Combined Vitrectomy Research Articles

Transient increase of flicker electroretinograms after combined cataract surgery and vitrectomy for idiopathic epiretinal membrane

To determine the characteristics of the changes in the amplitude of the flicker electroretinograms (ERGs) after combined cataract surgery and vitrectomy for an idiopathic epiretinal membrane (ERM). To accomplish this, we conducted a prospective study on 20 patients. Flicker ERGs and central macular thickness (CMT) were measured before the surgery (baseline), and at 1 week, 1 month, 3 months, and 6 months postoperatively. The mean amplitude of the flicker ERGs increased significantly by 63.5% at 1 week after surgery (P < 0.001) and then gradually decreased. The amplitude at 6 months was not significantly different from the baseline amplitude. This transient increase in the flicker ERG amplitudes after ERM surgery suggests that electrophysiologic evaluations of the therapeutic effects of vitrectomy should be performed 6 months postoperatively. The mean CMT decreased significantly at 1 week postoperatively (P < 0.001) and continued to decrease progressively over six months. The relative increase of amplitude at 1 week was significantly associated with the relative decrease of CMT at 6 months, and evaluation of retinal functional changes at 1 week may be able to predict the postoperative course of the ERM.

Prospective Evaluation of Results of Surgical Treatment of Patients with Idiopathic Macular Hole by Phacovitrectomy and Combined Cataract and Vitrectomy Surgery

Purpose of the study:The purpose of the study was to compare the morphological and functional results of the studied patients with idiopathic macular hole treated with a one-stage method (phacovitrectomy) and combined cataract and vitrectomy surgery.Material and methods:The study included 33 patients (33 eyes) with idiopathic macular hole treated at the Department of Retina and Vitreous Surgery in Lublin. Twenty-one eyes were surgically treated with phacovitrectomy (Group 1 MH). Twelve patients underwent two-stage, combined treatment with removal of the lens in the first stage and vitrectomy in the second (Group 2 MH). The assignment of patients to groups was random. All patients underwent 23-gauge sutureless vitrectomy with removal of the internal limiting membrane (internal limiting membrane peeling). SF6 gas was used as an intraocular tamponade at an isovolumetric concentration of 20% and face down position recommendation for 7 days. Cataract surgery was performed using the phacoemulsification method with an incision in the transparent part of the cornea with intracapsular, posterior chamber implantation of a monofocal lens. A 12-month observation period was established, measured from the date of vitrectomy performance, and in the case of a combined procedure, this period was extended by the time between each stage of treatment. At subsequent check-ups, the subjects underwent a complete ophthalmological examination, which included: best corrected distance visual acuity and best corrected near visual acuity, assessment of the anterior and posterior segments, in a slit lamp, measurement of retinal sensitivity in the macula using microperimetry, the Amsler test and optical coherence tomography examination of the macula.Results:In patients of the total studied group, an improvement in the best-corrected visual distance and near acuity was obtained, and in 88% retinal sensitivity in the macula was also achieved. In the group of patients subjected to phacovitrectomy (Group 1 macular hole) with an average minimum hole diameter of 487.48 µm before the procedure, after a one-year follow-up the mean best corrected distance visual acuity was 0.57 and best corrected near visual acuity 0.51, with macular retinal sensitivity of 26.65 dB. However, in the group of patients subjected to combined cataract and vitrectomy, an average minimum hole diameter of 521.58 µm 12 months after trans pars plana vitrectomy was performed as well as an average best corrected distance visual acuity of 0.64, best corrected near visual acuity of 0.5, and retinal sensitivity in the macula of 25.98 dB. There were no statistically significant differences between phacovitrectomy and the combined procedures in terms of the improvement in the values of distance and near visual acuity and macular retinal sensitivity 12 months after trans pars plana vitrectomy. A statistically significant improvement in retinal sensitivity in the macula was observed in Group 1 macular hole during the 12-month follow-up, while in the combined procedure group the improvement was not statistically significant.Conclusions:Vitrectomy is an effective method of treating maculopathy in the form of macular hole. Morphological and functional improvement was noted in all patients, regardless of the treatment method used. There were no statistically significant differences between phacovitrectomy and the combined procedure in terms of the improvement achieved in the values of distance visual acuity parameters, near vision and retinal sensitivity in the macula 12 months after trans pars plana vitrectomy. A common feature of patients with worse results on individual variables was a longer duration of the disease and a larger size of the hole prior vitrectomy.

Alterations in the Ocular Surface and Corneal Subbasal Nerve Plexus Following Various Retinal Surgical Procedures: A One-Year Confocal Microscopy Prospective Study.

To evaluate the effects of retinal surgery on the ocular surface and corneal subbasal nerve plexus (SNP). Ninety-eight patients undergoing 23-gauge pars plana vitrectomy for various vitreoretinal disorders were prospectively studied. We collected detailed operative and perioperative data, measuring dry eye syndrome (DED) severity and Ocular Surface Disease Index (OSDI) scores before surgery and at postoperative intervals. In vivo confocal microscopy (IVCM) quantified SNP and dendritic cell (DC) densities. Fifty-three patients were analyzed. Post-surgery, OSDI scores rose from a baseline of 5.5 ± 3.5 to 12.24 ± 6.5 at one month, later reducing to 7.8 ± 4.0 after a year. DED severity increased from 0.6 ± 0.6 initially to 1.6 ± 0.6 at three months, returning to near baseline (0.9 ± 0.6) one year after surgery. DC densities increased notably by the third (58.85 ± 75.6 cells/mm²) and ninth (59.95 ± 86 cells/mm²) postoperative months, especially in patients undergoing combined phacoemulsification, vitrectomy, and C3F8 gas tamponade. SNP parameters, particularly nerve fiber density and length, showed significant declines one month post-surgery, not recovering to baseline levels within a year. Fiber density dropped from 19.06 ± 8.3 fibers/mm² preoperatively to 4.68 ± 4.8 fibers/mm² at one month, partially recovering to 10.64 ± 8.2 fibers/mm² at twelve months. Fiber length decreased from 13.31 ± 3.2 mm/mm² to 6.86 ± 3.4 mm/mm² at one month, later improving to 9.81 ± 4.5 mm/mm² at twelve months, notably in patients with silicone oil (SiO2) tamponade. Retinal surgery, especially when combined with phacoemulsification and C3F8 or SiO2 tamponade, significantly affects ocular surface integrity and SNP density, with these changes lasting up to a year. Expanded studies with more patients and longer follow-up, using finer 25- and 27-gauge vitrectomy tools, are recommended to confirm and extend these findings.

Incidence and management of intraocular lens opacification after primary phacovitrectomy for combined cataract and diabetic vitrectomy

Purpose To evaluate the incidence, risks, and sequelae of hydrophobic versus hydrophilic intraocular lens (IOL) opacification in diabetic patient’s undergone primary phacovitrectomy, and suggest the best management plan for IOL opacification. Patients and methods This retrospective study included 42 eyes of 42 diabetic patients scheduled for primary combined phacoemulsification and pars plana vitrectomy in Alpha vision center in the period from July 2021 to November 2022 for significant cataract and any cause that indicates pars plana vitrectomy in diabetic patients like unresolved vitreous hemorrhage, traction retinal detachment, combined traction rhegmatogenous retinal detachment, subhyaloid hemorrhage, and epiretinal membranes or combination of these pathologies. Hydrophilic IOLs were implanted in half patients while hydrophobic IOLs were implanted in the other half. All patients were followed up for their primary retinal pathology and for monitoring the incidence and progression of any IOL opacification. Patients who developed IOL opacification were examined for its visual impact and those who needed IOL exchange were scheduled for another surgery. Surgical details of the second intervention and any adverse events were recorded. Results Seven (33.3%) cases in hydrophilic group developed IOL opacification while no cases developed opacification in hydrophobic group (P=0.009). Five patients with IOL opacification required IOL exchange, with either secondary implantation of sulcus three pieces IOL or iris claw that resulted in significant improvement of patient’s vision. One patient of those undergone IOL exchange developed progressive secondary neovascular glaucoma. A statistically significant association between diabetic control and the level of glycosylated hemoglobin and the development of IOL opacification in hydrophilic group was noticed. Conclusion Diabetic patients who require primary phacovitrectomy have higher incidence of hydrophilic IOL opacification that may affect their vision and the sequelae of IOL exchange is considerable. So, it is recommended to use hydrophobic IOL in these patients. Tight glycemic control post diabetic vitrectomy may play a role in preventing the IOL opacification especially in implanted hydrophilic IOLs.

Comparison of flanged polypropylene scleral intraocular lens fixation with scleral sutured fixation

ObjectiveTo compare the outcome of 2 intraocular lens (IOL) scleral fixation techniques: double-flanged polypropylene and Hoffman scleral pocket. MethodsRetrospective case series of all patients who underwent IOL scleral fixation by either the flange (flange group) or Hoffman scleral pocket (Hoffman group) techniques at the Kaplan Medical Center and the Edith Wolfson Medical Center. ResultsA total of 140 patients were included (63 flange, 77 Hoffman). The final distance-corrected visual acuity was similar between the flange and Hoffman groups (0.42 ± 0.5 and 0.51 ± 0.5 logMAR, respectively; p = 0.23), but the spherical equivalent was less myopic in the flange group (–0.63 ± 2 and –2.3 ± 1.3 D, respectively; p = 0.003). In the flange group, there were more cases of elevated IOP (17.5% vs 5.2%; p = 0.02), corneal edema (11.1% vs 1.3%; p = 0.02), cystoid macular edema (15.9% vs 2.6%; p = 0.005), and IOL decentration (19% vs 7.8%; p = 0.07). The flange group had a higher rate of combined additional procedures during the fixation surgery (68.3% vs 32%; p < 0.001), but surgery duration was not prolonged (70 vs 77 minutes; p = 0.29). ConclusionComparison of scleral IOL fixations performed with the recently developed flange technique to the conventional Hoffman scleral pocket technique resulted in similar visual outcomes and less myopization. There were more complications in the newly adopted flange technique, which may be related to the higher rate of combined anterior vitrectomy and pars plana vitrectomy. The flange technique is effective, with a shorter learning curve and similar surgical time. Therefore, it can become a viable method for scleral IOL fixation in the absence of zonular support.

Расчет ИОЛ при комбинированной хирургии: факоэмульсификации катаракты и витрэктомии. Собственный опыт

At the present stage of development of ophthalmic surgical technique, indications for simultaneous cataract phacoemulsification and pars plana vitrectomy are constantly expanding, however, there is a problem of predicting refractive results, which is due to the difficulty of determining the effective position of the intraocular lens (IOL) in the eye without the presence of a vitreous body. Purpose. Assessment of the accuracy of the preoperative calculation of IOL in the eyes during combined surgery — cataract phacoemulsification and vitrectomy on the state of postoperative refraction. Material and methods. Combined surgery of cataract phacoemulsification and vitrectomy of pars plana with a caliber of 25 Gage was performed in 51 people (51 eyes) aged 70.4 ± 8.4 years. The calculation of IOL before surgery was carried out according to the data of a preoperative examination on an optical biometer IOL-Master-700 (Carl Zeiss, Germany), keratopography was performed on a rotary Scheimpflug camera (Oculus, Germany). The data on SRK-T with a range of more than 22.5 mm and Hoffer-Q with a range of less than 22.5 mm were used as a basis. Results. There were no complications during the operations and in the postoperative period. Preoperative uncorrected visual acuity (UCVA) was 0.21 ± 0.2 (0.05 to 0.8) and the best-corrected visual acuity (BCVA) was 0.44 ± 0.22 (from 0.1 to 0.9). The correction is from –9.0 D to +7.75 D (–0.61 ± 2.71 D). 6 months after the operation, the UCVA was 0.67 ± 0.22 (from 0.05 to 1.0), the BCVA was 0.9 ± 0.2 (from 0.3 to 1.0), respectively, while the correction was from –1.25 D to +1.0 D (–0.17 ± 0.94 D). The deviation from the expected refraction of the target at 1 week after surgery was ± 0.5 D, at 6 months after surgery ± 0.4 D, which turned out to be statistically insignificant (p &gt; 0.05). Conclusions. 1. Combined surgery phacoemulsification and vitrectomy in combination of cataracts with pathology of the vitreomacular interface, significantly increases visual acuity after surgery (by 0.43 ± 0.03, p &lt; 0.001). 2. Changes in clinical refraction during implantation of IOL based on hydrophobic acrylic in combined surgery are not statistically significant (an average shift of ± 0,4–0,5 D, p &gt; 0.05), which allows us to apply generally accepted formulas for calculating the effective position of IOL without using correction factors. Keywords: IOL calculation, cataract phacoemulsification, vitrectomy

Combined cataract and vitreoretinal surgery

Combined cataract surgery and vitrectomy is a surgical technique used to address both cataract and vitreoretinal disorders. With the advances in surgical tools, simultaneous removal of cataract associated with vitreoretinal disorders is gaining popularity. This technique offers several advantages over separate surgeries, including reduced surgical time and anaesthesia exposure, as well as quicker visual rehabilitation. However, the optimal timing and approach for combined cataract surgery and vitrectomy remain controversial.Indications for combined cataract surgery and vitrectomy include various vitreoretinal conditions, such as retinal detachment, diabetic retinopathy, macular holes, and epiretinal membranes. The timing of surgery depends on the severity of the cataract and the vitreoretinal pathology, as well as the surgeon's preference. The most common surgical techniques include phacoemulsification with posterior chamber intraocular lens implantation, followed by pars plana vitrectomy. The filling of the vitreous cavity is possible with several types of tamponades, such as different gases, but in extreme cases even with silicone oil. After gas tamponade, proper positioning of the patient is of great importance.Complications associated with combined cataract surgery and vitrectomy include posterior capsule rupture, intraocular lens dislocation, postoperative inflammation, and intraocular pressure elevation. However, the overall complication rate is low, and the visual outcomes are generally favourable.In conclusion, combined cataract surgery and vitrectomy is a useful technique for managing various vitreoretinal conditions. Proper patient selection, careful surgical planning, and close postoperative monitoring are critical for achieving optimal outcomes.

Comparative Evaluation of Visual Outcomes in Combined Cataract and Vitrectomy for Idiopathic Epiretinal Membrane with an Advanced or Conventional Intraocular Lens

Introduction: The aim of this study was to investigate the efficacy of new monofocal intraocular lens (IOL) in comparison with conventional monofocal IOL in patients undergoing combined cataract and vitrectomy surgery for epiretinal membrane (ERM). Methods: This prospective non-randomized comparative study included 65 eyes of 65 patients who underwent combined cataract and vitrectomy for ERM with implantation of advanced monofocal IOL (Eyhance ICB00, 33 patients) and standard monofocal IOL (Tecnis ZCB00, 32 patients). Monocular visual acuities were measured 6 months post-operatively, including corrected and uncorrected distance visual acuity (CDVA, UCDVA), uncorrected intermediate visual acuity (UCIVA), and uncorrected near visual acuity (UCNVA). Furthermore, contrast sensitivity and metamorphopsia were measured. Results: There was no significant difference between two groups regarding operation time, post-operative CDVA, UCDVA, UCNVA, and spherical equivalent (p > 0.05). Monocular UCIVA was significantly higher in the Eyhance IOL group than in the Tecnis IOL group (p = 0.005). The photopic and mesopic contrast sensitivities were comparable between each group for any spatial frequency (p > 0.05). The correlation coefficients from correlations between retinal wrinkling ratio and M score did not differ significantly between groups (p = 0.877), and the degree of metamorphopsia was not significantly related to the type of IOL (p = 0.969). Conclusions: In combined cataract and vitrectomy for ERM, Eyhance IOL provided significant better visual performance at intermediate distance than standard monofocal IOL without compromising operation time, distance vision, contrast sensitivity, and evaluating metamorphopsia. Eyhance IOL can be a useful option for both surgeons and patients.

Современные методы профилактики пролиферативной витреоретинопатии при обширных проникающих ранениях склеры

Relevance. Currently, there is no single algorithm for the management of patients with extensive penetrating wounds of the sclera, and the frequency of proliferative vitreoretinopathy, leading to adverse outcomes, is very high. Purpose. To present relevant data about prevention of proliferative vitreoretinopathy with extensive penetrating wounds of the sclera, as well as to identify the most effective methods. Material and methods. To complete this review, a literature search was carried out on the databases CyberLeninka, eLIBRARY, PubMed, using the keywords «proliferative vitreoretinopathy», «penetrating wounds of the sclera», «eye injury», «vitrectomy». Preference was given to scientific papers over the past 15 years. Results. There are various approaches in the treatment of severe penetrating wounds. Classical primary microsurgical treatment involves external treatment, suturing of the sclera wound, and delayed optical-reconstructive surgery (including vitrectomy) are performed 1–2 weeks after the acute inflammation reduces. As a rule, in the case of extensive wounds with a whole set of concomitant risk factors, this time is sufficient to trigger pathological proliferation, which aggravates the course of the wound process. This review presents publications proving that the treatment of severe complicated penetrating wounds of the sclera should go beyond the classical treatment and be aimed at early warning and prevention of proliferative vitreoretinopathy. Conclusion. Modern data prove the indisputable advantage of early vitrectomy performed with extensive penetrating scleral and corneoscleral wounds. Vitrectomy in combination with other methods of prevention of proliferative vitreoretinopathy is the most promising direction for the future research. Key words: proliferative vitreoretinopathy, penetrating wounds of the sclera, eye injury, vitrectomy

EARLY-ONSET OF FAMILIAL EXUDATIVE VITREORETINOPATHY: Clinical Characteristics, Management, and Outcomes.

To describe the clinical characteristics, management, and outcomes of toddlers (under the age of 3) diagnosed with familial exudative vitreoretinopathy. In this retrospective study, patients diagnosed with familial exudative vitreoretinopathy before the age of 3 were included. Presenting characteristics, genetic testing, management, and outcomes were collected. A total of 54 patients (108 eyes) with a mean age at diagnosis of 10.9 ± 2.6 months were included. Poor visual behavior (33%) and strabismus (26%) were the most common presenting symptoms, whereas screening only represented 11%. About half of included patients had a severe disease (stages 4 and 5). Genetic testing was positive in 40.7% of patients with 24% having a family history of familial exudative vitreoretinopathy. LRP5 was the most prevalent mutation (54.5%).Surgery was performed in 44.4% of eyes and was successful in 69.8% of cases. Failure exclusively occurred in eyes with severe stages. Among eyes evaluated for visual acuity (72 eyes), most (76.4%) had a vision of hand motion or better. Familial exudative vitreoretinopathy tended to be worse with earlier age at diagnosis, subsequently affecting the prognosis. Surgical intervention was common and primarily included lens-sparing vitrectomy and combined lensectomy and vitrectomy. Surgical success hinged on the stage of the disease.

Treatment of tuberous sclerosis complex-associated retinal astrocytic hamartoma complicated with vitreous hemorrhage

Three cases of tuberous sclerosis complex (TSC)-associated retinal astrocytic hamartomas (RAH) complicated with vitreous hemorrhage were presented in this report. The first patient received sirolimus monotherapy. The lipid exudation was absorbed gradually, but there remained some stable exudative masses around the macula covered by epiretinal membranes. The second case was treated with vitrectomy, followed by sirolimus and intravitreal anti-vascular endothelial growth factor (VEGF) treatment. The exudates were absorbed, and the tumor remained stable afterward. The third patient was initially treated with vitrectomy combined with anti-VEGF treatment, but vitreous hemorrhage re-occurred soon after the surgery. He was then treated with sirolimus, and the tumor remained stable afterwards without further recurrence. From experience of treating these three patients, we suggested that for TSC-RAH complicated with vitreous hemorrhage, vitrectomy in combination with sirolimus is suggested to be the better choice. Intravitreal anti-VEGF injection is a supplementary treatment.

Retinal Detachments in Pediatric Patients With X-Linked Retinoschisis: Characteristics and Surgical Outcomes.

Retinal detachments (RDs) are a complication of X-linked retinoschisis (XLRS) with a poor prognosis. This study aims to report outcomes of XLRS-RD repair in pediatric patients. The study is a retrospective analysis of pediatric patients undergoing vitreoretinal surgery for XLRS-RDs from 2000 to 2022. Nine patients (11 eyes) met inclusion criteria. All patients were boys, with a mean age of 8 years. Most RDs arose inferiorly (64%). Seven (64%) detachments were macula-involving. Seven (64%) detachments were repaired with combined scleral buckling and vitrectomy, two (18%) detachments were repaired with vitrectomy alone, one (9%) detachment underwent a primary scleral buckling procedure, and one (9%) asymptomatic detachment with a pigment demarcation line was observed. Silicone oil was used in eight of nine (89%) eyes undergoing vitrectomy. Final visual acuity was 20/200 or better in eight (73%) eyes. One eye that underwent surgical intervention remained unattached at follow-up. Surgical repair in patients with XLRSRDs was associated with successful reattachment, although visual prognosis varied. [Ophthalmic Surg Lasers Imaging Retina 2023;54:574-579.].

Scleral sutured toric intraocular lens with pars plana vitrectomy for the correction of corneal astigmatism without capsular support.

To describe the repair of a patient with bilateral subluxed cataract and corneal astigmatism in the setting of a coloboma of the iris, zonules, lens, and retina. Pre-operatively his best corrected acuity was 20/500 OD and 20/200 OS. His pre-operative refraction was -7.25 +1.00 at 080 OD and -7.75 +3.00 at 040 OS. On corneal topography, he had 1.95D and 1.45D of regular astigmatism in the right and left eye respectively. This technique involves pars plana vitrectomy in combination with the placement of a MX60 toric intraocular lens fixated to the sclera using 8-0 Gore-Tex in line with the axis of steep corneal astigmatism. The lens is affixed through two pair of nasal and temporal sclerotomies, with each pair located 3 mm posterior to the limbus and 5 mm apart, centered along the axis of steep astigmatism. Post-operatively the patient was 20/25 uncorrected OD and 20/20 uncorrected OS with a refraction of -0.75 +0.50 at 180 in the OD and -0.75 +1.00 at 180 in the OS. Scleral sutured toric intraocular lens placement and pars plana vitrectomy is a viable solution for patients with regular corneal astigmatism and cataract repair in the absence of zonular support.

Improved Intermediate Visual Function with New Monofocal Intraocular Lens in Combined Cataract and Vitrectomy Surgery for Retinal Disease.

To evaluate the usefulness of a newly generated monofocal intraocular lens (IOL) in patients with various retinal diseases who underwent combined cataract and pars plana vitrectomy surgery. This prospective observational study included 33 patients with various retinal diseases. Monocular best-corrected distance visual acuity (BCDVA), uncorrected distance visual acuity (UCDVA), uncorrected intermediate visual acuity (UCIVA), uncorrected near visual acuity (UCNVA), and contrast sensitivity were measured and compared with 40 age-matched patients in the standard monofocal IOL. The Eyhance IOL group demonstrated significantly better UCIVA at 6 months follow-up compared to the standard monofocal IOL group. No significant differences were observed between the two groups in contrast sensitivity, BCDVA, UCDVA, or UCNVA. The regression analysis showed a significant association between preoperative corrected distance visual acuity and improved UCIVA in the Eyhance IOL group. The Eyhance ICB00 IOL proved to be a valuable option for patients with retinal diseases undergoing combined cataract surgery and vitrectomy. It effectively improved intermediate vision without compromising contrast sensitivity or distance visual acuity.

Rotational stability of plate haptic toric intraocular lenses after combined 25-gauge vitrectomy and cataract surgery.

To evaluate the postoperative intraocular lens (IOL) rotational stability and residual refractive astigmatism following combined 25-gauge vitrectomy and cataract surgery with implantation of a plate haptic toric IOL. In this retrospective case series, 32 eyes of 32 patients underwent a combined 25-gauge vitrectomy and phacoemulsification for vitreoretinal diseases and cataract with regular corneal astigmatism of at least 1 diopter (D). A plate haptic toric IOL (AT Torbi 709M, Carl Zeiss Meditec AG) was implanted in all eyes. The outcome measures were rotational stability and refractive astigmatism up to 6mo postoperatively as well as the best corrected visual acuity (BCVA). Preoperative refractive astigmatism was 2.14±1.17 D, which was significantly reduced to 0.77±0.37 D six to eight weeks postoperatively and remained stable throughout the observation period (0.67±0.44 D at three months and 0.75±0.25 D at six months; for all groups: P<0.0001 compared to baseline). BCVA improved significantly from 0.36±0.33 logMAR preoperatively to 0.10±0.15 logMAR following surgery (P=0.02). Mean IOL axis deviation from the target axis was 3.4°±2.9° after six to eight weeks and significantly decreased over time (2.4°±2.6° six months after surgery; P=0.04). In one patient IOL, re-alignment was performed. Corneal astigmatism is significantly reduced following combined 25-gauge vitrectomy and cataract surgery. The plate haptic toric IOL position and axis remain stable during the observation period of six months.

Factors Associated with Reclosure of Posterior Capsule Aperture by Flat Opacifications with Pearls after Nd:YAG Laser Posterior Capsulotomy.

In this retrospective case series, we investigated factors associated with posterior capsule aperture (PCA) reclosure following neodymium-yttrium aluminum garnet (Nd:YAG) laser posterior capsulotomy. The study encompassed patients who underwent cataract surgery with intraocular lens (IOL) implantation or a combined vitrectomy, cataract surgery, and IOL implantation between 2009 and 2022. PCA reclosure was observed in 22 eyes of 17 patients: 45% (10 eyes) underwent the triple procedure, and 55% (12 eyes) received cataract surgery with IOL implantation. In our clinic, 14% of patients were given IOLs with a 4% water content, while 73% (13 eyes) of those experiencing PCA reclosure had IOLs with a 4% water content. The mean interval between Nd:YAG capsulotomies was notably shorter than that between the initial cataract surgery and the first Nd:YAG laser capsulotomy. We also identified five stages of PCA reclosure progression. In conclusion, IOL water content may be linked to PCA reclosure, and the time to recurrence is shorter with each successive reclosure. Further research is needed to verify these findings and uncover additional contributing factors.

Risk Factors for Early and Late Intraocular Lens Dislocation

Purpose: To evaluate risk factors predisposing to intraocular lens (IOL) dislocation after cataract surgery.Methods: The medical and surgical records of patients diagnosed with IOL dislocation between January 2011 and December 2021 after undergoing extracapsular cataract extraction, phacoemulsification, and phacoemulsification with pars plana vitrectomy at Hallym University Sacred Heart Hospital were reviewed retrospectively. Preoperative factors (ocular parameters and demographics) and intra-operative factors (surgery time, surgeon, and intra-operative complications) were compared according to early, late, and bilateral dislocation.Results: In 68 patents and 71 eyes, the average age at the diagnosis of dislocation was 63.3 years, and there were more males (77.5%) than females. Possible major factors predisposing to IOL dislocation were high myopia (9 eyes), retinal detachment (8 eyes), neodymium-doped yttrium aluminum garnet capsulotomy (6 eyes), and normal tension glaucoma (6 eyes). The rate of out-of-the bag dislocation was higher in early dislocation than in late. Early dislocation had a significantly older age, longer surgery time, and higher intraoperative complication rate during cataract surgery than did late dislocation. There was no difference in surgery time for late dislocated eyes compared to non-dislocated eyes. There was no difference in the incidence of dislocation between phacoemulsification and phacoemulsification with pars plana vitrectomy; there were seven eyes with prior vitrectomy only, with late dislocation. Of the seven patients with bilateral IOL dislocation, one had retinitis pigmentosa, two had retinal detachment, and one had high myopia. Bilateral dislocation patients were significantly younger at the time of cataract surgery, compared to unilateral dislocation patients.Conclusions: Early dislocation was associated with long surgery time and intraoperative complications, while late dislocation had no significant correlation with surgery-related factors. A history of vitrectomy and combined vitrectomy with cataract surgery seemed to be associated with late dislocation, but this association was not significant.

Pars plana vitrectomy and subretinal tissue plasminogen activator for large exudative submacular hemorrhage: a case series

BackgroundTo evaluate anatomical and functional outcomes of patients with large submacular hemorrhage (SMH) who treated by pars plana vitrectomy (PPV) in combination with subretinal tissue plasminogen activator (TPA) injection, intraocular gas tamponade, and with additional post-operative interventions.MethodsMedical records of 9 patients who presented with large SMH secondary to age-related macular degeneration (AMD) and underwent PPV, subretinal TPA injection, and gas tamponade at Chiang Mai university hospital between January 2012 and January 2020 were reviewed. Collected data included preoperative visual acuity (VA), SMH extent and duration, intraoperation and post-operation complications, post-operative anatomical and VA responses, and the need for administer post-operation additional treatments.ResultsOverall, five patients were male and four patients were female with a mean (SD) age of 66.9 (7.7) years and a mean (SD) follow-up of 21.1 (16.1) months. A mean (SD) duration of SMH was 15.1 (10.9) days with a mean (SD) extent of SMH was 6.2 (3.4) disc diameters. At 1-month post-operation, complete SMH displacement was noted in eight (88.9%) patients. The mean (SD) VA significantly improved from LogMAR 1.9 (0.4) to 1.1 (0.4), (P = 0.004). During follow-up, eight patients (88.9%) were given additional therapy (anti-vascular endothelial growth factor (anti-VEGF) monotherapy, photodynamic therapy, or in combination). At final follow-up, a mean (SD) LogMAR VA of 0.9 (0.4) was significantly improved compared to baseline (P = 0.004). For intra- and post-operation complications, none developed intraoperative retinal break and retinal detachment.ConclusionsVitrectomy with subretinal TPA injection, intraocular gas tamponade, and additional post-operation treatments provide benefit for anatomical and visual outcomes for patients with large SMH. It may consider as one of effective treatment in this group of patients.

Staged lensectomy and vitrectomy in the management of stage 5C retinopathy of prematurity with corneal opacification: long-term follow up.

To verify the feasibility and safety of staged lensectomy and vitrectomy in stage 5C retinopathy of prematurity (ROP) with corneal opacification. This was a retrospective, interventional, consecutive case series. Twenty-two eyes of 18 stage 5C ROP patients with corneal opacification were included. Regular combined lensectomy and vitrectomy were not prescribed due to the invisible fundus. Staged lensectomy and posterior vitrectomy were performed. The anatomical and visual outcomes were reviewed at the final follow-up visit. The mean gestational age of ROP patients was 29.3±1.6wk (range: 27-32wk), comprising 8 males and 10 females. The average birth weight was 1363.0±300.0 g. All the eyes had corneal opacity and flat or disappeared anterior chambers pre-operatively. Two eyes had complicated cataract and 7 eyes had retrolental fibroplasia. Six eyes had posterior pupillary synechiae or membranes. Seven (31.8%) eyes had vascularly active retinas. The average interval between two procedures was 6.8±4.6mo (2.5-18.5mo). After surgeries, all the patients had normal anterior chambers. Fourteen eyes had clear corneas. The intraocular pressure of 3 eyes with glaucoma was controlled by medication. Two eyes had ocular phthisis. The retina was reattached in 3 eyes and partially attached in 11 eyes. Visual acuity ranged from no light perception to hand motion. Staged lensectomy and vitrectomy are procedures that can halt progression to further complications and preserve some useful eyesight in stage 5C ROP patients with corneal opacification. The earlier the lensectomy is performed, the better the prognosis is.

Refractive Outcomes of Combined Cataract Surgery and Vitrectomy Compared to Cataract Surgery Alone

Purpose: The aim of the study was to evaluate the refractive outcomes of combined cataract surgery and vitrectomy compared to cataract surgery alone. Methods: This retrospective chart review study included two groups: (1) combined surgery in 103 eyes (101 patients) who underwent cataract surgery with posterior chamber intraocular lens (PCIOL) placement by a single cataract surgeon and vitrectomy by a single vitreoretinal surgeon at the same surgical setting; (2) cataract surgery alone by the same surgeon in 107 eyes (84 patients). Refractive outcomes and complications between the combined and cataract surgery alone group were compared. The predicted refractive error was compared to postoperative refractive outcomes in both groups, surgically induced astigmatism (SIA), intraoperative or postoperative complications of either cataract surgery or vitrectomy, and cystoid macular edema. Results: There was no statistically significant difference between predicted and actual postoperative refractive outcomes between the combined and cataract surgery alone groups (within ±0.5 diopters [D], p = 0.099; within ±1.0 D, p = 0.721). There was no difference in SIA refractive outcomes between the two groups (p = 0.509). The use of intraoperative gas for retina tamponade did not significantly affect postoperative refractive outcomes. Both cataract surgery and vitrectomy were successfully performed without unexpected complications from either procedure affecting the other. Discussion/Conclusion: Combined cataract surgery and vitrectomy allows excellent refractive outcomes equal to cataract surgery alone, allowing each procedure to be performed independently by separate anterior and posterior segment surgeons. Combined procedures can be performed in eyes with a variety of retinal indications and can include fluid-gas exchange with minimal risk of PCIOL malposition or change in targeted refraction.