Primary Vitrectomy Research Articles

Influence of Scone Oil on Iris Microangiopathy in Diabetic Vitrectomized Eyes

This study evaluates the influence of intraocular silicone oil on iris diabetic microangiopathy in diabetic vitrectomized eyes. The authors examined 20 eyes of 20 patients with diabetes undergoing primary vitrectomy for fractional diabetic retinal detachment, endophotocoagulation, and 1000 centistokes silicone oil tamponade. The vascular status of the iris in these eyes was examined by iris fluorescein angiography once before silicone oil injection and again when it was removed (mean follow-up, 8.3 months). Iris diabetic microangiopathy, including breakdown of the blood-iris barrier and iris neovascularization, improved or remained stable in 40% of eyes. It worsened in 60% of eyes, including all aphakic eyes. Neovascular glaucoma developed in one of them. A significant correlation was found between worsening of iris diabetic microangiopathy and both aphakia (P = 0.01) and severe immediate postvitrectomy inflammation (P = 0.02). Eyes with recurrent retinal detachment (n = 4) showed worsening of iris diabetic microangiopathy, but this was not significantly correlated. Aphakic vitrectomized eyes have a higher risk of iris diabetic microangiopathy developing, even after silicone oil tamponade. Immediate postoperative intraocular inflammation also is a risk factor for worsening of iris diabetic microangiopathy in phakic eyes. Recurrence of retinal detachment was not significantly correlated with worsening of iris status.

The management of intraocular foreign bodies

This study of 69 cases of retained intraocular foreign body confirms that eyes with anterior segment foreign bodies fare better than those with posterior segment foreign bodies, that eyes with smaller foreign bodies fare better than those with larger, and that the magnet is the safest method of removal. There is no evidence to support primary vitrectomy in every case of posterior segment foreign body. Computerised tomography is the best method of localisation, but a foreign body can be missed on computerised tomography, and a plain x-ray is still the best method of detection.

Silicone Oil Injection After Failed Primary Vitreous Surgery in Severe Ocular Trauma

In 42 cases of complicated retinal detachment following trauma after failed primary vitrectomy, at six months follow-up anatomic retinal reattachment posterior to the scleral buckle was achieved in 20 of 40 eyes (50%). Of the 40 eyes, 11 (28%) had a visual acuity of 5/200 or better. Of the eyes that were completely attached posterior to the buckle at six months, 13 of the 20 (65%) remained attached at the last follow-up examination. Many patients who had visual acuities of 5/200 or better at six months experienced a progressive decrease in visual acuity over three years, primarily because of recurrent retinal detachments and corneal edema. A final visual acuity of 5/200 or better was obtained in only five of the 42 eyes (12%) at the last follow-up examination.

Anterior bulbus perforation and vitrectomy in the 'minipig'.

Wound healing after experimental anterior eye perforation, including lens, ciliary, body and vitreous, was studied in 12 miniature pigs (minipigs). In half of the eyes, perforation was followed by removal of the damaged lens and suturing of the wound. In the other half, a primary subtotal vitrectomy was performed after removal of the lens. The behaviour of the connective tissue in the wound-healing process was not fundamentally changed by subtotal vitrectomy. In both groups very little fibrous ingrowth into he vitreous structure was observed, suggesting that the pig vitreous has marked antifibroplastic properties. The anatomical and technical features of vitrectomy in the minipig, and the advantages and disadvantages of this animal model are discussed. It appears that the eye of the minipig is ideal for the study of biochemical factors preventing fibrous ingrowth into the vitreous.

Electrocoaptation conjunctival closure in retinal detachment surgery.

This report describes the method of electrocoaptation, a sutureless technique for closure of the conjunctiva, in 75 patients who underwent primary scleral buckling or vitrectomy procedures. The technique is safe, rapid, easily performed, and results in a secure wound that heals well.

Vitrectomy in the management of intraocular foreign bodies and their complications.

Twenty-six eyes with intraocular foreign bodies (IOFB) and/or their sequelae were treated by pars plana vitrectomy and associated surgery. One-step removal of the IOFB in combination with pars plana vitrectomy resulted in early visual rehabilitation and minimal complications. Of 11 eyes with IOFB treated by primary vitrectomy at the time of IOFB removal 20/50 or better visual acuity was obtained in 10 (91%). Four of these eyes had retinal injury, 3 of which were successfully repaired without subsequent complication and with retention of good visual function. In 3 eyes IOFBs were not removed owing to chronic retinal encapsulation. These eyes continue to retain good visual acuity, and ERG studies show no evidence of retinal toxicity. Of 12 eyes in which vitrectomy was performed for sequelae of IOFB only 5 (41%) showed visual improvement better than 20/50. Only in 2 of 7 eyes with tractional retinal detachment could the retina be reattached. In cases of retinal injury primary vitrectomy, cryocoagulation, and scleral buckling are suggested for prevention of late traction retinal detachment.

Primary vitrectomy as a preventive surgical procedure in the treatment of severely injured eyes.

The results of treating 72 severely injured eyes by primary vitrectomy combined with anterior and posterior segment reconstruction are presented. This approach aims at improving the visual prognosis by allowing fundus examination and immediate retinal surgery where indicated, and by preventing the more severe complications associated with vitreous and anterior segment disorganisation. The prospects for improved visual results and the problems encountered, particularly secondary haemorrhage, are discussed.

Surgical management challenges and clinical results of bimanual micro-incision phacoemulsification cataract surgery in children with congenital cataract

Small incisions in cataract surgery have shown to reduce tissue damage, postoperative inflammation and pain. To describe in detail the surgical management challenges and clinical results of bimanual micro-incision phacoemulsification cataract surgery in children with congenital cataract. In 22 eyes of 14 children aged from 11 months to 17 years with congenital cataract, micro-incision cataract surgery with lensectomy, bimanual aspiration or phacoemulsification and implantation of an intraocular lens (SN60WF, Alcon®) was performed under general anesthesia. The visual equivalent obtained with age-related methods, the slit-lamp examination, and refractive outcome were documented in the medical records and were analyzed retrospectively. The patients fulfilled at least 3 months of follow up. In all operated eyes, micro-incision cataract surgery could be performed without serious intra-operative complications. Lensectomy was safely combined with a primary posterior capsulorhexis and anterior vitrectomy in 17 of 22 eyes. Corneal incision length ranged between 2.2 mm and 2.6 mm (mean: 2.3 ± 0.2 mm). No cases of postoperative hypotony and increased inflammation were observed. One eye required surgical removal of the after-cataract 7 months after surgery. Laser capsulotomy for posterior capsular opacification had to be performed in 2 (9 %) eyes. In all other eyes (19/22), visual axis remained clear during follow-up. Micro-incision cataract surgery is a promising alternative to conventional pediatric cataract surgery, since the technique showed to be comparably safe and effective. Longer follow-up examinations will now be performed.

Corneal approach 20 Guage vitrectomy system for the management of congenital cataract.

Objective:To evaluate the efficacy and complications of 20 gauge vitrectomy via corneal approach for the management of congenital cataract.Method:We performed anterior capsular vitreorhexis, lens matter aspiration (LMA), primary posterior vitrectorhexis and anterior vitrectomy via corneal approach using 20 gauge vitrectomy system in children younger than two years of age with congenital cataract between January 2014 to December 2014. The intra and postoperative complications were observed.Results:Twenty nine eyes of 21 children were included in this study. Congenital cataract surgery using 20 gauge vitrectomy system via corneal approach did not reveal any intra operative complication. Post operatively all children were able to freely open their operated eyes. Conjunctival congestion at the incision site in four eyes and mild anterior chamber reaction in 8 eyes were seen on 1st daywhich resolved at one week follow up. Other major post operative complications such as inflammatory membrane, irregular pupil, posterior/anterior syneache and opacification of visual axis were not seen during follow up period.Conclusion:The 20-gauge vitrectomy system via corneal approach is easy to perform, is less time consuming, safe and effective for the management of congenital cataract in younger children.