Role Of Pars Plana Vitrectomy Research Articles

Review on Surgical Management of Diabetic Macular Edema

Literature review for surgical management for both tractional and non-tractional diabetic macular edema; with and without internal limiting membrane peeling. According to the DRCR prospective study, traction relaxation allowed vision gain and reduction in central foveal thickness in tractional diabetic macular edema. Also data from small scale and pilot studies about the role of pars plana vitrectomy for non-tractional CI-DME management, showed visual gain and edema resolution in both naive and refractory cases. It is concluded that pars plana vitrectomy has a role the management of DME; however, large scale trials are needed to define the role, optimum timing, and patients characteristics for the usage of vitrectomy in non-tractional DME management.

The role of pars plana vitrectomy in the management of fungal endogenous endophthalmitis.

To identify the causative microorganism of fungal endogenous endophthalmitis in our tertiary referral uveitis center and review the therapeutic role of pars plana vitrectomy in patients with fungal endogenous endophthalmitis. Seven eyes of six cases were identified as fungal endogenous endophthalmitis through positive cultures of ocular fluids and clinical presentations. The final anatomical and functional results were evaluated. Four women (66.7%) and two men (33.3%) underwent vitrectomy. Control of infection was achieved early on in all cases. Candida (71.4%) and Aspergillus (28.6%) species were identified as causative fungi in patients with fungal endogenous endophthalmitis. Two patients were reoperated due to reinfection and retinal detachment, respectively. Visual acuity improved in six eyes (85.7%) and worsened in one eye (14.3%). At the final examination, the retina was flat in all cases. No eye developed phthisis bulbi. Candida species are the most common causative organisms of fungal endogenous endophthalmitis in this study. Pars plana vitrectomy in fungal endogenous endophthalmitis may enhance the treatment of infection by removing fungal elements in the vitreous and aid in diagnosis. Vitrectomy may also be an important tool in the management of vision-threatening post-infectious sequelae such as retinal detachment and reinfections.

Comparison of microbiology and visual outcomes of patients undergoing small-gauge and 20-gauge vitrectomy for endophthalmitis.

BackgroundThe role of pars plana vitrectomy (PPV) for endophthalmitis has evolved over recent decades but the literature is lacking on comparisons between small-gauge and 20-gauge vitrectomy.ObjectiveTo evaluate evolving etiological and microbiological trends in patients undergoing vitrectomy for endophthalmitis and to compare culture-positive rates and visual outcomes between small-gauge (23- and 25-gauge) and 20-gauge instrumentation during vitrectomy for endophthalmitis.MethodsTen-year retrospective comparative case series and prospective laboratory in vitro testing. Tertiary care academic referral center. Patients who underwent PPV for endophthalmitis between 2003 and 2013. Vitreous biopsies were obtained in all cases. The effect of vitrectomy gauge (20-, 23-, and 25-gauge) and vitreous cutting rate (1,500 and 5,000 cuts per minute) on the viability of bacterial culture was evaluated in an in vitro prospective laboratory investigation.Main outcome measuresComparison of etiology, microbiology culture-positive rates, and visual outcomes between small-gauge and 20-gauge instrumentation in patients undergoing PPV for infectious endophthalmitis.ResultsA total of 61 cases of vitrectomy for endophthalmitis were identified over a 10-year period; of these, 34 were treated with small-gauge (23- and 25-gauge) vitrectomy and 27 were treated with 20-gauge vitrectomy. In the small-gauge group, 12 cases (35.3%) yielded culture-positive results versus 20 cases (74.1%) with culture positivity in the 20-gauge cohort (P=0.002). The most common cause of endophthalmitis was cataract surgery and the most frequently identified organism was coagulase-negative Staphylococci in both groups. There was no significant difference in mean postoperative visual acuities between groups (P=0.33). Etiological trends indicate an increase in endophthalmitis due to intravitreal injection in the small-gauge group (n=9) compared to the 20-gauge group (n=3) (P=0.001). In vitro laboratory testing revealed no significant difference in rates of culture growth for different vitrectomy gauge sizes or vitreous cutting speeds.Conclusion and relevanceSmall-gauge vitrectomy for endophthalmitis yields final visual outcomes comparable to 20-gauge instrumentation. A significant difference in culture-positive rates was observed between small-gauge and 20-gauge instrumentation for vitrectomy in endophthalmitis; however, laboratory testing indicates this is not related to either vitreous gauge size or cutter speed. Intravitreal injections are emerging as a common etiology of vitrectomy for endophthalmitis.

Pars Plana Vitrectomy alone vs Vitrectomy with scleral buckling for PRDs

AbstractPseudophacik Retinal Detachment is a subgroup of Rhegmatogenous Retinal Retachments with some unique characteristics, such as the number and location of retinal breaks, certain intraoperative technical difficulties and possibly an increased risk of proliferative vitreoretinopathy. Recent evidence has established the role of pars plana vitrectomy as a primary method of managing these cases. The role of using scleral buckling techniques in combination with vitrectomy as well as the types of buckling that could be used remains controversial. At this talk, the above issues will be discussed in full, and a review of the literature as well as the personal experience of the speaker will attempt to clarify the role of using combined techniques in managing those cases.

Pars Plana Vitrectomy for Vitreoretinal Complications of Behçet Uveitis

Purpose. To evaluate the role of pars plana vitrectomy (PPV) for the treatment of vitreoretinal complications of ocular Behçet disease (BD). Methods. Retrospective review of the medical records of all patients who underwent PPV for vitreoretinal complications of Behçet uveitis in the Ophthalmology Department of the Hospital Clinic of Barcelona, Barcelona, Spain, from January 1994 until December 2011. Preoperative and postoperative best-corrected visual acuities (BCVA), ocular findings, treatments, surgical indications, and outcomes were evaluated in all patients. Results. Twelve patients (14 eyes) were included in the study. Indications for PPV were the following: vitreous hemorrhage in 4 eyes (28.5%), persistent vitreous opacities in 3 eyes (21.4%), rhegmatogenous retinal detachment in 2 eyes (14.3%), macular hole in 2 eyes (14.3%), persistent cystoid macular edema in 2 eyes (14.3%), and combined tractional and rhegmatogenous retinal detachment in 1 eye (7.1%). At last examination (median follow-up 105 months, range 6-209 months), BCVA increased 3 Snellen lines or more in 6 eyes (42.9%). Immunosuppressive treatment could be reduced in 5 patients (41.6%). No serious ocular inflammatory episodes presented during the follow-up in those operated patients. Conclusions. In this retrospective series with long-term follow-up, PPV can treat secondary vitreoretinal complications of Behçet uveitis, restoring or stabilizing vision without major adverse events.

The Role of Pars Plana Vitrectomy in the Diagnosis and Treatment of Uveitis

To assess the diagnostic yield of vitreous fluid analysis and the therapeutic effect of pars plana vitrectomy in patients with suspected intraocular inflammation. During 2004-2008, pars plana vitrectomy was performed in 89 patients (101 eyes) out of 1233 patients with uveitis. Vitreous specimens were analyzed by cytologic and histopathologic examination, microbiologic culture, polymerase chain reaction, antibody determination, and flow cytometry. Vitrectomy was performed in 85 eyes for both diagnostic and therapeutic purposes; the remaining 16 eyes underwent only diagnostic pars plana vitrectomy. Preoperative and postoperative best-corrected Snellen visual acuity was compared. Preoperative diagnoses were infection in 40 patients, malignant masquerade syndrome in 10 patients, and idiopathic uveitis in 39 patients. Vitreous analysis contributed to the determination of diagnosis in 54 patients (61%). Final diagnoses were infection in 42 patients, malignant masquerade syndrome in 6 patients, benign masquerade syndrome in 16 patients, and idiopathic uveitis in 25 patients. Vitreous fluid collected from each eye underwent approximately 2.2 (range 1-6) laboratory tests. Therapeutic reasons for vitrectomy were the treatment of complications of uveitis in 42 eyes and/or intravitreal application of anti-infectious or cytostatic drugs in 49 eyes. Overall, the visual acuity improved in 45% of eyes, remained unchanged in 45% of eyes, and decreased in 10% of eyes in 3 months after surgery. Pars plana vitrectomy with carefully selected testing is a valuable tool for assessment of diagnosis in a large proportion of patients with uveitis. Moreover, the therapeutic effect of vitrectomy can improve the visual outcomes in these patients.

Vitrectomy in Diabetic Retinopathy

Pars plana vitrectomy (PPV) is integral to the management of late complications in diabetic retinopathy. As a greater understanding of the pathophysiology of diabetic eye disease has developed, so the role of PPV has evolved. This article reviews the current indications for PPV in diabetes (vitreous haemorrhage, tractional retinal detachment and combined rhegmatogenous and tractional retinal detachment) and the evidence for potential future applications, such as in diabetic macular oedema. The role of pharmacological adjuncts, such as antivascular endothelial growth factor (VEGF) agents, to reduce intraocular complications, improve success rates and minimise post-operative complications is examined. Drug-induced vitreolysis as a tool in achieving complete vitreoretinal separation, thus reducing progression of diabetic retinopathy, is discussed. It has already become routine practice for endolaser photocoagulation to be employed during PPV and, in the future, vitreolytic and antiproliferative agents may also be important as adjuncts to achieve good outcomes.

Postoperative endophthalmitis: optimal management and the role and timing of vitrectomy surgery

To review the evolving role of pars plana vitrectomy, as well as other therapeutic modalities, in the treatment and prevention of postoperative endophthalmitis and its sequelae. Medline database searches and review of recent relevant literature on the prevention and treatment of postoperative endophthalmitis. Despite significant technologic advances in ophthalmic surgery and the ready availability of improved pharmacologic agents, the rates of postoperative endophthalmitis have dramatically increased over the last decade. New surgical procedures, interventions, and techniques have increased patient exposures to this serious surgical complication. Cause, presentation, and outcome vary significantly requiring a tailored approach to each case. Appropriate prophylaxis and good surgical technique remain the mainstays of prevention. Intravitreal antibiotics and pars plana vitrectomy remain the primary treatment options. Postoperative endophthalmitis is a complex and multifaceted entity with potentially grave visual consequences. It requires a multifaceted approach, including appropriate prevention and prophylaxis, rapid recognition, and aggressive management. Since publication of the Endophthalmitis Vitrectomy Study, improvements in pharmacologic agents and vitrectomy techniques have refocused debate on the role of early surgical intervention in this condition.

Pars-plana-Vitrektomie bei idiopathischen Glaskörpertrübungen

The aim of this study was to evaluate the role of pars plana vitrectomy (PPV) in patients with persistent vitreous floaters (VF) in phakic (56.7 %) or pseudophakic (43.3 %) eyes. A retrospective study of 24 consecutive patients (30 eyes) who underwent a 2-port-PPV using indirect opthalmoscopy between 1992 and 2003 was carried out. Main outcome measures were postoperative visual acuity (PVA), incidence of postoperative complications and patient satisfaction, which has been assessed retrospectively using a detailed questionnaire. Symptoms resolved in all patients. PVA was significantly better (0.91 +/- 0.2 vs. 0.84 +/- 0.2 preoperative visual acuity) or equal in 25 patients (83.3 %). One pseudophakic patient (3.3 %) experienced a retinal detachment 48 months after surgery. In 5 of 17 phakic eyes (35 %) a cataract extraction had to be performed during the follow-up period. All patients were satisfied with their overall visual function. This study shows PPV to be a safe and effective primary treatment for visually disturbing VF. In spite of the small number of cases with a lower PVA (5 eyes/16.7 %), which in the most severe case corresponded to a reduction of VA from 1.0 to 0.6 due to a nuclear sclerosis of the lens, all patients were satisfied. As vitreoretinal complications may occur, a critical patient selection and a careful preoperative assessment of specific risks of vitrectomy are mandatory.

Management of Inferior Breaks in Pseudophakic Rhegmatogenous Retinal Detachment With Pars Plana Vitrectomy and Air

To determine the role of pars plana vitrectomy without scleral buckling and air as a tamponade with 24 hours of prone positioning in the management of inferior breaks in primary pseudophakic rhegmatogenous retinal detachment. Prospective, noncomparative, interventional case series. Fifteen consecutive eyes (15 patients) with primary pseudophakic rhegmatogenous retinal detachment with causative breaks located between the 4-o'clock and 8-o'clock positions underwent pars plana vitrectomy with air tamponade. The prone position was maintained for 24 hours. Anatomic and functional results are presented. The anatomic reattachment rate was 93.3% after 1 procedure and 100% at the 6-month visit. Mean preoperative best-corrected visual acuity was 20/60 (range, 20/400 to 20/25) and mean postoperative best-corrected visual acuity was 20/30 (range, 20/100 to 20/20). In 1 case the retina redetached at the second week because of an undetected break. Postoperative epiretinal membrane was observed in 1 case. Pars plana vitrectomy and air tamponade with only 24 hours of prone positioning postoperatively is effective in the management of primary pseudophakic rhegmatogenous retinal detachment with causative breaks between the 4-o'clock and 8-o'clock positions.

Result of early vitrectomy for endogenous Klebsiella pneumoniae endophthalmitis.

To determine the role of pars plana vitrectomy (PPV) in the treatment of Klebsiella pneumoniae endogenous endophthalmitis. Records of seven consecutive patients (10 eyes) diagnosed with Klebsiella endogenous endophthalmitis were retrospectively reviewed. Five patients (71%) had diabetes, and four (57%) had a liver abscess as the source. In most cases, the inflammation progressed within days and resulted in decreased vision worse than hand motions and a total vitreous abscess, despite systemic and intravitreal antibiotic injections. A PPV with subretinal abscess drainage and silicone oil tamponade was performed within 2 weeks. After 6 months, the retina remained attached in all eyes (100%), and vision was counting fingers or better in five eyes (50%). Two eyes recovered visual acuity between 20/63 and 20/125. Physicians should be alerted to the development of endogenous endophthalmitis in patients with Klebsiella septicemia, especially in diabetics with a hepatobiliary abscess. Aggressive therapy, including early vitrectomy with antibiotic injection, may improve the final outcome in this otherwise devastating ocular condition.

Vitrectomy for vitreous opacification in Fuchs' heterochromic uveitis.

To assess the role of pars plana vitrectomy (PPV) for symptomatic vitreous opacification in a series of patients with Fuchs' heterochromic uveitis (FHU). A retrospective review was undertaken of 13 patients with FHU who underwent vitrectomy for vitreous opacification between April 1989 and December 1998. An improvement in visual symptoms was recorded in all patients, 9 of 13 (69%) demonstrating at least a 2 line increase in Snellen visual acuity. All but one patient attained 6/9 or better visual acuity post-operatively. Surgery was uneventful and did not appear to exacerbate any existing intraocular inflammation. From this series we conclude that PPV has an important role in the management of patients with FHU who present with symptomatic vitreous opacification.

Pars Plana Vitrectomy for Intraocular Inflammation-related Cystold Macular Edema Unresponsive to Corticosteroids A Preliminary Study

To determine the role of pars plana vitrectomy in patients with intraocular inflammation-related cystoid macular edema that is unresponsive to corticosteroids. Eleven eyes of nine patients underwent a standard three-port pars plana vitrectomy. The primary indication was intraocular inflammation-related cystoid macular edema that was unresponsive to oral, sub-Tenon's, and topical corticosteroids. Preoperative follow-up ranged from 20 months to 144 months (average, 70 months). Postoperative follow-up ranged from 3 months to 108 months (average, 21 months). Seven eyes (64%) improved 4 or more lines of Snellen visual acuity within 4 weeks. Two eyes (18%) remained unchanged and 2 eyes (18%) worsened. Cystoid macular edema improved by clinical examination and fluorescein angiography in 9 eyes (82%) and by clinical examination alone in 2 eyes (18%). No intraoperative complications were noted. Postoperative complications consisted of cataract formation in 1 eye (9%), glaucoma in 2 eyes (18%), and epiretinal membrane formation in 1 eye (9%). Pars plana vitrectomy may have a role in the treatment of intraocular inflammation-related cystoid macular edema that fails to respond to corticosteroids. The subgroup of patients who benefit most remains to be identified.

Pars plana vitrectomy for retinal detachment with unseen retinal holes.

A study was made of a consecutive series of 47 cases of rhegmatogenous retinal detachment treated by pars plana vitrectomy in which no holes were identified preoperatively. The view of the fundus during preoperative examination varied from being totally clear to completely obscured by media opacities. The role of pars plana vitrectomy in finding retinal holes peroperatively is considered. The incidence of discovering holes and the locations of those found at the time of surgery are presented. The significance of these findings is discussed. Where the preoperative view was good and the extent of proliferative vitreoretinopathy (PVR) did not exceed grade C2, retinal reattachment was achieved in 75% of the cases. A review made of a similar group of patients treated with conventional retinal buckling before the introduction of pars plana vitrectomy revealed that successful retinal reattachment was achieved in 70% of cases. The study concludes that pars plana vitrectomy, while being necessary for cases of rhegmatogenous retinal detachment when the view of the retina is obscured, will not always reveal the presence of a retinal break. If the preoperative view of the retina was good and the extent of PVR did not exceed grade C2, pars plana vitrectomy did not seem to offer obvious advantages over conventional buckling procedures.

Pars plana vitrectomy in the management of intraocular inflammation.

To evaluate the role of pars plana vitrectomy in the management of intraocular inflammation with dense vitreous opacification, vitrectomy was performed in 14 patients with chronic uveitis, 6 eyes with retinal periphlebitis, and in 8 cases of endophthalmitis. Visual acuity improved in 21 eyes, remained unchanged in 3, and deteriorated in 4 cases (follow-up period 2 months to 3 years). Pre-existing retinal damage such as cystoid macular oedema or degeneration restricted final visual acuity. In most eyes inflammation (aqueous flare and cells) diminished, except in hypotonic eyes with chronic iridocyclitis, which also gained little in vision. The results indicate that vitrectomy is valuable in the treatment of chronic uveitis with vitreous opacification due to cellular invasion and membrane formation, in periphlebitis with vitreous hemorrhages, and in endophthalmitis.