Vitrectomy In Patients Research Articles

Отдаленные результаты витрэктомии у пациентов с травматическим гемофтальмом

Отдаленные результаты витрэктомии у пациентов с травматическим гемофтальмом

Analysis of the histopathological features of recurrent retinoblastoma after vitrectomy

Objective: To analyze the histopathological features and histopathological risk factors (HRF) of tumor recurrence after vitrectomy in patients with retinoblastoma (RB). Methods: Retrospective case series. Twenty-nine patients (29 eyes) who underwent enucleation from April 2014 to April 2019 at the Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University due to tumor recurrence after vitrectomy in the other hospitals were enrolled and archived. The pathological sections of the other hospitals were read by the pathologists of the department and the pathological report was written. Histopathological features and HRF were analyzed in this group of patients. The HRF used in this study was defined as tumor invasion of the optic nerve, the choroid (the largest diameter ≥ 3 mm and mostly reaching the inner sclera), the sclera, the anterior segment of the eye, and tumor passing through the scleral and growing outside the eyeball. Results: Of the 29 patients with RB recurrence after vitrectomy, 18 (62.1%) were male and 11 (37.9%) were female. The age was 1-10 years with a median age of 3 years. Among 29 eyes, the tumor invaded the ciliary body in 19 eyes (65.5%), the iris in 14 eyes (48.3%), the anterior chamber in 10 eyes (34.5%), and the anterior chamber angle in 7 eyes (24.1%). Of the 29 eyes, 27 eyes (93.1%) had HRF. The most common HRF was invading the anterior segment of the eye(77.8%, 21/27). Conclusions: In patients with recurrence after vitrectomy for RB, the most common tumor invasion site in histopathology is the anterior segment of the eye, particularly the ciliary body. More than 90% of the patients have HRF. Vitrectomy for RB treatment requires a rigorous surgical indication assessment. (Chin J Ophthalmol, 2019, 55: 854-859).

Intravitreal ranibizumab for persistent diabetic vitreous haemorrhage: a randomised, double-masked, placebo-controlled feasibility study.

To determine the feasibility of a definitive study of intravitreal ranibizumab to promote the clearance of persistent diabetic vitreous haemorrhage and thereby avoid vitrectomy. This randomised, double-masked, placebo-controlled feasibility study recruited24 participants with persistent diabetic vitreous haemorrhage listed for pars plana vitrectomy.Participants were randomised to a single 0.5-mg intravitreal ranibizumab injection or a single subconjunctival saline injection.The primary outcome measure was thenumber of participants requiring pars plana vitrectomy at week 7. Eight of 12 participants (66.7%) in the ranibizumab group required vitrectomy at week 7 versus 12 of 12 (100%) in the placebo group (absolute risk reduction 33.3%, 95% confidence interval 2.1-70.7%;p=0.09). One additional eye in the ranibizumab group required vitrectomy by 12months. Mean visual acuity letter score at 12months was 72.7±12.3 in the ranibizumab group and 75.1±10.1 in the placebo group. Safety was similar across groups. Intravitreal ranibizumab may reduce the likelihood of proceeding to vitrectomy in patients with persistent, dense diabetic vitreous haemorrhage. Further studies appear feasible and justified.

Diagnostic vitrectomy: a case series in a single referral center

Abstract Objective To study the results and safety of diagnostic vitrectomy in patients with unknown etiology panuveitis. Methods A retrospective descriptive observational study was carried out in which a total of 29 patients (37 eyes) were included, who underwent a vitreous biopsy due to acute intraocular inflammatory processes. In all, demographic and clinical data were collected. We studied the specific samples extraction methods and their diagnosic processing. Results Of the 29 patients analyzed, 18 were men. Mean of age was 63.11 years old (Standard Deviation: 14.55). The most frequent initial symptom was visual acuity decrease, with mean initial visual acuity being 20/40, excluding 8 eyes that had vision lower than 20/200. 21 presented unilateral ocular involvement. Vitrectomy was performed in all of them obtaining a dry sample. Vitrectomy was performed in all of the patients obtaining a dry sample. Moreover, the following techniques were done: 5 retinal biopsies, obtaining 5 Muestra diluidas, 1 subretinal abscess aspirate and 1 aqueous humor aspirate. The most frequent processing technique that was used was cytology in 25 eyes, followed by PCR (polymerase chain reaction) in 11 eyes and culture in 10 eyes. Diagnosis was achieved in 94.5% of patients. Main diagnosis found was lymphoma, followed by toxoplasmosis. Conclusions Diagnostic vitrectomy is very important in ophthalmic inflammation identification. Different techniques for obtaining and processing can be used.

Vitrectomía diagnóstica: serie de casos en un centro de referencia

ObjectiveTo study the results and safety of diagnostic vitrectomy in patients with unknown etiology panuveitis. MethodsA retrospective descriptive observational study was carried out in which a total of 29 patients (37 eyes) were included, who underwent a vitreous biopsy due to acute intraocular inflammatory processes. In all, demographic and clinical data were collected. We studied the specific samples extraction methods and their diagnosic processing. ResultsOf the 29 patients analyzed, 18 were men. Mean of age was 63.11 years old (standard deviation: 14.55). The most frequent initial symptom was visual acuity decrease, with mean initial visual acuity being 20/40, excluding 8 eyes that had vision lower than 20/200. 21 presented unilateral ocular involvement. Vitrectomy was performed in all of them obtaining a dry sample.Vitrectomy was performed in all of the patients obtaining a dry sample. Moreover, the following techniques were done: 5 retinal biopsies, obtaining 5 muestras diluidas, 1 subretinal abscess aspirate and 1 aqueous humor aspirate. The most frequent processing technique that was used was cytology in 25 eyes, followed by PCR (polymerase chain reaction) in 11 eyes and culture in 10 eyes.Diagnosis was achieved in 94.5% of patients. Main diagnosis found was lymphoma, followed by toxoplasmosis. ConclusionsDiagnostic vitrectomy is very important in ophthalmic inflammation identification. Different techniques for obtaining and processing can be used.

Long-term results and risk factors influencing outcome of gas tamponade for myopic foveoschisis with foveal detachment

To evaluate the long-term results of gas tamponade without vitrectomy in patients with myopic foveoschisis (FS) and foveal detachment (FD). Twenty eyes of 20 patients with myopic foveoschisis and foveal detachment were analysed retrospectively. All patients received an intravitreal injection of 0.2-0.3 mL C3F8 as an initial treatment. The patients were followed up for at least 18 months after the procedure. The refractive status, best-corrected visual acuity (BCVA), and anatomical abnormalities in macular area before and after the treatment were assessed and recorded. After initial gas tamponade, FD resolved completely (defined as responders) in 14 eyes, resolved partially in 2 eyes (defined as partial responders), and worsened in 4 eyes (non-responders) at the 3-month follow-up visit. Vitrectomy was performed in four eyes that showed increased detachment (two cases) or developed macular hole (two cases). Repeated gas injection was performed in two recurrent cases after initial success at the 3-month follow-up, and the foveal detachment once again resolved. Overall, 70% of our cases demonstrated resolution of FD at the 3-month follow-up and the long-term responders to gas injection was 65%. The risk factors for treatment failure were: (1) The presence of optical coherence tomography (OCT)-evident premacular membranes (p = 0.03) and (2) the height of FS measured >588 µm (p = 0.009). Our data supported that gas tamponade may be effective as an alternative treatment for selected cases of myopic FS with FD. The procedure may be especially beneficial in patients without OCT-evident premacular membranes and have low height of FS.

Limited Vitrectomy in Patients with Idiopathic Macular Hole

Background:Partial posterior hyaloidectomy is suggested to minimize traction on the vitreous base and thus reduce the risk of iatrogenic breaks in patients with macular hole and epiretinal membrane.Aims:To evaluate the safety and efficacy of limited vitrectomy in patients with macular hole.Study Design:Retrospective cohort study.Methods:Fifty-two consecutive patients who underwent macular hole surgery without complete peripheral vitreous removal were included in the study. The improvement in visual acuity, the incidence of retinal breaks and detachment, anatomical results, and intraoperative and postoperative complications of this technique were evaluated.Results:The median visual acuity was 0.2 (0.1-0.4) before surgery and 0.5 (0.3-0.6) after surgery (p<0.001). None of the patients had retinal breaks or detachments. A sulfur hexafluoride was used in 24 patients (46.2%), and perfluoropropane was used in 28 patients (53.8%). Three patients (5.76%) had revision surgery because of recurrence of the macular hole. We did not observe proliferative vitreoretinopathy or surgery-related major complications in any patient during the follow-up period.Conclusion:Limited vitrectomy without removal of the peripheral vitreous seems to be effective and safe with minimal risk of peripheral retinal breaks and detachment.

Effectiveness of prophylactic intravitreal bevacizumab injection to proliferative diabetic retinopathy patients with elevated preoperative intraocular VEGF in preventing complications after vitrectomy.

PurposeThis study aimed to elucidate the effects of intravitreal bevacizumab (IVB) injections for the prevention of post-vitrectomy complications in proliferative diabetic retinopathy (PDR) patients with elevated vitreous vascular endothelial growth factor (VEGF) concentration.DesignProspective case series.MethodsThirty-three patients (42 eyes) with PDR who underwent primary vitrectomy in the Department of Ophthalmology, Tokyo Medical University Hospital were studied. We measured VEGF concentrations in vitreous humor collected at the time of vitrectomy using ELISA. IVB injections were performed after vitrectomy in patients with vitreous VEGF levels exceeding 1,000 pg/mL. New bleeding occurring within 1 month of vitrectomy was defined as early vitreous hemorrhage (VH).Main outcome measureThe incidence of complications after vitrectomy including postoperative early VH.ResultsIVB injections were administered to 11 eyes (26%) with vitreous VEGF concentrations exceeding 1,000 pg/mL. None of the 11 eyes that received an IVB injection developed early VH. Among 31 eyes (74%) with vitreous VEGF concentrations lower than 1,000 pg/mL, two eyes (6%) developed early VH after vitrectomy.ConclusionsProphylactic IVB injections administered to patients with elevated preoperative intraocular VEGF concentrations were effective in preventing post-vitrectomy early VH.

Vitrectomie diagnostique dans les inflammations intraoculaires : étude d’une série rétrospective

To determine the diagnostic and functional yield of vitrectomy in patients with uveitis of unknown origin. A single-centered retrospective study was performed on patients who underwent a diagnostic vitrectomy for uveitis in the Department of Ophthalmology of the Nancy University Hospital from January 2011to December 2016. Vitreous samples were analyzed in the cytology laboratory by cytological and immunohistochemical techniques, and in the microbiological laboratory by culture and bacterial, fungal and viral PCR, depending on clinical findings. Preoperative and one- and six-month postoperative visual acuity were collected and compared. Thirty-four patients (39vitrectomies) were included. Vitreous testing led to a diagnosis in 14out of 39cases (36%): 10intraocular lymphoma, 2amyloidosis, 1CMV retinitis, and 1choroidal metastasis of cutaneous melanoma with vitreous dissemination. Vitrectomy was negative in 20patients. Visual acuity improved from 1.2±0.7logMAR preoperatively to 0.8±0.7logMAR at 1month (p<0.001) and 0.9±0.8logMAR at 6months (p=0.054). In our study, diagnostic vitrectomy and vitreous fluid analysis were useful to diagnose uveitis of unknown origin, most of which were found to be intraocular lymphomas. Visual acuity improved for the majority of patients. Diagnostic vitrectomy with appropriate vitreous analysis related to clinical examination must be considered in the evaluation of uveitis of unknown origin.

Индуцированная интраоперационная гипотония при субтотальной витрэктомии у пациентов с регматогенной отслойкой сетчатки

Индуцированная интраоперационная гипотония при субтотальной витрэктомии у пациентов с регматогенной отслойкой сетчатки

Relationship between the morphology of the foveal avascular zone and the degree of aniseikonia before and after vitrectomy in patients with unilateral epiretinal membrane.

Persistent metamorphopsia, particularly aniseikonia, is a troublesome problem which may occur after epiretinal membrane (ERM) surgery. To clarify if the preoperative foveal avascular zone (FAZ) morphology can be used as a predictor of postoperative residual aniseikonia, the morphological changes in the FAZ and the degree of aniseikonia between before and 12months after vitrectomy for epiretinal membrane (ERM) were measured and analyzed. Thirty patients, each with a unilateral idiopathic ERM, who underwent treatment between September 2016 and March 2017 were enrolled for this prospective case series study. Best-corrected visual acuity (BCVA), the degree of aniseikonia, central foveal thickness (CFT), FAZ area (FAZa), perimeter (FAZp), and circularity in ERM eyes were examined before and 1, 3, 6 and 12months after surgery. The fellow eye without an ERM was also examined and used as the control. The interocular ratios of the CFT, FAZa, and FAZp in ERM eyes with those in control eyes were also calculated. Multiple regression analysis was performed on preoperative parameters that were found to be significantly correlated with the 12-month aniseikonia in univariate analyses. The BCVA in the ERM eyes was significantly improved at 1month after surgery (P < .0001) The degree of aniseikonia was significantly reduced only after 12months (P = .004). The CFT had decreased significantly by 3months after the surgery and continued decreasing thereafter (P < .0001). Both FAZa and FAZp were significantly smaller in the ERM eyes than in the control eyes throughout the study period (P < .0001 and P < .0001, respectively), with no change in either parameter over the study period. Correlation analyses revealed that the degree of aniseikonia was significantly correlated with pre- and postoperative CFT, CFT ratio, FAZa, FAZa ratio, FAZp, and FAZp ratio. Within preoperative OCT parameters, FAZa ratio remained significant after multiple regression analysis was performed (P < .0001). Aniseikonia changed little over the long term following ERM surgery. Preoperative FAZ area ratio was identified as a significant predictor of postoperative aniseikonia.

Bimanual irrigation-aspiration for ectopia lentis and use of a small incision for 4-point scleral-sutured foldable intraocular lens and anterior vitrectomy in patients with Marfan syndrome.

Purpose:This study evaluated bimanual intracapsular irrigation-aspiration for ectopia lentis with use of a small incision for 4-point scleral fixation of a foldable posterior-chamber intraocular lens (IOL) and anterior vitrectomy in patients with Marfan syndrome.Methods:We performed a retrospective study of 18 eyes from 10 patients with Marfan syndrome who underwent surgical intervention for ectopia lentis at our clinic between July 2012 and September 2018. In this study, intraoperative and postoperative complications, uncorrected visual acuity, best-corrected visual acuity, spherical equivalent, intraocular pressure, and endothelial cell density were evaluated.Results:No intraoperative complications were reported. In all cases, early postoperative evaluation revealed a clear cornea, round pupil, and well-centered IOL. Mean logMAR uncorrected visual acuity improved from 1.09 preoperatively to 0.56 postoperatively (P < 0.05). Mean logMAR best-corrected visual acuity improved from 0.45 preoperatively to 0.17 postoperatively (P < 0.05). Aside from transient ocular hypertension, no postoperative complications were reported.Conclusion:The combined surgical technique presented above yields excellent visual outcomes with an extremely low incidence of complications. This approach is simple, safe, and effective in the treatment of ectopia lentis in patients with Marfan syndrome.

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

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

The outcomes of epiretinal membrane peeling in patients with foveal herniation

BackgroundTo evaluate the surgical outcomes of vitrectomy in patients with foveal herniation associated with epiretinal membrane (ERM).MethodsThis was a retrospective case series. The patients who had a foveal herniation associated with ERM, underwent vitrectomy, and had a minimum follow-up period of 12 months were included. The visual and anatomical outcomes were assessed during the first 12 months of follow-up and at the last follow-up visit. The main outcome measure was the reorganization pattern of foveal pit at month 12.ResultsEleven eyes of 11 patients were included. The mean postoperative follow-up period was 14.8 ± 2.6 months. The foveal contour was completely restored in 5 eyes (45.5%), partially restored in 5 eyes (45.5%), and was not restored in 1 eye (9.1%) at postoperative month 12 follow-up visit. The mean preoperative best corrected visual acuity was 0.61 ± 0.16 LogMAR and increased to 0.49 ± 0.16 LogMAR at month 12 (p < 0.0001). The mean preoperative central retinal thickness was 476 ± 128 micrometers and decreased to 302 ± 70 micrometers at month 12 (p < 0.0001).ConclusionThe foveal contour was restored in 45.5% of the eyes and visual acuity was significantly increased by a mean of 1.2 LogMAR lines at month 12 in patients with foveal herniation associated with ERM.

Anatomic Outcomes and Prognostic Factors of Vitrectomy in Patients with Primary Rhegmatogenous Retinal Detachment Associated with Choroidal Detachment

ABSTRACTPurpose: This study was undertaken to assess the associations between the anatomic outcomes of patients who underwent vitrectomy for rhegmatogenous retinal detachment associated with choroidal detachment (RRDCD) and their preoperative variables.Methods: A total of 175 patients with RRDCD who underwent vitrectomy in one eye were included in the analysis. The primary outcome measured was the retinal status after primary vitrectomy and at the end of follow-up.Results: The retinal reattachment rate was 72.57% after primary surgery, and the final total reattachment rate was 89.14% after follow-up. Binary logistic regression analysis identified that the retinal reattachment rate after primary vitrectomy was significantly associated with older age (odds ratio = 1.03, p = 0.02), mild proliferative vitreoretinopathy (PVR) (PVR grade C vs. PVR grades A–B: odds ratio = 0.31, p = 0.04; PVR grade D vs. PVR grades A–B: odds ratio = 0.03, p < 0.01), and intravitreal steroid treatment (odds ratio = 4.60, p = 0.02), and that the final retinal reattachment rate was independently associated with older age (odds ratio = 1.05; p = 0.01).Conclusions: Vitrectomy is a good surgical option for RRDCD. Older age, mild preoperative PVR, and perioperative intravitreal triamcinolone acetonide injections increase the primary reattachment rates after one operation. Older age was the only independent prognostic factor for the final retinal reattachment in patients with RRDCD.

Comparative study of straight vs angled incision in 27-gauge vitrectomy for epiretinal membrane.

PurposeThe purpose of this study was to compare straight and angled incisions in 27-gauge microincision vitrectomy in patients with epiretinal membrane (ERM).MethodsSeventy-three eyes of 68 patients with ERM who underwent straight (35 eyes) or angled incision (38 eyes) for 27-gauge microincision vitrectomy were retrospectively evaluated.ResultsNo statistically significant difference was found between the two groups in postoperative logarithm of minimal angle of resolution best-corrected visual acuity. The intraocular pressure and rate of hypotony 1 day postoperatively did not differ between the straight- and angled-incision groups (intraocular pressure: 11.5 vs 13.4 mmHg, respectively; rate of hypotony: 20% vs 8%, respectively). Surgical wound closing occurred by postoperative day 10 in both groups.ConclusionA straight incision is as safe and useful in ERM vitrectomy as an angled one.

Thin Rigid Contact Lens Used in Vitreous-Retinal Surgery for Corneal Protection: A Randomized Controlled Trial.

To design a rigid contact lens (CL) to be used in combination with a wide-angle viewing system and analyze its protection for corneal epithelial during vitreous-retinal surgery. A thin and lightweight rigid CL was designed and constructed. The impact of the CL on the visualized fundus range was evaluated using a concrete eye model. Patients with severe proliferative diabetic retinopathy (PDR) were randomized to either the CL group, corneal protective agent (CPA) group, or balanced salt solution (BSS) group. All patients underwent phacoemulsification and a standard 23-gauge three-port vitrectomy. Surgery time and corneal fluorescein staining score (FSS) postoperatively were mainly measured. In the eye model, a larger area of fundus was visualized with the use of our CL under 128 D or 60 D Resight lens. The mean surgery time was 51.36±8.06 min, 50.89±8.26 min, and 55.46±9.14 in CL, CPA, and BSS group, respectively (F=2.325, P=0.105). In eight eyes in the BSS group, corneal epithelial layer was peeled off because the dryness of the cornea could not maintain a clear fundus image. The FSS in BSS group was markedly higher than that of CL and BSS group 1 day (P<0.001), 3 days (P<0.001), and 7 days (P=0.002) postoperatively. There was no statistical significance of the FSS between CL and CPA group at each follow-up endpoint. The CL that we designed can slightly enlarge the visible fundus range and efficiently protect corneal epithelium during vitrectomy for patients with PDR.

Anatomic and Functional Effects of Pars Plana Vitrectomy in Patients with Diabetic Tractional Retinal Detachment

Anatomic and Functional Effects of Pars Plana Vitrectomy in Patients with Diabetic Tractional Retinal Detachment

Cautious choice of vitrectomy in patients with retinoblastoma

In recent years, the treatment concept of retinoblastoma has changed from focusing on saving children's life to preserving the eyeballs and useful visual function. As a promising way to retain the eyeball, the application of vitrectomy in patients with retinoblastoma has long been debated. In view of the special anatomical structure of eyes and the biological characteristics of retinoblastoma cells, retinoblastoma is always prone to recurrence and metastasis after vitrectomy. Therefore, vitrectomy could hardly be a routine treatment and it should be used in retinoblastoma patients cautiously. (Chin J Ophthalmol, 2018, 54: 649-651).

Erratum: Risk factors for requirement of filtration surgery after vitrectomy in patients with proliferative diabetic retinopathy [Corrigendum

[This corrects the article on p. 733 in vol. 12, PMID: 29713141.].