Pars plana vitrectomy in patients with intermediate uveitis

Objective: To describe the effect of pars plana vitrectomy in patients with intermediate uveitis. Methods: Retrospective analysis of the clinical course and visual outcome following pars plana vitrectomy in patients with intermediate uveitis. Results: Thirty-two patients (43 eyes) were included in the study. Pars plana vitrectomy was combined with cataract surgery in 22 of 43 eyes. The intermediate uveitis was associated with sarcoidosis in 16 eyes and multiple sclerosis in five eyes, and was idiopathic in 22 eyes. The mean (±SD) follow-up was 45.6 (±38) months (range: 6–146 months). In 19 of 43 eyes (44.1%), there was improvement in the course of uveitis, allowing the discontinuation of immunosuppressive treatment in seven patients. Cystoid macular edema resolved in 12 of 37 eyes (32.4%). Forty of 43 eyes achieved a better or retained their initial visual acuity. The remaining three eyes deteriorated by two or more lines in the Snellen chart due to the progression of cataract, chronic cystoid macular edema, and glaucomatous optic atrophy, respectively. Conclusions: The results of this study suggest that pars plana vitrectomy may have a beneficial effect on the course of uveitis and the associated complications of cystoid macular edema, thereby reducing the need for long-term immunosuppression. Pars plana vitrectomy combined with simultaneous cataract surgery can improve the visual outcome in these patients.     

伴有角膜浑浊玻璃体视网膜手术临床探讨

目的探讨眼外伤角膜浑浊状态下玻璃体视网膜手术的手术时机、方法及技巧。方法对65例（67眼）眼外伤角膜浑浊（≥2／5面积）术中采用刮除角膜上皮、应用棱镜式接触镜、转动眼位及头位、巩膜外顶压及临时人工角膜等不同的手术方法和技巧,完成玻璃体视网膜手术。结果本组67眼全部顺利完成手术中各项操作,其中9眼眼内异物均在直视下摘出。术后有13眼（19．40％）视网膜脱离,其中6眼再次手术成功,7眼放弃手术。随访6～12个月,最终视力≥眼前数指者39眼（58．21％）,眼球萎缩9眼（13．43％）。同时行穿透性角膜移植3眼,2眼植片透明,1眼植片浑浊。结论眼外伤角膜浑浊状态下,应尽量采取相应措施完成玻璃体视网膜手术,以挽救视功能或保留眼球。     

Pars plana vitrectomy for macular degenerative disorders.

We describe nine patients (10 eyes) treated with pars plana vitrectomy for vitreous hemorrhage secondary to disciform macular degeneration. Nine of the eyes showed improved acuity at about 3 months and at the last follow-up visit (6 to 30 months). Two of the patients had ambulatory acuity (counting fingers or better) before surgery, compared with all the patients at the last follow-up visit. Vitrectomy may be beneficial in this subgroup of patients with macular degeneration.     

Pars plana vitrectomy for removal of intravitreous Cysticercus.

Pars plana was used for the removal of an intravitreous cysticercus, with minimal postoperative inflammation and an excellent visual result. This approach avoids lens removal and the visualization provided by the operating microscope allows removal of all vitreous humor particles and debris. The aspirated specimens allowed identification of the Taenia solium cysticercus.     

Pars plana vitrectomy in the pediatric population: indications and long-term results.

PURPOSE: To establish the indications and the long-term results of pars plana vitrectomy (PPV) in the pediatric population. METHODS: PPV was performed in 60 eyes of 57 children, 45 boys and 12 girls, aged from 6 to 15 years. Twenty-nine eyes (48%) suffered from complicated rhegmatogenous or traction retinal detachment (RD) with advanced proliferative vitreoretinopathy (PVR), 19 eyes (32%) had RD due to an idiopathic or traumatic giant tear (GT), 7 eyes (11%) had an intraocular foreign body (IOFB), and 5 eyes (9%) had hemorrhage or exudation into the vitreous. In 43 eyes (65%) silicone oil implantation (SOI) was indicated, in 39 eyes (91%) a primary SOI, and in 4 eyes (9%) a secondary SOI. The patients were followed up for 6-72 months, mean 42 months. RESULTS: At the end of follow-up, anatomical success with a flat macula was achieved in 77% of the eyes, and functional success with visual acuity of 0.02 and better in 72%. The results were best in IOFB and traction RD after penetrating injury (success in 100% and 91%); the worst results were in RD after regressed retinopathy of prematurity and RD due to idiopathic GT (success in 50% and 54%). After SOI silicone oil was removed in 27 out of 43 eyes (63%), and the retina remained attached in 23 of these eyes (85%). CONCLUSIONS: Indications and the long-term results of PPV in children were comparable with those in the adult. By far the most frequent indications were injuries and their complications. In complicated RD, a radical approach with primary SOI and later silicone oil removal proved useful. In children, with their long life expectancy, timely removal of silicone oil is vital for maintaining the function of the eye.     

Pars plana vitrectomy and lamina cribrosa puncture in absolute glaucoma.

Two patients with refractory end-stage glaucoma who had no light perception underwent pars plana vitrectomy and lamina cribrosa puncture to relieve pain and decrease intraocular pressure. The patients presented with blind, painful eyes and high intraocular pressure (> 40 mm Hg). After the procedure, the pain was relieved and the intraocular pressure was lowered in both cases. The patients remained asymptomatic. Pars plana vitrectomy and lamina cribrosa puncture might be related to the decrease of intraocular pressure, probably by facilitating drainage of aqueous humor through the optic nerve.     

外伤性睫状体脱离的治疗--平坦部巩膜切开冷凝

目的 评价切开平坦部巩膜冷凝术治疗外伤性睫状体脱离的效果。方法 对22例外伤性睫状体脱离行平坦部巩膜切开冷凝并随访分析。结果 双例中一次手术眼压恢复正常者21例，占94．45％，未发现手术并发症。结论 平坦部巩膜切开冷凝术是外伤性睫状体脱离的一种简便、有效而安全的治疗方法。     

Pars plana technique for removal of congenital subluxated lenses in young patients

Lensectomy with the pars plana technique was performed in 16 eyes of 11 patients (2 female, 9 male) with congenital subluxated lenses. Lens subluxation was associated with homocystinuria in 2 patients, Marfan's syndrome in 4, congenital simple ectopia lentis in 2 and without any known heredity in 3 patients. The reason for removal was in all eyes optical disturbances. Five patients were operated on both eyes. All lenses were removed with the Kl?ti Vitreous Stripper through the pars plana. No complications occurred. Retinal detachment was present pre-operatively in both eyes in one patient with homocystinuria. In the post-operative period, prophylactic photocoagulation and cryotherapy were performed in 7 eyes in 6 patients (6 photocoagulation and 1 cryo). The pars plana technique for removal of clear subluxated lenses in young individuals seems to be the method of choice. Complications are negligible and the method gives excellent optical results.     

Pars plana lentectomy for treatment of congenital cataract

BACKGROUND: Congenital cataract surgery can be performed using a pars plicata/plana or a limbal approach, if placement of an intraocular lens at the time of cataract removal is not a consideration. Because of the high incidence of secondary cataract formation in children the operation should be combined with capsulotomy and anterior vitrectomy. METHODS: The series consisted of 30 eyes from 20 consecutive children who suffered from congenital cataract and underwent cataract surgery between May 1995 and June 2000. The inclusion criterion was congenital cataract affecting the visual axis. We performed the operations as lens aspiration with anterior and posterior capsulotomy and anterior vitrectomy via the pars plana or plicata. We used contact lenses to rehabilitate vision. All patients received intensive orthoptic and pleoptic treatment. RESULTS: This surgical technique provided in all eyes a clear visual axis. During follow-up of 3 months to 4.5 years, secondary cataract developed in five eyes. Retinal detachment, glaucoma and endophthalmitis did not occur. One patient developed contact lens intolerance and a secondary intraocular lens was placed in the ciliary sulcus. DISCUSSION: Lentectomy via a pars plana or pars plicata approach is a suitable and safe method for treating cataract in children. Our chosen method of lentectomy is an alternative to early implantation of an intraocular lens. It is possible to perform uncomplicated secondary implantation of an intraocular lens in the ciliary sulcus.     

Pars plana vitrectomy relieves the depression in patients with symptomatic vitreous floaters

AIM: To explore the susceptible association between the insulin-like growth factor-1 receptor (IGF1R) single nucleotide polymorphism (SNP) and age-related cataract (ARC), and investigate the underlying mechanisms in human lens epithelial (HLE) cells. METHODS: Totally 1190 unrelated participants, comprising 690 ARC patients and 550 healthy individuals in Han Chinese population were recruited and genotyped for target SNP. The χ2-test was used to detect genotypic distribution between the patient and control groups and the logistic regression was performed to adjust the age and gender. Meanwhile, different biological experimental methods, such as CCK-8 assay, flow cytometry, Q-PCR and Western blot, were used to detect cell viability, cell cycle progression and apoptosis in HLE cells or IGF1R knockdown HLE cells. RESULTS: The rs1546713 in IGF1R gene was identified (P=0.046, OR: 1.606, CI: 1.245, 2.071), which shown a significant relevance with ARC risk under the dominant model. The results demonstrated that IGF1R knockdown inhibited cell proliferation by inducing cell cycle arrested at S phase and promoting apoptosis. Mechanistically, the cell cycle blocked at S phase was linked with the alterations of cyclinA, cyclinB, cyclinE and P21. The pro-apoptosis function of IGF1R may related with stimulating the activation of Caspase-3 and altering the expression levels of apoptotic proteins, including Bcl-2, Bax and Caspase-3. CONCLUSION: This study first report that IGF1R polymorphisms may affect susceptibility to ARCs in Han Chinese population and provide new clues to understanding the pathogenic mechanism of ARCs. Notably, IGF1R is likely a potential target for ARC prevention and treatment.     

玻璃体切割手术治疗化脓性眼内炎

目的 观察玻璃体切割手术治疗化脓性眼内炎的疗效。方法 对1999年6月～2003年2月在我院行玻璃体切割术的14例(14只眼)化脓性眼内炎患者进行回顾性分析。除眼内异物外，其余患者临床诊断化脓性眼内炎后均先采用保守治疗，密切观察1～2天无好转而行玻璃体切割手术。眼内炎的原因：眼球穿通伤13只眼，青光眼术后晚期滤过泡感染1只眼。玻璃体切割手术前先抽取前房及玻璃体腔内液体涂片及培养。采用标准三通道闭合式玻璃体切割手术，7只眼因前房积脓及晶状体前大量渗出和3只眼外伤性白内障影响手术而同时切除晶状体，8只联合巩膜环扎。缝合巩膜切口后玻璃体腔内注射罗氏芬2．5mg及地塞米松0．4mg。术后全身继续使用抗生素及激素1周。术后平均随访14．8个月(2～24个月)．结果 14只眼中术后视力提高12只眼(85．7％)，眼球保留13只眼(92．6％)。5只眼培养阳性。术后玻璃体腔内少量出血2只眼，无其它手术并发症。结论 玻璃体切割手术联合眼内注射抗生素治疗化脓性眼内炎疗效可靠。只要手术时机选择适当，大多数患者能保住眼球，恢复有用视力。     

Pars plana vitrectomy for the management of sever diabetic retinopathy.

In 100 severely diseased diabetic eyes we performed pars plana vitrectomy. After a median follow-up time of seven months, major visual improvement was achieved in 49% of the eyes. An additional four eyes maintained a preoperatively good visual acuity resulting in an overall success rate of 53%. Eyes with only vitreous hemorrhages did better (71%) than eyes with posterior retinal detachments (31%). We did not observe new tissue proliferation in any of the operated eyes.     

Pars plana vitrectomy and sutured posterior chamber lens implantation

Transcleral suturing of posterior chamber intraocular lenses (IOLs) was developed to extend the benefits of IOL visual rehabilitation to eyes lacking capsular support and to avoid the complications of closed loop interior chamber IOLs. Although most frequently implanted after complicated cataract surgery or penetrating keratoplasty, they are indicated in several situations following pars plana vitrectomy. The surgical techniques have evolved to minimize the risk of complications, but the surgery remains technically more demanding and time-consuming than insertion of a modern open loop anterior chamber IOL. No randomized trials have compared the relative risks of each lens type, which leaves surgeon preference as the major determinant of what lens is implanted. It is likely, however, that in eyes with extensive anterior chamber angle damage or large iris defects, sutured posterior chamber IOLs will remain the first choice for surgical rehabilitation.