Transconjunctival Vitrectomy Research Articles

Predictive parameters for anatomical surgical success in full-thickness macular holes : Aretrospective evaluation of 391eyes

Full-thickness macular hole (FTMH) is arare disease. Not all FTMHs can be closed by primary surgical intervention. This work aims to characterize alarge patient population with FTMHs and to detect possible predictive factors for anatomical treatment success. The study comprises aretrospective analysis of all consecutive idiopathic macular holes between March 2008 and June 2019 at the University Eye Hospital Cologne. Epidemiologic data, preoperative parameters (size of the FTMH), and surgical technique were examined in relation to the closure rate following primary surgery. The anatomical closure rate for idiopathic FTMH after primary surgery was 83.6%. No association between age, gender, and lens status and closure rate could be shown. Regarding anatomical surgical success, the favorable prognostic factors identified were asmall FTMH size, short symptom duration, performance of transconjunctival 23-gauge vitrectomy, and application of the inverted flap technique of the internal limiting membrane (ILM). Surgical treatment represents avaluable treatment option for patients with macular holes due to good prospects of success. Prompt intervention after diagnosis using 23-gauge vitrectomy and an ILM flap with gas tamponade seems to result in the most favorable outcomes.

Long-term surgical results of trabeculectomy for secondary glaucoma in Val30Met hereditary transthyretin amyloidosis

This study reports the long-term results of trabeculectomy (LEC) for secondary glaucoma in hereditary transthyretin (ATTRv) amyloidosis patients and its correlation with prior vitrectomy. A retrospective case series was conducted involving 31 consecutive eyes of 20 ATTRv amyloidosis patients who underwent LEC between 2007 and 2020. The mean follow-up period was 73.2 ± 37.0 months (range: 20–181 months). Postoperative intraocular pressures (IOPs) were evaluated based on the following criteria: (a) IOP between 6 and 21 mmHg without additional glaucoma surgeries, except for laser suture lysis, (b) IOP between 6 and 15 mmHg without additional glaucoma surgeries, except for laser suture lysis, and (c) IOP between 6 and 21 mmHg without additional glaucoma surgeries, except for needling and laser suture lysis. Kaplan–Meier analysis revealed survival rates after LEC of 0.52 at 36 months, 0.42 at 60 months, and 0.25 at 84 months under criterion (a); 0.49 at 36 months, 0.27 at 60 months, and 0.11 at 84 months under criterion (b); and 0.76 at 36 months, 0.71 at 60 months, and 0.65 at 84 months under criterion (c). Eyes with a history of small gauge transconjunctival vitrectomy (SGTV) exhibited a tendency towards lower survival rates, although no statistically significant difference was observed (log-rank test; p = 0.193 under criterion (a) and p = 0.0553 under criterion (b)). Our findings suggest that LEC and additional needling procedures can provide some control over IOP; however, the overall postoperative outcomes of LEC for ATTRv amyloidosis remain unsatisfactory, even in the era of SGTV with reduced conjunctival scarring.

The eye and lymphoma: New concepts of an old acquaintance

AbstractIntraocular lymphoma (IOL) is a life‐threatening condition that results from the proliferation of malignant lymphocytic cells arising from either the central nervous system (CNS) (primary CNS lymphoma) or outside the CNS with secondary dissemination and metastasis to the eye (secondary IOL). Primary intraocular lymphoma (PIOL), also known as primary vitreoretinal lymphoma (PVRL), is a subset of PCNSL where the findings are ocular.PVRL is particularly feared because it can manifest as non‐specific uveitis, leading to a potentially fatal diagnostic delay. Although clinical and ancillary parameters can provide valuable diagnostic clues, the only valid confirmation comes from cytological analysis and molecular studies of clonality based on vitreous and/or (sub)retinal biopsies performed during vitrectomy. Standard three‐port twenty‐five‐gauge transconjunctival vitrectomy is the usual sampling technique; however, it is important to remember that the diagnostic yield of vitreous cells depends on the way samples are harvested, transported and analysed. Even when surgical recommendations are strictly followed and analyses performed by trained pathologists, the diagnostic yield of vitrectomy is not 100%.The objective of this course is to describe the clinical features of PVRL and its characteristics on ancillary exams in both typical and more challenging situations, and present the diagnostic procedures that are or will be available in the near future. Therapeutic management will be discussed later during this course.

OCT ANGIOGRAPHY IN DISEASES OF THE VITREORETINAL INTERFACE.

Present the use of Optical Coherence Tomography Angiography (OCTA) in vitreoretinal interface diseases and results of macular capillary network evaluation before and after idiopathic macular hole surgery (IMD). Prospective evaluation of functional results, anatomical and OCTA findings before and after IMD surgery. The group consists of 8 eyes of eight patients. Preoperatively and 1, 3 and 6 months after surgery, the best corrected visual acuity (BCVA) was examined, fundus photography was performed, examination of the macula by spectral-domain optical coherence tomography (SD OCT), determination of the stage of IMD according to Gases and also OCTA examination. The area of the foveal avascular zone (FAZ) and vascular density (VD) were evaluated by using of the OCTA. The operation was performed in all cases by transconjunctival suture 25G vitrectomy by one surgeon, always peeling the inner limiting membrane. An expansive gas, 7x 20% SF6, 1x 15% C3F8, was used for vitreous tamponade. In all 8 cases, the primary closure of the IMD occurred after the operation. The mean BCVA improved statistically significantly from 0.74 to 0.48 logMAR (p = 0.0023). The average FAZ area decreased from 0.345 mm² to 0.25 mm² after surgery (p = 0.0458). The mean VD increased from 7.93 mm-1 to 8.38 mm-1 (p = 0.2959). Assessment of the macular capillary network in patients with diseases of the vitreoretinal interface offers new findings and important details that can lead to prognostic information and a better understanding of the pathogenesis of the disease. We demonstrated a statistically significant reduction in FAZ in the eyes after successful IMD surgery and an indirect relationship between the improvement of BCVA and the change in FAZ area in our cohort.

Combined transconjunctival sutureless three-port vitrectomy and scleral fixation of intraocular lens.

The aim of this article is to describe an innovative and minimally invasive surgical technique for posterior vitrectomy combined with secondary intraocular lens implantation, using a sutureless scleral fixation Carlevale intraocular lens (I71 FIL SSF Carlevale lens. Soleko IOL Division, Italy). The technique was conducted with only three transconjunctival sclerotomies and a corneal tunnel to perform intraocular lens explantation, posterior vitrectomy and Carlevale intraocular lens implantation. It is easier, quicker, and less invasive than the traditional technique with conjunctival peritomy, two scleral flaps and five sclerotomies. Surgery was performed uneventfully on three eyes of three patients. Two of them presented a luxation of the intraocular lens into the vitreous chamber, while one patient presented an intraocular lens subluxation. No complications were observed after a 5 to 8 months of follow-up. The intraocular lenses were well positioned, no conjunctival erosion was noted, and the intraocular pressure remained normal at all stages. This is the first report of a combined procedure of IOL explantation, posterior vitrectomy and secondary IOL implantation using only three transconjunctival sclerotomies. This appears to be less invasive and it causes less discomfort to the patient. We suggest considering this technique in all those cases requiring a combined procedure in absence of a proper capsular support.

A 27 - Gauge Microincision Vitrectomy Surgery for Posterior Segment Diseases in a Tertiary Centre, Nepal

Introduction: Transconjunctival micro incision vitrectomy surgery (MIVS) with 23 or 25 gauge instrumentation is more advantageous than traditional 20 gauge surgery. We intended to evaluate the visual outcome, complications and indication of various vitreoretinal diseases using 27 Gauge vitrectomy systems. 
 Methods: This study was a prospective, interventional, non-comparative study conducted in Nepal Eye Hospital from June 2017 to July 2018. Fifty-two patients with various vitreoretinal diseases were recruited. The main outcome measures included corrected distance visual acuity (CDVA) preoperative and postoperative, intraocular pressure (IOP) preoperative and postoperative, indication for vitreoretinal surgery, intraoperative complications, and postoperative complications.
 Results: Fifty two eyes of 52 patients (26 men and 26 women; mean age, 59 years) underwent 27-gauge pars planavitrectomy. Surgical indications included epiretinal membrane (n = 11), full-thickness macular hole (n = 11), rhegmatogenous retinal detachment [n = 14 (12 vitrectomy only and two vitrectomy with scleral buckle)], vitreous haemorrhage (n = 3), vitreous opacities (n = 3), silicon oil removal (n = 3), proliferative diabetic retinopathy [n = 6 (5 vitreous haemorrhage and one tractional retinal detachment)], posterior IOL dislocation (n = 1). Postoperative complications included transient ocular hypertension in eight eyes (15.39%), transient hypotony in five eyes (9.62%) and vitreous haemorrhage in five eyes (9.62%). No cases of postoperative endophthalmitis, sclerotomy - related tears, or choroidal detachments were encountered in the follow-up period. Mean corrected distance visual acuity improved from 20 / 796 (logarithm of the minimum angle of resolution, 1.60 ± 0.64) preoperatively to 20 / 49 (logarithm of the minimum angle of resolution, 0.42 ± 0.26) postoperatively (p = 0.000,) at final follow up.
 Conclusions: 27-gauge micro-incision vitrectomy surgery was found to be a safe and effective suture-less surgery with favourable outcomes, in terms of vision.

Sympathetic ophthalmia after 27-G pars plana vitrectomy

BackgroundSympathetic ophthalmia (SO) is a bilateral diffuse uveitis that can arise after ocular trauma or ocular surgery in the inciting eye. Pars plana vitrectomy (PPV) is one of the risk factors for SO. Several reports have described SO developing after 23- and 25-G PPV, but none have described SO occurring after 27-G PPV. We describe herein a case of SO after 27-G PPV for rhegmatogenous retinal detachment.Case presentationA 42-year-old woman presented with visual disturbance in the right eye. Best-corrected visual acuity (BCVA) was 6/200 in the right eye. Fundus examination revealed off-macula retinal detachment with retinal tears at both ends of retinal lattice degeneration at the temporal-oven peripheral retina of the right eye. We therefore performed 27-G sutureless PPV on the right eye. After 12 days, the retina was reattached, and BCVA improved to 6/30 in the right eye. Fifteen days postoperatively, she experienced headache and reduced vision in both eyes. Symptoms gradually worsened, and she visited our hospital 21 days postoperatively. BCVA was 6/30 in the right eye and 6/15 in the left eye. Slit-lamp examination revealed uveitis in the anterior chambers of both eyes, and fundus examination showed papillitis and subretinal detachment at the posterior poles of both eyes. Optical coherence tomography revealed subretinal fluid in the maculae of both eyes and fluorescein angiography showed multiple hyperfluorescent leakage sites in the retinal pigment epithelium. Cerebrospinal fluid examination showed pleocytosis and human leukocyte antigen testing showed expression of the DR04 phenotype; therefore, the patient was diagnosed with SO. She was treated with steroid therapy, and her visual disturbance subsided and the subretinal fluid improved as well. Her BCVA was 6/15 for the right eye and 6/5 for the left eye 93 days after the initial surgery.ConclusionThe present case shows that even if the sclerotomy site of 27-G PPV is small, there is still a risk of SO occurring in the eyes of patients who underwent transconjunctival vitrectomy. Ophthalmologists should recognize SO as complication of 27-G PPV and carry out proper management as early as possible.

Incidence and risk factors for intraocular pressure rise after transconjunctival vitrectomy.

Purpose:To study the incidence and risk factors of raised intraocular pressures (IOPs) in the follow-up of transconjunctival sutureless vitrectomy (TSV).Methods:A retrospective observational study was performed on 635 patients who underwent TSV under a single surgeon. The IOPs were recorded using a calibrated non-contact tonometer at seven postoperative visits, viz., day 1, 7 and 1, 3, 6 months, and 1 day and 1 month following silicone oil removal.Results:IOP rise was seen in 24.25% (154) out of the 635 eyes studied. Among patients under 50 years of age, 37.73% had an IOP rise, compared to 21.55% above 50 years (Odds Ratio 2.206). Among males, 30.32% had an IOP rise, as compared to 15.98% females (OR 2.287). In eyes with retinal detachment, 49.16% had raised IOP (OR 5.435), and 24.05% with proliferative diabetic retinopathy (OR 1.780), as opposed to 15.38% with macular hole and 12.32% with epiretinal membrane. This was statistically significant (P < 0.001). In eyes with silicone oil, 34.9% developed a rise in IOP (OR 2.738) as compared to 11.94% of other surgeries (OR 0.697). This was statistically significant (P < 0.001).Conclusion:We observed an increase in IOP postoperatively, more in those under 50 years, males and patients undergoing surgery for RD and PDR.

Outcomes after 23G trans-conjunctival parsplana vitrectomy and suturing of sclerotomy using 10/0 Nylon in patients with diabetic retinopathy in private hospital of Sargodha.

To determine astigmatic and intraocular pressure changes after 23G transconjunctival parsplana vitrectomy in diabetic retinopathy cases with the use of temporary 10/0 nylon suture to sclerotomy site. The prospective experimental study was conducted during 2018 at Zaheer Laser Eye Centre, Sargodha, Pakistan, and comprised patients with confirmed diagnosis of diabetic retinopathy. Postsurgery, 10/0 nylon suture was removed on 1st postoperative day and astigmatism and intraocular pressure were measured on day, at 1 week, 1 month and 3 months. Data was analysed using SPSS 19. Of the 120 patients, 60(50%) each were women and men. The overall mean age was 54.01±13.81years. Mean intraocular pressure before surgery was 19.98±3.19mmHg, and 3 months after the surgery it was 19.98±1.89 mmHg. Mean corneal astigmatic reading before surgery was 1.25±0.85 and after 3 months post-surgery, it was 1.42±0.71. The mean values remained statistically non-significant across all the follow-up points (p>0.05). Astigmatism and intraocular pressure changed non significantly after 23G trans-conjunctival p ar s p la na v i t rec tomy a nd tempor a r y s u tur in g of s c le ro tomi es u s i ng 1 0 / 0 ny l o n .

A novel, low-cost and practical illumination approach for bimanual vitrectomy.

OBJECTIVE:The present study aims to describe a novel, low-cost, transconjunctival sutureless bimanual vitrectomy illumination approach and evaluate its surgical outcome.METHODS:Thirty-six eyes of 36 patients who underwent pars plana vitrectomy with the above-mentioned technique were included in this study. Four trocars were placed in superotemporal, inferotemporal, inferonasal and superonasal quadrants. A piece (23 mm) was cut from 30G intravenous cannula and a 30 mm endoillumination probe was placed inside this sleeve. This design limited the entry of the light probe into the vitreous cavity to 7 mm and provided a safe illumination by the assistant without the risk of damaging the retinal tissue.RESULTS:Thirty-six eyes of 36 patients were included (24 male, 12 female, mean age: 58.4±14.3 years) in this study. Thirty patients had rhegmatogenous retinal detachment (six of these patients with coexisting choroidal detachment), four patients had diabetic tractional retinal detachment, one patient had a nucleus drop and one patient had an intraocular foreign body. The mean follow-up time after pars plana vitrectomy (PPV) was 5.05±4.4 months. LogMAR best-corrected visual acuity improved significantly after PPV (p<0.001). Postoperative complications included recurrent detachment in two eyes, hypotony in one eye and endophthalmitis in one eye. The transient rise in intraocular pressure was observed in 19 patients, but there was no significant difference between the preoperative and postoperative mean IOP in the long term follow-up.CONCLUSION:This bimanual vitrectomy system provided favorable outcomes without increasing the cost of standard PPV. The advantage of this system over the chandelier illumination include the reduction in glare, the possibility to change the direction of the light during the surgery to better illuminate the surgical site and the lower cost. This approach can be used in any vitrectomy system (20G, 23G, 25G, and 27G) by changing the size of the IV cannula.

25G Ultrasonic Vitrectomy in Surgical Treatment of Idiopathic Macular Hole

Introduction. Idiopathic macular hole (IMH) is a frequent disorder of the posterior segment of the eye that impacts on visual functions leading to the reduction of visual acuity and the manifestation of metamorphopsia. In the majority of cases the basic treatment technique for IMH is a three-port transconjunctival guillotine vitrectomy. In the key of the further development of vitrectomy the latest and most interesting is the use of ultrasonic energy for vitreous fragmentation. Members of staff of the Department of Ophthalmology with the Course of Additional Professional Education of Bashkir State Medical University jointly with the Department of Microsurgical Equipment of CJSC Optimedservice have built a 25G ultrasonic vitrectomy system with the mechanism of action that turns the vitreous body into easy-to-remove emulsion with the use of ultrasound.Materials and methods. This paper presents a clinical case of idiopathic macular hole successfully treated with the method of 25G subtotal ultrasonic vitrectomy.Results and discussion. The data obtained through comprehensive ophthalmological examination and supported by fundus-camera, OCT and OCTA images made it possible to make a diagnosis of vitreomacular traction syndrome, idiopathic macular hole, J. D. Gass stage 3. 25G subtotal ultrasonic vitrectomy was performed on the universal ophthalmic surgery system Optimed Profi (Optimedservice, Russia) with intraoperative OCT-controlled internal limiting membrane staining and peeling, and apposition of the macular hole edges with gas tamponade. A good outcome, both anatomical and functional, was achieved; IMH has closed and a positive visual acuity dynamic has been recorded.Conclusion. We can thus conclude that 25G subtotal ultrasonic vitrectomy with ILM peeling and gas tamponade is an effective IMH treatment method that ensures high visual functions.

Incidence of acute postoperative endophthalmitis following macular surgery in France between 2006 and 2016.

To report the incidence of acute postoperative endophthalmitis (POE) after macular surgery in France between 2006 and 2016 and to identify associated factors. This retrospective database study included all hospital discharge records involving a surgical procedure for an epiretinal membrane or a macular hole in France from January 2006 to October 2016. Acute POE was identified by two codes in the tenth edition of the International Classification of Diseases within 42days of a macular surgical procedure in the French national administrative database. In France, 152034 macular surgical procedures for epiretinal membranes or macular holes were recorded from 1 January 2006 to 31 October 2016. Suspected acute POE was reported in 381 cases. The incidence of POE was 0.25% overall, 0.30% for epiretinal membrane surgery and 0.14% for macular hole surgery. In multivariable Poisson regression analysis, epiretinal membrane surgery was associated with POE [incidence rate ratio (IRR), 2.24; 95% CI, 1.62-3.11; p<0.001]. For epiretinal membrane surgery, the 2010-2011 period was significantly associated with a higher risk of POE (IRR, 1.66; 95% CI, 1.13-2.42; p=0.03). The incidence of POE after macular surgery was 0.25% overall in France between 2006 and 2016 and twice higher for epiretinal membrane surgery than for macular hole surgery. For epiretinal surgery only, the incidence of POE was higher in 2010-2011 (period of the switch to transconjunctival vitrectomy) than in the rest of the study period.

Analysis of Changes in Corneal Topography after 27-Gauge Transconjunctival Microincision Vitrectomy Combined with Cataract Surgery.

Purpose To investigate changes in the corneal shape before and after vitrectomy, over a period of time, using a 27-gauge system. Methods Forty-five eyes underwent a combination of cataract surgery and vitrectomy. The surgeries were performed using a 27-gauge transconjunctival vitrectomy system, in which the corneal topography could be performed up to three months after the surgery. The surgeries were performed for an epiretinal membrane in 11 eyes, a macular hole in 14 eyes, and rhegmatogenous retinal detachment in 20 eyes. All of the surgeries were performed by the same surgeon, and in all cases, a 4-port 27-gauge vitrectomy device was used. Cataract surgery in all patients was performed with a 2.4 mm corneoscleral incision at 11 o'clock. The surgeries were performed without suturing the operative wound in all cases. Corneal topography was performed using a TMS-4 topographer (Tomey Corporation, Tokyo, Japan). The examinations were performed the day before and 1 day, 1 week, 1 month, and 3 months after the surgery. The results of corneal topography for the spherical, regular astigmatic, asymmetric, and high-order irregular astigmatic components were compared before and after surgery. Results No significant differences were seen in any of the components in the epiretinal membrane group, but significant differences were seen in the asymmetric components and the high-order irregular astigmatic components between the macular hole and rhegmatogenous retinal detachment groups (p < 0.05). There were no significant changes in intraocular pressure on any measurement time in the postoperative period compared to preoperative intraocular pressure. Conclusion Irregular astigmatism was seen after surgery when 27-gauge vitrectomy with a 4-port system was performed together with cataract surgery with a 2.4 mm incision.

Active silicone oil removal with 23 gauge transconjunctival system; ‘'Doganay silicone oil extraction system''

Aim: To describe a new and simple silicone oil removal method with 23-gauge (G) transconjunctival vitrectomy system. Material and Methods: This is a prospective, single center, interventional clinical trial. A hundred thirty-three eyes of 133 patients were enrolled in this study. 1000 centistoke (cSt) silicone oil was removed with our new method. Main outcome measurements were silicone oil removal time, number of sutured 23 G sclerotomy sites, intraoperative and postoperative complications, preoperative and postoperative intraocular pressure (IOP) alterations, and preoperative and postoperative visual acuity changes. Results: The mean time between pars plana vitrectomy surgery with silicone oil endotamponade and silicone oil removal was 8.5±3.5 months. Mean silicone oil removal time was 141.7±37.7 seconds. 210 of total 293 sclerotomies sites required suture. A statistically significant decrease in postoperative IOP was found only on day 1 (p

Vitrectomy and iOCT-assisted inverted ILM flap technique in patients with full thickness macular holes

In large full thickness macular holes (FTMH) the closure rate after vitrectomy and conventional internal limiting membrane (ILM) peeling is less than 90%. The aim of this study was to examine the visual acuity and anatomical success rate with high-resolution optical coherence tomography (OCT) after transconjunctival sutureless 23-gauge pars plana vitrectomy as well as intraoperative OCT (iOCT) and Brilliant Peel (BP)-assisted ILM peeling using the inverted ILM flap technique in patients with large FTMHs. In this retrospective study 25eyes of 25 consecutive patients with large FTMH were treated by 23-G vitrectomy with BP and iOCT-assisted ILM peeling using the inverted ILM flap technique followed by gas tamponade. In all patients best corrected visual acuity (BCVA) and the maximum diameter, base and height of the FTMH as well as intraretinal alterations were measured preoperatively using high-resolution spectral domain OCT (SD-OCT, Spectralis, Heidelberg Engineering, Germany). The BCVA was measured after 1, 3, and 6months. Additionally, the closure rate and the microstructural integrity of the outer retinal layers, e.g. external limiting membrane (ELM), ellipsoid zone und photoreceptor outer segment (OS) were registered in the SD-OCT and correlated with the results of BCVA after macular hole surgery. In all surgical procedures with the inverted ILM flap technique the application of iOCT enabled agood visualization and acontrolled positioning of the ILM flaps. At baseline mean BCVA was 0.2 (0.7 logMAR) and improved significantly after 1, 3 und 6months to 0.4 (0.4 logMAR), 0.5 (0.3 logMAR) and 0.63 (0.2 logMAR), respectively. The closure rate of the FTMHs was 100%. Microstructural integrity of the outer retinal layers was evaluated semiquantitatively and showed good correlation with BCVA. Vitrectomy with BP and iOCT-assisted ILM peeling using the inverted ILM flap technique in patients with large FTMH is avery controlled and safe microsurgical strategy and shows good functional and anatomical results. The morphology of the FTMH, the ILM flap and the position of the inverted ILM flap under air was well visualized by IOCT. The microstructural integrity of the outer retinal layers is displayed in detail on SD-OCT and represents an important predictive parameter for BCVA after macular hole surgery.

Idiopathic full thickness macular hole in a 10-year-old girl

BackgroundMacular holes in children are generally associated with trauma.Case presentationWe report the first case of an idiopathic full thickness macular hole in a 10-year-old girl. 23-gauge transconjunctival pars plana vitrectomy, induction of a posterior vitreous detachment, ILM blue-assisted internal limiting membrane peel, fluid–air exchange and air-26% sulfur hexafluoride (SF6) exchange was performed with subsequent macular hole closure.ConclusionThis is the first reported case of an idiopathic full thickness macular hole in a child. Treatment with pars plana vitrectomy with peeling of the ILM resulted in significant anatomic and functional improvement.

Combined 23-gauge transconjunctival vitrectomy and scleral fixation of intraocular lens without conjunctival dissection in managing lens complications

BackgroundTo evaluate the safety and efficacy of combined 23-gauge transconjunctival pars plana vitrectomy and scleral fixation of intraocular lens (IOL) without conjunctival dissection.MethodsA retrospective study in Chang Gung Memorial Hospital, Keelung and Taoyuan, Taiwan. Patients receiving combined 23-gauge transconjunctival pars plana vitrectomy and scleral fixation of IOL without conjunctival dissection were enrolled. The ocular findings, causes of lens complication, surgical procedures, type of IOL used, and complications were documented.ResultsWe included 40 eyes from 39 patients (27 male, 12 female) with a mean age of 59.5 [standard deviation (±) 14.8] years old. The mean follow-up duration was 6.8 ± 5.4 months. The cause of lens complications was ocular trauma in 24 (60%) eyes, cataract surgery complications in 11 (28%) eyes, and spontaneous subluxation of crystalline lens in 5 (13%) eyes. The overall best corrected visual acuity (BCVA) (logMAR) improved from 1.359 ± 0.735 to 0.514 ± 0.582 (p < 0.001). The BCVA also improved significantly in each group with different causes of lens complications. Preoperative BCVA was the only factor associated with the postoperative visual outcome (p = 0.008). Most surgery-related complications were self-limited, including mild vitreous hemorrhage (5%), microhyphema (5%), transient elevated intraocular pressure (3%), and transient hypotony (3%). Cystoid macular edema and IOL decentration was found in 3 (8%) eyes and 1 (3%) eye respectively.ConclusionsCombined 23-gauge transconjunctival vitrectomy and scleral fixation of IOL without conjunctival dissection is effective and safe in managing a wide variety of lens complications, with good postoperative comfort and visual recovery.Trial registrationRetrospective study, not applicable.

Autologous Plasma Enriched with Platelet Lysate for the Treatment of Idiopathic Age-Related Macular Degeneration: A Prospective Study

Background: Plasma enriched in growth factors is widely used in medical practice. However, the clinical efficacy of its application in the treatment of age-related retinal integrity violations is investigated insufficiently. Aims: The aim of the study was to evaluate the clinical efficacy of autologous plasma enriched with platelet lysate for treating age-related macular degeneration. Materials and methods: A three-port subtotal transconjunctival vitrectomy was performed and administration of the autologous plasma enriched with platelet lysate was indicated. Autologous plasma enriched with platelet lysate was received from the peripheral blood. We assessed visual acuity, intraocular pressure; conducted optical coherent tomography examination of the eye on the side of the pathological process. Results: The study demonstrated that the combination of a standard 3-port transconjunctival subtotal vitrectomy followed by tamponade of the gap using the autologous plasma enriched with platelet lysate with the injections of the autologous plasma enriched with platelet lysate in the area of pterygopalatine fossa on the side of the operated eyes statistically significantly promoted recovery of the visual acuity in the early postoperative period (15 days) and late period (90 days) if compared with patients who received only surgical treatment (p≤0.05). Use of the autologous plasma enriched with platelet lysate in the treatment increased the closing rate of the tearing of the retina in the macular region up to 62,5%, while only surgical treatment leads to the closure of the defect of the retina in 37.5% of cases. The study showed that autologous plasma enriched with platelet lysate contains cytokines, growth factors, and nitric oxide which are involved in the regeneration/reparation of the retina. Conclusions: Additional administration of the autologous plasma enriched with platelet lysate in the scheme of treatment patients with age-related macular degeneration is accelerating the closure of retinal tears of the eye and improves visual acuity.

23-gauge transconjunctival vitrectomy for posterior segment intraocular foreign bodies.

This study is a report of the outcomes of 23-gauge (G) transconjunctival vitrectomy (TV) performed to treat a posterior segment intraocular foreign body (IOFB). The data of 14 eyes of 14 patients who underwent 23-G TV for the removal of a posterior segment IOFB were reviewed in this study. Surgery was initiated with a 23-G system in each case and the posterior segment IOFB was removed through the enlarged sclerotomy site. All of the patients were male. The mean age of the patients was 36.6+-11.0 years. The foreign body (FB) was located in the vitreous in 11 eyes and in the retina in 3 eyes. Before the 23-G TV, complicated cataract was detected in 6 eyes, vitreous hemorrhage was detected in 5 eyes, and retinal detachment was detected in 1 eye. The size of the FB ranged from 3 mm to 7 mm; 12 of the FBs were metallic and 2 were glass. Silicone oil was used as a tamponade agent in 5 eyes and gas tamponade (C3F8) was used in 4 eyes. The mean follow-up time was 8.15+-2.9 months. At the last examination, of the 14 eyes included in the study, the visual acuity (VA) was 0.1 or better in 10 eyes and less than 0.1 in 4 eyes because 2 eyes had peri-macular scar, 1 eye had massive sub-epiretinal membrane and 1 eye had retinal re-detachment. 23-G TV is seen as an effective and minimally invasive technique to remove posterior segment IOFBs.

The quantitative assessment of alterations in lens transparency after transconjunctival 27-gauge microincision vitrectomy surgery.

PurposeTo evaluate the baseline and post-vitrectomy lens densitometry values by a Scheimpflug camera in eyes with epiretinal membrane that were treated with 27-G microincision vitrectomy surgery (MIVS) without tamponade and to compare the results with those in fellow healthy eyes.Patients and methodsProspective case series. The lens densitometry measurements of 24 patients, who underwent 27-G MIVS without any tamponade for the treatment of epiretinal membrane, were taken preoperatively and on the first week, first month, and third month postoperatively with Pentacam HR-Scheimpflug imaging system.ResultsThe mean lens densitometry values at Zone 1 and average lens densitometry values significantly increased in the study eyes on the first month when compared with the preoperative values (P=0.011, P=0.033, respectively). Additionally, there were statistically significant differences regarding the mean lens densitometry values of Zone 1 and Zone 2, and also average lens densitometry values between the preoperative and third month postoperative values (P=0.003, P=0.021, P=0.009, respectively). However, the densitometry values of fellow eyes were similar at preoperatively and all the postoperative follow-up periods (P>0.05 for all).ConclusionsThis study suggests that 27-G MIVS might cause post-surgical lens density changes even in early postoperative months and vitreous may play an important role in protecting the transparency of the lens.