Vitreoretinal Surgery In Patients Research Articles

Comparative Evaluation of The Clinical Efficacy of Various Technologies of Intraoperative Endolaserphotocoagulation in Patients with Proliferative Diabetic Retinopathy

Purpose. To develop a safe and effective endolaserphotocoagulation technology used during vitreoretinal surgery in patients with advanced stage of proliferative diabetic retinopathy.Methods. We observed 88 patients (88 eyes) aged from 42 to 73 years (59 % women; 41 % men). All patients were divided into 2 equal groups based on age and gender, as well as preoperative functional results, a main group in which the developed technology of precision intraoperative endolaser coagulation was used (46 eyes), and a control group with a traditional technique of performing endolaser coagulation during vitreoretinal intervention (42 eyes). Results. Assessment of clinical and morphometric parameters in the main and control groups was carried out after 1, 3 and 6 months. The data obtained indicate a significant increase in BCVA (0.23 ± 0.05) in the group from the 3rd month of observation, no signs of increased IOP, as well as a decrease in retinal thickness in the foveal zone (up to 272.0 ± 27.3 μm) during the observation period up to 6 months. The study of the frequency of complications confirms the safety of the developed technology, which is confirmed by the low probability of developing rubeosis (1 case), neovascular glaucoma (1 case) and recurrence of retinal detachment in the main group of patients (2 cases) during a follow­up period of 6 months.Conclusion. The developed technology of precision endolaser coagulation is characterized by a higher (compared to the traditional technique) level of safety and clinical effectiveness, which is confirmed by the following main points: a greater likelihood of increasing BCVA; absence of increase in IOP during long­term observation, decrease in retinal thickness in the foveal zone starting from the 3rd month of observation; a significant reduction in the likelihood of postoperative complications.

Отдаленные результаты этапного хирургического лечения осложненной начальной катаракты у пациентов с далекозашедшей диабетической ретинопатией

Purpose. To evaluate the efficacy of second-stage phacoemulsification (PE) of complicated initial cataract after vitreoretinal surgery (VRS) in patients with advanced proliferative diabetic retinopathy (PDR). Material and methods. 216 patients with PDR and complicated initial cataract who underwent surgery were included. These patients were divided into four groups according to their management. In the group I patients were subjected to a two-step surgical procedure: VRS with silicone oil tamponade was performed as the first step, followed by the second step — PE+IOL implantation + silicone oil removal. In the group II PE was performed simultaneously with VRS and silicone oil tamponade. The second step differed in the removal of silicone oil from the vitreous cavity. In the group III patients were subjected to a two-step surgical procedure: VRS with gas tamponade performed as the first step in their treatment; followed by the second step, PE and the IOL implantation. In the group IV PE performed simultaneously with VRS with gas tamponade. Results. Patients in subgroup I and group III had better functional results than those in subgroup II and group IV, respectively (p < 0,001). The subgroup IIa (n = 9; 14.5 %) showed higher incidence of NVG than the subgroup Ia (n = 2; 3.2 %), p = 0.027. There also was a higher rate of NVG in group IV (n = 6; 19,3 %) compared to group III (n = 1; 3,1 %), p = 0,04. Conclusion. Phacoemulsification of initial cataract at the second stage after VRS in patients with advanced PDR provides a sparing approach to surgical treatment in this category of patients and allows to improve anatomical and functional results of VRS. In addition, it contributes to reduction of number and severity of postoperative complications. Keywords: proliferative diabetic retinopathy; vitreoretinal surgery; phacoemulsification

A NOVEL EMBEDDED-STYLE CORNEAL CONTACT LENS: For Emergency Vitreoretinal Surgery in Patients with Severe Corneal Opacities.

A NOVEL EMBEDDED-STYLE CORNEAL CONTACT LENS: For Emergency Vitreoretinal Surgery in Patients with Severe Corneal Opacities.

Аспекты макулярной хирургии у пациентов с патологической миопией

Patient with high and ultra-high myopia belong to the one of the most difficult categories for the vitreoretinal surgery because of the morphological features of choroid, retina and vitreomacular interface: axial length over 26 mm, the presence of posterior staphyloma, thinning of choroid, a combination of hypo- and hyperpigmentation of the retina pigment epithelium. Therefore, the improvement of the technique of vitreoretinal surgery in patients with pathological myopia remains relevant. Purpose. To optimize the technique of vitreoretinal surgery in patients with pathological myopia. Material and methods. There are 14 patients (14 eyes) with myopic traction maculopathy against the background of pathological myopia with clinical refraction from 10 to 26 D were under observation. The axial length of the eye averaged 31.23 ± 1.94 mm. All patients underwent microinvasive three-port vitrectomy 25G. In connection with the anatomical features of the myopic eye, special methods of surgical manipulations in the macular region were used. Results. The obtained positive anatomical and functional results of the treatment demonstrated their effectiveness and safety, which made it possible to develop a certain algorithm for surgical manipulations in macular surgery in patients with pathological myopia. Conclusion. The use of non-standard techniques of vitreoretinal surgery, highly specialized tools and methods for visualizing the structures of the central zone of the retina optimizes the results of the treatment of macular pathology in patients with pathological myopia. Keywords: high myopia, traction maculopathy, epiretinal membrane, vitrectomy, cataract

Risk factors and surgical outcomes for the concurrence of intraocular lens dislocation with vitreoretinal diseases.

The weakness and dialysis of lens zonule after cataract surgery may lead to dislocation of intraocular lens (IOL). It has been shown that cataract surgery could induce or aggravate posterior vitreous detachment (PVD) due to postoperative inflammation and increased volume of vitreous cavity. PVD is associated with the occurrence of several vitreoretinal diseases, such as rhegmatogenous retinal detachment and macular hole. This study aims to explore risk factors for dislocation of IOL concurring with vitreoretinal disease, such as retinal detachment and macular hole, and to evaluate the efficacy and complications of surgical intervention for these abnormalities concurrently. Ten patients (10 eyes) who diagnosed as rhegmatogenous retinal detachment, traumatic macular hole, high myopic macular hole, and combined with IOL dislocation at the Department of Ophthalmology of Xiangya Hospital from January 2004 to December 2020 were enrolled. The patients received vitreoretinal surgery and reposition of IOL by scleral suturing. Medical records were reviewed to figure out the time and type of IOL dislocation. Preoperative and 1 year of postoperative best corrected visual acuity, intraocular pressure, corneal endothelial density, and complications of surgical management were analyzed. Ten patients including 4 high myopia, 4 ocular contusion, and 2 who experienced IOL dislocation during the posterior capsulotomy were included in this study. Coexistence of IOL dislocation and vitreoretinal abnormalities occurred in patients with high myopia, ocular contusion, and capsulotomy. IOL dislocation happened in the vitreoretinal surgery in patients with high myopia or intraoperative capsulotomy. IOL dislocation occurred preoperatively in patients with ocular contusion. IOL capsular bag complex dislocation and out-of-the-bag IOL dislocation were found in 4 and 6 patients, respectively. Surgical relocation of dropped IOL and repair of vitreoretinal disease improved the best corrected visual acuity from preoperative 1.79±0.39 to postoperative 1.13±0.45 (P<0.001). The density of corneal endothelial cells in patients was lower than that before surgery [(1 806.40±181.20) cells/mm2 vs (1 914.00±182.22) cells/mm2, P<0.001]. There was no significant difference in intraocular pressure before and after surgery (P=0.099). Postoperative complications included high intraocular pressure and recurrent retinal detachment. Dislocation of IOL may be concurrent with vitreoretinal disease. High myopia, blunt contusion, and capsulectomy might be the risk factors for intraocular lens dislocation. The surgical technique used in the present study is successful in manipulating these disorders with optimal functional results and less severe complications.

To Evaluate the Surgical Outcome of Epiretinal Membrane Retrospective Study

The epiretinal membrane (ERM) is a common vitreoretinal intersurface disorder in elderly individuals. The objective of the study was to evaluate the outcome of vitreoretinal surgery in patients with epiretinal membrane. We retrospectively reviewed the medical records of thirteen eyes of 12 patients with ERM with mean age group of 63 ± 6.07 (53 – 73) years who underwent vitreoretinal surgery in Tilganga Institute of Ophthalmology and completed at least 3 month postoperative follow up from April 2018 to March 2019. The patients’ pre- and post-operative best corrected visual acuity, slit-lamp examination findings, and optical coherence tomography (OCT) images were evaluated. Three cases were pseudophakic. Out of 10 phakic eyes, 7 had combined surgery and 3 had consecutive surgery (Pars Plana Vitrectomy followed by cataract surgery). The median baseline best corrected visual acuity in Log MAR was was 0.7 (0.6-1.00) which improved to 0.30 (0.25-0.60) in 3 month follow up which was statistically significant (p-0.04).OCT parameters showed decrease in mean CMT from 411.15± 94.52 µm to 318.61 ±118.87µm (p - 0.002). One eye developed inferior retinal detachment at 6 weeks follow up, two eyes had postoperative IOP &gt;30mmHg which was managed with topical anti-glaucoma medication and two had persistent cystoid macular edema. Pars plana vitrectomy with membrane peeling is safe and effective in restoring visual acuity in patients with ERM. Though the study population was small with short duration of follow up, results are encouraging, so need further prospective large multi-centered study to determine the effectiveness of ERM surgery

Comparative Incidence of Postoperative Hemorrhage in Vitreoretinal Surgery in Patients on Anti-Coagulants.

Data regarding hemorrhagic complications of direct oral anticoagulants (DOACs) and vitreoretinal surgery are limited. Multicenter analysis of longitudinal, aggregated electronic health records of patients undergoing pars plana vitrectomy (PPV) with no prior history of ocular hemorrhage. Retrospective analysis of patients undergoing PPV between January 1, 2013, and December 31, 2019. The main outcomes were development of postoperative hemorrhagic complications within 1 month following vitreoretinal surgery. A total of 58,131 eyes underwent PPV, with 2,956 (5.1%) on anticoagulant medication prior to surgery. Eight hundred twenty-eight eyes (1.4%) developed a postoperative hemorrhage. Of eyes with anticoagulation use, 50 of 2,956 (1.29%) developed a hemorrhage, whereas 778 of 55,175 (1.41%) of the eyes with no prior anticoagulation use developed a postoperative hemorrhage (P = .2107). Use of DOACs prior to vitreoretinal surgery does not appear to be associated with increased rates of postoperative intraocular hemorrhage. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:374-379.].

Heads-up 3D viewing system in rhegmatogenous retinal detachment with proliferative vitreoretinopathy - A prospective randomized trial.

Purpose:To compare the outcomes of vitreoretinal surgery in patients with primary and recurrent rhegmatogenous retinal detachment (RRD) with proliferative vitreoretinopathy (PVR) on 3 dimensional digitally assisted visualization system (3D-DAVS) and conventional analogue microscope (CAM).Methods:68 patients with primary (50) and recurrent (18) RRD with PVR > C1 were included. One group underwent surgery on 3D-DAVS while the other on CAM. The parameters studied included detachment rate, best-corrected visual acuity (BCVA), duration of surgery, mean endo-illumination levels of 23 G (Gauge) micro incision vitrectomy system (MIVS) and microscope and satisfaction of surgeon and observers based on a framed questionnaire. The mean duration of follow up was three months.Results:68 eyes of 68 patients with median age 52.5 (range 18–68) years were included. 50 had primary RRD and 18 had recurrent RRD. Detachment rate at the end of three months was comparable in both groups of primary (P > 0.99) and recurrent (P = 0.21) RRD. Mean duration of surgery in minutes for 3D DAVS and CAM group was 61.8 (±22.07) and 58.04 (±12.33), respectively, in primary RRD and 37.22 (±10.27) and 36.55 (±5.92), respectively, in recurrent RRD group. Mean endo-illumination in 3D DAVS (14.5%) group was half of that in CAM (34.17%) group. Surgeon and observer satisfaction scores were significantly higher for 3D DAVS group.Conclusion:3D DAVS is a safe and effective modality or performing VR surgery in RRD with PVR. 3D DAVS allows lower endo-illumination levels provides superior surgeon ergonomics and offers better learning opportunities to the trainees.

Outcomes of vitreoretinal surgery in patients with posterior segment intraocular foreign body

Outcomes of vitreoretinal surgery in patients with posterior segment intraocular foreign body

Vitreoretinal surgery in patients with intraocular lens dislocation into the vitreous

Vitreoretinal surgery in patients with intraocular lens dislocation into the vitreous

LONG-TERM ANATOMICAL AND FUNCTIONAL OUTCOMES FOLLOWING VITRECTOMY FOR ADVANCED COATS DISEASE.

To assess the long-term anatomical and functional results of vitreoretinal surgery in patients with advanced Coats disease. Retrospective analysis of 23 patients who underwent 23-gauge pars plana vitrectomy combined with transscleral cryotherapy, laser photocoagulation, and intraocular tamponade between 2005 and 2014 and had a follow-up of at least 1 year. The primary outcomes were mean visual acuity and anatomical success. The average age at the time of surgery was 8.7 ± 1.3 years (range, 2-18 years). The mean follow-up period was 55.2 ± 31 months (range, 12-120 months). In 16 eyes (70%), further treatment was not necessary. In the remaining 7 patients (30%), revision surgery with silicone oil tamponade was required. In 20 eyes (87%), the retina was reattached. At the final visit, 8 eyes (35%) had improved mean Snellen visual acuity from 20/1,000 at initial presentation to 20/160, 3 eyes (13%) showed stabilization, and 6 eyes (26%) had decline in visual acuity. No enucleation was necessary, and no progression to neovascular glaucoma was observed. Pars plana vitrectomy combined with cryotherapy, laser photocoagulation, and intraocular tamponade could be an effective treatment option for advanced Coats disease. Despite surgery, disease-related complications remained high, but the main aim of management in these young patients is functional and anatomical stability.

Anatomical and functional outcomes following vitrectomy for advanced familial exudative vitreoretinopathy: a single surgeon's experience

PurposeTo assess the anatomical and functional results of vitreoretinal surgery in patients with advanced familial exudative vitreoretinopathy (FEVR).MethodsRetrospective analysis of data for 10 eyes of 9 patients with advanced FEVR...

HEMORRHAGIC RISK OF VITREORETINAL SURGERY IN PATIENTS MAINTAINED ON NOVEL ORAL ANTICOAGULANT THERAPY.

To evaluate the frequency and type of perioperative hemorrhagic complications associated with vitreoretinal surgery in patients undergoing systemic treatment with the newer anticoagulant and antiplatelet agents including rivaroxaban, apixaban, dabigatran, and prasugrel. Retrospective review of a cohort of patients being treated with anticoagulant and antiplatelet drugs, who underwent any vitreoretinal surgical procedure over a 2-year period. Thirty-six eyes of 33 patients were identified who underwent vitreoretinal surgical operations while being treated systemically with anticoagulant and antiplatelet therapy. No eyes suffered perioperative complications of retrobulbar hemorrhage, suprachoroidal hemorrhage, or subretinal hemorrhage. Four eyes (11.1%) experienced postoperative vitreous cavity hemorrhage after which two eyes (5.5%) required repeat surgical intervention and two eyes (5.5%) cleared spontaneously. Although there is a relative risk to such surgery in patients who are taking novel oral anticoagulants, these findings suggest that patients may safely undergo vitreoretinal surgery while maintaining therapy with rivaroxaban, apixaban, dabigatran, and prasugrel.

Vitreoretinal Complications and Vitreoretinal Surgery in Osteo-Odonto-Keratoprosthesis Surgery

To describe the indications for and approaches to vitreoretinal surgery in patients with osteo-odonto-keratoprosthesis (OOKP). Retrospective case series. This was a retrospective review of all patients who had undergone OOKP surgery between 2003 and 2012 at our center. OOKP procedures were performed for severe ocular surface disease according to the indications and techniques described in the patient demographics of the Rome-Vienna Protocol. Indications for retinal surgery, surgical outcomes, and intraoperative and postoperative complications were documented. Operative techniques were reviewed from the surgical records, and any subsequent surgeries were also recorded. Thirty-six patients underwent OOKP, and retinal surgery was indicated in 13 (36%). The indications for and approaches to surgery were retinal detachment repair using an Eckardt temporary keratoprosthesis; assessment of retina and optic nerve health prior to OOKP surgery, using either a temporary keratoprosthesis or an endoscope; endoscopic cyclophotocoagulation for intractable glaucoma; endoscopic trimming of a retroprosthetic membrane; or vitrectomy for endophthalmitis with visualization through the OOKP optic using the binocular indirect viewing system. In all cases, retinal surgical aims were achieved with a single procedure. Postoperative vitreous hemorrhage occurred in 16 patients (44%), but all resolved spontaneously. OOKPs represent the last hope for restoration of vision in severe ocular surface disease, and the retinal surgeon is frequently called upon in the assessment and management of these patients. Temporary keratoprostheses and endoscopic vitrectomies are valuable surgical tools in these challenging cases, improving functional outcomes without compromising OOKP success.

PRECLINICAL EVALUATION AND INTRAOPERATIVE HUMAN RETINAL IMAGING WITH A HIGH-RESOLUTION MICROSCOPE-INTEGRATED SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY DEVICE

The authors have recently developed a high-resolution microscope-integrated spectral domain optical coherence tomography (MIOCT) device designed to enable OCT acquisition simultaneous with surgical maneuvers. The purpose of this report is to describe translation of this device from preclinical testing into human intraoperative imaging. Before human imaging, surgical conditions were fully simulated for extensive preclinical MIOCT evaluation in a custom model eye system. Microscope-integrated spectral domain OCT images were then acquired in normal human volunteers and during vitreoretinal surgery in patients who consented to participate in a prospective institutional review board-approved study. Microscope-integrated spectral domain OCT images were obtained before and at pauses in surgical maneuvers and were compared based on predetermined diagnostic criteria to images obtained with a high-resolution spectral domain research handheld OCT system (HHOCT; Bioptigen, Inc) at the same time point. Cohorts of five consecutive patients were imaged. Successful end points were predefined, including ≥80% correlation in identification of pathology between MIOCT and HHOCT in ≥80% of the patients. Microscope-integrated spectral domain OCT was favorably evaluated by study surgeons and scrub nurses, all of whom responded that they would consider participating in human intraoperative imaging trials. The preclinical evaluation identified significant improvements that were made before MIOCT use during human surgery. The MIOCT transition into clinical human research was smooth. Microscope-integrated spectral domain OCT imaging in normal human volunteers demonstrated high resolution comparable to tabletop scanners. In the operating room, after an initial learning curve, surgeons successfully acquired human macular MIOCT images before and after surgical maneuvers. Microscope-integrated spectral domain OCT imaging confirmed preoperative diagnoses, such as full-thickness macular hole and vitreomacular traction, and demonstrated postsurgical changes in retinal morphology. Two cohorts of five patients were imaged. In the second cohort, the predefined end points were exceeded with ≥80% correlation between microscope-mounted OCT and HHOCT imaging in 100% of the patients. This report describes high-resolution MIOCT imaging using the prototype device in human eyes during vitreoretinal surgery, with successful achievement of predefined end points for imaging. Further refinements and investigations will be directed toward fully integrating MIOCT with vitreoretinal and other ocular surgery to image surgical maneuvers in real time.

Changes in tear film after minimal vitreoretinal surgery in patients with hypertension

Objective To observe the changes in tear film after minimal vitreoretinal surgery in patients with hypertension.Methods One hundred and thirty-three eyes of 133 patients (47 patients with systemic hypertension as group A and 86 eyes without systemic hypertension as group B) underwent 23- gauge or 25-gauge vitreous microsurgery were enrolled in this study.The contralateral eyes were regarded as the control group.Uncomfortable symptoms score,break-up time (BUT),Schirmer'sI test (S I T) and corneal fluorescein staining (CFS) were recorded before and after surgery in all patients.Data were analyzed with a Wilcoxon rank sum test,Kruskal-Wallis one-way ANOVA and independent samples t test.Results Comparison between non-surgery eyes of group A and group B indicated no statistical difference in CFS and BUT score at each follow-up (Z=-3.229,-2.780,-2.018,-2.379,-3.374,-3.213:t=-2.452,-2.963,- 2.580,- 3.018,- 2.339,- 2.374; P＞0.05).However,statistical difference of S I T between the two groups was found either 1 day before surgery or 10 days after surgery (t =- 4.668,-5.384; P＜0.05).Comparing the CFS and BUT in group A at 1,3 days after operation with 1 day before surgery,the differences were statistically significant (Z=- 5.229,-4.780; P＜0.05; t=- 5.633,-4.884; P=0.001).The statistical significance was noticed in S I T between 1 day before surgery and 1 day after surgery (t =- 4.743,P =0.001).Comparison between uncomfortable symptoms scores of operated eyes in group A and group B revealed no significant difference between 1 and 3 days after surgery.Nineteen patients (14％) complained of pain and red eye.,There was no statistical difference between CFS score at each follow-up (Z=-3.123,-3.730,-2.198,-3.379,-3.434,-2.393; P＞0.05).There were significant differences between BUT scores of operated eyes in two groups at 1 and 3 days after operation (t=-5.537,-5.014; P＜0.05).There was also a significant statistical difference between S I T 1 and 3 days after operation between groups (t=-3.653,-4.371; P＜0.05).Conclusions The stability of tear film in hypertension patients is poorer than normal patients.The secretion of tears in hypertension patients declines and the tear film recovers slowly after the surgery. Key words: Vitrectomy/adverse effects; Surgical procedures,minimally invasive; Hypertension; Tears/metabolism

Outcomes of Vitreoretinal Surgery in Patients with Closed-Globe Injury

To evaluate the clinical features, visual outcomes, and prognostic factors in patients who underwent vitreoretinal surgery after closed-globe injury. Retrospective review of patients with closed-globe injuries who underwent vitreoretinal surgery between January 2003 and December 2007. The study cohort included 46 eyes from 46 patients who underwent vitreoretinal surgery for posterior segment injury. Retinal detachment was the most frequent indication for the surgery, in 33 eyes (72%). After surgery, final visual acuity of 20/400 or better was achieved in 35 eyes (76%), while 11 eyes (24%) had visual acuity less than 20/400 (poor visual outcome). The most frequent reason for poor outcome was proliferative vitreoretinopathy (PVR) (6 eyes), followed by macular complications (3 eyes) and optic atrophy (2 eyes). Two cases with PVR became phthisical following repeated vitreoretinal procedures and also lost light perception. Prognostic factors associated with poor outcomes included delayed presentation, presenting visual acuity of less than 20/400, the presence of initial macular detachment, and the need for additional surgical intervention (p<0.05). No statistical difference was found in final visual acuity between eyes with or without retinal detachment (p>0.05). Also, the presence of damage to the anterior segment was not significantly associated with poor visual outcome (p>0.05). In patients with posterior segment pathology caused by closed-globe trauma, retinal detachment was the most common reason for vitreoretinal surgery and PVR was the main cause of surgical failure. The poor visual outcomes associated with delayed presentation suggest that patients need to be referred for further management.

Maintenance of Warfarin Anticoagulation for Patients Undergoing Vitreoretinal Surgery

To evaluate the risk of hemorrhagic complications associated with vitreoretinal surgery in patients whose warfarin sodium therapy was continued throughout the surgical period. A review of 1737 records of patients undergoing pars plana vitrectomy was conducted. Inclusion criteria included patients receiving warfarin therapy whose international normalized ratios (INRs) were elevated above normal values on the day of surgery. Intraoperative and postoperative hemorrhagic complications were documented. Fifty-four patients underwent 57 vitreoretinal surgical procedures with warfarin therapy and were divided into groups as follows: group S with INRs of 1.20 to 1.49, values considered subtherapeutic; group B with INRs of 1.50 to 1.99, values considered borderline therapeutic; group T with INRs of 2.00 to 2.49, values considered therapeutic; and group HT with INRs of 2.50 or greater, values considered highly therapeutic. No patients experienced anesthesia-related or intraoperative hemorrhagic complications. Two (7.7%) of 26 eyes in group S and 2 (16.7%) of 12 eyes in group HT experienced postoperative hemorrhages. All of the patients with vitreous hemorrhages had spontaneous clearing without additional treatment. Many patients may safely undergo vitreoretinal surgery while maintaining therapeutic levels of warfarin anticoagulation. We experienced no intraoperative hemorrhagic complications; the 4 postoperative complications resolved spontaneously without persistent visual sequelae or the need for supplemental surgery.

Outcomes of Vitreoretinal Surgery in Patients With X-Linked Retinoschisis

To assess the outcomes of vitreoretinal surgery in the treatment of vision-threatening posterior segment complications of X-linked retinoschisis. The authors performed a retrospective analysis of 16 eyes from 11 patients who underwent vitreoretinal surgery. All the patients had a documented positive family history of X-linked retinoschisis, and all patients had bilateral macular disease. The ages of the patients ranged from 14 months to 37 years (mean age 15.1 years; median age 11.5 years), and postoperative follow-up ranged from 3 months to 10 years (mean 2.8 years; median 1 year). The indications for surgical intervention included rhegmatogenous retinal detachment (12 eyes), vitreous hemorrhage (2 eyes), progression of the schisis cavity through the fovea (2 eyes), cataract associated with a persistent hyperplastic primary vitreous-like condition (2 eyes), and exudative maculopathy (1 eye). The primary surgical intervention included pars plana vitrectomy alone (7 eyes), pars plana vitrectomy and pars plana lensectomy (4 eyes), and a scleral buckle procedure alone (5 eyes). Surgical success (defined as reattachment of the retina, removal of media opacities, or arrest of schisis progression) was achieved in 14 of 16 eyes, after an average of 1.2 procedures per eye. The major reason for reoperations was recurrent retinal detachment due to proliferative vitreoretinopathy. Two eyes were eventually enucleated due to pain associated with neovascular glaucoma resulting from recurrent retinal detachment. Of the remaining 14 eyes, visual acuity improved in 8 eyes and remained unchanged in 6 eyes. Vitreoretinal surgery is often helpful in stabilizing or improving visual function in patients with posterior segment complications from X-linked retinoschisis.

Sophisticated vitreoretinal surgery in patients with a healthy fellow eye. An 11-year retrospective study.

Forty-four patients who had undergone successful vitreoretinal surgery were included in a retrospective study intended to evaluate the real benefit of surgery in each case. All patients presented with a retinal detachment complicated by proliferative vitreoretinopathy in one eye, the fellow eye being healthy. The number of operations undergone by each patient and the total operating time per patient were carefully recorded. Objective parameters such as visual acuity, visual field and stereoscopic function were monitored. Visual comfort and subjective complaints were graded by means of a questionnaire given to the patients. Any severe event occurring in the fellow eye during the follow-up period was also registered. Sophisticated vitreoretinal surgery in patients with a good fellow eye is useful to the patient if binocular function can be restored at least partially. Correction of unilateral aphakia by a contact lens should not be considered an acceptable solution.