosthesis has been used successfully in three cases without the need to place a separate infusion, which risks iatrogenic retinal breaks or retinal dialyses. Droplet condensation on the posterior surface of the infusion temporary keratoprosthesis was reduced compared with the standard temporary keratoprosthesis. We have developed a wide-field temporary keratoprosthesis with an integrated infusion cannula for use during pars plana vitrectomy in eyes with severe corneal opacity. This device eliminates the risk of complications related to the pars plana infusion cannula.