Small-gauge Pars Plana Vitrectomy Research Articles

Outcomes after giant peripheral retinotomy and anterior flap retinectomy for rhegmatogenous retinal detachments with advanced proliferative vitreoretinopathy using small gauge vitrectomy.

To analyze the visual and anatomical outcomes for eyes with rhegmatogenous retinal detachment (RRD) and advanced proliferative vitreoretinopathy (PVR) undergoing giant peripheral retinotomy (GPR) using 25-gauge pars plana vitrectomy (PPV). In this retrospective multi-center study, patients with RRD with either anteroposterior or circumferential retinal shortening and advanced PVR requiring more than 90-degree GPR with/without relaxing retinotomy were included. Subjects of either gender, any age group, and with complete surgical notes were included. Outcome measures of the study included anatomical success (i.e. complete retinal re-attachment) at 6 months using survival analysis, visual outcomes, and post-operative complications. Forty-one eyes of 41 patients (33 males) with a mean age of 44.9 ± 21.4 years were included. At 6 months follow-up, anatomical success was seen in 29 eyes (70.7%) with a cumulative re-attachment rate of 66% (95% confidence interval = 48 = 79%). All re-detachments occurred at ≤6 months with a peak at 4-6 months (n = 9). Twenty-three eyes (56%) achieved ambulatory vision (5/200) or better. Direct perfluorocarbon liquid-silicone oil exchange was performed in 20 eyes. Intra-operative complications included persistent retinal folds (2 eyes), subretinal air (1 eye), and subretinal bleed (1 eye). Eleven eyes (26.8%) developed secondary glaucoma (2 eyes required a drainage device), and hypotony of ≤6 mmHg was noted in 3 eyes (7.3%). Corneal decompensation was noted in 8 eyes (19.5%), and 3 eyes (7.3%) underwent re-surgery for re-RRD. After GPR using small gauge PPV, two-thirds achieve anatomical success, and over half have ambulatory vision, but overall post-operative complications can occur in more than half of the eyes.

SF 6 COMPARED WITH C 2 F 6 FOR INFERIOR RHEGMATOGENOUS RETINAL REPAIR : The Manchester Pseudophakic Retinal Detachment Study.

To compare SF 6 relative with C 2 F 6 in the anatomical and functional outcomes following pars plana vitrectomy for uncomplicated primary pseudophakic rhegmatogenous retinal detachment with inferior causative breaks. This is a retrospective, comparative study on eyes with pseudophakic rhegmatogenous retinal detachment with inferior causative breaks that had small-gauge pars plana vitrectomy repair using SF 6 and C 2 F 6 tamponade between 2011 and 2020 at a tertiary centre in the United Kingdom. Primary outcome was single surgery anatomical success, and the secondary outcome was best-corrected visual acuity. Propensity score matching, using preoperative findings as covariates to account for relevant confounders, was performed. From 162 pseudophakic rhegmatogenous retinal detachment eyes with inferior causative breaks, the median (interquartile range) follow-up was 82 (52-182) days. The single surgery anatomical success was 156 (96.3%) overall: 47 of 47 (100.0%) and 109 of 115 (94.8%) in the SF 6 and C 2 F 6 groups, respectively ( P = 0.182). Relative to the SF 6 group, the C 2 F 6 group had a higher mean number of tears (SF 6 : 3.1[2.0], C 2 F 6 : 4.5[2.7], P = 0.002) and greater retinal detachment extent (SF 6 : 5.3[2.9], C 2 F 6 : 6.2[2.6] clock hours, P = 0.025). Following propensity score matching analysis, 80 eyes were matched with 40 in each group to homogenize preoperative factors. No significant difference was found in single surgery anatomical success and best-corrected visual acuity between the groups following propensity score matching. Primary pars plana vitrectomy with gas tamponade leads to a high single surgery anatomical success rate in uncomplicated pseudophakic rhegmatogenous retinal detachment with inferior causative breaks with no additional benefit associated with long-acting tamponade when comparing C 2 F 6 with SF 6 .

Expansile gas concentration in primary pseudophakic retinal detachment repair, effect on intraocular pressure and outcomes; the Manchester Pseudophakic Retinal Detachment Study.

To investigate the effect of isovolumetric and expansile gas tamponade concentrations on single surgery anatomical success (SSAS) and day 1 intraocular pressure (IOPD1) following pars plana vitrectomy (PPV) for mild-moderate complexity primary pseudophakic rhegmatogenous retinal detachment (PRD). We conducted a single-centre retrospective continuous and comparative study on eyes that had undergone small-gauge PPV using isovolumetric versus expansile gas for PRD repair between 2011 and 2020 at a single tertiary vitreoretinal centre in UK. We performed propensity score matching (PSM) using preoperative findings as covariates to account for relevant confounders. Significant risk factors such as proliferative vitreoretinopathy C or giant retinal tears were excluded. From 456 eyes, PSM analysis matched 240 eyes with 120 in each group. The median (interquartile range) follow-up was 96 (59 to 218) days. The SSAS was 229/240 (95.8%) overall; 115/120 (95.8%) and 114/120 (95.0%) in isovolumetric and expansile groups, respectively (p = 1.000). Relative to the isovolumetric group, the expansile group had lower proportion of eyes with IOP ≤ 21mmHg (odds ratio, 95% confidence interval, 0.40 [0.23-0.68], p < 0.001); but significantly higher number of eyes with IOP ≥ 22mmHg (2.53 [1.48-4.34], p < 0.001), ≥ 25mmHg (2.77 [1.43-5.33], p < 0.001), ≥ 30mmHg (2.90 [1.28-6.58], p = 0.006) and ≥ 40mmHg (p = 0.029, isovolumetric: 0 [0%] vs expansile group: 6 [5%]). There was only one case of hypotony (≤ 5mmHg) 1/240 (0.4%) which occurred in the expansile group. Expansile gas concentration does not impact SSAS but is associated with significantly raised IOPD1 with no reduction in hypotony rates following PPV for primary PRD.

DRAINAGE RETINOTOMY IS A RISK FACTOR FOR SURGICAL FAILURE AFTER PARS PLANA VITRECTOMY IN PATIENTS WITH PRIMARY UNCOMPLICATED RHEGMATOGENOUS RETINAL DETACHMENT.

To identify risk factors for recurrent retinal detachment after uncomplicated pars plana vitrectomy in patients with primary rhegmatogenous retinal detachment (RRD). This single-center retrospective study included patients with primary RRD who underwent 23-gauge and 25-gauge pars plana vitrectomy at Hiroshima University Hospital between January 2016 and May 2021. All patients had ≥3 months of follow-up. Patients were excluded if they had preoperative proliferative vitreoretinopathy worse than Grade C1; giant retinal tears; tractional, exudative, or traumatic retinal detachment; or the use of perfluorocarbon liquid. Factors that influenced RRD treatment outcome and postoperative complications were evaluated. We analyzed 519 eyes of 509 patients who underwent pars plana vitrectomy for primary RRD. The primary and final success rates were 93.8% and 99.8%, respectively. Drainage retinotomy was a risk factor for surgical failure in both multivariate analysis (odds ratio 2.36, 95% confidence interval 1.08-5.15, P = 0.0314) and a propensity score-matching analysis (odds ratio 3.20, 95% confidence interval 1.14-9.04, P = 0.0277). Postoperative epiretinal membrane was associated with drainage retinotomy in multivariate analysis (odds ratio 1.93, 95% confidence interval 1.04-3.57, P = 0.0358). The avoidance of drainage retinotomy during small-gauge pars plana vitrectomy in patients with RRD may lead to better surgical success and less frequent epiretinal membrane formation.

VITRECTOMY FOR DIABETIC COMPLICATIONS: A Pooled Analysis of Randomized Controlled Trials Using Modern Techniques and Equipment.

To report updated clinical outcomes in subjects undergoing pars plana vitrectomy (PPV) using modern techniques and equipment for the treatment of proliferative diabetic retinopathy-related complications. Pooled analysis of five randomized clinical trials conducted at the same institution and included both study and control subjects from the trials. There were 943 subjects who prospectively underwent small-gauge PPV with antivascular endothelial growth factor pretreatment for proliferative diabetic retinopathy-related complications and completed 6-month follow-up. The visual acuity of the study population improved from median 2.00 (interquartile range 1.3, 2.3) at baseline to median 1.00 (interquartile range 0.5, 1.3) at 6 months. One hundred and eighty-four patients (19.5%) achieved 20/50 or better acuity, and 652 patients (69.1%) achieved 20/200 or better acuity at 6 months. The vision improved or remained stable in 901 patients (95.5%), and 11 patients (1.2%) developed no light perception at 6 months. Intraoperative complications occurred in 343 cases (36.4%), and 199 cases (21.1%) experienced a postoperative complication. The most common postoperative complication was vitreous hemorrhage in 124 cases (62.3% of all complications). Unplanned secondary PPV was necessary in 86 cases (9.1%). This study reports updated clinical outcomes in patients undergoing PPV for proliferative diabetic retinopathy-related complications which compares favorably with the age before small-gauge PPV and antivascular endothelial growth factor pretreatment.

Intraocular perfluorodecalin and silicone oil tamponade (double filling) in the management of complicated retinal detachment: functional and anatomical outcomes using small-gauge surgery.

PurposeTo describe the functional and anatomical results of complicated retinal detachment (RD) treated with small-gauge pars plana vitrectomy (PPV) and combined perfluorodecalin and polydimethylsiloxane tamponade (double filling, DF).MethodsRetrospective analysis of consecutive patients with complex RD (severe proliferative vitreoretinopathy, inferior/posterior/giant retinal tears, and traumatic detachments) treated with small-gauge PPV, membrane peeling, and DF at the Department of Ophthalmology at San Gerardo Hospital, Monza, Italy. Main outcome measures included best-corrected visual acuity (BCVA), rates of retinal reattachment, and complications.ResultsThis study included 15 patients with a median follow-up (FU) of 6 months (range 1–22). Three patients with early retinal redetachment under tamponade and FU shorter than 3 months were excluded from the final functional analysis, but they were considered anatomical failure. At the last examination, BCVA improved in 50% of patients and remained stable in 25% of patients and anatomical success was achieved in 73% of eyes, 64% of them without any endotamponade. Three eyes had retinal redetachment after perfluorodecalin/silicone oil exchange because of diffuse proliferative vitreoretinopathy (PVR) and required reoperation to achieve retinal attachment. In eyes with anatomical success, macular pucker was the most frequent long-term complication (27%).ConclusionIn the management of complex RD, small-gauge pars plana vitrectomy, and double filling endotamponade using wide-angle viewing systems was a well-tolerated and effective technique to preserve visual acuity and achieve anatomical success.

Epiretinal Membrane Surgery Using Intraoperative OCT-Guided Membrane Removal in the DISCOVER Study versus Conventional Membrane Removal

To provide a comparative assessment of clinical outcomes between patients undergoing intraoperative OCT (iOCT) and conventional surgery for pars plana vitrectomy (PPV) with epiretinal membrane (ERM) peel. Case-control retrospective, comparative assessment. Patients undergoing PPV with membrane peel for ERM with eyes pooled from the prospective Determination of Feasibility of Intraoperative Spectral Domain Microscope Combined/Integrated OCT Visualization During En Face Retinal and Ophthalmic Surgery (DISCOVER) iOCT study and eyes undergoing conventional ERM surgery without iOCT. Visual acuity and OCT assessment before ERM surgery and at 1-, 3-, 6-, and 12-month follow-up after standard small-gauge PPV with iOCT feedback (iOCT DISCOVER group) or PPV with compulsory internal limiting membrane (ILM) peeling (conventional group). Visual acuity, central subfield thickness (CST), reoperation rate, and ERM recurrence were determined by record review and post hoc assessment of clinical OCTs after ERM peel. Visual acuity and ERM recurrence. A total of 262 eyes were included. Visual acuity (VA) improved 11.9 letters in the iOCT group (P<0.0001) and 12.1 letters in the conventional group (P < 0.0001) at 12 months after ERM surgery. Visual acuity improvement did not differ between the iOCT and conventional groups at 1, 3, 6, or 12 months after surgery (P>0.05 for each time point). Preoperative mean CST decreased in the iOCT group (P < 0.0001) and conventional group (P < 0.0001) with no difference between groups in CST reduction at 12 months (P= 0.36). No reoperations or visually significant recurrent ERMs occurred in either cohort. Intraoperative OCT-guided ERM removal without mandated ILM peeling provided similar VA and anatomic results to conventional ILM peeling for ERM. Future randomized prospective studies are needed to assess fully the possible role of iOCT in ERM surgery and to evaluate the potential impact of nonfoveal ERM persistence or recurrence in comparison with conventional surgery.

Small-Gauge Pars Plana Vitrectomy for Visually Significant Vitreous Floaters.

This article evaluates our experience at a retina-only private practice with small-gauge pars plana vitrectomy (PPV) for visually significant vitreous floaters. We review the surgical outcomes, complication rates, and percentage of second-eye surgery for the same indication. A retrospective, interventional case series was conducted of consecutive patients undergoing PPV for significant vitreous floaters from September 2014 to December 2018 at a high-volume vitreoretinal surgery practice. Preoperative visual acuity (VA), complication rates, and visual outcome following surgery were evaluated. A total of 104 eyes in 81 patients underwent PPV for visually significant floaters; 35 (43.2%) patients had PPV in both eyes. Mean preoperative VA was 0.16 ± 0.17 logMAR (∼20/29 Snellen equivalent) and improved to 0.12 ± 0.15 logMAR (∼20/26 Snellen; Wilcoxon test, P = .008) at the last follow-up after PPV. All patients had improvement in VA at the final postoperative visit, with a VA of 20/40 or better achieved in 93.3% of cases. The complication rate of vitreous hemorrhage postoperatively was 0.96%. There were no cases of postoperative retinal tears, breaks, or endophthalmitis. Small-gauge PPV in the carefully selected patient is an effective and safe procedure to eliminate symptoms. VA following PPV for vitreous floaters significantly improved. Nearly half of the patients studied (43.2%) underwent PPV in the other eye.

Outcomes of small-gauge vitreoretinal surgery without scleral-depressed shaving of the vitreous base in the era of wide-angle viewing systems

PurposeTo evaluate outcomes of small-gauge pars plana vitrectomy (PPV) for the treatment of rhegmatogenous retinal detachment (RD) without scleral-depressed shaving of the vitreous base.MethodsRetrospective, consecutive case series. Surgical technique included...

Systemic Approach to Prevent Inadvertent Perfusion in Eyes with Extensive Choroidal Detachment, Suprachoroidal Fluid, and Hypotony During Pars Plana Vitrectomy.

IntroductionRhegmatogenous retinal detachment (RRD) with extensive choroidal detachment (CD), suprachoroidal fluid (SCF), and lower intraocular pressure (IOP) markedly increase the difficulty of pars plana vitrectomy (PPV) because it makes the insertion and placement of the trocar cannulas for PPV time-consuming and technically challenging. In this study, we developed a systemic approach that avoids the risks of sclerotomy or using a longer trocar to help in the safe placement of the trocar cannulas in order to prevent inadvertent fluid/air perfusion during PPV in RRD eyes with extensive CD, SCF, and hypotony.MethodsThis is a prospective case series study. Consecutive patients diagnosed with RRD with extensive CD, SCF, and hypotony were recruited. The main steps included injecting transconjunctival intravitreal fluid to increase IOP and enable the passive egress of SCF into the subconjunctival space, creating and broadening the inner opening for the trocar cannulas, transillumination with an endoillumination light pipe, and indentation of the infusion cannula to create maximum visual exposure of the inner segment and help peripheral shaving around the infusion tip. Main outcomes: the success rate of the infusion placement into the vitreous cavity, surgical duration, intra- and postoperative complications, and functional and anatomical outcomes.ResultsThirty-eight patients (38 eyes) were included. The first-time success rate of cannula placement into the vitreous cavity was 100%, with a mean surgical duration of 8.5 ± 1.8 min. No intra- or postoperative complications related to the approach were observed. Significant vision improvement was noted in 68.4% (26/38) of the patients at the final follow-up. The primary and final retinal reattachment rates were 94.7% (36/38) and 100% (38/38), respectively.ConclusionThis systemic approach is a feasible option to ensure the safe placement of trocar cannulas and prevent inadvertent perfusion during small-gauge PPV in RRD eyes with extensive CD, SCF, and hypotony, without the need for a draining sclerotomy, a longer trocar, or a sharp clearing of the cannula tip.

Long-term Safety and Efficacy of Sutureless Vitrectomy for Combined Epiretinal and Internal Limiting Membrane Removal

Purpose: The purpose of this case series is to evaluate the long-term visual outcomes of patients undergoing epiretinal membrane (ERM) removal combined with internal limiting membrane (ILM) peeling via sutureless vitrectomy. Methods: A retrospective review was conducted of 45 patients (45 eyes) with ERMs treated with 25-gauge pars plana vitrectomy (PPV) from 2010 to 2011. Data assessed included baseline characteristics, preoperative and postoperative best-corrected visual acuity (BCVA), ERM recurrence rate during follow-up, and complications arising during follow-up. Results: PPV resulted in a statistically significant improvement in BCVA (20/61 preoperatively, 20/41 1 year postoperatively, and 20/45 at the end of follow-up). Mean duration of follow-up was 66.3 months (range, 26-89). Forty-one of 45 (91%) eyes had improved or stable vision, while 4/45 (8.9%) had worse vision. ERMs recurred in 12/45 eyes (26.7%), of which 1/45 (2.2%) required reoperation. The remaining 11 recurrent ERMs were documented as visually insignificant. Mean time to ERM recurrence was 29.3 months (range, 4-72). Conclusions: In one of the longest mean follow-up studies to date, small-gauge PPV for ERM and ILM removal results in statistically significant and stable long-term visual improvement. Despite ILM removal, ERMs did recur in a substantial proportion of patients, though the vast majority were not visually significant.

ANALYSIS OF PARS PLANA VITRECTOMY INCISIONS USING LIVE BACTERIA

To analyze small gauge pars plana vitrectomy sclerotomies using live bacteria transformed with green fluorescent protein (GFP). Twenty-eight human cadaver eyes were specially harvested for this study. Small gauge vitrectomy was performed on each eye and the wounds were closed with various techniques (sutured, sutureless, and cauterization). Live Staphylococcus epidermidis that has been transformed with a green fluorescent protein was applied to the overlying conjunctival surface. Analysis of all vitreous samples was analyzed with confocal laser microscopy to identify the presence of bacteria. All wounds were analyzed histopathologically. A high concentration of bacteria was noted in 2 of 3 eyes in the sutureless, 23-G perpendicular incision group postinoculation. There were no bacteria detected in any postvitrectomy sample that were closed with cautery or a beveled incision. No bacteria were found in postvitrectomy samples of sutureless 27-G perpendicular incisions and sutureless 27-G beveled incisions. Finally, there were no bacteria detected in both eyes with 23-G perpendicular incisions that had a partial air-fill. Live bacteria can be effectively used to analyze wound integrity. Closing sclerotomy sites with cautery proved effective in a model using fresh, human cadaver eyes. 27-G perpendicular incisions may be just as competent as 27-G beveled incisions.

Complications of minimally invasive vitreous surgery can not be ignored

Pars plana vitrectomy (PPV) has become an important means of treating complex vitreoretinopathy, and the introduction of small-gauge PPV instrumentation and techniques has even considerably widened the surgery choice. Though the small-gauge PPV systems have many advantages, ophthalmologists must realize that the small-gauge PPV does not necessarily refer to minimally invasive PPV. Ophthalmologists should not just pursue the small incision, ignore the principle of minimally invasive PPV and the rational choice of indications, and underestimate surgical risks and postoperative complications. Ophthalmologists must be familiar with the advantages and limitations of minimally invasive PPV so as to achieve the best therapeutic effects with minimized trauma. (Chin J Ophthalmol, 2017, 53: 321-324).

Small-Gauge Pars Plana Vitrectomy With SF6 Gas for the Repair of Primary Rhegmatogenous Retinal Detachment With Multiple Breaks.

To compare outcomes of 25-gauge pars plana vitrectomy (PPV) and sulfur hexafluoride (SF6) gas for primary rhegmatogenous retinal detachment (RRD) associated with multiple-quadrant versus single-quadrant breaks. A retrospective study of patients with RRD who underwent 25-gauge PPV with breaks involving multiple quadrants (Group A) or versus a single quadrant (Group B). One hundred eighteen eyes of 118 patients with a mean age of 60.4 years ± 11.8 years were reviewed, 27 with multiple-quadrant breaks and 91 with single-quadrant breaks. Single surgery anatomical success was achieved in 92.6% of Group A versus 93.4% of Group B patients (P = .88). The location and number of quadrants did not account for the variation in single surgery success or visual outcome. RRD with multiple-quadrant breaks is not associated with worst outcomes than single-quadrant breaks when treated with 25-gauge PPV and SF6 gas. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:820-827.].

Valved versus nonvalved cannula small-gauge pars plana vitrectomy for repair of retinal detachments with Grade C proliferative vitreoretinopathy

PurposeValved cannulas are a recent addition to small-gauge pars plana vitrectomy (PPV) and provide stable intraocular fluidics. The goal of this study was to compare outcomes and postoperative complication rates of valved vs nonvalved cannula small-gauge PPV for repair of retinal detachments (RDs) complicated by Grade C proliferative vitreoretinopathy (PVR).MethodsA retrospective chart review of 364 consecutive eyes with either valved or nonvalved cannula PPV for RD repair was performed. The primary outcomes were single surgery and final anatomic success and change in best-corrected visual acuity for repair of RDs complicated by Grade C PVR.ResultsWe identified 36 eyes in the valved group and 31 eyes in the nonvalved group with Grade C PVR RD. The single surgery success was 83% vs 77% (P=0.555) and the final anatomic success was 94% vs 87% (P=0.404) in the valved vs nonvalved eyes, respectively. The mean final visual acuity gain was −0.36 logarithm of the minimum angle of resolution (logMAR; approximate Early Treatment Diabetes Retinopathy Study [ETDRS] score =17 letters) in valved eyes vs −0.33 logMAR (approximate ETDRS score =16 letters) in nonvalved eyes (P=0.81). Postoperative complication rates including postoperative day 1 hypotony, hypertony, and anterior chamber fibrin formation; postoperative retention of intraocular or subretinal perfluorocarbon liquid; and subsequent epiretinal membrane peel were not statistically different between groups.ConclusionValved cannula PPV yields equivalent visual acuity and anatomic outcomes without increased postoperative complication rates compared to traditional nonvalved cannula PPV for Grade C PVR-associated RD repair.

SURGICAL OUTCOMES IN PATIENTS WITH MACULAR PUCKER AND GOOD PREOPERATIVE VISUAL ACUITY AFTER VITRECTOMY WITH MEMBRANE PEELING.

To evaluate whether patients with macular pucker (epiretinal membrane [ERM]) and good preoperative visual acuity (20/50 or better) benefit from small-gauge pars plana vitrectomy with membrane peeling. Retrospective chart review of eyes undergoing small-gauge pars plana vitrectomy for ERM. Inclusion criterion was impaired visual acuity (20/50 or better) due to ERM. Exclusion criteria were preoperative visual acuity of 20/60 or worse, previous surgery (other than uncomplicated cataract surgery), and any documented evidence of macular or corneal disease that would limit visual potential. The main outcome measure was final visual acuity. Secondary outcomes included the role of internal limiting membrane peeling, and the effect of preoperative cystoid macular edema and internal limiting membrane peeling on visual acuity. One hundred and forty eyes met inclusion criteria of which 94% underwent 25-gauge vitrectomy (remainder had 23-gauge). There was a statistically significant improvement in final vision with the mean preoperative visual acuity of 0.305 logMAR (20/40) and 1-year visual acuity of 0.250 logMAR (20/35) (P = 0.0167). Cataract formation in phakic patients had a significant effect on the final visual outcome. Fifty-six of 63 patients (89%) in the phakic cohort developed a visually significant cataract by study end. The mean time to recommendation of cataract surgery was 8.4 months. Thirty-eight eyes (27%) had preoperative cystoid macular edema. Fifty-nine eyes (42%) underwent internal limiting membrane peeling. Neither one of these secondary outcome measures had a significant effect on the final visual outcome. Pars plana vitrectomy is both efficacious and safe an option for patients with ERMs and good preoperative vision. Eyes with an ERM and vision 20/50 or better had a statistically significant improvement in the final visual outcome after small-gauge pars plana vitrectomy surgery. As with large-gauge vitrectomy, cataract formation occurred in most phakic eyes within the first year after surgery.

Changes in retinochoroidal thickness after vitrectomy for proliferative diabetic retinopathy.

To evaluate the changes in the peripheral retinochoroidal thickness after pars plana vitrectomy (PPV) with scatter photocoagulation for proliferative diabetic retinopathy (PDR). Small gauge PPV was performed on 22 eyes with PDR with scatter photocoagulation, and on 32 eyes with an epiretinal membrane (ERM) without photocoagulation as control. The peripheral retinochoroidal thickness was measured at 5 mm from the limbus in the four quadrants using anterior segment optical coherence tomography preoperatively, and 3 days and 1 and 2 weeks after the surgery. In eyes with a peripheral choroidal detachment, the retinochoroidal thickness and the height of choroidal detachment were measured separately. The total peripheral thickness was defined as the sum of retinochoroidal thickness and the height of choroidal detachment. A significant larger number of eyes developed a choroidal detachment in the PDR group than in the ERM group 3 days after surgery (P < 0.001). The total peripheral choroidal thickness 3 days after surgery was significantly thicker than that before surgery in the PDR group (P = 0.009). The increase in the total peripheral thickness in the PDR group was significantly greater than that in the ERM group at 3 days after surgery (P = 0.007). The number of photocoagulation burns was significantly and positively correlated with the total peripheral thickness (r = 0.57, P = 0.006). We conclude that the transient thickening of the total peripheral thickness in early postoperative stage for PDR was due to the intraoperative scatter photocoagulation.

Epiretinal membrane and cystoid macular edema after retinal detachment repair with small-gauge pars plana vitrectomy.

To evaluate the incidence rates of cystoid macular edema (CME) and epiretinal membrane (ERM) formation after uncomplicated primary 23-G and 25-G retinal detachment (RD) repair and to identify risk factors associated with postoperative CME and ERM formation. This was a consecutive interventional case series of 587 eyes that underwent one RD repair with 23-G or 25-G pars plana vitrectomy (PPV) with scleral buckling. Epiretinal membrane and CME were confirmed by optical coherence tomography (OCT) and fluorescein angiography (FA). A total of 587 eyes with a mean follow-up of 404 days had incidence rates of 35.1% for ERM and 15.2% for CME. The incidence of ERM after combined PPV and scleral buckling (48.4%) (n = 61) was greater (p&lt;0.0001) compared to that after PPV alone (31.2%) (n = 144). Epiretinal membrane and CME develop frequently after small-gauge RD repair. Pars plana vitrectomy combined with scleral buckling is associated with a higher incidence of ERM. Patients might benefit from increased use of OCT and FA to help rule out CME/ERM.

Small-Gauge Pars Plana Vitrectomy for the Management of Symptomatic Posterior Vitreous Detachment after Phacoemulsification and Multifocal Intraocular Lens Implantation: A Pilot Study from the Pan-American Collaborative Retina Study Group.

Purpose. To determine the efficacy of 23-gauge pars plana vitrectomy (PPV) for symptomatic posterior vitreous detachment (PVD) on visual acuity (VA) and quality after multifocal intraocular lenses (IOLs). Methods. In this prospective case series, patients who developed symptomatic PVD and were not satisfied with visual quality due to floaters and halos after multifocal IOL implantation underwent PPV. Examinations included LogMAR uncorrected visual acuity (UCVA), intraocular pressure, biomicroscopy, and indirect ophthalmoscopy at baseline and 1, 7, 30, and 180 days postoperatively. Ultrasonography and aberrometry were performed. The Visual Functioning Questionnaire 25 (VFQ-25) was administered preoperatively and at 30 days postoperatively. Both the postoperative UCVA and questionnaire results were compared to preoperative findings using the Wilcoxon test. Results. Sixteen eyes of 8 patients were included. VA significantly improved from 0.17 to 0.09 postoperatively (P = 0.017). All patients reported improvement of halos, glare, and floaters. VFQ-25 scores significantly improved in general vision (P = 0.023), near activities (P = 0.043), distance activities (P = 0.041), mental health (P = 0.011), role difficulties (P = 0.042), and driving (P = 0.016). Conclusion. PPV may increase UCVA and quality of vision in patients with bilateral multifocal IOLs and symptomatic PVD. Larger studies are advised.

Cataract formation following vitreoretinal procedures.

PurposeTo evaluate the incidence and prevalence of cataract formation, progression, and extraction in patients that underwent vitreoretinal procedures and to evaluate factors that can potentially predispose patients to postoperative cataracts.Materials and methodsThe medical records of consecutive patients who underwent vitreoretinal surgery at the Yale Eye Center with at least 6 months of follow-up and no prior intraocular surgery were obtained. Preoperative, intraoperative, and postoperative data were recorded and analyzed in this retrospective observational study. The main outcome measures were defined as cataract extraction, formation, and progression after vitreoretinal procedures. The lens status of the surgical eye was recorded preoperatively and at 1 month, 3 months, 6 months, 12 months, 24 months, and 36 months postoperatively.ResultsA total of 193 eyes of 180 patients fulfilled the inclusion criteria. The percentages of eyes with mild lens change were 96% after 20-gauge pars plana vitrectomy (PPV), 72% after small gauge (23- and 25-gauge) PPV, 38% after scleral buckle (SB), 38% after pneumatic retinopexy (PR), and 91% after PPV plus SB (PPV+SB). Posterior subcapsular and nuclear sclerotic cataracts were the most common with almost all developing within 24 months. There was no statistically significant difference (P=1.00) between the rate of cataract extraction after 20-gauge (41%) and small gauge PPV (42%), but there was a statistically significant difference between PPV and non-PPV (SB, 6%; PR, 7%; P<0.001) and PPV and PPV+SB groups (69%; P=0.0063).ConclusionCataracts were common following PPV regardless of the gauge. SB and PR led to the lowest while PPV+SB led to the highest risk of postoperative cataracts.