Pars plana vitrectomy for vitreous opacity associated with ocular sarcoidosis resistant to medical treatment

OBJECTIVE: To examine the results of pars plana vitrectomy for nonclearing vitreous opacities associated with ocular sarcoidosis that is resistant to corticosteroid treatment. METHODS: Eight consecutive patients (11 eyes) with vitreous opacities and uveitis associated with sarcoidosis were studied. All patients were resistant to or intolerant of corticosteroid therapy. All eyes underwent pars plana vitrectomy, followed by evaluation of visual acuity and recording of the grade of inflammation and complications. RESULTS: Seven eyes had gained two or more lines of Snellen visual acuity six months postoperatively; visual acuity remained unchanged in the other four eyes. Vitreous inflammation was reduced in all cases. Severe postoperative inflammation did not recur in any eyes. Five eyes developed visually significant cataracts and underwent cataract extraction and intraocular lens insertion within 8-30 months. Based on slit-lamp biomicroscopy and fluorescein angiography, preoperative cystoid macular edema in five eyes resolved or improved within six months after vitrectomy. Postoperative complications included elevated intraocular pressure in three eyes, cataract formation in six eyes, epiretinal membrane formation in one eye, and choroidal neovascularization in one eye. None of the patients developed cystoid macular edema postoperatively. Only three patients received systemic corticosteroids after surgery. At the final visit, only one patient required systemic corticosteroid therapy. CONCLUSIONS: Pars plana vitrectomy appears to have beneficial effects on restoring vision, stabilizing vitreous inflammation, and reducing systemic corticosteroid requirements in eyes with thick vitreous opacities associated with sarcoidosis that is resistant to medical treatment.     

Pars plana vitrectomy for cystoid macular edema secondary to sarcoid uveitis

OBJECTIVE: To examine the results of pars plana vitrectomy for cystoid macular edema secondary to sarcoid uveitis resistant to medical treatment. DESIGN: Retrospective, interventional, noncomparative case series. SUBJECTS: Fourteen consecutive subjects (18 eyes) with cystoid macular edema associated with sarcoid uveitis resistant to medical treatment. INTERVENTION: All eyes underwent pars plana vitrectomy. Nine eyes also underwent peeling of the epiretinal membrane or removal of the posterior vitreous cortex. MAIN OUTCOME MEASURES: Status of macular edema, visual acuity, and complications. RESULTS: Ten eyes (56%) improved 2 or more lines of Snellen visual acuity within 12 months. Six eyes (33%) remained unchanged, within a line of preoperative Snellen visual acuity, and two eyes (11%) worsened by 2 or more lines of Snellen visual acuity. Slit-lamp biomicroscopy showed that cystoid macular edema had resolved in 14 eyes (78%) within 9 months postoperatively. One eye (6%) had minimal edema, whereas three eyes (17%) remained unchanged biomicroscopically at the final visit. Postoperative complications included cataract formation, glaucoma, optic nerve atrophy, epiretinal membrane formation, and tractional retinal detachment. No severe postoperative inflammation was noted. CONCLUSIONS: Pars plana vitrectomy seems to have a beneficial effect on cystoid macular edema caused by sarcoidosis resistant to medical treatment.     

Vitrectomy for chronic pseudophakic cystoid macular edema.

PURPOSE: We report the results of pars plana vitrectomy for chronic pseudophakic cystoid macular edema unresponsive to medical treatment. METHODS: Retrospective analysis of 23 consecutive eyes of 23 patients with chronic pseudophakic cystoid macular edema was performed. Eyes with vitreous incarceration into the cataract wound or vitreous-cornea contact were excluded from the study. Preoperatively, all eyes had cystoid macular edema confirmed on fluorescein angiography and were unresponsive to medical treatment. Pars plana vitrectomy was performed using standard techniques and vitreous adhesions to the iris, intraocular lens, or both were lysed if present. RESULTS: The mean interval between cataract surgery and vitrectomy was 32.3+/-30.9 months (median, 20 months; range, 3 to 110 months). The vitreous was adherent to the iris or intraocular lens in 12 eyes (52.2%) and was present in the anterior chamber with no evidence of adhesions in seven eyes (30.4%). In four eyes (17.4%) the vitreous was posterior to the iris plane with no adhesions to anterior segment structures. The median preoperative best-corrected visual acuity was 20/200, and the median final postoperative best-corrected visual acuity was 20/60 (P<.0001) after a mean follow-up of 30.2+/-31.2 months (median, 14 months; range, 2 to 109 months). Final best-corrected visual acuity improved by a mean of 3.3+/-2.6 Snellen lines, with a median percent change of 70% (mean, 57.3%; range, 0% to 99%). In all 23 eyes the cystoid macular edema resolved postoperatively by biomicroscopic examination in a mean period of 3.3 months (median, 2 months; range, 1 to 12 months). CONCLUSIONS: In pseudophakic eyes with chronic cystoid macular edema unresponsive to medical treatment, vitrectomy resulted in resolution of the cystoid macular edema with improved visual acuity in some cases. Clinical improvement may occur in eyes with no apparent vitreous disturbance.     

Cystoid macular edema associated with latanoprost therapy in a pseudophakic vitrectomized patient after removal of silicone oil endotamponade

PURPOSE: To describe the occurrence of cystoid macular edema in a pseudophakic vitrectomized patient following use of latanoprost (0.005%). METHODS: A 58-year-old patient underwent routine cataract surgery with posterior chamber lens implantation complicated by rhegmatogenous retinal detachment three months later. A pars plana vitrectomy was performed with silicone oil endotamponade which was removed six months later. Five months after oil removal, the patient presented with secondary open-angle glaucoma treated with latanoprost 0.005% eye drops once daily. RESULTS: Two weeks after initiation of latanoprost treatment, visual acuity dropped from 0.8 to 0.3 due to cystoid macular edema confirmed by fluorescein angiography. After discontinuing latanoprost therapy and with topical corticosteroid treatment, cystoid macular edema slowly resolved, and within 6 months, visual acuity improved to 0.8. CONCLUSIONS: Despite its marked ocular hypotensive effect, latanoprost should be carefully used in patients after uncomplicated cataract surgery if the vitreous body was removed by pars piana vitrectomy.     

Vitrectomy in uveitis associated with ankylosing spondylitis

Chronic recurrent iridocyclitis in three eyes of two patients with ankylosing spondylitis was associated with posterior spillover of inflammatory cells into the vitreous cavity. Continued inflammation resulted in significant vitreous opacification in all three eyes. After pars plana vitrectomy (two eyes) and cataract extraction with subtotal vitrectomy (one eye), visual acuity improved and stabilized in all three instances. Ocular inflammation was not appreciably exacerbated by surgical intervention. Vitreous opacification did not recur after vitrectomy, but visual improvement was limited because of chronic cystoid macular edema.     

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.     

Pars plana vitrectomy for epiretinal membrane associated with sarcoidosis

PURPOSE: To examine retrospectively the visual outcomes in patients undergoing vitrectomy for epiretinal membranes secondary to sarcoid uveitis. METHODS: Eleven consecutive patients (11 eyes) with epiretinal membrane and uveitis associated with sarcoidosis underwent pars plana vitrectomy. RESULTS: Nine eyes (82%) gained two or more lines of Snellen visual acuity at 1-12 months after surgery. However, 4 of these 9 eyes lost two or more lines of Snellen visual acuity by the final visit. Overall, 5 eyes (45%) had attained at least two Snellen lines of visual acuity improvement, 5 eyes (45%) were unchanged, and 1 eye (10%) had worsened by two lines at the final visit. Nine eyes (81%) achieved visual acuity of 20/40 or better by the final visit. Slit-lamp biomicroscopy and fluorescein angiography showed that cystoid macular edema had resolved in 4 of 7 eyes postoperatively; vitritis improved in all cases. Postoperative complications included cataract formation, glaucoma, and membrane recurrence. Subsequent surgeries consisted of cataract extraction in 2 eyes and membrane peeling in 1 eye. CONCLUSIONS: Pars plana vitrectomy appears to have a beneficial effect on restoring vision in eyes with epiretinal membrane and uveitis associated with sarcoidosis, but final visual acuity was limited by the development of cataract and membrane recurrence.     

Pars plana vitrectomy for intraocular inflammation-related cystoid macular edema unresponsive to corticosteroids. A preliminary study.

PURPOSE: To determine the role of pars plana vitrectomy in patients with intraocular inflammation-related cystoid macular edema that is unresponsive to corticosteroids. METHODS: Eleven eyes of nine patients underwent a standard three-port pars plana vitrectomy. The primary indication was intraocular inflammation-related cystoid macular edema that was unresponsive to oral, sub-Tenon's, and topical corticosteroids. Preoperative follow-up ranged from 20 months to 144 months (average, 70 months). Postoperative follow-up ranged from 3 months to 108 months (average, 21 months). RESULTS: Seven eyes (64%) improved 4 or more lines of Snellen visual acuity within 4 weeks. Two eyes (18%) remained unchanged and 2 eyes (18%) worsened. Cystoid macular edema improved by clinical examination and fluorescein angiography in 9 eyes (82%) and by clinical examination alone in 2 eyes (18%). No intraoperative complications were noted. Postoperative complications consisted of cataract formation in 1 eye (9%), glaucoma in 2 eyes (18%), and epiretinal membrane formation in 1 eye (9%). CONCLUSION: Pars plana vitrectomy may have a role in the treatment of intraocular inflammation-related cystoid macular edema that fails to respond to corticosteroids. The subgroup of patients who benefit most remains to be identified.     

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。     

Pars plana vitrectomy for aphakic cystoid macular edema

The authors used a combined limbal and pars plana vitrectomy approach to treat 17 consecutive eyes (16 patients) with chronic aphakic cystoid macular edema associated with vitreous incarceration in the cataract wound. Criteria for surgery included: decreased visual acuity to 20/50 or worse; cystoid macular edema confirmed by fluorescein angiography; persistent edema of 6 months or longer; and visible vitreous incarceration in the limbal wound. The vitreous was successfully removed from the limbal wound in 16 of 17 eyes. Postoperatively, vision improved by two lines or more in 11 eyes (65%). The surgical technique is described.     

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。     

Causes of reduced visual acuity on long-term follow-up after cataract extraction in patients with uveitis and juvenile rheumatoid arthritis.

We reviewed the long-term follow-up on a consecutive series of 16 eyes from ten patients with juvenile rheumatoid arthritis-associated cataracts that were removed by using pars plana lensectomy and vitrectomy. All patients had prominent cataracts, chronic uveitis, posterior synechiae, and vitreitis preoperatively, and had at least 12 months of follow-up postoperatively. The median length of follow-up was 51 months (range, 12 months to ten years). In the early postoperative period, a visual acuity of 20/70 or better was obtained in 13 of 16 eyes (81%). With longer follow-up, the final visual acuity was 20/70 or better in only nine of 16 eyes (56%). The primary categories of delayed visual loss in these cases were glaucoma and macular disease (chronic cystoid macular edema, macular hole, hypotony maculopathy, and recurrent macular pucker). Despite these limitations in maintaining good visual acuity, a pars plana lensectomy and vitrectomy approach is effective for cataracts in these patients with uveitis.     

Evaluation of results of combined pars plana vitrectomy and cataract removal

PURPOSE: Cataract often coexists with pathologies of the vitreous body. Moreover, after several months after vitrectomy, the lens becomes opaque. Lens opacities interfere with appropriate visualisation of the vitreous chamber and the eye fundus, which makes performing vitreoretinal procedures difficult. For this reason, in such patients, a combined procedure of pars plana vitrectomy and cataract extraction can be considered. This is retrospective analysis of the indications and results of combined cataract extraction and pars plana vitrectomy. MATERIAL AND METHODS: The data were based on case histories of patients who underwent combined cataract extraction and pars plana vitrectomy in the years 2001 - 2003, in the Department of Ophthalmology, Medical University of Lód?. The evaluated data included: diagnosis, pre- and postoperative best corrected visual acuity, intraocular pressure, pre- and postoperative state of the anterior and posterior segment of the eye and the employed surgical techniques. RESULTS: The examined group consisted of 40 patients (40 eyes), including 20 men and 20 women, at the age from 13 to 76 years old (mean 55.7, SD+/-14.6). The indications to vitrectomy were: vitreous haemorrhage, retinal detachment, vitreoretinal proliferations, intraocular foreign body, persistent hyaloid artery and endophthalmitis. Phacoemulsification was the most often used method of cataract extraction (34 people, 85%). In three patients cataract was removed by classical extracapsular cataract extraction (ECCE), and in further 3 patients bimanual aspiration was used. In terms of anatomical results, therapeutic success was achieved in 35 cases (87,5%). Improvement of visual acuity was observed in 28 people (70%), unchanged visual acuity in 10 people (25%), and a decrease in visual acuity in 2 patients (5%). Improvement of visual acuity at least 2 lines on Snellen's chart was achieved in 20 patients (50%).     

A phacovitrectomy with a clear corneal incision for a full-thickness macular hole

PURPOSE: To describe the results of a pars plana vitrectomy, combined with phacoemulsification, using a sutureless, superotemporal, clear corneal incision for patients with a macular hole. METHODS: This study reviewed the records of 22 patients (22 eyes) who underwent a phacoemulsification with the insertion of an acrylic intraocular lens, using a 3.2 mm superotemporal clear corneal incision and a pars plana vitrectomy with an internal limiting membrane peeling in one session, for the treatment of a macular hole. RESULTS: All 22 patients had their macular holes closed using the combined surgical procedures. The mean preoperative visual acuity was 0.086, and the mean postoperative visual acuity was 0.173. This improvement was statistically significant (paired Student's t-test, p < 0.05). No patients developed posterior capsular opacity, retinal detachment, or a cystoid macular edema. The surgically induced astigmatism (SIA) was 0.808 diopters (0.808 +/- 0.761) two months after surgery. CONCLUSIONS: Combining cataract surgery with vitrectomy can achieve visual rehabilitation in the early postoperative period without requiring post-vitrectomy cataract surgery. A sutureless clear corneal incision, used in this procedure, can minimize the SIA and promote postoperative wound healing. If sutureless, transconjunctival, pars plana vitrectomy can be used more widely in the future, then the simplified, combined cataract surgery using a small clear corneal incision will also become more common, hence decreasing operation time, and hastening postoperative recovery.     

Long-term results of pars plana vitrectomy in the management of complicated uveitis.

This retrospective study evaluates the long term efficacy of pars plana vitrectomy on the preservation of vision in complicated chronic uveitis, including endogenous intermediate uveitis and other entities. Combined vitrectomy-lensectomy was performed in 10 eyes with complicated cataracts, and 18 vitrectomies were done without lensectomies. The mean follow up was 45 months. Additional retinal surgery (for example, scleral buckling) was performed in five eyes. Visual acuity improved in 23 eyes (82.8%) following surgery, with 16 eyes (57%) achieving a vision better than 6/24. The main causes for vision less than 6/24 were persistent cystoid macular oedema (three eyes), macular puckers (one eye), retinal vascular obliterations (four eyes), optic atrophy (five eyes), and chorioretinal scars (seven eyes). Postoperative complications were cataract formation (seven eyes), cystoid macular oedema (one eye), and tractional retinal detachments (three eyes). The surgical intervention resulted in a remarkable reduction of the severity of inflammation or frequency of exacerbations, and allowed significant tapering (11 eyes) or withdrawal (11 eyes) of the topical steroids, or oral corticosteroids (10 cases). Pre-existent cystoid macular oedema resolved in three eyes. Pars plana vitrectomy, eventually combined with lensectomy, may visually rehabilitate eyes with chronic uveitis and media opacities, and may reduce the activity of disease postoperatively.     

Combined cataract surgery and vitrectomy for breakthrough vitreous hemorrhage from age-related macular degeneration

PURPOSE: To report combined cataract extraction (CE), posterior chamber intraocular lens (PCIOL) implantation, and pars plana vitrectomy (PPV) for concurrent cataract and breakthrough vitreous hemorrhage from age-related macular degeneration (AMD). METHODS: Retrospective case series. RESULTS: Six eyes were included in the study. The postoperative follow-up interval ranged from 3 to 22 months (mean 8 months). Preoperative visual acuity (VA) ranged from 20/400 to hand motion. Postoperatively, 5/6 eyes had 2 or more lines of visual improvement. Three eyes were better than 20/200. CONCLUSIONS: Combined CE, PCIOL insertion, and PPV in selected patients with cataract and breakthrough vitreous hemorrhage from AMD was successful in improving VA in the majority of patients.     

Combined surgery, phacoemulsification, implantation of intraocular lens and pars plana vitrectomy

PURPOSE: To evaluate the effectiveness, technical feasibility and incidence of complications after combining pars plana vitrectomy, phacoemulsification and intraocular lens implantation. MATERIAL AND METHODS: The results of combined vitreoretinal and cataract surgery in 100 eyes of 96 patients were retrospectively and prospectively analyzed. The mean follow-up period was 8.4 months. All patients had clinically significant lens opacities and vitreoretinal pathology requiring pars plana vitrectomy. Indications for vitreoretinal surgery included: persistent vitreous haemorrhage (28 eyes), vitreous hemorrhage combined with tractional retinal detachment (50 eyes), tractional retinal detachment without vitreous haemorrhage caused by proliferative diabetic retinopathy (7 eyes), rheumatogenous retinal detachment with proliferative vitreoretinopathy (10 eyes) and dislocated crystalline lens in the vitreous (5 eyes). RESULTS: Postoperatively, best corrected visual acuity improved in 81 eyes (81%)- by two lines or more in 31 eyes (31%) - by less than two lines in 50 eyes (50%). In 14 eyes (14%) visual acuity was unchanged and was worse in 5 cases (5%). Postoperative complications included fibrin reaction, posterior synechias of the iris, vitreous hemorrhage, neovascular glaucoma, posterior capsule opacification, redetachment of retina. CONCLUSIONS: Our cases confirm previous study, that performing phacoemulsification, IOL implantation and vitrectomy in one operation is safe and allows visual recovery with good technical results.     

The effect of internal limiting membrane peeling on chronic recalcitrant pseudophakic cystoid macular edema: a report of two cases

PURPOSE: To describe the effect of internal limiting membrane peeling in chronic recalcitrant pseudophakic cystoid macular edema. DESIGN: Two interventional case reports. METHODS: Two consecutive patients with chronic pseudophakic cystoid macular edema of 11-22 months duration, after uncomplicated cataract surgery, unresponsive to previous treatment, were enrolled. The surgical technique consisted of pars plana vitrectomy and internal limiting membrane peeling. Main outcome measures included best-corrected visual acuity, biomicroscopic appearance, and perifoveal leakage on fluorescein angiography. Optical coherence tomography scans were performed postoperatively. RESULTS: Pars plana vitrectomy with internal limiting membrane peeling resulted in anatomical, angiographic, and functional improvement in both patients, for total follow-up periods of 8 and 11 months, respectively. CONCLUSION: To our knowledge, this is the first report of chronic pseudophakic cystoid macular edema that favorably responded to pars plana vitrectomy with internal limiting membrane peeling, as concluded after a MEDLINE search.     

Vitrectomy surgery for the treatment of the vitreo-retinal complications of the pars planitis

ObjectiveTo evaluate the effect of pars plana vitrectomy in the management of patients with pars planitis.MethodsA retrospective analysis of the clinical course, post-operative complications and recurrent uveal inflamation following pars plana vitrectomy in patients with pars planitis.ResultsThe study included 22 eyes of 19 patients. The mean follow-up was 55.7 (±39.6) months (range 7 – 144 months). The surgical indications were, persistent vitreous opacities in 10 eyes, vitreous haemorrhage in 9 eyes, and epiretinal membrane in 3 eyes. There was an improvement in the clinical course of the uveitis in 19 of the 22 eyes (86.4%), allowing the suspension of the systemic treatment in 16 patients. An improvement of the visual acuity was observed in 20 eyes (90.9%). The most common post-operative complications were, lens opacities in 9 eyes (40.9%), and glaucoma in 4 eyes (18.2%).ConclusionsThe results of this study suggest that pars plana vitrectomy has a beneficial effect on the course and visual function of patients with vitreo-retinal complications associated with pars planitis.     

Pars plana vitrectomy in ocular Behçet's disease

Purpose: To evaluate the results of pars plana vitrectomy in Behçet patients with dense vitreous opacities, and its effect on intraocular inflammatory episodes and visual prognosis. Methods: The study group consisted of nine patients (one eye in eight patients, both eyes in one) with Behçet's disease who underwent pars plana vitrectomy because of dense vitreous opacification. The indications for vitrectomy, the effect of vitrectomy on the frequency of severe intraocular inflammatory episodes, and visual prognosis were investigated in these patients. All the patients were male, and their ages ranged between 28–45 years. Combined lensectomy was performed on those with complicated cataracts. The postoperative follow-up was between 12–66 months. Results: In all of the patients preoperative visual acuity was hand motions. Postoperatively there was no change in vision in five eyes, however visual acuity improvedin five eyes, between counting fingers and 0.4. None of the patients showed any severepostoperative intraocular inflammatory episodes, and phthisis did not develop in any ofthe patients. Conclusion: In this study, pars plana vitrectomy was found to have a beneficial effect on the prognosis of vision. There was also a decrease in the frequency of severe intraocular inflammatory episodes in patients with Behçet's disease with severe vitreous opacities, who did not respond to maximum medical treatment. However, further studies on larger groups should be performed in order to confirm the findings of this study.