玻璃体切除联合白内障手术治疗复杂性视网膜脱离

目的:评价玻璃体切除联合白内障手术治疗复杂性视网膜脱离的疗效和安全性。方法:回顾性病例系列研究。122例137眼复杂性视网膜脱离患者接受玻璃体切除联合白内障手术治疗。主要结果包括术后视力和并发症。结果:术后随访时间平均12.8mo。主要病因包括孔源性视网膜脱离,牵拉性视网膜脱离和增殖性糖尿病视网膜病变。术后1,6和12mo与术前比较视力提高大于等于2行分别为37眼(27.0%)、55眼(40.1%)和61眼(44.5%)。结论:玻璃体切除联合白内障手术治疗复杂性视网膜脱离是一种有效、安全的手术。     

Long-term results of vitreous surgery for proliferative diabetic retinopathy

In order to study long-term anatomical and functional results the authors evaluated the data from 260 patients who underwent pars plana vitrectomy for proliferative diabetic retinopathy. Indications for surgery were: vitreous hemorrhage, 68 eyes (26.2%); vitreous hemorrhage & tractional retinal detachment, 84 eyes (32.3%); tractional retinal detachment, 82 eyes (31.5%); and combined tractional-rhegmatogenous retinal detachment, 26 eyes (10%). In 118 eyes vitreoretinal surgery was combined with silicone-oil tamponade.The retina was completely attached posterior to a scleral buckle in 251 eyes (96%) at the time of the last examination. After a follow-up period of at least 12 months in a group of patients with vitreous hemorrhage, visual acuity improved in 88% of the eyes. Visual acuity was better than 0.5 in 31% of eyes. In group of eyes with nonresorbing vitreous hemorrhage & tractional retinal detachment visual acuity improved in 52% of eyes. Visual acuity improved in 76% of eyes with tractional retinal detachment and in 81% of eyes with combined tractional & rhegmatogenous retinal detachment. When comparing the latest postoperative visual acuity to visual acuity after three months postoperatively, visual acuity was unchanged in 88%, in 10% it became worse and in 3 cases (1%) became better. In the postoperative period, recurrent vitreous hemorrhage occurred in 33 (13%) eyes, reproliferation in 12 eyes.Cataract developed in 45 of 168 phakic eyes. If postoperative visual acuity before cataract formation was good, extracapsular cataract extraction with posterior chamber intraocular lens implantation was performed. Otherwise simple intra or extracapsular cataract extraction was performed. In 19 cases cataract operation was performed together with silicone oil extraction. Neovascular glaucoma developed postoperatively in 15 eyes (6%). Retinal detachment occurred postoperatively in 21 eyes (8%). In 15 eyes the retina was successfully reattached after additional operations.     

Combined phacoemulsification, vitrectomy, foreign-body extraction, and intraocular lens implantation

PURPOSE: To assess the outcome of simultaneous phacoemulsification, pars plana vitrectomy, intraocular foreign-body extraction, and intraocular lens (IOL) implantation. SETTING: SSK Ankara Eye Hospital, Department of Vitreoretinal Surgery, Ankara, Turkey. METHODS: Seventeen patients with corneal perforation, intraocular foreign body, vitreous hemorrhage, and lens opacity had simultaneous clear corneal phacoemulsification, pars plana vitrectomy, intraocular foreign-body extraction, and IOL implantation. RESULTS: Postoperative complications included massive retinal fibrosis in 2 patients, retinal detachment in 1, and cilioretinal artery occlusion in 1. At a mean follow-up of 15.2 months, best corrected visual acuity improved in the remaining 13 eyes (76%). The IOL was stable in all cases. CONCLUSION: Combined phacoemulsification with IOL implantation and vitreoretinal surgery was safe in selected cases of penetrating ocular trauma resulting from an intraocular foreign body.     

严重PDR玻璃体切割术后雷珠单抗注射的效果观察

目的：对严重增殖性糖尿病视网膜病变的患者行玻璃体切割术后行雷珠单抗注射的效果观察。方法：回归性分析。12例严重增殖性糖尿病视网膜病变患者(12眼)接受睫状体平坦部玻璃体切割术,同时给予硅油、惰性气体或者平衡液的玻璃体腔填充。在手术结束的同时给予雷珠单抗的玻璃体腔注射。结果：随访时间平均为2.75 mo。这12眼中分别包括玻璃体积血(1眼);玻璃体积血伴纤维血管化增生(1眼);玻璃体积血伴牵拉性视网膜脱离(3眼);纤维血管化增生伴牵拉性视网膜脱离(2眼);玻璃体积血伴新生血管性青光眼伴牵拉性视网膜脱离(1眼);玻璃体积血伴纤维血管化增生伴牵拉性视网膜脱离(2眼);玻璃体积血伴纤维血管化增生伴新生血管性青光眼伴牵拉性视网膜脱离(1眼);玻璃体积血伴牵拉性孔源性视网膜脱离(1眼)。12眼中,8眼行玻璃体腔硅油填充,2眼行惰性气体填充,2眼行平衡液填充。所有的患者之前均未接受任何治疗。视网膜脱离复位率为10/10(100%)。1眼术后出现前房积血。9眼术后最佳矫正视力较术前提高,2眼无明显变化,1眼较术前下降。 OCT检查显示8眼术后未见黄斑水肿。结论：玻璃体切割术后雷珠单抗注射对严重增殖性糖尿病视网膜病变患者有明显的治疗效果：手术成功率明显提高;患者视力显著提高;糖尿病黄斑水肿的发生概率减少;术中及术后并发症的发生率降低。     

Combined clear corneal phacoemulsification, vitreoretinal surgery, and intraocular lens implantation.

PURPOSE: To evaluate the technical feasibility, outcome, and incidence of complications after combined clear corneal phacoemulsification with intraocular lens (IOL) implantation and vitreoretinal surgery. SETTING: Department of Ophthalmology, Giessen, Germany. METHODS: The results of combined cataract and vitreoretinal surgery in 38 eyes (36 patients) were retrospectively analyzed. All patients had clinically significant lens opacities and vitreoretinal pathology requiring pars plana vitrectomy. Thirty-seven IOLs were implanted in the capsular bag, and 1 was sulcus fixated. RESULTS: Postoperatively, visual acuity improved in 20 eyes (52.6%), was unchanged in 16 (42.1%), and was worse in 2 (5.3%). Postoperative complications consisted of anterior chamber fibrin exudation (3 eyes), hyphema (2 eyes), vitreous hemorrhage (1 eye), posterior capsule opacification (16 eyes), neovascular glaucoma (2 eyes), proliferative vitreoretinopathy and redetachment (1 eye), and retinal redetachment after silicone oil removal (1 eye). CONCLUSION: Compared with 2 separate operations in patients with significant lens opacities and vitreoretinal pathology, combined cataract and vitreoretinal surgery provided more rapid visual rehabilitation. The visual outcome and complications depended primarily on underlying posterior segment pathology and were not related to the combined procedure technique.     

玻璃体手术治疗自发性玻璃体积血

目的观察玻璃体手术治疗非糖尿病性自发玻璃体积血的疗效及其与手术时机的关系。方法45例(46眼)非糖尿病性自发玻璃体积血行标准三通道闭合式玻璃体切除并联合眼内激光光凝等手术,并对不同时机手术的患者术后视力及并发症进行分析。结果1月以内手术者术后视力均提高。1月以上手术者14眼中术后视力提高者2眼,不变8眼,下降3眼。手术并发症主要为术中出血和医源孔及术后高眼压。术中医源孔和术后视网膜脱离均为1月以上手术者。结论玻璃体手术治疗非糖尿病性自发玻璃体浓密积血者疗效佳,并发症少。考虑玻璃体积血为视网膜裂孔所致者应及时手术。     

超声乳化人工晶状体植人联合玻璃体切除术治疗增生型糖尿病视网膜病变

目的评价晶状体超声乳化、囊袋内人工晶状体植入联合玻璃体切除术治疗增生型糖尿病视网膜病变（PDR）的临床效果。方法回顾性分析合并不同程度白内障的增生型糖尿病视网膜病变6l例（66眼）。其中PDRlV期20眼,V期33眼,Ⅵ期13眼。实施晶状体超声乳化、囊袋内人工晶状体植人联合玻璃体切除术。观察术后视力改善程度和术中术后并发症。结果术后视力改善：PDR1V期19眼（95．0％）,V期28眼（84．8％）,Ⅵ期13眼（38．5％）。术后视力低下者多伴有明显的糖尿病黄斑病变。术中术后主要并发症包括：医源性裂孔7眼（10．6％）;玻璃体积血,术中17眼（25．8％）,术后7眼（10．6％）;角膜上皮延期愈合9眼（13．6％）;角膜水肿8眼（12．1％）。结论超声乳化、人工品状体植入联合玻璃体切除术治疗合并不同程度白内障的增生型糖尿病视网膜病变是安全有效的,可使大多数患者视力改善,避免玻切术后并发白内障再次手术。糖尿病黄斑病变是影响术后视力提高的主要原因。     

Epiretinal membrane formation after pars plana vitrectomy in proliferative diabetic retinopathy]

Recurrent epiretinal membranes are a major contributing factor to functional and visual failures after pars plana vitrectomy for proliferative vitreoretinal disorders. In this study 222 consecutive eyes that have had pars plana vitrectomy for proliferative diabetic retinopathy (operated in 1986 und 1987) were evaluated retrospectively. The study focuses on a subgroup of 108 consecutive eyes all with preoperative tractional retinal detachment and all operated with primary silicone oil injection. A minimum follow up of six months was present in 90% of these cases. Permanent visual success was observed in 40% of the eyes, most of which had dense vitreous hemorrhage preoperatively. Multivariant analysis revealed that among several potential risk factors recurrent epiretinal membranes as well as silicone oil were significantly associated with visual failure. Because of the high incidence of recurrent epiretinal membranes associated with poor functional results silicone oil injection following pars plana vitrectomy should be employed restrictively in patients with proliferative diabetic retinopathy.     

玻璃体切除术后白内障放置后节眼内灌注行超声乳化人工晶状体植入术

目的:探讨玻璃体切除术后白内障在行超声乳化人工晶状体植入术时放置后节眼内灌注的临床效果。方法:对31例35眼玻璃体切除术后的白内障患者行超声乳化吸出及人工晶状体植入术,手术时常规放置后节眼内灌注,观察术后视力、眼底状况及手术并发症。结果:35眼中,术后最佳矫正视力≥0.5者4眼,0.3～0.4者8眼,0.1～0.2者18眼,数指～0.1者5眼;并发症:角膜轻度水肿4例,玻璃体出血1眼,脉络膜脱离1眼,术后晶状体后囊混浊2眼。结论:玻璃体切除术后发生的白内障,在选择超声乳化摘出及人工晶状体植入术的同时,放置后节眼内灌注是一种比较安全而有效的方法。     

Combining phacoemulsification with pars plana vitrectomy in patients with proliferative diabetic retinopathy: a series of 223 cases

PURPOSE: To describe the results of combined phacoemulsification, insertion of posterior chamber intraocular lens (PCIOL), and pars plana vitrectomy for patients with retinal disorders resulting from diabetic retinopathy. DESIGN: Retrospective, consecutive, noncomparative, interventional case series. PARTICIPANTS: Two hundred twenty-three patients with vitreoretinal disorders secondary to diabetic retinopathy. METHODS: A case series of 223 consecutive patients with retinal disorders resulting from diabetic retinopathy who underwent combined phacoemulsification, insertion of PCIOL, and pars plana vitrectomy. MAIN OUTCOME MEASURES: Vision, number of secondary procedures, and complications. RESULTS: Two hundred twenty-three patients (153 with vitreous hemorrhage, 58 with traction retinal detachment, and 12 with macular traction) underwent combined surgery. The average increase in vision was 4.3 Snellen lines. The average follow-up was 10 months. Retinal detachment occurred in 5% of patients who underwent surgery. Diabetic macular edema was found in 12% after combined surgery. Cystoid macular edema was found in 3%. Vitreous hemorrhage requiring another procedure occurred in 11%. Twenty-two patients (10%) required a repeat vitrectomy (12 for vitreous hemorrhage and 10 for retinal detachment). CONCLUSIONS: Combined phacoemulsification, insertion of PCIOL, posterior capsulectomy, and pars plana vitrectomy can be used to treat patients with complications resulting from proliferative diabetic retinopathy. Combined surgery may prevent a second operation for postvitrectomy cataract, allowing earlier visual rehabilitation.     

Results of combined vitreoretinal surgery and phacoemulsification with intraocular lens implantation

Purpose : To assess the outcome and complications after combined pars plana vitrectomy and phacoemulsification with intraocular lens implantation in patients with concomitant cataract and vitreoretinal abnormalities. Methods : This retrospective study consisted of 113 eyes of 109 patients with various vitreoretinal abnormalities and visually significant cataract. Vitreoretinal surgery was combined with clear corneal phacoemulsification and intra‐ocular implantation. Results : The combined surgery resulted in minimal complications, and postoperative visual acuity was improved in 83 eyes (71.6%). Visual acuity was improved by two or more lines in 26 eyes (66.6%) with proliferative diabetic retinopathy, 22 eyes (73%) with proliferative vitreoretinopathy, eight eyes (30.7%) with macular abnormalities, four eyes (55.5%) with trauma and two eyes (40%) with retinal vein occlusion. Conclusions : The combined vitreoretinal surgery and phacoemulsification with intraocular lens implantation was safe and effective in treating vitreoretinal abnormalities coexisting with cataract. Combined surgery is recommended for all patients having simultaneous vitreoretinal pathological changes and cataract. The addition of phacoemulsification does not prolong vitreoretinal operative time notably nor increase the risk of intraoperative and post‐operative complications significantly.     

玻璃体切除联合白内障手术治疗增生性糖尿病视网膜病变的临床效果

目的观察玻璃体切除硅油填充术联合超声乳化白内障摘除人工晶状体植入术治疗增生性糖尿病视网膜病变的临床疗效。方法根据患者自愿原则,将53例（57只眼）增生性糖尿病视网膜病变Ⅵ期患者分成联合手术组和玻璃体手术组。联合手术组33例（33只眼）,单纯玻璃体手术组20例（24只眼）。联合手术组进行玻璃体视网膜手术、硅油填充、超声乳化白内障摘除及折叠型人工晶状体植入术,单纯玻璃体手术组进行玻璃体视网膜手术及硅油填充。对两组术后视网膜复位情况和并发症进行对照分析。结果联合手术组视网膜完全复位29只眼,视网膜复位率为87．9％;单纯玻璃体手术组视网膜完全复位20只眼,视网膜复位率为83．3％,两组比较差异无统计学意义（P=0．626）。联合手术组发生虹膜新生血管1只眼（3．0％）,单纯玻璃体手术组发生虹膜新生血管2只眼（8．3％）。均发生在视网膜未复位的患者,两组比较差异无统计学意义（P=0．775）。结论玻璃体视网膜手术联合超声乳化白内障摘除人工晶状体植入术治疗增生性糖尿病视网膜病变安全有效,联合手术可避免再次行白内障手术。     

Incidence of rhegmatogenous retinal detachment after vitrectomy in eyes of diabetic patients

PURPOSE: To assess the incidence of rhegmatogenous retinal detachment (RRD) after pars plana vitrectomy (PPV) among diabetic patients with complications of proliferative diabetic retinopathy. METHODS: Ninety-three eyes of diabetic patients-who underwent PPV with or without intraocular gas tamponade for complications of proliferative diabetic retinopathy-were reviewed retrospectively. Indication for vitrectomy was vitreous hemorrhage in 80 patients (86.1%), tractional retinal detachment in 3 (3.2%), and vitreous hemorrhage associated with tractional retinal detachment in 10 (10.7%). RESULTS: Four (4.3%) of 93 eyes developed an RRD after vitrectomy. The primary reason for vitrectomy was recurrent or nonresolving vitreous hemorrhage. The retina was attached with one additional surgical procedure in two of these eyes; the other two had to undergo a third operation before attachment was achieved. CONCLUSION: RRD occurs in a small percentage of patients after PPV with or without gas tamponade for vitreous hemorrhage or tractional retinal detachment caused by proliferative diabetic retinopathy. Thorough postoperative follow-up is important to make early diagnosis and intervention possible.     

One hundred consecutive cases of pars plana vitrectomy with the vitreous stripper

The results of 100 consecutive cases of pars plana vitrectomy are reported. Vitrectomy was performed on accunt of complications of diabetic retinopathy (37 eyes), complicated retinal detachment (28 eyes), vitreous haemorrhage of various causes (17 eyes), vitreous haemorrhage and complications secondary to injuries (13 eyes) and secondary cataract or vitreous in the anterior chamber creating corneal dystrophy (5 eyes). With an average follow-up time of 14.2 months, vitrectomy resulted in visual improvement in 55 eyes, unchanged visual acuity in 24 eyes and reduced visual acuity in 21 eyes. The operative and postoperative complications were: secondary vitreous haemorrhage (11 eyes), retinal detachment (8 eyes), haemorrhagic glaucoma (7 eyes), retinal tears (5 eyes), lens injury (4 eyes), corneal dystrophy (2 eyes) and endophthalmitis (1 eye).     

有晶状体眼的全玻璃体切除术

目的 :探讨有晶状体眼切除全玻璃体的可能性及其效果。方法 :对 4 8例 ( 50只 )有晶状体眼患者 ,做标准经睫状体平部三通道玻璃体切除术 ,同时将基底部和睫状体平部玻璃体一起切除。其中裂孔性视网膜脱离 1 4只眼 (包括巨大裂孔 3只眼 ) ,闭合性眼外伤 4只眼和开放性眼外伤 1 1只眼 (包括化脓性眼内炎 2只眼 ) ,黄斑部疾病 7只眼 ,各种原因玻璃体出血 5只眼 ,静脉周围炎 4只眼 ,急性视网膜坏死综合征 3只眼 ,糖尿病性视网膜病变 2只眼。手术后定期检查视力、眼球前段、眼底和眼压 ,最后复诊时用压陷三面镜检查并在再次手术中探查睫状体平部。结果 :充分全玻璃体切除 38只眼 ,部分全玻璃体切除 1 2只眼。无巩膜穿刺孔玻璃体嵌顿和轻度嵌顿者占 86 % ,未发生前段增生性玻璃体视网膜病变。无咬伤晶状体和睫状体并发症。一次手术成功率是 90 % ,再次视网膜和玻璃体手术总的成功率是 94 % ,患者视力较术前明显提高 (P <0 .0 5)。主要并发症是医源性视网膜裂孔、角膜上皮水肿、巩膜穿刺孔并发症、青光眼、视网膜再脱离和术中术后白内障。结论 :有晶状体眼全玻璃体切除术切实可行 ,能预防或减少与巩膜穿刺孔相关的并发症和前段增生性玻璃体视网膜病变。     

增生性糖尿病视网膜病变合并白内障的联合手术治疗

目的探讨玻璃体手术联合晶状体超声乳化治疗增生性糖尿病性视网膜病变（PDR）合并白内障的临床疗效。方法分析19例（20只限）增生性糖尿病性视网膜病变合并不同程度白内障患者行白内障超声乳化联合玻璃体手术同时进行人工晶状体囊袋内植入的临床资料，观察术后视力改善程度及术中术后并发症。结果随访2—16个月，所有术眼人工晶状体位置良好，手术后20只限中有16只限（80％）视力有不同程度的提高，其中视力提高二行以上13只限（65％）；视力较术前无改善4只限（20％）。术后视力恢复不佳的原因主要与不同程度的糖尿病黄斑病变、视网膜广泛缺血有关。术后并发症包括高眼压、虹膜后粘连、玻璃体腔再出血、视网膜再脱离、晶状体后囊混浊及新生血管性青光眼等。结论玻璃体手术联合白内障超声乳化人工晶状体植入术治疗增生性糖尿病性视网膜病变合并白内障是安全和有效的，可使大多数患者视力改善，且无明显并发症。     

Combined cataract surgery and vitrectomy for recurrent retinal detachment

PURPOSE: To report our experience with combined cataract surgery, posterior chamber intraocular lens implantation, and pars plana vitrectomy in the management of recurrent retinal detachment (RD) and visually significant cataract. METHODS: Retrospective chart review of patients with cataract and recurrent RD who underwent combined cataract extraction, posterior chamber intraocular lens implantation, and pars plana vitrectomy between January 1991 and September 1998 at the Bascom Palmer Eye Institute. Sixteen eyes were included. All eyes had visually significant cataract and had undergone primary repair of the RD with encircling scleral buckle; eight eyes also had undergone pars plana vitrectomy during the primary repair. The technique of cataract extraction included phacoemulsification (10 eyes), extracapsular cataract extraction (5 eyes), and pars plana lensectomy (1 eye). All eyes underwent pars plana vitrectomy, membrane peeling, fluid-air exchange, endolaser treatment, and placement of a retinal tamponade. Perfluoropropane (C3F8) gas was used in 14 eyes, and silicone oil was placed in two eyes. RESULTS: The postoperative follow-up interval ranged from 4 to 64 months (mean, 16 months). Preoperative visual acuity ranged from 20/60 to hand motions and was better than 20/200 in 3 (19%) eyes. Postoperatively, 9 (56%) eyes improved to better than 20/200. Anatomic success was achieved after the initial reoperation in 13 (81 %) eyes. With further surgery, the overall success rate was 94%. CONCLUSIONS: Combined cataract surgery, posterior chamber intraocular lens implantation, and pars plana vitrectomy in selected patients with cataract and recurrent RD was successful in improving visual acuity and achieving retinal reattachment in most of these reoperated patients.     

Vitrectomy for retained lens fragments in the vitreous after phacoemulsification

PURPOSE: To assess the visual results, retinal detachment (RD) rate, incidence of glaucoma, and intraocular lens (IOL) placement after vitrectomy for removal of retained lens fragments in the vitreous after phacoemulsification. SETTING: Department of Ophthalmology, University Hospital of Lund, Lund, Sweden. METHODS: This retrospective noncomparative interventional case series included all cases of pars plana vitrectomy for removal of retained lens fragments from January 1997 through January 2000. RESULTS: Sixty-six eyes of 65 patients had pars plana vitrectomy with removal of the lens material over the 3-year period. Visual acuity on presentation was 0.1 or worse in 36 eyes (54%). Visual acuity after vitrectomy was 0.5 or better in 35 eyes (53%). The postoperative visual acuity was worse than 0.1 in 14 eyes (21%). Twenty-seven (56%) of the 48 eyes operated on within 1 week and 8 (44%) of the 18 eyes operated on later achieved a visual acuity of 0.5 or better. Twelve eyes (80%) that had secondary posterior chamber IOL implantation achieved an acuity of 0.5 or better. An RD occurred in 7 eyes (11%). CONCLUSIONS: There was no statistically significant difference in outcomes between those having vitrectomy the first few days after cataract surgery and those having it later, although there was a trend toward better results when the vitrectomy was done sooner. Secondary IOL implantation resulted in a good visual outcome. Retinal detachment was the most severe complication.     

Incidence of retinal detachment and visual outcome in eyes presenting with posterior vitreous separation and dense fundus-obscuring vitreous hemorrhage

PURPOSE: To determine visual outcomes and the incidence of retinal detachment in eyes presenting with posterior vitreous separation and dense fundus-obscuring vitreous hemorrhage. DESIGN: Retrospective consecutive noncomparative interventional case series. PARTICIPANTS: Thirty-six eyes (15 right eyes and 21 left eyes) of 34 patients (18 female and 16 male) ranging in age from 42 to 94 years. Mean follow-up was 14 months. METHODS: A comparison of the best-corrected initial visual acuities versus final visual acuities after spontaneous resolution of vitreous hemorrhage or surgical intervention. The number of eyes that were found to have retinal tears or that had a rhegmatogenous retinal detachment develop was documented. Logarithm of the minimum angle of resolution-converted visual acuities was used for comparison. Categorical data were analyzed by Fisher's exact test, and population means were compared by Student's t test. MAIN OUTCOME MEASURES: Final mean visual acuities, number of eyes with at least one retinal tear, location of retinal tears, number of eyes that had retinal detachment develop, and the number of eyes repaired with scleral buckling surgery and/or pars plana vitrectomy. RESULTS: Twenty-four of 36 eyes (67%) were found to have at least one retinal break (range, 0-4 breaks), with 88% of breaks located in the superior retina. Eleven eyes (31%) had more than one retinal break. Fourteen of 36 eyes (39%) had a rhegmatogenous retinal detachment develop that was repaired with pars plana vitrectomy and scleral buckling. An additional 14 eyes (39%) underwent vitrectomy for nonclearing vitreous hemorrhage. The incidence of retinal detachment in eyes with a history of retinal detachment in the contralateral eye was 75% (P = 0.04). Seven of 14 eyes (50%) with retinal detachment had coexisting proliferative vitreoretinopathy. Most retinal breaks and detachments occurred in emmetropic or myopic eyes. For all 36 eyes the mean preoperative visual acuity was 20/1233, and the mean final visual acuity was 20/62 (P < 0.0001). Eyes that had a macula-off retinal detachment develop had worse final visual outcomes (20/264; P = 0.01), as did eyes that had proliferative vitreoretinopathy develop (20/129; P = 0.04). CONCLUSIONS: Acute, spontaneous, nontraumatic posterior vitreous separation with dense fundus-obscuring vitreous hemorrhage is associated with a high incidence of retinal tears and detachment. Close follow-up with clinical examination and ultrasonography is necessary, because many of these eyes may eventually require surgical intervention. Aggressive management with early vitrectomy should be considered when there is a history of retinal detachment in the contralateral eye.     

Results of cataract surgery in previously vitrectomized eyes

PURPOSE: To evaluate the difficulties and results of manual extracapsular cataract extraction (ECCE) and phacoemulsification cataract surgery performed in previously vitrectomized eyes. SETTING: Pécs University of Sciences, Faculty of Medicine, Department of Ophthalmology, Pécs, Hungary. METHODS: This retrospective case-control study comprised a series of 84 cataract extractions with or without intraocular lens implantation. Forty-three patients had manual ECCE and 41, phacoemulsification. The intraoperative and postoperative complications and visual outcomes in the 2 groups were analyzed and compared. RESULTS: Cataract extractions were performed a mean of 15.8 months (range 1 to 86 months) after the pars plana vitrectomy. The indications for vitrectomy were diabetic retinopathy, retinal detachment, proliferative vitreoretinopathy, giant retinal tear, macular hole, eye trauma, vitreous hemorrhage after central retinal vein occlusion, and uveitis. Primary posterior capsule fibrosis was the most common intraoperative complication, occurring in 24% of eyes. Posterior capsule rupture occurred in 5 eyes in the ECCE group and 3 in the phacoemulsification group. Zonulysis occurred in 2 and 1 eyes, respectively. A dropped nucleus occurred in 3 cases in the phacoemulsification group. Posterior capsule opacification and secondary glaucoma were the most common postoperative complications, occurring in 5 and 3 cases in the ECCE group, respectively, and in 3 and 4 cases in the phacoemulsification group. Visual acuity 6 weeks postoperatively improved or remained within 2 Snellen lines in 95% of eyes, which is comparable to data in the recent literature. CONCLUSIONS: Phacoemulsification gave better results than manual ECCE in previously vitrectomized eyes. Underlying retinal disease limited the final visual acuity.