Primary Vitrectomy Research Articles

Vitrectomy in Small idiopathic MAcuLar hoLe (SMALL) study: conventional internal limiting membrane peeling versus inverted flap.

To compare conventional internal limiting membrane (ILM) peeling versus inverted flap technique in small idiopathic macular hole. Retrospective, multicentre cohort study including consecutive eyes with a ≤250 μm idiopathic macular hole treated with primary vitrectomy. The primary outcome was best-corrected visual acuity (BCVA) change and macular hole closure rate. Closure patterns on optical coherence tomography (OCT) and rates of external limiting membrane (ELM) and ellipsoid zone (EZ) recovery were considered as secondary outcomes. A total of 389 and 250 eyes were included in the conventional ILM peeling group and in the inverted flap group, respectively. Hole closure rate was comparable between the two groups (98.5% in the ILM peeling group and 97.6% in the inverted flap group). Mean BCVA was comparable between the two groups at baseline (p = 0.331). At 12 months, mean BCVA was 0.14 ± 0.19 logMAR in the conventional ILM peeling group and 0.17 ± 0.18 logMAR in the inverted flap group (p = 0.08). At 12 months, 73% of eyes had a U-shape closure morphology in the conventional ILM peeling group versus 55% in the inverted flap group. At 12 months, ELM recovery rate was 96% and 86% in the conventional ILM peeling group and in the inverted flap group, respectively (p < 0.001); EZ recovery rate was 78% and 69%, respectively (p = 0.04). The inverted flap technique provides no advantages in terms of visual outcome and closure rate in small idiopathic macular hole surgery. Additionally, this technique seems to impair postoperative restoration of external retinal layers compared with conventional peeling.

К вопросу расчета ИОЛ у пациентов с витреоретинальной патологией

Purpose. To estimate the probability of a change in the calculated IOL after microinvasive vitrectomy 25G in patients with operated macular rupture. Methods. A retrospective analysis of patients operated on for a macular rupture with a diameter from 400 microns to 1000 microns was performed. The exclusion criteria were: the axial length of the eye is less than 22.0 mm and more than 26.0 mm, recurrence of previously operated macular ruptures, the presence of concomitant ocular pathology that can affect the final postoperative result (macular degeneration, glaucoma, diabetic and postocclusive retinopathy), the presence of previously performed surgical interventions on the retina. The study involved 64 eyes, of which 34,37 % (22 eyes) with a native lens; 14,06 % (9 eyes) with artifacia before vitrectomy; 6,25 % (4 eyes) vitrectomy with cataract phacoemulsification and IOL implantation and 45,31 % (29 eyes) cataract phacoemulsification with IOL implantation was performed within 4–9 months after primary vitrectomy. These patients were the study group. The comparison parameters are best corrected visual acuity, K1, K2, Ave. K1, Ave. K2, Axis, Ave. K2-K1, axial length of the eye, Ave. axial length of the eye, as well as calculated models of IOL and implantable after vitreoretinal surgery. Results. The change in the optical strength of the IOL occurred in 44,82 %. The change in the IOL model is 37,93 %. The change in the optical strength and model of the IOL is 20,68 %. The change in the optical strength of the previous IOL model is 24,1%. The change in the strong axis of more than 20 ° with the previous IOL parameters is 13,79 %. Only in 27,58 % there were no changes in the calculation of IOL. Conclusion. An individual approach to the calculation and selection of intraocular lenses in patients with vitreoretinal pathology allows implantation of all types of IOLs with maximum patient satisfaction with the functional result. Keywords: biometric indicators, IOL, vitrectomy, cataract, phacoemulsification, keratometry

Outcomes of Primary Vitrectomy for Rhegmatogenous Retinal Detachment With No Postoperative Positioning.

Purpose: To evaluate the anatomic and visual outcomes of primary vitrectomy for rhegmatogenous retinal detachment (RRD) repair using no amount of postoperative prone positioning to clarify the role of face-down posturing for RRD reattachment. Methods: This retrospective consecutive interventional case series comprised patients who had primary vitrectomy for RRD repair. The surgical outcomes, single-surgery anatomic success rate, and postoperative best-corrected visual acuity (BCVA) were assessed. The primary objective was to evaluate the anatomic and visual outcomes of vitrectomy RRD reattachment using no postoperative prone positioning. Results: This study comprised 116 eyes of 116 patients. Single-surgery anatomic success was achieved in 112 (96.5%) of 116 eyes. The single-surgery anatomic success rate was 100% in phakic patients (n = 56) and 93% in pseudophakic patients (n = 60), with both groups having an improvement in the mean BCVA. Conclusions: Primary vitrectomy with no postoperative prone positioning is a successful surgical intervention for RRD repair. The anatomic closure rate in this study is one of the highest reported in the literature and involved a large number of macula-off RRDs, with minimal complications and a significant improvement in BCVA, primarily using 14% perfluoropropane for gas tamponade.

Primary Vitrectomy versus Tap and Inject for Fungal Endophthalmitis: Meta-Analysis and Comparison with Data from a Reference Centre

ABSTRACT Purpose We aimed to compare the visual outcomes after pars plana vitrectomy (PPV) versus tap and inject (T&I) in fungal endophthalmitis (FE) reported in the literature and to compare the findings from the literature with data from a reference centre. Methods We performed a systematic review and meta-analysis of studies reporting the use of PPV versus T&I in FE. We also performed a retrospective review of the clinical records of patients with endophthalmitis from a reference centre in Colombia. Results We included 13 studies with 334 eyes; 53.59% received PPV and 46.4% received T&I. The overall relative risk of improving ≥ 2 lines in PPV versus T&I was 0.98 (95% confidence interval [CI] 0.80–1.22; p = 0.88) with a mean difference of final visual acuity of 0.26 (95% CI 0.12–0.63; p = 0.18). There were no significant differences in subgroup analysis. Data from the reference centre included 32 endophthalmitis cases, 15.6% of which had a fungal aetiology (80% received PPV and 20% T&I). There were no significant differences in the subgroup analysis. Conclusions Based on the findings from the literature and the reference centre, T&I is noninferior to PPV. This is the first meta-analysis in the literature evaluating these effects in FE. It is necessary to execute new prospective randomised controlled studies in patients with endophthalmitis.

Profile of Unilateral Cataract in Pediatric Patients: A 3 Year Retrospective Study

Abstract&#x0D; Introduction &amp; Objectives : Unilateral cataract presents from 19.6% to 55.5% of pediatric cataract in children by many previous reported studies. This condition is treatable, but delayed treatment may cause visual impairment. This study aims to understand characteristic and treatment of unilateral cataract in children.&#x0D; Methods : The study involved a retrospective review of medical records of patients aged 0-17 years with unilateral cataract who presented to Dr. Kariadi Hospital Semarang from 2019 to 2022. Cases of cataract secondary to causes such as trauma or uveitis were excluded.&#x0D; Results : Thirty-five patient was included in this study, 51% of whom were male and 49% female. The mean age at presentation is 60.49  48.23 months and mean age of onset is 36.77  45.94 months. The most common presenting complaint was whitish eye (81%) while others presented with blurred vision. All the patients had leukocoria, 28% have microcornea, 3% have persistent pupillary membrane. Half of patient (51%) have strabismus, with exotropia being the most common type (34.17%). Eight patients had congenital rubella syndrome, one patient had cytomegalovirus infection while others did not have any systemic condition related to cataract. Majority of patient (17%) treated with phacoaspiration, primary posterior capsulotomy, anterior vitrectomy and intraocular lens implantation. Intraocular lens was implanted in 71% patient and 54% patients given spectacles.&#x0D; Conclusion : Unilateral cataract is disease with isolated and sporadic incident. The majority of patients did not have systemic condition related to unilateral cataract. The most common treatment is phacoaspiration, primary posterior capsulotomy, anterior vitrectomy and intraocular lens implantation.

PERSISTENT SUBRETINAL FLUID AFTER VITRECTOMY FOR MACULAR HOLE-ASSOCIATED RETINAL DETACHMENT.

To evaluate the incidence, associated factors, and outcome of persistent subretinal fluid (SRF) after vitrectomy for macular hole-associated retinal detachment (MHRD). A total of 158 eyes from 156 patients with MHRD who achieved macular hole closure after primary vitrectomy were included in the analysis; persistent SRF was defined as the presence of SRF for more than 1 month after first surgery. Preoperative and postoperative parameters were analyzed for their relationship with SRF development. Persistent SRF was observed in 19 eyes (12.0% of 158) postoperatively. Seven eyes (36.8% of 19) with persistent SRF eventually displayed complete absorption during follow-up. Univariate analysis revealed that eyes with persistent SRF were statistically associated with internal limiting membrane inverted flap, duration of symptoms, tamponade (perfluoropropane/silicone oil: 14/5 vs. 35/104, P < 0.001), and MHRD subtype (Type 1/Type 2/Type 3: 15/4/0 vs. 60/40/39, P = 0.003). In multivariate analysis, only internal limiting membrane inverted flap (odds ratio, 15.778, 95% confidence interval, 3.170-78.523; P = 0.001) was positively associated with persistent SRF. There were no significant differences in best-corrected visual acuity improvement ( P = 0.425) between the SRF involved foveal and without involved foveal groups and no significant differences between the SRF complete absorption and incomplete absorption groups. Absorption of persistent SRF may be more difficult in MHRD eyes than in ordinary rhegmatogenous retinal detachment eyes. The internal limiting membrane inverted flap in MHRD was associated with a greater likelihood of persistent SRF. The location and incomplete absorption of persistent SRF did not seem to be associated with the final visual outcome.

The Effects of Cataract Surgery on Children's Vision: A Systematic Review.

Five-fifths of all incidents of blindness in Saudi Arabia may be attributed to cataracts. Cataracts are the second major cause of blindness, responsible for 35.5% of cases. Therefore, the purpose of the research was to measure the visual acuity improvement after cataract surgery in children. This systematic review followed PRISMA guidelines for reporting systematic reviews. All procedures followed the recommendations of the Cochrane handbook. Studies of varying study designs, both published and unpublished, are included. Retrospective studies with outcomes of pediatric cataract surgery were identified from various databases. After an initial screening, 108 out of 167 items were deemed unsuitable for publication. There were 59 full-text papers assessed for inclusion, and only seven matched the criteria. All the articles included were of a very high standard. Both the duration of therapy and the target population varied widely between the studies. The results indicated that the majority of childhood cataracts are hereditary. Primary posterior capsulectomy and anterior vitrectomy combined with cataract extraction and intra-ocular lens implantation is the treatment of choice for pediatric cataracts. It is recommended that surgery be performed in a properly equipped facility staffed by trained, cooperative personnel and that different procedures be used to enhance post-operative follow-up.

Presentation of cases who underwent vitrectomy for the management of idiopathic epiretinal membranes (iERM)

Epiretinal membrane (ERM) is a term used to describe cellular avascular membranes that form on the inner retinal surface, causing distortion and a decrease in the best corrected visual acuity (BCVA). The prevalence of ERM ranges from 7% to 29% in the general population. Pre‐macular fibroplasia, macular pucker, cellophane maculopathy and pre‐macular fibrosis have also been used to describe this condition. The majority of ERM's have no associated ocular abnormality and are termed idiopathic while the secondary ERM's are associated with preexisting or coexisting conditions such as diabetic retinopathy, cataract surgery, retinal detachment and retinal detachment surgery.Patients with ERM are usually monitored by measuring BCVA and retinal morphology. Last decades a valuable tool in diagnosis, grading, follow up and post‐surgical evaluation of ERM is Optical Coherence Tomography (OCT). OCT can demonstrate the presence of ERM, degree of traction, the presence of cystoid macular edema and various biomarkers such us the disorganization of the inner retinal layers (DRIL).ERM may remain stationary with minimal effect on visual performance. However, some cases may progress with worsening of symptoms, increasing retinal thickness and traction. In those symptomatic cases, surgical peeling of ERM through pars plana vitrectomy (PPV) is the treatment of choice. Some surgeons prefer to peel the Internal limiting membrane (ILM) during primary vitrectomy. Previous studies showed that 40–83% of patients gain on average of 2 or more lines of BCVA after ERM surgery.We present three cases of successful surgical ERM repair. The first patient had a longstanding ERM with DRIL, his symptoms were metamorphopsia and low vision. One month following vitrectomy gained 5 lines. BCVA improved from CF pre‐op to 5/10 Snellen chart 1 month post‐op, with good macular anatomical restoration. The second patient, 1 month postoperatively, had also good anatomical result but presented an eccentric macular hole even though we did not perform an ILM peel. The third patient, 18 months after a successful vitrectomy for ERM peel in his only eye and BCVA 8/10 cc on Snellen chart the first 6 months, he experienced a decline in his vision and an OCT revealed a full thickness macular hole. Hence, a second operation was performed with ILM peel and good anatomical and functional restoration.

Visual outcomes and prognostic factors of early pars plana vitrectomy for open globe injury.

To identify the clinical features and outcomes of early vitrectomy in patients with open globe injury (OGI) and the prognostic factors for visual outcome. This retrospective observational case series included 390 eyes in 389 patients diagnosed with OGI receiving vitrectomy within four days after injury. Preoperative parameters included the injury types, wound locations, consequent tissue damages, initial visual acuity (VA), and ocular trauma score. Postoperative outcome measures included surgical procedures, retinal (re)attachment, complications, and final VA. The logistic analysis evaluated the prognostic factors for visual outcome. Intraocular foreign bodies (59.2%) and penetrating injuries (28.7%) were the most common injury types. Among the 165 eyes with retinal detachment (RD), 121 (73.3%) had retinal reattachment during early primary vitrectomy, and 32 (19.4%) were repaired during a second or subsequent surgery. Thirteen eyes (3.3%) were enucleated. The final VA improved from the initial level in 207 eyes (55.2%), remained unchanged in 123 (32.8%), and decreased in 45 (12.0%). Multivariable regression revealed that the injury zone, initial VA, RD, and endophthalmitis were associated with poor visual outcomes (P < 0.05). Higher zone injury, low initial VA, RD, and endophthalmitis are predictors of poor visual outcome in eyes undergoing early vitrectomy for OGI.

Алгоритм лечения далеко зашедшей пролиферативной диабетической ретинопатии

Purpose. To develop an algorithm for the treatment of patients with advanced proliferative diabetic retinopathy with the determination of the stages of laser and surgical methods and evaluate its effectiveness. Material and methods. The study group included 38 patients (38 eyes) with type 1 diabetes mellitus (21 patients) and type 2 diabetes mellitus (17 patients, 16 of them with the insulin-requiring form of the disease). Patients age ranged from 24 to 75 years (41±8.6 years) old. All patients underwent staged treatment. Primary subtotal three-port 27 G vitrectomy was performed. Transpupillary patterned panretinal laser coagulation was performed at 1,5–2 months after the first stage of treatment. Panretinal laser coagulation was performed with a hexagonal matrix pattern with a laser spot diameter of 300 µm, exposure time of 30 ms on an Integre Pro Scan laser device (Ellex, Australia) with a wavelength of 561 nm using a panfundus lens. In cases of gas-air tamponade, panretinal laser coagulation was performed according to the same parameters in two sessions with an interval of 1–2 months between them, the average number of coagulates per session was 1053±107 applications. As the third stage of treatment, 1,5–2 months after panretinal laser coagulation, those patients whose vitreal cavity was tamponed with silicone oil underwent vitrectomy with the removal of silicone oil and it's replacement with a balanced solution. Results. The total number of treatment steps in the observation group (n=34) ranged from 1 to 5 and averaged 3±0.97. The time from primary vitrectomy followed by patterned panretinal laser coagulation to silicone oil removal was at average 3.7±0.48 months. Performing primary subtotal vitrectomy as the first stage of combined treatment made it possible achieve retinal attachment and its visualization throughout, to perform surgical intervention without massive endolaser coagulation, which reduced the duration of surgery and accelerated postoperative rehabilitation. The subsequent transpupillary panretinal laser coagulation of the retina in the pattern mode provided a dosed precision effect on the retina and made it possible perform the laser stage of treatment in one session. Conclusion. A step-by-step algorithm, including primary subtotal vitrectomy followed by simultaneous transpupillary pattern laser coagulation of the retina, is effective and safe in the treatment of proliferative diabetic retinopathy complicated by hemophthalmos. Key words: proliferative diabetic retinopathy, treatment algorithm, surgical treatment, laser treatment, vitrectomy, pattern laser coagulation

Vitrectomy for retinal detachment associated with macular hole: Prognostic factor analysis under different axial length conditions.

To identify prognostic factors for complete anatomical success (CAS) under different axial length (AL) conditions after vitrectomy plus internal limiting membrane (ILM) peeling for retinal detachment associated with macular hole (MHRD). This retrospective study included 243 patients (251 eyes) with MHRD who underwent primary vitrectomy plus ILM peeling. Multivariate logistic regression explored prognostic factors for CAS in AL <30 mm and ≥ 30 mm groups. Overall, 113 eyes (45.0% of 251) exhibited complete CAS after initial surgery. Eyes with CAS had greater best-corrected visual acuity improvement than eyes without CAS (p < 0.001). CAS was more common in eyes with AL < 30 mm (50.3% of 155) than in eyes with AL ≥ 30 mm (36.5%, 35/96; p = 0.032). In the AL < 30 mm group, CAS was associated with ILM insertion (odds ratio [OR], 2.824, 95% confidence interval [CI], 1.189-6.710; p = 0.019), silicone oil (SO)/perfluoropropane (C3F8) tamponade (SO: OR, 0.408, 95% CI, 0.191-0.873; C3F8: OR, 2.448, 95% CI, 1.145-5.234; p = 0.021) and staphyloma (OR, 0.318, 95% CI, 0.143-0.707; p = 0.005). In the AL ≥30 mm group, CAS was associated with ILM insertion (OR, 11.621, 95% CI, 2.557-52.813; p = 0.001), SO /C3F8 tamponade (SO: OR, 5.305, 95% CI, 1.206-23.334; C3F8: OR, 0.188, 95% CI, 0.043-0.829; p = 0.027) and age (OR, 0.928, 95% CI, 0.876-0.983; p = 0.011). Vitrectomy plus ILM peeling can effectively treat MHRD but has limited efficacy in eyes with AL ≥ 30 mm. ILM insertion was associated with more frequent CAS at any AL. C3F8 tamponade yielded better outcomes with AL < 30 mm; SO tamponade yielded better outcomes with AL ≥ 30 mm.

Современные подходы к оказанию высокотехнологичной офтальмологической помощи детям с ретинопатией недоношенных в Калужском филиале МНТК «Микрохирургия глаза»

Purpose. To present modern approaches to providing high-tech ophthalmic care to children with retinopathy of prematurity (ROP) in Kaluga branch of the S. Fyodorov Eye Microsurgery Federal State Institution. Methods. For the 2003–2022 period screening for detection of active ROP was carried out in 16 000 premature infants. Various stages of the disease were identified in 4129 premature infants (24.9 %). Premature infants with various stages and forms of active ROP have been subjected to multimodal diagnostics of changes in the vascular system of the eye since 2016. Early laser treatment by pattern laser coagulation of the retina using hexagonal patterns was carried out in 226 children (286 eyes) in 2016–2021. Transpupillary laser coagulation of the retina using navigatied laser system was performed in 16 premature babies (26 eyes) in 2021–2023. Primary vitrectomy for severe stage 3 active ROP with the development of extraretinal retinovitreal neovascularization involving the posterior hyaloid membrane was performed in 9 premature infants (12 eyes) in 2021–2023. Results. Based on a comprehensive analysis of the results of multimodal diagnostics, informative prognostic signs of the type of active ROP were established, according to the data of fluorescein angiography of the fundus, spectral optical coherence tomography in the angio mode, and color duplex scanning. These signs provide an accurate definition of the type of course of the disease – a decisive factor in the choice of tactics for managing patients. The developed technologies of pattern hexagonal and navigatied laser coagulation of the retina provide maximal percentage of disease regression. These technologies create the most favorable conditions for further development of visual functions. Primary vitrectomy in all cases made it possible to achieve stable regression of the pathological process. Conclusion. Modern approaches to the provision of high-tech ophthalmic care for children with ROP, implemented in Kaluga branch of S. Fyodorov Eye Microsurgery Federal State Institution, provide high efficiency in the treatment of active ROP with a minimal risk of late complications in the cicatricial period of the disease. Key words: retinopathy of prematurity; multimodal diagnostics; navigated laser coagulation of the retina; primary vitrectomy.

OCT biomarkers in predicting postoperative visual acuity after primary vitrectomy for rhegmatogenous retinal detachment

OCT biomarkers in predicting postoperative visual acuity after primary vitrectomy for rhegmatogenous retinal detachment

Early diagnosis of primary open-angle glaucoma in patients after primary vitrectomy due to rhegmatogenous retinal detachment

Early diagnosis of primary open-angle glaucoma in patients after primary vitrectomy due to rhegmatogenous retinal detachment

Outcomes of revision surgery for idiopathic macular hole after failed primary vitrectomy.

Persistent idiopathic macular hole (PIMH), the occurrence of idiopathic macular holes that have failed to close after standard pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling, has become a global health threat to the aging population. Because postoperative anatomic closure or restoration of visual acuity is more difficult to achieve in PIMH, surgical approaches that would yield the best outcomes remain to be elucidated. On paper, extended ILM peeling combined with silicone oil (SiO) tamponade is believed to be a feasible option for excellent macular hole closure. However, no studies on this combined treatment for PIMH is compared with simple air tamponade have been conducted. Thus, in this retrospective case series, we used spectral-domain optical coherence tomography (SD-OCT) and other technologies to investigate real-world evidence for the anatomical and functional outcomes of revisional PPV with either SiO or air tamponade for failed primary idiopathic macular hole surgery. We included the records of 76 patients with PIMH who had SD-OCT examinations and best-corrected visual acuity (BCVA). Regression analysis was performed to find factors affecting PIMH fracture closure. Seventy-six participants were allocated to a SiO group (n = 21, with an extended ILM peeling and SiO tamponade) or an air group (n = 55, with extended ILM peeling and air tamponade). Anatomical success was achieved in 18 (85.7%) and 40 (72.7%) eyes in the SiO and air groups, respectively (p = 0.37). BCVA was significantly improved in both subgroups of closed PIMH (SiO group: p = 0.041; air group: p < 0.001). Minimum linear diameter (MLD) was closely related to the closure rate (OR, 1.0; 95% CI (0.985-0.999); p = 0.03). MLD = 650 μm seemed like a cut-off point for closure rate (MLD ≤ 650 μm vs. MLD > 650 μm; 88.4% vs. 52%, p = 0.002). In conclusion, we demonstrated that extended ILM peeling combined with SiO or air tamponade is effective in PIMH treatment. Moreover, though not statistically significant herein, the anatomic closure rate was better for silicone-operated eyes than for air-operated eyes. MLD is the best predictor of PIMH closure; MLD ≤ 650 μm could achieve a significantly higher closure rate.

Risk factors for failure after primary vitrectomy with no scleral buckling for rhegmatogenous retinal detachment

Risk factors for failure after primary vitrectomy with no scleral buckling for rhegmatogenous retinal detachment

Complications Occurring Through 5 Years Following Primary Intraocular Lens Implantation for Pediatric Cataract

Lensectomy with primary intraocular lens (IOL) implantation is often used in the management of nontraumatic pediatric cataract, but long-term data evaluating the association of age and IOL location with the incidence of complications are limited. To describe the incidence of complications and additional eye surgeries through 5 years following pediatric lensectomy with primary IOL implantation and association with age at surgery and IOL location. This prospective cohort study used Pediatric Eye Disease Investigator Group cataract registry data from 61 institution- and community-based practices over 3 years (June 2012 to July 2015). Participants were children younger than 13 years without baseline glaucoma who had primary IOL implantation (345 bilateral and 264 unilateral) for nontraumatic cataract. Data analysis was performed between September 2021 and January 2023. Lensectomy with primary IOL implantation. Five-year cumulative incidence of complications by age at surgery (<2 years, 2 to <4 years, 4 to <7 years, and 7 to <13 years) and by IOL location (sulcus vs capsular bag) were estimated using Cox proportional hazards models. The cohort included 609 eyes from 491 children (mean [SD] age, 5.6 [3.3] years; 261 [53%] male and 230 [47%] female). Following cataract extraction with primary IOL implantation, a frequent complication was surgery for visual axis opacification (VAO) (cumulative incidence, 32%; 95% CI, 27%-36%). Cumulative incidence was lower with anterior vitrectomy at the time of IOL placement (12%; 95% CI, 8%-16%) vs without (58%; 95% CI, 50%-65%), and the risk of undergoing surgery for VAO was associated with not performing anterior vitrectomy (hazard ratio [HR], 6.19; 95% CI, 3.70-10.34; P < .001). After adjusting for anterior vitrectomy at lens surgery, there were no differences in incidence of surgery for VAO by age at surgery (<2 years, HR, 1.35 [95% CI, 0.63-2.87], 2 to <4 years, HR, 0.86 [95% CI, 0.44-1.68], 4 to <7 years, HR, 1.06 [95% CI, 0.72-1.56]; P = .74) or by capsular bag vs sulcus IOL fixation (HR, 1.22; 95% CI, 0.36-4.17; P = .75). Cumulative incidence of glaucoma plus glaucoma suspect by 5 years was 7% (95% CI, 4%-9%), which did not differ by age after controlling for IOL location and laterality. In this cohort study, a frequent complication following pediatric lensectomy with primary IOL was surgery for VAO, which was associated with primary anterior vitrectomy not being performed but was not associated with age at surgery or IOL location. The risk of glaucoma development across all ages at surgery suggests a need for long-term monitoring.

Four-port Vitrectomy in Rhegmatogenous Retinal Detachment

Purpose: The study investigated the results of direct surgical scleral depression using four ports and the chandelier lighting system in rhegmatogenous retinal detachment.Methods: Anatomical and functional success rates and complications were analyzed in 179 eyes diagnosed with rhegmatogenous retinal detachment that underwent primary vitrectomy using four ports at our hospital between March 2012 and February 2022.Results: A total of 168 (93.9%) eyes had anatomical success without reoperation while 11 (6.1%) developed recurrence. However, the final success rate was 100%. The best-corrected visual acuity improved significantly from logarithm of the minimum angle of resolution (logMAR) 1.03 ± 0.92 to logMAR 0.24 ± 0.39 after surgery (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). Complications included a temporary increase in the intraocular pressure (n = 3, 1.7%), leakage through the scleral incision (n = 2, 1.1%), hyphema and vitreous hemorrhage (n = 10, 5.6%), and iatrogenic retinal break (n = 1, 0.6%), but these improved after treatment.Conclusions: Four-port vitrectomy for rhegmatogenous retinal detachment in which scleral depression is directly performed using the chandelier lighting system is a useful surgical method. It allows effective visualization of the peripheral retina regardless of the assistant’s proficiency which results in a more meticulous surgery. The anatomical and functional results of this technique were similar to the conventional technique.

The Emulsification of Silicone Oil 5000 cs in Patients With Retinal Detachment.

Background The emulsification of silicone oil is a significant concern for those with rhegmatogenous retinal detachment (RRD) following surgery. The aim of the study was to assess the frequency of emulsification in the patients who underwent primary vitrectomy and were administered 5000 cs silicone oil. Methodology The Layton Rahmatullah Benevolent Trust in Lahore conducted an ophthalmology study from January 2022 to March 2023. The patients who had primary vitrectomy for RRD with silicone oil tamponade were included regardless of age or gender. Those on anti-inflammatory or steroid medications prior to surgery were excluded. Retinal attachment was examined 8-12 weeks post operation to assess silicone oil removal eligibility. Emulsification occurrence was reported. Data on emulsification time, visual acuity (pre- and post-removal), mean intraocular pressure (IOP), and clinical outcomes were collected and analyzed using the Statistical Package for Social Sciences (SPSS) software (IBM SPSS Statistics, Armonk, NY). The results were graphically presented with mean, standard deviations, frequencies, and proportions. Results A total of 158 patients underwent silicone oil removal after undergoing primary vitrectomy for RRDwith silicone oil. The mean age of the patients was 45.90 ± 17.8 years. The mean preoperative intraocular pressure (IOP) among the patients was 16.28 ± 2.97 mmHg. Post removal of silicone oil, the IOP was reduced to 12.66 ± 3.02 mmHg. In 11 out of 158 cases (6.9%) of RRD, emulsification had occurred with silicone oil 5000 cs. We found that out of 11 cases of emulsification, eight (72.73%) were 40 years or older in age. Seven (63.64%) patients had tamponade duration of 10 weeks or longer. However, the difference was not statistically significant. Conclusion In conclusion, our study found that the incidence of emulsification of 5000 cs silicone oil in the patients who underwent primary vitrectomy for the treatment of RRD was 6.9%. We observed that emulsification was more frequent in patients aged 40 years or older and those with a tamponade duration of 10 weeks or longer, although the difference was not statistically significant. Further investigation with bigger sample sizes and extended follow-up periods is required to verify our findings and explore potential factors that could lead to emulsification in this group of patients.

Effects of Perfluorocarbon Use during Rhegmatogenous Retinal Detachment Surgery on Postoperative Outcomes

Introduction: The aim of this study was to determine whether the use of perfluorocarbon liquid (PFCL) affects the rate of retinal re-attachments after an initial attachment by vitrectomy in eyes with rhegmatogenous retinal detachment (RRD). Methods: This was a retrospective, observational, multicenter study of 3,446 eyes registered in the Japanese vitreoretinal surgery treatment information database. Of these, 2,648 eyes had undergone vitrectomy as the first surgery for RRD. The re-attachment rates after the primary vitrectomy with or without PFCL were evaluated. In addition, the significance of factors affecting the re-detachments was determined by univariate and multivariate analyses. The measured outcomes were the rates of re-attachments after the primary vitrectomy with or without the use of PFCL. Results: A total of 2,362 eyes in the database were analyzed: 325 had and 2,037 did not have PFCL injected into the vitreous cavity during the vitrectomy. The rate of re-attachments was 91.5% in the PFCL group and 93.2% in the non-PFCL group (p = 0.46, χ² test). Although there were several risk factors associated with the re-detachments in eyes without PFCL (p < 0.05, Welch’s t tests, and Fisher’s exact tests), they were not associated in eyes with PFCL use. However, multivariate analyses showed that there was no significant association between the use and the non-use of PFCL in the rate of re-detachments (β = −0.08, p = 0.46). Conclusions: The use of PFCL during the initial vitrectomy for RRD does not affect the rate of re-attachments.