Vitrectomy For Tractional Retinal Detachment Research Articles

Internal Limiting Membrane Peeling in Patients Undergoing Vitrectomy for Tractional Retinal Detachment Secondary to Diabetic Retionpathy.

To assess the merits of internal limiting membrane (ILM) peeling during pars plana vitrectomy (PPV) in subjects with a tractional retinal detachment (TRD) secondary to proliferative diabetic retinopathy (PDR). One hundred and ninety one PDR subjects undergoing PPV for the principal indication of TRD were enrolled into this randomized controlled trial. Study subjects were intraoperatively randomized into one of the following treatment groups: Cohort A patients underwent ILM peeling, while Cohort B patients did not undergo ILM peeling. The main outcome was postsurgical epiretinal membrane (ERM) development at 6 months. The secondary outcome was attainment of ≥ 20/50 visual acuity (Snellen) at 6 months. One hundred and thirty nine subjects underwent randomization and completed the study's 6-month trial period. Cohort A had 3.1% (2/64) of subjects develop an ERM postoperatively, while Group B had 26.7% (20/75) of subjects develop an ERM postoperatively at 6 months (p<0.001). Attainment of ≥ 20/50 visual acuity (Snellen) at 6 months was found in 21.9% (14/64) of subjects in Cohort A and 9.3% (7/75) of subjects in Cohort B (p=0.039). PDR patients undergoing PPV for TRD have a lower frequency of postsurgical ERM formation and a greater likelihood of attaining ≥ 20/50 Snellen visual acuity at 6 months when ILM peeling is conducted. Specialists may consider peeling of the ILM during PPV an important surgical maneuver in this patient population.

Outcomes and Complications of Pars Plana Vitrectomy for Tractional Retinal Detachment in People With Diabetes

Tractional retinal detachment (TRD) occurs in approximately 5% of people with proliferative diabetic retinopathy and poses a threat to vision. Pars plana vitrectomy (PPV) is the treatment of choice for TRD. To determine anatomic and functional outcomes of PPV for the treatment of TRD in people with diabetes (dTRD). MEDLINE and Embase were searched systematically from January 1, 2000, to February 20, 2022. In addition, a reference list of eligible studies were screened. Eligible studies were those published in English, those reporting outcomes of PPV for dTRD, and those that included more than 25 eyes and with a minimum follow-up of 3 months. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines for data extraction/synthesis were followed, and the National Institute for Health quality assessment tool was used to assess risk of bias. Study eligibility was determined independently by 2 reviewers; data extraction was conducted by 1 reviewer and entries checked for accuracy by another. Data were pooled using a random-effects model. Main outcomes included rate of failure of retinal reattachment following 1 surgery and final visual acuity (VA). The association of baseline patient characteristics and surgical maneuvers with postoperative surgical outcomes was investigated. Of the 406 studies identified, 38 (3839 eyes) were eligible and included for analysis. Patients had a median (IQR) age of 52.2 (49.6-55.7) years. In the studies reporting patient sex (31 of 38 studies), 1441 were female individuals (50.1%). The overall failure rate of retinal reattachment after 1 surgery was 5.9% (95% CI, 1.4%-8.3%), and the mean final VA was 0.94 (95% CI, 0.82-1.05) logMAR (approximate Snellen equivalent, 6/53; 95% CI, 6/39-6/71). People with higher preoperative VA achieved higher postoperative vision (0.66 logMAR worse final vision; 95% CI, 0.39-0.84 per 1.0 logMAR worse at baseline; P <.001). On multivariable analysis, no other patient characteristics or surgical variables had a statistically significant association with outcomes. Results of this systematic review and meta-analysis suggest that PPV was an effective strategy to achieve retinal reattachment in people with dTRD. Given that higher preoperative VA was the only factor associated with higher postoperative vision, early intervention should be considered and discussed in detail with patients. Overall, final postoperative VA remains low, and patients should be counseled on the guarded prognosis of dTRD.

Early Diagnosis and Management of Aggressive Posterior Vitreoretinopathy Presenting in Premature Neonates.

Aggressive posterior vitreoretinopathy (APVR) manifests with a broad area of retinal avascularity, progressive neovascularization, and/or tractional retinal detachment during the neonatal period. A multicenter, retrospective, observational, consecutive case series study was performed to evaluate the retinal findings and structural retinal outcomes in patients treated for APVR within the first 3 months of life. Three premature neonates with a non-retinopathy of prematurity (ROP) APVR identified during routine ROP screening exams exhibited relatively severe, rapidly progressive retinal vascular abnormalities. Immediate laser photocoagulation of the avascular retina and vitrectomy for traction retinal detachment within several days to weeks improved or stabilized the retinal anatomy in all cases. This series describes clinical features in APVR in premature infants and suggests that early diagnosis and intervention may mitigate the typical aggressive course and poor prognosis of this condition. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:201-207.].

Clinical outcome of minimally invasive vitrectomy for ocular toxocariasis patients

Objective To observe the clinical outcome of minimally invasive vitrectomy for ocular toxocariasis (OT). Methods The clinical data of 37 eyes in 37 patients with OT who underwent 23-gauge vitrectomy were retrospectively reviewed. There were 27 male patients and 10 female patients. The age was from 9 months to 22 years, with the mean age of (7.90±4.47) years. Patients who can cooperate underwent non-contact tonometer examination, slit lamp examination, fundus photography, ultrasound examination, optical coherence tomography and ultrasound biomicroscopic examination. The visual acuity was from no light perception to 0.6. According to the clinical type of OT, 18 eyes had posterior granuloma, 13 eyes had peripheral granuloma, 4 eyes had endophthalmitis and 2 eyes had atypical presentation. Seventeen eyes had vitrectomy for tractional retinal detachment (TRD), 13 eyes for epiretinal membrane (ERM), 6 eyes for TRD combined with ERM and 1 eye for endophthalmitis. Twenty-five eyes had lens-sparing vitrectomy, 12 eyes had lensectomy with vitrectomy; five eyes had limbus incision and 32 eyes had pars plana incision. Five eyes (13.51%) had reoperation. Followed up from 6 months to 39 months, with the mean of (13.90±10.25) months. Results Vision improved in 25 of 35 eyes (71.43%), was unchanged in 9 eyes (25.71%), and was declined in 1 eye (2.86%). Retina was reattached in 22 of 23 eyes that had TRD before surgery (95.65%); the rest one eye had redetachment (4.35%). Three eyes had cataract after surgery, which accounted for 12% in lens-sparing eyes. Among them, 2 eyes had lensectomy therefore. ERM was removed and had no recurrence in 18 of 19 eyes (94.74%). Conclusion Minimally invasive vitrectomy for OT patients can improve their vision and achieve retinal reattachment. Key words: Toxocariasis/complications; Vitreoretinal surgery

Outcomes of Vitrectomy for Tractional Retinal Detachment in Diabetic Retinopathy

Outcomes of Vitrectomy for Tractional Retinal Detachment in Diabetic Retinopathy

A case involving an Ahmed&amp;trade; glaucoma valve transferred from the vitreous into the anterior chamber of the eye with a silicone oil tamponade for the treatment of neovascular glaucoma

PurposeTo report the short-term efficacy and safety of the transfer of an Ahmed™ glaucoma valve (AGV™) tube from the vitreous into the anterior chamber, in a patient with neovascular glaucoma who had undergone pars plana AGV™ implantation and ultimately needed a silicone oil tamponade.CaseA 41-year-old male with proliferative diabetic retinopathy in both eyes was referred to us for treatment in December 2009. Although the patient previously underwent several surgeries, he ultimately lost vision in his right eye. His left eye suffered from neovascular glaucoma after undergoing a pars plana vitrectomy for tractional retinal detachment. After several vitreous and glaucoma surgeries, the patient underwent implantation of a pars plana AGV™. Postoperatively, although his intraocular pressure was stabilized at approximately 10 mmHg, he had repeated vitreous hemorrhage and hyphema without improvement. He ultimately underwent PPV with a silicone oil tamponade and at the same time, the AGV™ tube was pulled out from the vitreous and inserted into the anterior chamber in order to avoid complications caused by the silicone oil.ResultsAt 19 months postoperative, the patient’s intraocular pressure had stabilized at 10 mmHg with no recurrence of vitreous hemorrhage and hyphema. Eventually, he lost vision in his left eye because of cerebral hemorrhage.ConclusionThe findings show that insertion of a pars plana AGV™ tube into the anterior chamber in a patient undergoing a silicone oil tamponade is both effective and safe in the short-term.

Bevacizumab (Avastin&amp;reg;) for the management of anterior chamber neovascularization and neovascular glaucoma

To establish the efficacy and safety of intravitreal bevacizumab in reducing iris and anterior chamber angle neovascularization and managing neovascular glaucoma. Prospective interventional case series. Eleven eyes of 11 patients with iris and anterior chamber angle neovascularization with refractory intraocular pressure were treated with intravitreal injection of 1.25 mg bevacizumab (Avastin((R))). The study group included eight males and three females aged 23 to 77 years (average, 62 years). Out of the 11 cases, five had proliferative diabetic retinopathy, of whom two had undergone vitrectomy for tractional retinal detachment and vitreous hemorrhage, and six were secondary to ischemic central retinal vein occlusion (CRVO). All patients were followed for eight to 16 months (average, 10 months). Iris and anterior chamber angle neovascularization receded in all eyes after one to three injections at monthly intervals. In five eyes, neovascularization recurred during the follow-up period. The intraocular pressure normalized in one eye. Four eyes were controlled with anti-glaucoma drops. A cyclodestructive procedure was required in two eyes. An Ahmet drainage valve was implanted in four eyes, including one controlled with additional antiglaucoma drops and one in which the intraocular pressure remained high while on maximum antiglaucoma medication and a cyclodestructive procedure was scheduled. Bevacizumab appears to be effective in reducing iris and anterior chamber angle neovascularization and is likely to extend our therapeutic options in the management of neovascular glaucoma.

En Bloc Perfluorodissection for Tractional Retinal Detachment in Proliferative Diabetic Retinopathy

En bloc perfluorodissection (EBPD) is a surgical dissection technique that facilitates removal of epiretinal membranes and the posterior hyaloid. It is carried out by injecting perfluorocarbon liquid between the retina and the posterior hyaloid to separate the epiretinal tissues from the subjacent retina. The objective of this study was to describe the technique and to demonstrate the applicability of using EBPD during vitrectomy in eyes with tractional retinal detachment (TRD) in proliferative diabetic retinopathy (PDR). Prospective, interventional case series. Fifty-seven patients (eyes) with TRD in PDR participated in the study. The author performed EBPD in 57 eyes (consecutive patients) during vitrectomy for TRD in severe PDR. Mean age of the patients was 42 years (range, 23-84 years). Mean surgical time was 50 minutes (range, 40-75 minutes). The group of patients was followed up for a mean of 18 months (range, 8-26 months). Best-corrected visual acuity (BCVA), retinal status, and complications at the end of follow up. None of the patients have developed ocular hypertension or undue inflammation, and anatomic success-accompanied by visual improvement (> or =2 Early Treatment Diabetic Retinopathy Study [ETDRS] lines) in 70.1% (40/57)-occurred in 100% (57/57) of eyes. In 14 eyes (24.5%), BCVA remained stable, and in 3 eyes (5.2%), BCVA decreased (> or =2 ETDRS lines). Final BCVA was 20/50 or better in 25%, between 20/60 and 20/400 in 47%, and worse than 20/400 in 28%. Complications included phthisis bulbi in 1 (1.7%) eye, iatrogenic retinal breaks in 4 (7%) eyes, vitreous hemorrhage requiring another procedure in 4 (7%) eyes, and cataract in 15 (26.3%) eyes. This report demonstrates the applicability of using EBPD during vitrectomy in eyes with TRD in PDR.

Soluble cellular adhesion molecules in proliferative vitreoretinopathy and proliferative diabetic retinopathy

PURPOSE. To measure vitreous levels of soluble intercellular adhesion molecule-1 (sICAM-1) and soluble vascular cellular adhesion molecule-1 (sVCAM-1) in the eyes of patients with retinal detachment (RD) due to proliferative diabetic retinopathy (PDR) or proliferative vitreoretinopathy (PVR) and to determine whether the levels of these mediators correlated with clinical parameters of disease. METHODS. Undiluted vitreous specimens were collected from 50 eyes of 48 patients undergoing vitrectomy for traction RD due to PDR (21 specimens) and recurrent RD due to PVR (19 specimens). Control vitreous specimens were obtained from patients undergoing macular hole repair (10 specimens). The levels of sICAM-1 and sVCAM-1 were measured in each sample by specific enzyme-linked immunoadsorbent assays. RESULTS. Vitreous levels of sICAM-1 were significantly increased in vitreous specimens from both PVR (median ± SD; 12.0 ± 76.3 ng/ml; P < 0.01) and PDR (8.4 ± 24.0 ng/ml; P < 0.01) when compared to vitreous from eyes with macular holes (0.3 ± 4.2 ng/ml). Vitreous levels of sVCAM-1 were significantly increased in both PVR (36.5 ± 255.2 ng/ml; P < 0.001) and PDR (26.2 ± 93.5 ng/ml; P < 0.01) when compared to control vitreous (17.7 ± 7.8 ng/ml). The vitreous levels of sICAM-1 were higher in cases of PDR which developed recurrent proliferative disease (P < 0.01) and recurrent RD (P = 0.01), whereas the levels of sICAM-1 in PVR and sVCAM-1 in PDR and PVR did not significantly correlate with these clinical parameters. CONCLUSIONS. Soluble forms of ICAM-1 and VCAM-1 are increased in the vitreous cavity of patients with RD due to PDR or PVR, reflecting the inflammatory nature of these conditions and suggesting a possible role for these mediators in the pathogenesis of proliferative retinal disease. The vitreous levels of these sCAMs at the time of surgery may serve as a marker of inflammation, but their specific levels do not predict the likelihood of recurrent proliferation or surgical anatomic success in most cases of PVR and PDR.

Lens Clarity after Lens-sparing Vitrectomy in a Pediatric Population

Purpose: The purpose of the study is to assess lens clarity after pediatric lenssparing vitrectomy.Methods: The study offers a retrospective analysis of 85 eyes of 77 pediatric patients who underwent lens-sparing vitrectomy for tractional retinal detachment or opaque media, and who were observed for 10 to 55 months.Results: A total of 57 eyes maintained clear lenses at last follow-up examination. Cataract was found in 13 (15%) of the 85 eyes. Fifteen eyes (18%) had undergone lens removal as part of reoperation for progressive ocular disease.Conclusion: Sixty-seven percent of pediatric lenses remained clear after lens-sparing vitrectomy.

Vitrectomy in diabetic patients with a blind fellow eye

Results of pars plana vitrectomy for complications of proliferative diabetic retinopathy were analysed in 32 consecutive patients with a blind fellow eye due to diabetic eye disease. The mean follow-up period was 22.3 months. Only 16% of all eyes examined had received full scatter photocoagulation prior to referral for vitrectomy. Out of 9 eyes with vitreous haemorrhage, 8 improved to a visual acuity of > or = 0.2 postoperatively. Amid 23 eyes which were vitrectomized for advanced traction retinal detachment, only 4 eyes improved to a postoperative visual acuity of > or = 0.02. In this group 12 eyes deteriorated after vitrectomy, 3 eyes progressing to no light perception. The postoperative visual outcome after vitrectomy for traction retinal detachment in this group of diabetics with a blind fellow eye (mean postoperative visual acuity 0.03 +/- 0.05) was significantly worse (p < 0.000) compared to a group of 196 patients with a seeing fellow eye who were vitrectomized for traction retinal detachment at our clinic (mean postoperative visual acuity 0.09 +/- 0.11). Therefore we conclude that traction retinal detachment in this subgroup of patients is a particularly severe presentation of diabetic retinopathy with a guarded functional prognosis after vitrectomy. Our results demonstrate the importance of timely full scatter photocoagulation and early vitrectomy in eyes with progressive fibrovascular proliferation not responding to panretinal photocoagulation. We conclude that especially diabetic patients with a blind fellow eye must be followed closely and assigned to vitrectomy at an earlier stage of their disease in order to improve functional prognosis.