Preoperative Posterior Vitreous Detachment Research Articles

RECURRENT FLOATERS AFTER LIMITED VITRECTOMY FOR VISION DEGRADING MYODESOPSIA.

Limited vitrectomy improves vision degrading myodesopsia, but the incidence of recurrent floaters postoperatively is not known. We studied patients with recurrent central floaters using ultrasonography and contrast sensitivity (CS) testing to characterize this subgroup and identify the clinical profile of patients at risk of recurrent floaters. A total of 286 eyes (203 patients, 60.6 ± 12.9 years) undergoing limited vitrectomy for vision degrading myodesopsia were studied retrospectively. Sutureless 25G vitrectomy was performed without intentional surgical posterior vitreous detachment (PVD) induction. CS (Freiburg Acuity Contrast test: Weber index, %W) and vitreous echodensity (quantitative ultrasonography) were assessed prospectively. No eyes (0/179) with preoperative PVD experienced new floaters. Recurrent central floaters occurred in 14/99 eyes (14.1%) without complete preoperative PVD (mean follow-up = 39 months vs. 31 months in 85 eyes without recurrent floaters). Ultrasonography identified new-onset PVD in all 14 (100%) recurrent cases. Young (younger than 52 years; 71.4%), myopic (≥-3D; 85.7%), phakic (100%) men (92.9%) predominated. Reoperation was elected by 11 patients, who had partial PVD preoperatively in 5/11 (45.5%). At study entry, CS was degraded (3.55 ± 1.79 %W) but improved postoperatively by 45.6% (1.93 ± 0.86 %W, P = 0.033), while vitreous echodensity reduced by 86.6% ( P = 0.016). New-onset PVD postoperatively degraded CS anew, by 49.4% (3.28 ± 0.96 %W; P = 0.009) in patients electing reoperation. Repeat vitrectomy normalized CS to 2.00 ± 0.74%W ( P = 0.018). Recurrent floaters after limited vitrectomy for vision degrading myodesopsia are caused by new-onset PVD, with younger age, male sex, myopia, and phakic status as risk factors. Inducing surgical PVD at the primary operation should be considered in these select patients to mitigate recurrent floaters.

Role of the Epipapillary Membrane in Maculopathy Associated with Cavitary Optic Disc Anomalies: Morphology, Surgical Outcomes, and Histopathology.

Purpose To evaluate the surgical outcomes of pars plana vitrectomy (PPV) with epipapillary membrane removal in patients with maculopathy associated with cavitary optic disc anomalies. Methods Eight patients (8 eyes) with cavitary optic disc anomaly-associated maculopathy who underwent PPV with epipapillary membrane removal were retrospectively reviewed. The best-corrected visual acuity (BCVA) and macular and papillary morphologies using enhanced depth imaging optical coherence tomography (EDI-OCT) were evaluated before and after treatment. Immunohistochemistry for an intraoperatively excised epipapillary membrane tissue was also performed. Results Before surgery, EDI-OCT revealed that epipapillary membrane was observed in all patients. Retinoschisis was resolved with no recurrence in all patients following vitrectomy regardless of a disease type or the presence or absence of preoperative posterior vitreous detachment. The mean final BCVA and central retinal thickness significantly improved compared with pretreatment values (P = 0.008 and 0.004, resp.). Immunoreactivity for S100 protein and glial fibrillary acidic protein, markers of astrocytes, was positive in the resected membrane tissues. Conclusions These results suggest that epipapillary membrane is involved in the pathogenesis of some patients with cavitary optic disc anomaly-associated maculopathy as well as posterior hyaloid membrane. PPV with epipapillary membrane removal may be a useful treatment option for this maculopathy. This trial is registered with UMIN000011123.

Incidence of Posterior Vitreous Detachment in Myopes Undergoing Femtosecond Laser-Assisted In-situ Keratomileusis Using a 200 kHz Femtosecond Laser System

Introduction: This is a Prospective non-randomized interventional clinical trial conducted to determine the incidence of posterior vitreous detachment (PVD) in myopes following femtosecond laser-assisted in-situ keratomileusis( FS-LASIK) using Wavelight FS200 (Alcon Laboratories Inc.). Methods: This prospective clinical trial was conducted on 30 eyes of 15 patients in the interval between June 2017 and March 2018. Patients who showed no evidence of preoperative PVD using dynamic B-scan ultrasound (US) underwent FS-LASIK using Alcon wavelight FS-200. Postoperative dynamic B-scan US was performed 3 weeks later to determine whether or not PVD will develop. Results: Only three eyes developed PVD postoperatively equivalent to an incidence of 10%. Conclusion: Incidence of PVD following FS-LASIK using Alcon wave light FS-200 is lower than that reported with other femtosecond laser systems with lower frequencies.

MACULAR DETACHMENT ASSOCIATED WITH INTRACHOROIDAL CAVITATION IN NONPATHOLOGICAL MYOPIC EYES.

To report the characteristics of a macular detachment associated with peripapillary intrachoroidal cavitation (ICC) and the outcomes of vitrectomy. The medical records of 69 eyes of 61 patients who underwent vitrectomy for macular detachment or macular retinoschisis but without vitreomacular traction or optic disc pit were reviewed. Optical coherence tomography was used to determine the morphology of the ICC. The outcomes of vitrectomy including the creation of a posterior vitreous detachment and internal limiting membrane peeling were evaluated. An ICC was detected in 3 of 3 eyes without pathologic myopia but none in 66 eyes with pathologic myopia (P < 0.0001). Myopic peripapillary conus was present in all 3 eyes, tilted disc in 2 eyes (67%), posterior staphyloma in 1 eye (33%), and no preoperative posterior vitreous detachment in all eyes. Optical coherence tomography detected a connection between the vitreous cavity and the ICC in two eyes with pit-like splitting and between the subretinal space and the ICC in two eyes. The macular detachment was resolved 5 months to 6 months postoperatively with improvement of vision. A macular detachment with ICC can be present in nonpathological myopic eyes. Vitreous surgery to create a posterior vitreous detachment with internal limiting membrane peeling may help resolve the macular detachment.

INTRAOPERATIVE SCLEROTOMY-RELATED RETINAL BREAKS DURING 23-GAUGE PARS PLANA VITRECTOMY

To study the incidence and characteristics of intraoperative sclerotomy-related retinal breaks encountered during 23-gauge pars plana vitrectomy. A retrospective consecutive case series was assembled from the surgical logs and charts of patients who underwent 23-gauge pars plana vitrectomy. Demographic data and preoperative, intraoperative, and postoperative records were examined. A total 548 eyes met the inclusion criteria. Of them, 145 eyes underwent pars plana vitrectomy for repair of a rhegmatogenous retinal detachment (RRD) and 403 eyes for other indications. Sclerotomy-related retinal breaks were found in 8 of 548 (1.45%) eyes. No breaks were found in the 145 RRD eyes. In non-RRD cases, 8 of 403 (1.98%) eyes had sclerotomy-related breaks. All breaks were adjacent to the superior sclerotomies. The incidence of postoperative retinal detachment was 0% (0 of 403) in the non-RRD group. In eyes with breaks, the primary surgical indication was vitreomacular traction in six of eight eyes and epiretinal membrane in two of eight eyes. Posterior vitreous detachment was absent in six of eight eyes, and six of eight eyes were phakic. Eyes with vitreomacular traction had a significantly higher incidence of breaks (P < 0.0001). Eyes with a surgical indication other than RRD had a higher incidence of breaks, but this was not statistically significant when compared with eyes with RRD (P = 0.087). Pars plana vitrectomy (23-gauge) is associated with a low incidence of sclerotomy-related retinal breaks and postoperative retinal detachments. Eyes with breaks are more likely to be phakic and without a preoperative posterior vitreous detachment. The presence of vitreomacular traction may be a risk factor for the development of intraoperative sclerotomy-related breaks.

Vitrectomy for optic disc pit-associated maculopathy with or without preoperative posterior vitreous detachment

BackgroundThe purpose of this study was to evaluate the efficacy of pars plana vitrectomy for the treatment of optic disc pit-associated maculopathy with or without preoperative posterior vitreous detachment.MethodsWe reviewed the clinical records of four consecutive patients who underwent pars plana vitrectomy in one eye for the treatment of optic disc pit-associated maculopathy, with an emphasis on the preoperative condition of the posterior hyaloid membrane.ResultsTwo of four eyes were confirmed to have an attached posterior hyaloid membrane, which was subsequently removed during surgery. Following vitrectomy, these two eyes experienced an improvement in visual acuity with complete retinal attachment of the macula. However, the other two eyes, which already had a posterior vitreous detachment at the time of surgery, showed a decrease in visual acuity with persistent maculopathy postoperatively.ConclusionPars plana vitrectomy for optic disc pit-associated maculopathy was beneficial for improving visual acuity in two eyes without preoperative posterior vitreous detachment but not in two eyes with preoperative posterior vitreous detachment. Our study suggests that preoperative assessment of a posterior hyaloid membrane is clinically important in predicting the surgical outcome of optic disc pit-associated maculopathy.

Posterior vitreous detachment and retinal detachment following cataract extraction

Cataract surgery induces considerable vitreous modifications that can lead to posterior vitreous detachment. Studies indicate that these changes, whether combined or not with peripheral retinal degenerations such as lattice areas, carry risk for subsequent retinal breaks or detachment. The incidence of retinal detachment increases after cataract extraction, but it decreases with improved surgical technique. Postoperative posterior vitreous detachment is a major promoter of retinal detachment after cataract surgery and is related to onset of most retinal tears leading to retinal detachment. Vitreous body destabilization increases the incidence of retinal detachment after surgery; this destabilization of the vitreous body can result from aggressive surgical technique, intraoperative or postoperative posterior capsule breaks, high myopia and retinal detachment in the fellow eye. These factors can act alone or together to determine the onset of anomalous forms of posterior vitreous detachment; in such cases, retinal breaks frequently develop and culminate in retinal detachment. Vitreous modifications occurring after cataract extraction in patients without preoperative posterior vitreous detachment may be involved in the onset of postoperative retinal detachment. Careful postoperative follow-up is recommended in these patients to allow early detection of posterior vitreous detachment arising after surgery.

Posterior Vitreous Detachment and Retinal Detachment after Cataract Surgery

To evaluate possible changes of vitreous status in emmetropic eyes after uneventful phacoemulsification surgery, and possible related complications such as the onset of retinal detachment (RD). Retrospective case series. Four hundred fifty-three emmetropic eyes from 453 patients (mean age, 62.03+/-5.57 years) subjected to uneventful phacoemulsification with intraocular lens implantation in the capsular bag were considered in the study. They had a refractive error within +/-0.5 diopters (mean, -0.21+/-0.08). Eyes with peripheral retinal lattice degeneration were included only if asymptomatic and only if the degeneration involved one retinal quadrant. After cataract surgery, the 453 eyes were evaluated preoperatively at days 1, 15, and 30 and months 3, 6, 12, 18, 24, 36, 48, and 60. The whole period of follow-up was 5 years. Evaluation of vitreous status by biomicroscopic examination, indirect binocular ophthalmoscopy, and B-scan ultrasonography. Postoperative onset of posterior vitreous detachment (PVD) and RD. After cataract surgery, a PVD occurred in 107 of 141 (75.88%) eyes without preoperative PVD or lattice degeneration. Posterior vitreous detachment occurred in 41 of 47 eyes (87.23%) with preoperative lattice degeneration and no PVD. Eyes with preoperative lattice degeneration and postoperative PVD showed a higher incidence of RD after cataract surgery (21.27%) than eyes without preoperative PVD or lattice degeneration (0.70%). In all patients with lattice degeneration, RD originated from horseshoe retinal tears on lattice areas located on the superior quadrants. No correlation was observed between the development of RD and age. Our results suggest that the onset of postoperative PVD should be considered an important risk factor for the development of RD after cataract surgery, particularly in eyes with lattice areas.

Effect of Microkeratome Suction During LASIK on Ocular Structures

To study the effect of microkeratome suction on ocular structures during LASIK. Observational, prospective case series. Twenty-one eyes of 11 patients with myopia or astigmatic myopia (8 females, 3 males) were included. The mean patient age was 36.3 years (median, 37 years; range, 24-48 years), and the mean spherical equivalent was -5.03 diopters (D) (median, -4.63 D; range, -2.38 to -8.38 D). We performed preoperative and intraoperative A-scan ultrasonography during application of suction using the Hansatome microkeratome (Bausch & Lomb Surgical, Munich, Germany) to create corneal flaps during LASIK. We also performed preoperative and postoperative B-scan ultrasonography of the posterior ocular segment with special attention to the presence and size of posterior vitreous detachment (PVD). We measured changes in the axial length, anterior chamber depth, lens thickness, and vitreous distance (distance from the posterior lens capsule to the posterior pole) during application of the microkeratome suction ring and recorded new occurrences of or increases in the size of the PVD after surgery. The lens thickness decreased (mean change, -0.20 mm; P = 0.001; 95% confidence interval [CI], -0.11 to -0.30) in 18 eyes during application of the suction ring. The vitreous distance increased (mean change, 0.20 mm; P = 0.004; 95% CI, 0.08-0.32) in 16 eyes. No statistically significant changes were found in the anterior chamber depth (P = 0.75) or axial length (P = 0.51). After surgery, 3 of 14 eyes (21.4%) experienced PVD that did not have echographic signs of PVD before surgery. Of 7 eyes with preoperative PVD, the PVD enlarged in 1 eye (14.3%). During application of microkeratome suction, the lens thickness decreases, whereas the vitreous distance increases, suggesting anterior traction on the posterior segment. The relationship between the observed PVD and LASIK merits further investigation.

Residual vitreous cortex after surgical posterior vitreous separation visualized by intravitreous triamcinolone acetonide

Objective To visualize the residual vitreous cortex (VC) on the retinal surface after surgical posterior vitreous separation (PVS) during a pars plana vitrectomy (PPV), especially in patients with diabetic retinopathy. Design Case–control study. Participants Patients with proliferative diabetic retinopathy (PDR), diabetic macular edema (DME), branch retinal vein occlusion (BRVO), and rhegmatogenous retinal detachment (RRD). Methods A triamcinolone acetonide (TA)–assisted vitrectomy was performed on patients with the following diseases: PDR (40 eyes), DME (26 eyes), BRVO (11 eyes), and RRD (17 eyes). Eyes with no apparent preoperative posterior vitreous detachment were enrolled in this study. After performance of surgical PVS, the residual VC was visualized as a white gel highlighted by TA. Based on this finding, the residual VC pattern was then divided into 3 groups: (1) diffuse type (VC was diffusely present in the temporal vascular arcade), (2) focal type (a small island of VC was left), and (3) no residual VC. A multivariate analysis using analysis of variance was performed regarding the residual VC pattern, disease type, age, and the 3 different surgeons. Main outcome measures Each surgeon determined the type of residual VC during the operation, and the results were confirmed by a postoperative review of the videotape records judged by the other 2 surgeons. Results Eighty percent of the PDR eyes demonstrated the diffuse type; 10%, the focal type; and 10%, no residual VC. Fifty-eight percent of the eyes with DME demonstrated the diffuse type; 19%, the focal type; and 23%, no residual VC. Eighteen percent of the BRVO eyes showed the diffuse type; 24%, the focal type; and 59%, no residual VC. Thirty percent of the RRD eyes showed the diffuse type; 30%, the focal type; and 40%, no residual VC. A multivariate logistic regression analysis showed that PDR was a predictor of the diffuse type of residual VC in comparison to RRD (odds ratio = 8.42, 95% confidence interval = 2.07–34.3). Neither age nor the surgeon was a significant factor for a specific type of residual VC. Conclusions Diabetic eyes more often demonstrated the diffuse type of residual VC, even after surgical PVS. This information may be valuable for surgeons performing a PPV on patients with diabetic retinopathy.

Vitrectomy for Diabetic Macular Edema: Effect of Glycemic Control (HbA1c), Renal Function (Creatinine) and Other Local Factors

Aims: To determine the effect of preoperative factors on the foveal thickness following vitrectomy for diabetic macular edema. Methods: Fifty-eight eyes of 47 patients underwent vitrectomy for diabetic macular edema. In all eyes, no clear, visible vitreomacular traction was present. Twelve eyes were pseudophakic before vitrectomy, and 31 eyes underwent concurrent phacoemulsification and intraocular lens (IOL) implantation. Multiple logistic regression analysis was used to assess the independent effect of age, history of photocoagulation, diabetic retinopathy status, preoperative posterior vitreous detachment, HbA_1c and serum creatinine levels within 2 weeks before surgery, lens status after surgery and follow-up period on the foveal thickness determined by optical coherence tomography. Results: The median preoperative visual acuity was 20/100 (range from 20/500 to 20/20), and the median postoperative visual acuity was 20/70 (range from 20/500 to 20/13). The preoperative visual acuity (logarithm of minimal angle of resolution; logMAR) was 0.73 ± 0.36 (mean ± SD; 20/107 Snellen acuity), and the mean postoperative logMAR visual acuity was 0.60 ± 0.39 (20/80), which was significantly better than the mean preoperative value (Wilcoxon signed rank test, p = 0.011). The mean ± SD of preoperative foveal thickness was 475.9 ± 172.5 µm, and the mean postoperative foveal thickness was 277.3 ± 171.9 µm. The mean postoperative foveal thickness was significantly thinner than the preoperative thickness (Student’s paired t test, p < 0.0001). Multiple logistic regression analysis showed that a preoperative low HbA_1c and postoperative pseudophakia were independently associated with the decrease in foveal thickness (p = 0.01, p = 0.04, respectively). Conclusions: The greater reduction in foveal thickness in eyes with an IOL probably resulted from a relatively larger amount of vitreous being removed during the vitrectomy. Because the decrease in foveal thickness may be related to the preoperative glycemic control and the amount of vitreous, these factors should be considered in the planning for vitrectomy.

Treatment of retinal detachments due to macular holes.

The authors successfully treated seven consecutive cases of retinal detachment due to macular holes using vitrectomy, an intravitreal bubble, and postoperative prone positioning. In five cases with preoperative posterior vitreous detachment, laser photocoagulation was applied to the edges of the macular hole after the retina had been flattened. No photocoagulation was used in the two cases without preoperative posterior vitreous detachment.