Standard Vitrectomy Research Articles

A modified approach to actively remove high viscosity silicone oil through 23-gauge cannula.

To report a simple approach to actively remove high viscosity silicone oil through a 23-gauge cannula via pars plana. Forty-eight eyes of 48 patients underwent silicone oil (5700 centistokes) removal (SOR) were enrolled. A section of blood transfusion set was prepared to connect a standard 23-gauge cannula and vitrectomy machine. Silicone oil was removed with suction of 500-mm Hg vacuum through the cannula. Main outcome measures were SOR duration, number of sutured sites, intraocular pressure (IOP), best-corrected visual acuity (BCVA), and complications. Silicone oil was successfully removed in all cases. The mean SOR time was 5.70±0.85min. Nine eyes (18.75%) needed suture partial sclerotomies. No intraoperative complications were noted. Transient hypotony (≤8 mm Hg) was seen in 3 eyes (6.25%) on postoperative day 1, but all resolved within 1wk. Retinal reattachment was achieved in all cases and no other postoperative complications were noted during 3-month following-up. BCVA at the final visit improved or stabilized in all patients comparing to the preoperative level. Active removal of high viscosity silicone oil through a 23-gauge instrument cannula jointed with blood transfusion set is a practical and reliable technique when considering two sides of efficacy and safety.

Proliferative Vitreoretinopathy: Therapeutic Strategies

Development of proliferative vitreoretinopathy (PVR) is one of the most important complications of vitreoretinal surgery. Reaching the decision to treat and surgical treatment itself are both challenging. Our own data and a review of the literature in PubMed are summarised. Pharmacological approaches to the prevention and treatment of proliferative vitreoretinopathy have been limited to concepts that have been investigated in preclinical and a few clinical studies. Anti-inflammatory and antiproliferative substances may be mentioned in this context. Surgical techniques range from scleral buckling to the gold standard pars plana vitrectomy, preferably with silicone oil endotamponade. Applying an encircling band, retinotomy or retinectomy can be useful in reattaching the tractional shortened retina. Surgery is still the method of choice for the treatment of PVR. Pharmacological strategies to prevent or treat PVR have not been established.

Short-Acting Gas Tamponade with Strict Face-Down Posturing for the Treatment of Idiopathic Macular Hole

ABSTRACTPurpose: A retrospective consecutive case series to evaluate the safety and efficacy of 25 gauge pars plana vitrectomy, ILM peeling, 20% SF6 gas tamponade and strict posturing for the treatment of idiopathic full-thickness macular holes. Methods: We report the results of 106 consecutive eyes that underwent standard 25-gauge pars plana vitrectomy, brilliant peel-assisted internal limiting membrane peel, fluid:gas exchange with 20% SF6 and strict posturing for one week. All patients were followed up at one week, one month, three months, and nine months postoperatively. Biomicroscopy at day 1 and biomicroscopy and OCT at week 1, months 1, 3, and 9 were used to assess macular hole status postoperatively. Pre- and postoperative logMAR visual acuity was compared. Results: The macular hole was closed in 102/106 eyes postoperatively (96.2%). Four eyes showed unclosed macular holes and underwent additional SF6 intravitreal injection and strict posturing for 10 days. All macular holes were eventually closed without the need of a second surgical procedure. Mean visual acuity improved from 0.63 logMAR preoperatively to 0.39 logMAR postoperatively. One case of retinal toxicity was reported due to accidental intravitreal injection of antibiotic. Conclusions: 25-gauge vitrectomy, ILM peel, and short-acting gas tamponade are highly effective for the treatment of macular holes. Additional intravitreal gas injection followed by strict posturing seems to be a simple and effective treatment for unclosed holes.

Inverted Internal Limiting Membrane Flap For Large Traumatic Macular Holes

The aim of the study was to assess the role of inverted internal limiting membrane flap as a treatment option for large traumatic macular holes.This is a prospective noncomparative study in which 12 eyes with large traumatic macular holes (basal diameter of 1300-2800 μm) since 3 to 6 months were subjected to standard 23-gauge vitrectomy with removal of the posterior hyaloid, brilliant blue G (BBG)-assisted internal limiting membrane peeling in a circular fashion keeping it attached to the edge of the hole to create a flap. At the end of the surgery, air fluid exchange was done with inversion of the internal limiting membrane flap inside the macular hole using the soft tipped cannula and sulfur hexafluoride 20% as tamponade. The main follow-up measures are the best corrected visual acuity and the optical coherence tomography for 6 to 9 months.All the included eyes had a closed hole from the first week postoperative and along the follow-up period (6-9 months). The best corrected visual acuity improved from 20/2000 to 20/200 with a median of 20/400 preoperatively to 20/400 to 20/50 with a median of 20/100 at the end of follow-up period.Inverted internal limiting membrane flap is a good adjuvant to standard vitrectomy in the management of large traumatic macular holes that led to the 100% closure rate and improvement of best corrected visual acuity.

Comparative Evaluation of the Different Assessment Methods of Life Quality in Patients with Vitreoretinal Pathology

Effectiveness of the patients with the vitreoretinal pathology with different quality of life (QL) comparative evaluation methods. Methods. 129 patients (before and after standard vitrectomy) with the 3 types of the vitreretinal pathology were examined (38 — with intraocular hemorrhage, 43 — proliferative diabetic retinopathy (PDR), 48 — retinal detachment). Complex examination (36 clinical, haemodynamic and electrophysiological indications) were performed before and 1 month after surgery. QL research was based on the QL-25 (Russian type of the VFQ-25), QL-9 (Russian type of VF-14) and authorial QL-20 questionnaire. Results. QL increasing was detected after the surgery (15.8–20.9%) in all cases of the vitreoretinal pathology type. Correlation analysis of the different QL has shown obvious QL-20 advantages, comparing to QL-9 and mostly QL-25, that was indicated by the statistically significant difference of the middle (all 36 indicators) KK (0,44±0,02; 0,35±0,02; 0,15±0,03) and higher KK relating to prognostic informative vision indicators (0,75–0,84; 0,69–0,74; 0,21–0,70). Conclusion. Results indicate actuality of the QL-20 method adaption in dispensary observation of the patients with different types of vitreoretinal pathology.

Comparison of 25-gauge sutureless vitrectomy and 20-gauge vitrectomy in the treatment of posterior capsule opacification in pseudophakic children.

To compare the effectiveness and safety of pars plana capsulotomy and vitrectomy using 25-gauge tansconjunctival sutureless vitrectomy system and 20-gauge vitrectomy system for posterior capsule opacification (PCO) in pseudophakic children. Retrospectively study. Pars plana capsulotomy and vitrectomy using 25-gauge sutureless vitrectomy system was performed for PCO in the study group (32 eyes). Patients in the control group (34 eyes) underwent capsulotomy and vitrectomy using standard 20-gauge vitrectomy system, providing a comparison between 2 groups with regard to preoperative and postoperative best corrected visual acuity (BCVA), intraocular pressure (IOP), and intraoperative and postoperative complications. The two groups were performed consequentially. The patients ages ranged from 2 to 13y (means: 6.61±2.73y). Surgical technique, intraoperative and postoperative complications, visual acuity, IOP, and recurrent PCO were recorded. The surgical procedure was performed uneventfully in all patients. Visual acuity improved significantly in both groups. BCVA improved in 22 eyes (81.5%) in the study group and in 28 eyes (87.5%) in the control group. There was no statistical difference of visual acuity that were attainable in two groups (H=0.115, P=0.909). Mean postoperative IOP showed no significant difference between the groups at 1wk. All sort of PCO were accomplished by 20-gauge system, while 25-gauge system was effective for pearls style and 2 grade of fibrous PCO, and was insufficient to grade 3 of PCO. In the study group two cases were not accomplished by 25-gauge system while 20-gauge system conquered them. Compared with the control group, mean operative time for opening and closing the sclerotomy in the study group was considerably reduced. The mean follow-up was 38.2mo (range: 8-79mo). During the follow-up period, no incision leakage, corneal edema, vitreous loss, IOL damage, retinal detachment, recurrent PCO, or other complications were noted. Pars plana capsulotomy and vitrectomy using 25-gauge transconjunctival sutureless vitrectomy appeared to be a safe and effective approach for PCO in pseudophakic children. Combined sutureless surgery needed shorter setup time for sclerotomy and caused less surgical trauma than combined surgery with 20-gauge vitrectomy. Therefore, this type of procedure would be a good option for selected cases with PCO in pseudophakic children.

A method to decrease the frequency of unintentional slippage after vitrectomy for rhegmatogenous retinal detachment.

To investigate a method for preventing retinal slippage after standard vitrectomy for rhegmatogenous retinal detachment. Eighty six eyes with bullous rhegmatogenous retinal detachment underwent successful standard vitrectomy. Patients were divided into 2 groups. In Group 1, 44 patients started face-down positioning at approximately 10 minutes after the end of the surgery. In Group 2, 42 patients started face-down positioning immediately at the end of the surgery. Postoperative retinal slippage was determined by fundus autofluorescence at 1 month postoperatively. Statistical analysis examined several factors to determine the association between the start time of the face-down positioning and retinal slippage. Retinal slippage occurred in 63.6% of Group 1 and in 24.0% of Group 2 patients. This difference was statistically significant (P = 0.004, Fisher's exact probability test). Both the extent of retinal slippage (P = 0.029) and the face-down position (P < 0.001) were significantly associated with the retinal slippage. Earlier implementation of face-down positioning may prevent retinal slippage after surgery in eyes with rhegmatogenous retinal detachment treated by standard vitrectomy.

Correlation Between the Dynamic Postoperative Visual Outcome and the Restoration of Foveal Microstructures After Macular Hole Surgery

To analyze the long-term dynamic healing process of outer retinal changes for 1 year in patients who underwent a standard vitrectomy procedure for idiopathic macular hole (MH) repair. Retrospective, consecutive, observational case series. Data were collected on 60 eyes of 56 patients (30 women, 26 men) that underwent successful pars plana vitrectomy (PPV) and internal limiting membrane (ILM) peeling for idiopathic MH from January 2011 to December 2012. The age distribution ranged from 56 to 85 years (mean: 64 years). Forty eyes underwent combined phacoemulsification, PPV, ILM peeling, and intraocular lens implantation; 20 preoperative pseudophakic eyes underwent PPV and ILM peeling only. The main outcome measures included logMAR best-corrected visual acuity (BCVA) and macular microstructures determined by spectral-domain optical coherence tomography performed pre- and postoperatively during follow-up visits at 1, 3, 6, 9, and 12 months. One month after surgery, 24 eyes (40%) showed normal external limiting membrane (ELM), 36 eyes (60%) showed normal ELM at 3 months, and 54 eyes (90%) showed normal ELM 12 months after surgery. Six eyes (10%) revealed a continuous ellipsoid zone (EZ) at 1 month, 18 eyes (30%) at 3 months, and 48 eyes (80%) at 12 months postoperatively. There were no eyes with a disrupted ELM in the presence of an intact EZ line. The eyes with intact ELM and/or intact EZ line showed better BCVA than eyes with defects in ELM or EZ line. On the contrary, glial cell presentation is significantly associated with worse postoperative BCVA. However, the presence of foveal cystoid change is not significantly associated with postoperative BCVA. The ELM and EZ line at the fovea recovered and the presence of glial cells and cystoid space resolved gradually after surgery. The postoperative visual acuity was correlated with resolved glial cells and a restored ELM and EZ line.

Retained silicone tip of diamond-dusted membrane scraper during vitrectomy in a valved cannula system

To report a complication of retained silicone tip from a diamond-dusted membrane scraper (DDMS) that occurred while using a valved cannula vitrectomy system. Retrospective review of three cases that underwent 23 gauge (G) sutureless vitrectomy for idiopathic macular hole (cases 1 and 2) and myopic macular schisis (case 3). In all three cases following a standard vitrectomy, the internal limiting membrane (ILM) peeling was initiated by using a 23G DDMS. During the insertion of the DDMS, the flexible silicone tip of the 23G DDMS was detached from the metal shaft and was retained in the 23G valve system and in case 3, the silicone tip got dislodged from the valve onto the retina. Subsequent ILM peeling was completed by using an end-gripping forceps. All underwent intravitreal gas injection at the end. No other complications were noted. These three cases demonstrate an uncommon complication of retained silicone tip within the valved cannula vitrectomy system and this complication should be considered while using flexible instruments in valved cannula systems.

Correlative Microscopy of Lamellar Hole-Associated Epiretinal Proliferation.

Purpose. To describe morphology of lamellar hole-associated epiretinal proliferation (LHEP) removed from eyes with lamellar macular holes (LMH). Methods. Based on optical coherence tomography data, 10 specimens of LHEP were removed from 10 eyes with LMH during standard vitrectomy. Specimens were prepared for correlative light and electron microscopy (CLEM) using an immunonanogold particle of 1.4 nm diameter that was combined with a fluorescein moiety, both having been attached to a single antibody fragment. As primary antibodies, we used antiglial fibrillary acidic protein (GFAP), anti-CD45, anti-CD64, anti-α-smooth muscle actin (α-SMA), and anticollagen type I and type II. Results. In LHEP, GFAP-positive cells possess ultrastructural characteristics of fibroblasts and hyalocytes. They represent the major cell types and were densely packed in cell agglomerations on vitreous collagen strands. Epiretinal cells of LHEP rarely demonstrated contractive properties as α-SMA-positive myofibroblasts were an infrequent finding. Conclusion. CLEM indicates that epiretinal cells in LHEP might originate from the vitreous and that remodelling processes of vitreous collagen may play an important role in pathogenesis of eyes with LMH.

Combined Vitrectomy and Clear Corneal Phacoemulsification in Patients with Vitreoretinal Diseases

Background: The aim of the study was to examines the results, intraoperative and postoperative complications, and visual outcomes of combined phacoemulsification and pars plana vitrectomy (PPV) under sub-Tenon’s anesthesia. Methods: This retrospective study included 56 eyes of 56 patients who underwent combined vitrectomy and clear corneal cataract surgery for posterior segment disease. All patients had applied randomly. A 50:50 mixture of 2% lidocaine and 0.75% bupivacaine was applied for sub-Tenon’s anesthesia followed by a standard phacoemulsification-IOL procedure and three-port vitrectomy. Visual outcomes and surgical complications of patients were measured the during the mean 9 months after surgery. Results: Preoperatively, indications for 12 (21%) of the patients were retinal detachment, 25 (45%) were diabetic intravitreal haemorrhage, and 19 (34%) were intravitreal haemorrhage related to retinal vein occlusion for combined surgery. None of the cases in this study experienced intraoperative capsule rupture, but two cases had iatrogenic retinal tearing. In the first postoperative visit, none of the patients exhibited hypotony, corneal oedema was observed in five patients and four patients had elevated intraocular pressure (IOP). None of the patients who received the perfluoropropane gas injection had elevated IOP. Eleven patients had the same visual acuity and 45 patients had improved visual acuity at the end of the follow-up period. Postoperatively, four cases developed 160-180° posterior synechiae due to inflammation, and one case developed 360° posterior synechiae and elevated intraocular pressure. Posterior capsule opacification developed in three cases, and none of the patients experienced IOL decentralization. Conclusion: Combined surgery, 23-gauge vitrectomy and clear corneal phacoemulsification, under sub-Tenon’s anesthesia was safe and effective in patients with posterior segment disease.

Removal of Silicone Oil From Intraocular Lens Using Novel Surgical Materials.

To design, fabricate, and evaluate novel materials to remove silicone oil (SiO) droplets from intraocular lenses (IOL) during vitreoretinal surgery. Three different designs were fabricated using soft lithography of polydimethylsiloxane (PDMS), three-dimensional (3D) inverse PDMS fabrication using water dissolvable particles, and atomic layer deposition (ALD) of alumina (Al2O3) on surgical cellulose fibers. Laboratory tests included static and dynamic contact angle (CA) measurements with water and SiO, nondestructive x-ray microcomputer tomography (micro-CT), and microscopy. SiO removal was performed in vitro and ex vivo using implantable IOLs and explanted porcine eyes. All designs exhibited enhanced hydrophobicity and oleophilicity. Static CA measurements with water ranged from 131° to 160° and with SiO CA approximately 0° in 120 seconds following exposure. Nondestructive x-ray analysis of the 3D PDMS showed presence of interconnected polydispersed porosity of 100 to 300 μm in diameter. SiO removal from IOLs was achieved in vitro and ex vivo using standard 20-G vitrectomy instrumentation. Removal of SiO from IOLs can be achieved using materials with lower surface energy than that of the IOLs. This can be achieved using appropriate surface chemistry and surface topography. Three designs, with enhanced hydrophobic properties, were fabricated and tested in vitro and ex vivo. All materials remove SiO within an aqueous environment. Preliminary ex vivo results were very promising, opening new possibilities for SiO removal in vitreoretinal surgeries. This is the first report of an instrument that can lead to successful removal of SiO from the surface of IOL. In addition to the use of this instrument/material in medicine it can also be used in the industry, for example, retrieval of oil spills from bodies of water.

IATROGENIC RETINAL BREAKS IN 25-GAUGE VITRECTOMY UNDER AIR COMPARED WITH THE STANDARD 25-GAUGE SYSTEM FOR MACULAR DISEASES

To evaluate the incidence rates of iatrogenic retinal breaks in eyes that underwent 25-gauge vitrectomy under air compared with 25-gauge standard vitrectomy for idiopathic macular holes or idiopathic epiretinal membranes. In this retrospective, comparative interventional study, 435 eyes were enrolled. In all patients after core vitrectomy and epiretinal/inner limiting membrane peeling, complete vitrectomy of the base was performed, respectively under air (air group) or under fluid infusion (standard group). The number of eyes with iatrogenic retinal breaks was significantly lower in the air group than in standard group (4/197 and 16/238, 2% and 7%, respectively; P = 0.035). A postoperative retinal detachment developed in 2 eyes (1%) in the standard group, and in no eyes of the air group (0%). Factors related to the occurrence of retinal breaks were surgically induced posterior vitreous detachment (P = 0.006), standard vitrectomy (P = 0.023), and surgery for macular hole (P = 0.030). The 25-gauge vitrectomy under air is associated with a lower incidence rate of retinal breaks compared with the standard 25-gauge vitrectomy.

玻璃体腔硅油或C 3 F 8 填充对增生型糖尿病视网膜病变并发单纯玻璃体积血玻璃体切割手术疗效的影响

Objective To observe the effect and complications of vitrectomy combined with intraocular silicon oil or C3F8 filling for proliferative diabetic retinopathy (PDR).Methods Eighty-six consecutive patients (101 eyes) with PDR-related vitreous hemorrhage who underwent primary standard three-port vitrectomy and intraocular tamponade of silicone oil or C3 F8 were included in this retrospective study.They were divided into silicone oil group and C3F8 groups.There was no statistically significant difference between these two groups of patients for gender,age,duration of diabetes,fasting glucose,history of hypertension,diabetic kidney disease history,history of cardiac and vascular diseases,body mass index and smoking history.There was statistically significant difference between these two groups of patients for visual acuity (Z=-2.604,P=0.009).There was no statistically significant difference between these two groups of patients for intraocular pressure before surgery (Z=0.064,P=0.949).The mean follow-up was (20.3±16.4) months with a range from 1 to 47 months.The patients were followed up for visual acuity,intraocular pressure,neovascular glaucoma (NVG),the incidence of retinal detachment,recurrent vitreous hemorrhage,and repeated operation for complications.Results Visual acuity (t=-3.932,-8.326; P=0.000,0.000) and intraocular pressure (t=-3.159,-2.703; P=0.006,0.009) were changed significantly after surgery for both groups.Between these two groups after surgery,there were significant differences of visual acuity (Z=-1.879,P=0.040),intraocular pressure (Z=-3.593,P=0.000),and complications (revision operation,retinal detachment,recurrent vitreous hemorrhage and NVG) (t =-2.777,-2.102,-2.308,-2.013 ; P ＜ 0.05).Conclusion Intraocular silicone oil tamponade can reduce the postoperative complications of PDR,especially for severe retinal neovascularization,exudation associated with retinal edema. Key words: Diabetic retinopathy/complications; Vitreous hemorrhage/surgery; Vitrectomy; Silicone oils/therapeutic use; Noble gases/therapeutic use

Clinical research of silicone oil removal with a 23-Gauge vitrectomy system

Objective To investigate the effects of Oxane 5700 silicon oil removal with 23G transconjunctival sutureless vitrectomy system(23G TSV).Methods Sixty-eight eyes of 68 consecutive patients undergoing Oxane 5700 silicone removal were collected,and were divided into 23G minimally invasive group (35 eyes)and 20G traditional group(33 eyes).Results The silicone oil was removed successfully in all patients,the mean duration of follow-up was (5.61 ± 1.24) months.There were significant differences between 23G minimally invasive group and 20G traditional group in the mean operation time (t =21.582,P =0.000).There were also significant differences between two groups in the wound opening time and closing time (t =28.681,t =29.720,P =0.000).The best corrected visual acuity in 23 G minimally invasive group was better than that in 20G traditional group at one day after surgery,there was significant differences between two groups(F =6.087,P ＜ 0.05).The intraocular pressure (IOP) at one day after surgery in both groups was lower than that of preoperative,there were significant differences between two groups (F =6.087,P ＜ 0.05).During the operation and follow-up,there was significant differences between two groups in the median of days discomfort and conjunctival congestion of the eye(Z =-2.253,-3.628,P ＜0.05).Conclusion The 23G TSV is a safe and effective surgical technique to remove Oxane 5700 silicone oil.Compared with traditional standard 20-gauge vitrectomy system surgery,it is time-saving with less red-eye appearance look and high degree of comfort. Key words: Vitrectomy, system, 23-Gauge; Removal, Oxane 5700, silicone oil

Management of vitreous loss and dropped nucleus during cataract surgery.

The intraoperative management of complication during cataract surgery of vitreous loss and dropped nucleus strongly influences the outcome, and a well-rehearsed plan for both staff and surgeons is needed. Preventative measures, early recognition, damage control, and resolution are discussed in this article. Maintenance of appropriate pressure relationships and tissue planes limits vitreous prolapse and the surgeon's primary goal is to avoid vitreous traction resulting in retinal tears and detachment. A pars plana approach to anterior vitrectomy with staining of the prolapsed vitreous is the most effective technique. Although residual lens material should be removed from the anterior and posterior chambers, once a fragment is lost to the posterior segment, the authors advocate referral for a standard three-port posterior vitrectomy with fragmenter as needed because the goal of the cataract surgeon is to offer the patient a clean, pseudophakic anterior segment and the best chance for an optimal visual recovery.

Intravitreal vascular endothelial growth factor

To evaluate whether a specific pre-analytical stabilization regimen is needed for naïve vitreous taps to detect true values of intrinsic VEGF levels. Fourteen consecutive patients with different vitreomacular pathologies without blood-retina-barrier breakdown were scheduled for standard 23-gauge three-port pars plana vitrectomy, and naïve vitreous taps were sampled at the beginning of each procedure. The extracted vitreous specimen was split; one half was immediately stored in a -20 °C freezer (unstabilized samples) and the other half was instantly stabilized with albumin (2.5 % final conc.), followed by arginine stabilization (1.25 M final conc.) and consecutively stored in a -20 °C freezer (stabilized samples). Intravitreal VEGF was detected in all 14 analyzed samples (100 %). VEGF levels were shown to be 46.5 pg/ml ± 62.3 pg/ml (MV ± SD; range: 5.99-232.3 pg/ml) in unstabilized, and 120.4 pg/ml ± 94.4 pg/ml (range: 42.9 pg/ml-289.6 pg/ml) in stabilized vitreous samples. Intravitreal VEGF levels in stabilized vitreous samples were on average 2.6-fold, and thus significantly higher than in unstabilized taps of same eyes (p = 0.001, Wilcoxon test). VEGF levels in stabilized vitreous samples can be up to 8.5 times higher than in corresponding unstabilized vitreous taps of same eyes (bootstrap analysis). Intravitreal VEGF levels in unstabilized samples correlate with those in stabilized vitreous taps (r = 0.594; p = 0.025; Pearson). An adequate pre-analytic stabilization regimen is needed to evaluate the most accurate intravitreal VEGF levels. This in turn will result in a better understanding of the physiological as well as pathological role of VEGF within the eye. Furthermore, knowing the true value of intravitreal VEGF levels will help to calculate the dosage of intravitrealy applied anti-VEGF drugs.

Quick Referral and Urgent Surgery to Preempt Foveal Detachment in Retinal Detachment Repair.

This study aimed to evaluate the consultation and referral pathway and benefit of urgent surgery within 24 hours of outpatient clinic presentation on increasing the ratio of eyes with fovea-on at surgery and visual outcomes in retinal detachment cases. This is a retrospective, interventional case series. A total of 106 eyes underwent an operation for rhegmatogenous retinal detachment. Standard vitrectomy or explant scleral buckling was performed. The ratio of eyes with fovea-on at the time of operation, anatomical success rate, and postoperative best corrected visual acuity were measured. Of the106 eyes, 46 (43.4%) already were fovea-off at initial eye clinic visit, and 9 eyes became fovea-off during referral. Consequently, 55 patients (51.9%) were fovea-off when presenting to our outpatient clinic. Retinal detachment was within 1 disc diameter of the fovea in 9 of 51 eyes with fovea-on at outpatient clinic presentation, but surgery within 24 hours spared 6 eyes from foveal involvement. The anatomical success rate of primary surgery was 98.8% (81/82 eyes) by vitrectomy and 83.3% (20/24 eyes) by scleral buckling. Postoperative best corrected visual acuity of the fovea-on group was significantly higher (mean [SD], -0.019 [0.22] logarithm of the minimal angle of resolution) than that of the fovea-off group (mean [SD], 0.32 [0.45] logarithm of the minimal angle of resolution; P = 0.002). More than half (51.9%) of our cohort had already been fovea-off by outpatient presentation. Therefore, efforts to urge patients to visit operating facilities promptly seem to be as important as the urgent surgeries themselves.

Dropped lens fragment, dislocated intraocular lens.

Management of posteriorly dislocated crystalline lens has traditionally been performed with a standard 20-gauge vitrectomy system. The latest surgical platforms integrate multiple devices into single systems and feature advanced fluidics, vitreous cutting technology, and intraocular pressure control along with continued improvements in small-gauge instrumentation and wide-angle viewing systems. This allows truly robust removal of core vitreous and outstanding control of the surgical field on par with its 20-gauge predecessor, resulting in an expanded spectrum of complex vitreoretinal maneuvers feasible with 23- or 25-gauge systems. Posteriorly dislocated crystalline lens/intraocular lens is one such indication which can be safely and effectively managed by a 23- or 25-gauge vitrectomy system alone or combined with the 20-gauge fragmatome/forceps with lesser complications and early recovery.

The Ocular Consequences and Applicability of Minimally Invasive 25-Gauge Transvitreal Retinochoroidal Biopsy

To determine the applicability and ocular morbidity of the 25-gauge transvitreal retinochoroidal biopsy technique in the management of intraocular tumors. Retrospective, consecutive, observational, single-surgeon case series. A total of 124 biopsies were performed in 123 patients with intraocular tumors in the posterior segment from January 1, 2009, through December 31, 2011. The biopsies were performed under general anesthesia with standard 25-gauge vitrectomy equipment. The vitreous body and the retinotomies were left untreated with the exception of 1 patient in whom a complete vitrectomy and oil tamponade were performed. Histopathologic examination of all samples was performed and cytogenetic testing with fluorescence in situ hybridization and multiplex ligation-dependent probe amplification were performed in the uveal melanomas. Median follow-up time was 26.3 months (range, 2.0-47.2 months). Histopathologic diagnosis and chromosome 3 analysis of the biopsy-obtained tissue sample. Clinical observations included visual acuity, retinal detachment, vitreous hemorrhage, and secondary enucleation. Histopathologic diagnosis was obtained in 97.6% (n = 121) of the intraocular tumors, and chromosome 3 status could be determined in 97.3% (n = 110) of uveal melanoma patients. Preoperative retinal detachment was present in 65% (n = 55). Apart from in 1 case, all retinal detachments remained stable during surgery. Additionally, 7.1% (n = 6) of cases demonstrated retinal detachment during the follow-up period, and vitreous hemorrhage was observed in 96.5% of cases (n = 82) 1 day after surgery. Both conditions regressed spontaneously in nearly all cases. Retinal detachment surgery and vitrectomy resulting from persistent vitreous hemorrhage was performed in 3.5% (n = 3) and 5.9% (n = 5) of patients, respectively. The frequency of secondary enucleated eyes was 6.7% (n = 5). Free tumor cells after biopsy were described in 15.9% (n = 7), but no tumor recurrence at the sclerotomy sites was observed. A decrease in visual acuity from better than 0.1 (20/200) at diagnosis to 0.1 or worse at 1 and 3 years of follow-up was observed in 21.7% (n = 13) and 41.7% (n = 5) of patients, respectively. The 25-gauge transvitreal retinochoroidal biopsy provides a large sample, adequate for histopathologic examination and cytogenetic analysis. The procedure is associated with a low risk of ocular complications.