Peripheral Vitreous Research Articles

The role of ultra-widefield imaging with navigated central and peripheral cross-sectional and three-dimensional swept source optical coherence tomography in ophthalmology: Clinical applications.

To assess central and peripheral retinal and choroidal diseases using ultra-widefield (UWF) fundus imaging in combination with navigated central and peripheral cross-sectional and three-dimensional (3D) swept source optical coherence tomography (SS-OCT) scans. Retrospective study involving 332 consecutive patients, with a nearly equal distribution of males and females. The mean age of patients was 52 years (range 18-92 years). Average refractive error was -3.80 D (range +7.75 to -20.75 D). The observations in this study demonstrate the efficacy of peripheral navigated SS-OCT in assessing various ocular conditions. The technology provides high-quality images of the peripheral vitreous, vitreoretinal interface, retina, and choroid, enabling visualization of vitreous floaters and opacities, retinal holes and tears, pigmented lesions, and peripheral retinal degenerations. 3D OCT scans enhance the visualization of these abnormalities and improve diagnostic and therapeutic decisions. Navigated central and peripheral cross-sectional and 3D SS-OCT scans offer significant complementary benefits in the assessment and management of retinal diseases. Their addition to UWF imaging provides a comprehensive view of central and peripheral ocular structures, aiding in early detection, precise anatomical measurements, and objective monitoring of disease progression. In addition, this technology serves as a valuable tool for patient education, a teaching tool for trainees, and documentation for medico-legal purposes.

Silicone oil emulsification: A literature review and role of widefield imaging and ultra-widefield imaging with navigated central and peripheral optical coherence tomography technology.

Silicone oil (SO) emulsification is a significant concern in vitreoretinal surgery, leading to various complications. Despite the high prevalence of SO emulsification within the eye, there is currently no standardized method for its early detection. The recent introduction of widefield (WF) imaging and ultra-WF (UWF) imaging with navigated central and peripheral optical coherence tomography (OCT) techniques have shown promising results in providing high-resolution images of the peripheral vitreous, vitreoretinal interface, retina, and choroid. This enhanced visualization capability enables the early identification of emulsified SO droplets, facilitating a proactive therapeutic approach, and mitigating associated adverse events. This comprehensive literature review aims to provide an updated overview of the topic, focusing on the role of WFimaging and UWF imaging and navigated central and peripheral swept-source OCT (SS-OCT) in the early detection and management of SO emulsification. The review discusses the current understanding of SO emulsification, its associated complications, and the limitations of existing detection methods. In addition, it highlights the potential of WF and UWF imaging and peripheral OCT as advanced imaging modalities for improved visualization of SO emulsification. This review serves as a valuable resource for clinicians and researchers, providing insights into the latest advancements in the field of vitreoretinal surgery and the promising role of WF imaging and UWF imaging and navigated central and peripheral SS-OCT in the management of SO.

Four-Point Refixation for In-the-Bag Intraocular Lens Dislocation Into Vitreous Cavity With Implantable Capsular Hooks.

Four-Point Refixation for In-the-Bag Intraocular Lens Dislocation Into Vitreous Cavity With Implantable Capsular Hooks.

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

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

The Utility of Peripheral Vitrectomy Featuring Scleral Indentation during Scleral Fixation of Intraocular Lenses

Purpose: We evaluated the utility of peripheral vitrectomy featuring scleral indentation; we compared a group who underwent peripheral vitrectomy to a control group for whom vitrectomy was combined with scleral fixation of intraocular lenses (IOLs) in patients exhibiting IOL dislocations.Methods: From January 2018 to December 2020, 20 eyes of patients evidencing IOL dislocations that underwent total vitrectomy, IOL removal, and IOL scleral fixation were evaluated; peripheral vitrectomy with scleral indentation was performed in 10 patients. All operations were performed by the same surgeon. We excluded patients with follow-up periods less than 6 months, those with a history of retinal and/or glaucoma surgery, and patients with retinal abnormalities or glaucoma that might significantly compromise visual acuity. The postoperative best-corrected visual acuity, intraocular pressure, astigmatism changes, and complications were retrieved from the medical records.Results: Six months after surgery, the best corrected visual acuity was 0.95 (the Snellen measure) in the group who underwent peripheral vitrectomy featuring scleral indentation, and 0.60 in the control group (p = 0.029). The total astigmatism values were 0.48 diopter in the former and 2.80 diopter in the latter group; the difference was significant (p &lt; 0.001).Conclusions: In patients with IOL dislocations who underwent vitrectomy combined with IOL scleral fixation, improvements in visual acuity were further enhanced when peripheral vitrectomy was combined with scleral indentation. Complete removal of the peripheral vitreous may stabilize IOL positioning by the remnant vitreous.

Surgical Outcome of Intraocular Lens Implantation in Children with Bilateral Developmental Cataract

Purpose: To evaluate the visual outcome and long-term complications of intraocular lens implantation along with primary posterior capsulectomy &amp; anterior vitrectomy in children with bilateral developmental cataract. Methods: This retrospective study was carried out on the 48 eyes of 24 children who had undergone cataract surgery under general anesthesia. Age range was 2 to 8 years. All patients underwent primary posterior capsulectomy, primary in-bag intraocular lens (IOL) implantation, irrigation-aspiration of lens debris, and anterior vitrectomy. At intervals of one week, one month, three months, and six months, every case was evaluated. After 6 months best corrected visual acuity was recorded and intraocular pressure, anterior chamber angle, optic disc, and peripheral retina were evaluated. Results: Postoperative best corrected visual acuity were 6/6 in 10.4% eyes, 6/9-6/18 in 56.3% and &lt;6/18 in 33% eyes. Intra ocular pressures were found within normal limit (12 ± 2.09 mm of Hg) in all cases. Anterior chamber angle was normal in 44 eyes (91.7%). Peripheral retina and vitreous were normal in all cases. No significant Optic disc changes were noticed. The most common cause of decreased vision was amblyopia (79.2%) in the fellow eye due to delayed surgery. Conclusion: Amblyopia is the main cause of decreased visual recovery in children after cataract surgery. Surgical intervention in proper time results in good visual outcome.

Surgical Outcome of Intraocular Lens Implantation in Children with Bilateral Developmental Cataract

Purpose: To evaluate the visual outcome and long-term complications of intraocular lens implantation along with primary posterior capsulectomy &amp; anterior vitrectomy in children with bilateral developmental cataract. Methods: This retrospective study was carried out on the 48 eyes of 24 children who had undergone cataract surgery under general anesthesia. Age range was 2 to 8 years. All patients underwent primary posterior capsulectomy, primary in-bag intraocular lens (IOL) implantation, irrigation-aspiration of lens debris, and anterior vitrectomy. At intervals of one week, one month, three months, and six months, every case was evaluated. After 6 months best corrected visual acuity was recorded and intraocular pressure, anterior chamber angle, optic disc, and peripheral retina were evaluated. Results: Postoperative best corrected visual acuity were 6/6 in 10.4% eyes, 6/9-6/18 in 56.3% and &lt;6/18 in 33% eyes. Intra ocular pressures were found within normal limit (12 ± 2.09 mm of Hg) in all cases. Anterior chamber angle was normal in 44 eyes (91.7%). Peripheral retina and vitreous were normal in all cases. No significant Optic disc changes were noticed. The most common cause of decreased vision was amblyopia (79.2%) in the fellow eye due to delayed surgery. Conclusion: Amblyopia is the main cause of decreased visual recovery in children after cataract surgery. Surgical intervention in proper time results in good visual outcome.

Quantification of the peripheral vitreous after vitreous shaving using intraoperative optical coherence tomography

ObjectiveTo evaluate the technique of peripheral vitreous shaving during vitrectomy, we measured the residual peripheral vitreous using intraoperative optical coherence tomography (iOCT).Methods and AnalysisThis retrospective study included 44 eyes that...

Surgical Outcome of Intraocular Lens Implantation in Children with Bilateral Developmental Cataract

Purpose: To evaluate the visual outcome and long-term complications of intraocular lens implantation along with primary posterior capsulectomy &amp; anterior vitrectomy in children with bilateral developmental cataract.&lt;/p&gt; &lt;p&gt;Methods: This retrospective study was carried out on the 48 eyes of 24 children who had undergone cataract surgery under general anesthesia. Age range was 2 to 8 years. All patients underwent primary posterior capsulectomy, primary in-bag intraocular lens (IOL) implantation, irrigation-aspiration of lens debris, and anterior vitrectomy. At intervals of one week, one month, three months, and six months, every case was evaluated. After 6 months best corrected visual acuity was recorded and intraocular pressure, anterior chamber angle, optic disc, and peripheral retina were evaluated.&lt;/p&gt; &lt;p&gt;Results: Postoperative best corrected visual acuity were 6/6 in 10.4% eyes, 6/9-6/18 in 56.3% and &lt;6/18 in 33% eyes. Intra ocular pressures were found within normal limit (12 ± 2.09 mm of Hg) in all cases. Anterior chamber angle was normal in 44 eyes (91.7%). Peripheral retina and vitreous were normal in all cases. No significant Optic disc changes were noticed. The most common cause of decreased vision was amblyopia (79.2%) in the fellow eye due to delayed surgery.&lt;/p&gt; &lt;p&gt;Conclusion: Amblyopia is the main cause of decreased visual recovery in children after cataract surgery. Surgical intervention in proper time results in good visual outcome

The observation of secretogranin Ⅲ in the peripheral blood and vitreous of patients with diabetic retinopathy

Objective: To study the expression levels of secretogranin Ⅲ (SCG3) in the peripheral blood and vitreous of patients with diabetic retinopathy (DR). Methods: Cross-sectional research. A total of 77 patients (41 men and 36 women, 77 eyes) received vitrectomy in Tianjin Medical University Eye Hospital from May to December 2018, with an average age of (60.75±11.34) years. According to the blood glucose level, diabetes history and fundus status, all the patients were divided into the DR group and the non-diabetic group. According to the patients' blood lipids and body mass index (BMI), patients were further divided into subgroups of high blood lipids, normal blood lipids, high BMI and normal BMI. All patients were tested with eye examinations, height and weight to calculate the BMI, and blood lipid levels in the peripheral blood. The vitreous was collected during the vitrectomy surgery, and the levels of SCG3 in the vitreous and peripheral blood were analyzed by ELISA. All the data were analyzed statistically with Wilcoxon rank sum test. Results: There were 43 patients in the DR group, among whom 25 had hyperlipidemia, 18 had normal blood lipids, 22 had a high BMI, and 21 had a normal BMI. There were 34 patients in the non-diabetic group, among whom 13 had hyperlipidemia, 21 had normal blood lipids, 17 had a high BMI, and 17 had a normal BMI. The level of SCG3 in the DR group [6.02 (4.34, 11.76) ng/ml] was higher than that in the non-diabetic group [4.30 (3.20, 10.78) ng/ml] (Z=-2.339, P =0.019). The level of SCG3 in the hyperlipidemia subgroup of the DR patients [7.94 (5.33, 13.51) ng/ml] was higher than that in the normal blood lipid subgroup of the non-diabetic patients [4.04 (3.12, 7.77) ng/ml] (Z=-3.473, P=0.001), and higher than that in the DR patients without hyperlipidemia [4.45 (3.71, 9.14) ng/ml] (Z=-2.511, P=0.012). The level of SCG3 in the DR patients with a high BMI [7.12 (4.56, 13.12) ng/ml] was higher than that in the non-diabetic patients with a normal BMI [3.53 (3.16, 4.38) ng/ml] (Z=-3.767, P =0.000). The level of SCG3 in the DR patients with a normal BMI [5.72 (4.10, 11.60) ng/ml] was higher than that in the non-diabetic patients with a normal BMI (Z=-2.862, P = 0.004). SCG3 in the plasma was rare or can not be detected. Conclusions: The concentration of SCG3 in the vitreous increase in DR patients. However, SCG3 can not be detected in the healthy vascular system. (Chin J Ophthalmol, 2020, 56: 933-937).

Endodiathermy assisted vitreous base and anterior hyaloid visualization during vitrectomy for rhegmatogenous retinal detachment.

To describe a novel technique to visualize vitreous base and the anterior hyaloid during vitrectomy for Rhegmatogenous Retinal Detachment (RRD). Retrospective, single-center study enrolling all patients who underwent vitrectomy for RRD between June 2015 and June 2018. After core vitrectomy and the necessary additional procedures, endodiathermy was activated near the edge of the peripheral vitreous. This created a heat-induced bubble stream and the bubbles were entangled in the vitreous base and anterior hyaloid. As a result, the vitreous base and anterior hyaloid were visualized and removed. Between June 2015 and June 2018, a total of 210 cases of rhegmatogenous retinal detachment were treated with vitrectomy. Endodiathermy assisted vitreous base shaving and anterior hyaloid removal was used in those cases with a very low incidence of iatrogenic peripheral retinal breaks during vitreous base shaving (2%), and with no case of lens injury related to the technique. We achieved a final anatomical success of 95.2% in the study period after mean number of operations of 1.3 ± 0.2. Endodiathermy near the peripheral vitreous was not associated with any intraoperative or postoperative complications. Endodiathermy assisted vitreous base and anterior hyaloid visualization is a safe adjuvant method that could help in achieving complete and rapid vitreous base shaving and anterior hyaloid removal.

NOVEL ENDOSCOPE-ASSISTED VITREOUS SURGERY COMBINED WITH ATMOSPHERIC ENDOSCOPIC TECHNIQUE AND/OR SUBRETINAL ENDOSCOPIC TECHNIQUE FOR RHEGMATOGENOUS RETINAL DETACHMENT WITH GRADE C PROLIFERATIVE VITREORETINOPATHY.

The purpose of this study was to investigate the clinical outcomes of novel endoscope-assisted vitreous surgery techniques in patients with rhegmatogenous retinal detachment complicated by Grade C proliferative vitreoretinopathy. Eight consecutive patients who had undergone endoscope-assisted vitreous surgery for rhegmatogenous retinal detachment complicated by Grade C proliferative vitreoretinopathy were investigated. The peripheral vitreous was cut under air with the aid of endoscopic view (atmospheric endoscopic technique), and the subretinal proliferation was removed under subretinal endoscopic observation (subretinal endoscopic technique). Retinal reattachment was achieved after the primary surgery without a large retinotomy and scleral buckling in each case. The mean follow-up was 16.8 months (range, 8-28 months). Atmospheric endoscopic technique was performed in all cases, and subretinal endoscopic technique was performed in three cases. After surgery, the mean best-corrected visual acuity significantly improved from 20/778 to 20/111 (P = 0.014). Although microretinal breaks occurred during the removal of vitreous using atmospheric endoscopic technique in all cases, there were no severe postoperative complications, such as retinal detachment or proliferative vitreoretinopathy. Endoscope-assisted vitreous surgery with atmospheric endoscopic technique and/or subretinal endoscopic technique is safe and effective in the treatment of rhegmatogenous retinal detachment with Grade C proliferative vitreoretinopathy.

An experimental and clinical study on the initial experiences of Brazilian vitreoretinal surgeons with heads-up surgery.

To evaluate the initial experiences of several vitreoretinal surgeons in Brazil, both experienced and beginners, with a three-dimensional (3D) system, and to report the advantages and disadvantages of this technology. We also report surgical manipulations performed using the heads-up method in porcine eyes. For full-thickness idiopathic macular holes (MHs), we analyzed the times required for pars plana vitrectomy (PPV) and internal limiting membrane (ILM) rhexis by using traditional microscopy and 3D system, and to evaluate anatomical surgical results. During experimental vitreoretinal surgery on porcine eyes, two retinal surgeons applied the heads-up method. In clinical surgery, 14 retinal surgeons performed almost all types of vitreoretinal surgeries in association with facectomy, Ahmed glaucoma valve implant, or minimally invasive glaucoma surgery using an iStent®. The Ngenuity® 3D Visualization System was digitally integrated with intraoperative optical coherence tomography, the Verion™ Image-Guided System, and an endoscope (with a modified GoPro® camera). To compare the 3D system with traditional microscopy, ergonomics, educational value, image sharpness, depth perception, field of view, advantages and disadvantages, and technical feasibility were assessed using a questionnaire. One year later, the 14 surgeons answered the same questionnaire again, in order to assess whether they became more comfortable or not with 3D. For treating MHs, four surgeons (surgeon 1, fellows 1, 2, 3) performed the total of 40 surgeries. Each one performed 10 surgeries (5 with traditional microscopy and 5 with 3D visualization). The completion time for PPV and ILM rhexis were determined by using both methods. In porcine eyes, disabling the color channels allowed better visualization of the ILM, either with Brilliant Blue G (BBG), indocyanine green chorioangiography (ICG), or açai dye; transillumination through the sclera was also better without a color channel, but visualization of the peripheral vitreous was better with a blue channel. Regarding clinical experience, the questionnaire responses showed that the respondents generally favored the heads-up method compared with traditional microscopy (p < 0.05); however, despite a slightly higher average score, the 3D system was not statistically significantly preferred in terms of technical feasibility (p = 0.1814). Answering again the same questionnaire 1year later, the 14 surgeons felt more comfortable with 3D (p < 0.05). The type of surgery benefitting most from the 3D system was peeling of the ILM or epiretinal membrane (p < 0.001), and that receiving the least benefit was anterior segment surgery (p < 0.001). In addition, surgeons did not report benefits of color channels, preferring to disable it (p < 0.001). Comparisons between the average time for full PPV and ILM rhexis by using the two methods were non-significant, neither in each individual case of 3D surgery for each surgeon. Surgeon 1 had always been faster than his fellows. Thirty-six (90%) full-thickness MHs were successfully closed with one surgery. The 3D system was preferred to traditional microscopy. The 3D system was especially helpful for certain specific types of surgeries and served as an educational tool, having reduced illumination and allowing precise focusing. Concerning MH surgery, heads-up method was similar to traditional microscopy regarding length of time and anatomical surgical results. As a digital platform, it will be amenable to constant upgrades and may ultimately become the new standard for ophthalmic surgery.

Macular Hole: Etiology, Physiopathology, Diagnosis, Differential Diagnosis, and Treatment

Retinal defects evolving whole neural layers in the macular area especially in the fovea are being called macular hole (idiopathic macular hole; IMH). It causes painless central visual loss and deterioration of vision that is called metamorphopsia. Antero-posterior dynamic forces (vitreomacular traction; VMT) caused by tangential tractional vectors of the prefoveal vitreous cortex and progression to full-thickness macular hole due to weakening of the inner retinal layers are attributed for the etiology of macular hole. IMH is seen frequently unilaterally in females and patients &gt; 65 years of age. An approach for IMH treatment, aiming to release the traction and closure of the macular hole by pharmacological vitreolysis is the use of ocriplasmin, which is a plasmin derivative. To release the synechia on the vitreomacular interface and to normalize the abnormalities of the retinal surface are the aims of IMH surgery. Besides, vitreoretinal surgery constitutes suitable conditions for the closure of the hole. Separation and detachment of the posterior hyaloid, core vitrectomy, removal of the peripheral vitreous, and Internal Limiting Membran (ILM) peeling are the standard stages of the classic IMH surgery. Condition of the other eye, presence of Epiretinal Membran (ERM), hole width, patient's age, and quality of life are important factors when evaluating the patients. Ocriplasmin alternative must be kept in mind in holes smaller than 400 μ especially if VMT is existent. IMH is such a pathology that can be treated successfully by vitrectomy and ILM peeling at the present situation.

Ultrasound biomicroscopic imaging in paediatric ocular toxocariasis

PurposeTo determine the potential and usefulness of ultrasound biomicroscopy (UBM) as a diagnostic procedure on a larger cohort of paediatric patients with ocular toxocariasis.MethodsUBM was performed on 41 eyes of...

Characteristics of patients with spontaneous dislocation of in-the-bag intraocular lens after pars plana vitrectomy.

To determine the characteristics of eyes with late in-the-bag dislocation of an intraocular lens (IOL) after pars plana vitrectomy (PPV). Fourteen eyes of 14 patients with a dislocated IOL after PPV were studied retrospectively. The data collected from the medical charts included the age, sex, history of eye diseases, axial length, and interval from PPV to time of IOL dislocation. The surgical procedures used during the PPV were also recorded. Seven eyes had undergone PPV for rhegmatogenous retinal detachment; 6 eyes, for proliferative diabetic retinopathy; and 1 eye, for retinal vein occlusion. The average interval between the PPV and the diagnosis of the dislocated IOL was 6.2years (range 2.3-10.1years). In all eyes, the peripheral vitreous was thoroughly removed with scleral depression during the PPV. The IOL dislocation was most likely caused by damage to the zonular fibers by the peripheral vitrectomy with scleral depression.

Results of Peripheral Vitrectomy Under Air in Rhegmatogenous Retinal Detachment.

To evaluate the safety and efficacy of peripheral vitrectomy under air in rhegmatogenous retinal detachment (RRD). Consecutive patients who underwent 23-gauge pars plana vitrectomy for RRD were included. After removal of core vitreous and drainage of subretinal fluid, peripheral vitreous was removed under air infusion without scleral indentation. Silicone oil or C3F8 gas was used as tamponade. Forty-five eyes of 45 patients were evaluated retrospectively. Mean LogMAR, which was 1.65 LogMAR ± 1.44 LogMAR preoperatively, decreased to 0.26 LogMAR ± 0.28 LogMAR (P < .001; paired t-test). Initial and final reattachment rates were 91% and 98%, respectively. Scleral indentation was not necessary in any case. Iatrogenic retinal breaks occurred in three initial cases. Macular hole developed in one case after reoperation. Peripheral vitrectomy under air is safe and effective in cases with RRD. Air eliminates the need for scleral indentation, stabilizes the retina, and allows sufficient clarity for vitrectomy. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:51-54.].

Ultrasonographical assessment of implanted biodegradable device for long-term slow release of methotrexate into the vitreous

Our group has developed a biodegradable drug delivery device (micro-implant) for long-term slow intraocular release of methotrexate (MTX) that can be implanted in the peripheral vitreous. The purpose of this study was to assess the position of the implanted devices and the status of the adjacent vitreous and peripheral retina over time using B-scan ocular ultrasonography (US). In each of the eight New Zealand rabbits used in this study, a chitosan (CS) and poly-lactic acid (PLA)-based micro-implant containing approximately 400 μg of MTX and a placebo micro-implant without MTX were inserted into the peripheral vitreous of the right and left eyes, respective, employing minimally invasive surgery. B-scan US imaging was performed on all of the rabbits immediately after implant insertion and on two rabbits at each of several pre-determined time points post-insertion (post-insertion days 5, 12, 19, and 33) to evaluate the position of the micro-implants and identify any evident morphological changes in the micro-implants and in the peripheral retina and vitreous during treatment. US imaging revealed stable positioning of the PLA-coated CS-based MTX micro-implant and the placebo micro-implant in the respective eyes throughout the study and lack of any changes in size, shape or sonoreflectivity of the micro-implants or abnormalities of the peripheral vitreous or retina in any of the study eyes. In summary, US did not show any evident morphological changes in the micro-implants, shifts in post-insertion position of the micro-implants, or identifiable changes in the micro-implants or peripheral vitreous and retina of the study eyes.

Intravitreal Ranibizumab for Diabetic Macular Edema Treatment in Phakic Vitrectomized Eyes

Purpose: To show the effect of intravitreal ranibizumab injections in treating DME in phakic vitrectomized eyes versus pseudophakic vitrectomized eyes. Method: The medical records of 12 patients seen in the Retina Clinic and diagnosed to have DME were prospectively reviewed. The inclusion criteria were Phakic vitrectomized eyes. The exclusion criteria were pseudophkia and vitrectomized eyes with internal limiting membrane peeling. The main outcome measures included mean change in best corrected visual acuity (BCVA) from baseline, mean change in CMT, and mean number of 0.5 mg intravitreal ranibizumab injections administered during the follow up. Result: At baseline assessment, the mean (±SD) Logarithm of the Minimum Angle of Resolution (Log MAR visual acuity) was 0.71 (±0.56). At the 12 weeks, follow up assessment the mean Log MAR VA was significantly improved to 0.32 (±0.20), (p = 0.036). At baseline assessment, OCT was 390.75 (±51.40). The mean OCT at 4 weeks was significantly reduced to 353.83 (±49.49), (p = 0.019). Furthermore, at the 8 weeks follow up assessment, the mean OCT continued its significant trend of improvement to reach 341.08 (±60.24), (p = 0.016) and 294.42 (±57.27) in the 8 and 12 weeks follow up assessments respectively. Conclusion: In this small, prospective series, there was improvement in BCVA and CMT in the short-term after intravitreal Ranibizumab (IVR) for DME in previously phakic vitrectomized eyes. This may be attributable to a more remaining peripheral vitreous in phakic eyes behind the crystalline lens after vitrectomy which may clog the zonular area between anterior and posterior chambers and slowing down the antiVEGF clearance through the anterior chamber. Thus, vitreous works as a reservoir for anti-VEGF in phakic vitrectomized eyes comparing to pseudophakic vitrectomized eyes.

Air as Tamponade for Retinal Detachments

To determine whether air can be used as a reliable tamponade agent after pars plana vitrectomy in selected primary retinal detachment (RD). Twelve eyes with fresh RD were included. Exclusion criteria were presence of fibrosis, fixed folds, proliferative vitreoretinopathy of grade C or greater, and giant retinal tears. The number, location, and types of breaks, extension of RD, and whether the macula was attached were documented. A 25-gauge 3-port pars plana vitrectomy was carried out. Central and peripheral vitreous was removed to eliminate traction and relieve tractional forces provoked by the air bubble injected at the end. Argon endolaser or cryotherapy was applied around all breaks. Filtered air was used as an internal tamponade. Patients were followed up at 24 hours, 1 week, and 1, 3, 6, and 12 months. Air bubble took 10.7 days (range 7-15 days) to resolve. Visual acuity (VA) improved from 1.35 ± 1.21 logMAR preoperatively to 0.20 ± 0.25 after a follow-up time of 12 months. We achieved a primary postoperative success rate of 100% at 1 month and 91.6% at 12 months. We achieved a good success rate with air tamponade and limited laser. This approach allows for quicker VA recovery associated with a rapid disappearance of air. This may benefit patients who live at higher altitudes.