Ultrasound biomicroscopy of residual vitreous base after vitreoretinal surgery

Residual vitreous base after vitreoretinal surgery was evaluated by ultrasound biomicroscopy (UBM). Twenty aphakic and pseudoaphakic patients (20 eyes) undergoing surgery for different vitreoretinal diseases were evaluated by high-frequency (50 MHz), high-resolution (50 microm) UBM, performed the day before surgery, weekly up to 1 month after surgery and then monthly. One week after surgery, the vitreous remnants were 'hardly visible' in 3 cases, 'visible' in 6 cases and 'highly visible' in 11. At the end of the follow-up (2.2 months), the 'hardly visible' cases increased to 6 and the 'visible' cases to 12, while the 'highly visible' cases decreased to 2. UBM demonstrated that vitreous base remnants were present in spite of accurate surgery; a spontaneous volume reduction of vitreous was observed during the follow-up.     

Ultrasound biomicroscopy of sclerotomy sites after pars plana vitrectomy for diabetic vitreous hemorrhage

OBJECTIVE: This study was aimed at assessing changes at the sclerotomy site using the ultrasound biomicroscope (UBM) in eyes that underwent primary pars plana vitrectomy for complications of proliferative diabetic retinopathy. DESIGN: Prospective, observational case series. PARTICIPANTS: Eighty-six eyes of 84 patients with vitreous hemorrhage caused by proliferative diabetic retinopathy. INTERVENTION: Three-port pars plana vitrectomy followed by UBM evaluation of all sclerotomy sites between 6 and 8 weeks after surgery. Correlation with intraoperative findings done in case of reoperations. Forty-one eyes had repeat UBM at 6 months. MAIN OUTCOME MEASURES: The changes at the sclerotomy site were classified into six groups: well healed, gape, plaque, vitreous incarceration, fibrovascular proliferation, and anterior hyaloidal fibrovascular proliferation (AHFVP). The UBM characteristics of each of the groups were defined. The findings at 6 months were compared with those at 6 to 8 weeks. RESULTS: At 6 to 8 weeks after surgery, most sclerotomies were well healed or had either moderate to high reflective plaques bridging the site. Wound gape was seen in 22.1% of active ports, 32.6% of light ports, and 25.6% of infusion ports. Vitreous incarceration was seen most often at the infusion port (18. 6% of eyes). Fibrovascular proliferation was seen in 9.3% of active ports, 12.8% of light ports, and 15.1% of infusion ports. Thirteen eyes had recurrent vitreous hemorrhage 6 to 8 weeks after surgery. Cases with rebleeding and no fibrovascular proliferation at the sclerotomy on UBM did well with outpatient fluid-air exchange (two eyes) or observation only (three eyes). Those with fibrovascular proliferation on UBM (eight eyes) required more extensive surgery. CONCLUSIONS: UBM is helpful in detecting complications at the sclerotomy sites after pars plana vitrectomy and is an invaluable tool in the assessment of the patient before reoperation.     

How to perform intravitreal injections

Drugs to treat retinal diseases are often injected intravitreally. This procedure can cause severe complications. We present ways to minimize the risk for complications. Rigorous preoperative antisepsis with povidone iodine, a sterile environment (using gloves and a mask for the injector, a lid speculum, and a drape on the eye to be injected), and immediate follow-up after injection are key issues of the injection technique.     

Effect of interposition maneuver during cannula removal on vitreous incarceration rate in vitrectomized eyes measured by ultrasound biomicroscopy

Purpose: To evaluate the influence of the cannula removal maneuver on the postoperative incisional vitreous incarceration using an experimental model of vitrectomized eye. Methods: Prospective, experimental, randomized and observer-masked experimental study in which 23-gauge transconjunctival sutureless vitrectomy was performed through oblique sclerotomies in cadaveric pig eyes. Once the vitrectomy was finished, one of the superior cannulas was removed with the light probe introduced through it, and the other cannula was extracted with the cannula plug inserted. Postoperative incisional vitreous incarceration was evaluated by ultrasound biomicroscopy (UBM). Results: 60 eyes included. Considering the 60 superior sclerotomies whose cannulas were extracted with the light pipe inserted, vitreous incarceration was observed in 35% of them. On the other hand, 71.6% of the incisions whose cannulas were removed with the cannula plug inserted showed vitreous incarceration (p = 0.00013). Conclusions: Interposing the light probe through the cannula when it is removed seems to reduce the postoperative wound vitreous incarceration rate in our experimental model.     

Evaluation of pain during intravitreal Ozurdex injections vs intravitreal bevacizumab injections

Purpose

The purpose was to evaluate the pain associated with intravitreal Ozurdex injections, and to compare it with that associated with intravitreal bevacizumab injections.

Methods

The study included 57 eyes of 57 patients who received an intravitreal Ozurdex injection at our institution. Pain was measured by the visual analog scale (VAS). Additional parameters recorded included age, sex, indication for the injection, number of previous Ozurdex injections in the study eye, presence of diabetes mellitus, and lens status. Data were compared with a 2 : 1 sex- and age-matched control group of 114 patients who received intravitreal bevacizumab injections.

Results

Indications for injection included diabetic macular edema (40.4%) and macular edema secondary to central and branch retinal vein occlusion (28% and 31.6%, respectively). Pain scores on the VAS ranged from 0 to 90, with a mean of 20.8±20.3. There was no significant difference in pain between Ozurdex and bevacizumab injections. Pseudophakia was correlated with increased pain in Ozurdex injections.

Conclusions

This is the first series evaluating the pain associated with intravitreal Ozurdex injections. Despite a larger needle gauge and tunneled injection technique, intravitreal injection of Ozurdex is not associated with increased pain compared with bevacizumab. This finding may be a potential advantage for Ozurdex, and may serve to improve patient compliance with future long-term treatment protocols.     

Ultrasound biomicroscopy of conjunctival lesions

BACKGROUND: The value of ultrasound biomicroscopy in the diagnosis of conjunctival lesions is not well established. PATIENTS AND METHODS: For the examination of conjunctival lesions, we used an ultrasound biomicroscope (Humphrey, Zeiss, Oberkochen) with a high frequency transducer (30 MHz). Between January 2000 and August 2001, 28 patients (16 female, 12-male) with conjunctival lesions, aged 9 to 81 years, were available for this study. RESULTS: Histological examination of the excised tissue displayed the presence of a compound naevus (8/28), cysts (6/28), inflammatory processes (3/28), granulomatous processes (2/28), lymphomas (2/28), foreign bodies (2/28), a pterygium (2/28), a malignant melanoma (1/28), a primary acquired melanosis (1/28), and a conjunctival amyloidosis (1/28). Using ultrasound biomicroscopy we were able to demonstrate a cystic tumour in the six patients (21 %) with a cyst of the conjunctiva. In patients suffering from solid tumours of the conjunctiva the definite diagnosis could not be made with ultrasound biomicroscopy alone. The eight patients with compound naevus displayed a somewhat heterogeneous sonographic structure within the tumour. In the patient with a foreign body we were able to demonstrate posterior shadowing of the underlying tissue. CONCLUSION: For evaluation of conjunctival lesions caused by a cyst or a solid tumour, ultrasound biomicroscopy may be an additional diagnostic tool, e. g. for assessing the margins of the tumour. However, up to now it is not possible to differentiate between different lesions solely by means of ultrasonography.     

Ultrasound biomicroscopy of eyelid lesions

This study compared ultrasound biomicroscopy with histopathology in discerning depth of eyelid lesions and tissue characteristics. Ultrasound biomicroscopy (50 MHz) was used to analyze lesion depth and tissue characteristics of eight patients with eyelid lesions referred to a university-based referral practice prior to excisional biopsy. This data was then compared to histopathologic findings. Lesion depth measured by ultrasound biomicroscopy was correlated with histopathologic depth with a linear regression. Ultrasound biomicroscopy correlated highly to histopathology with regards to tissue characteristics and lesion depth (R(2) = 0.87). Ultrasound biomicroscopy accurately measures depth of eyelid lesions and accurately determines tissue characteristics.     

Management of glaucoma implants occluded by vitreous incarceration

PURPOSE: To review the authors' experience in the management of aphakic or pseudophakic patients without an intact posterior capsule who had undergone glaucoma implant surgery complicated by vitreous incarceration in the tube, resulting in increased intraocular pressure or combined rhegmatogenous and tractional retinal detachment. METHODS: Retrospective review of the clinical features, treatment, and outcomes of eight patients who had vitreous incarceration in a glaucoma implant drainage tube. In each patient, a model 425 (7 patients) or model 350 (1 patient) Baerveldt glaucoma implant was used. RESULTS: Vitreous incarceration in the tube was first diagnosed 1 day to 49 weeks after surgery (mean, 7.5 weeks; median, 1 week). The interval between glaucoma implant surgery and pars plana vitrectomy ranged from 22 to 365 days (mean, 125 days). Before management with pars plana vitrectomy or neodymium:yttrium-aluminum-garnet laser vitreolysis, intraocular pressure ranged from 25 to 62 mm Hg (mean, 40 mm Hg). Four patients were initially treated with neodymium:yttrium-aluminum-garnet laser vitreolysis, which was successful in only one patient. Six patients were successfully treated with pars plana vitrectomy, and one patient declined surgery. Follow-up after treatment of the incarceration ranged from 5 weeks to 15 months (mean, 8.3 months). After pars plana vitrectomy, intraocular pressure ranged from 9 to 24 mm Hg (average, 14 mm Hg). Postoperative visual acuity remained within one line of the preoperative visual acuity in each of the six patients undergoing pars plana vitrectomy. CONCLUSIONS: Pars plana vitrectomy is effective in managing vitreous incarceration in glaucoma implant tubes. Previous anterior vitrectomy does not prevent incarceration.     

Ultrasound biomicroscopy of eyelid eccrine hidrocystoma

CASE REPORT: A 58-year-old white female noted a lesion on her left lower eyelid, present for 3 months. Examination disclosed a dark-blue, subepithelial, smooth mass along the cilia near the punctum. The lesion did not transmit light and was thought to be a solid mass, such as a deep-blue nevus or melanoma versus a cystic mass with internal debris. Ultrasound biomicroscopy showed a fairly circumscribed echolucent mass measuring 3.2 x 3.5 mm suggestive of a cyst with numerous internal echo impedances. Following resection, histopathologic evaluation disclosed a cyst lined by a dual layer of eccrine sweat ductal epithelium, consistent with eccrine hidrocystoma. COMMENTS: Eyelid hidrocystomas can be pigmented and can be confused clinically with melanocytic tumors. Ultrasound biomicroscopy can provide helpful diagnostic information about the internal architecture of such lesions.     

Ultrasound biomicroscopy diagnosis of congenital glaucoma

BACKGROUND: In children with congenital glaucoma the assessment of the anterior chamber and the chamber angle might be difficult since scarring and opacities of the cornea are often seen. The purpose of our study was to reveal in vivo--morphology of the anterior segment in patients with congenital glaucoma and opaque cornea. PATIENTS AND METHODS: In 46 eyes of 23 children with different degrees of corneal opacities we performed ultrasoundbiomicroscopy (UBM) of the anterior chamber after having performed a complete ophthalmological examination in general anesthesia. RESULTS: Massive abnormalities of the anterior segment morphology were detected in 5 eyes with completely cloudy cornea. In eyes with partial opacity of the cornea, UBM gave additional information concerning the anterior chamber angle topography, as iris remnants in aniridia, or anterior synechia. CONCLUSION: Especially in cases with extensive corneal opacities the UBM allows us to get morphological and topographic information about the anterior segment and helps to establish an individual strategy for surgical management.     

原发性虹膜睫状体囊肿在正常人群中的发生状况

目的 探讨原发性虹膜睫状体囊肿(以下简称囊肿)在正常人群中的发生及分布状况.方法 200例(400只眼)受检者采用超声生物显微镜(UBM)进行眼前段检查,记录囊肿数量、眼别、部位、象限分布,探讨囊肿在正常人群中的发生状况及年龄分布.采用t检验、χ2检验和直线相关分析进行统计分析.结果 200例(400只眼)中,发现有囊...     

眼部碱烧伤超声生物显微镜图像特征研究

目的应用超声生物显微镜(ultrasound biomicros-copy,UBM)对不同程度碱烧伤患者眼前段结构进行观察,研究图像特征,对烧伤的程度、治疗手段及预后进行评估。方法观察6例12眼碱烧伤急性期患者,临床Ⅱ度烧伤者6眼,Ⅲ度烧伤者4眼,Ⅳ度烧伤者2眼。在烧伤的急性期作UBM检查,检查内容包括前房、房角、后房、睫状体,并将检查结果与临床表现相联系。结果碱烧伤急性期6眼UBM图像均显示有不同程度的前部及中间葡萄膜炎表现,房水混浊,睫状体水肿多见,根据碱烧伤程度和范围不同角膜有不同程度的水肿。UBM表现如下:Ⅱ度碱烧伤图像表现为角膜上皮回声增强,烧伤若累及后弹力层,表现为后弹力层花边样改变,角膜厚度在水肿区明显增厚;Ⅲ度碱烧伤图像表现为角膜上皮缺失区上皮反光带的缺失或不连续,角膜厚度明显增厚,后弹力层出现回声光带不明确以及断裂;Ⅳ度碱烧伤图像表现为角膜正常回声影像完全消失,角膜呈不均匀中强回声,角膜与巩膜相延续部分结构不清,角膜缘后巩膜层水肿明显,巩膜结构呈现不均匀强回声影像。结论UBM可显示不同程度的眼表烧伤后眼前节的情况,严重的碱烧伤不仅造成角膜5层组织不可逆的改变,而且造成眼前节较重的葡萄膜炎表现,导致预后不良。     

Ultrasound biomicroscopy of sclerotomy sites: the effect of vitreous shaving around sclerotomy sites during pars plana vitrectomy

PURPOSE: To study the difference in the amount of vitreous incarceration between conventional pars plana vitrectomy (PPV) and PPV with vitreous shaving around sclerotomy sites. METHODS: A dynamic in vivo examination using ultrasound biomicroscopy (UBM) was performed on the sclerotomy sites of 22 eyes after PPV. Patients were divided into two groups. In the study group (n = 11), the vitreous was completely shaved from the internal initial sclerotomy by cotton-tip depressed vitrectomy under coaxial illumination. In the control group (n = 11), no vitreous shaving was performed. RESULTS: Vitreous incarceration into sclerotomy sites was significantly less in the study group compared with the control group (P <0.001). No difference was seen among the three sclerotomy sites regarding vitreous incarceration within individual eyes. No difference was seen between eyes operated by right- and left-handed surgeons. CONCLUSIONS: Vitreous shaving of sclerotomy sites using depressed vitrectomy significantly reduces vitreous incarceration. This may reduce the rate of sclerotomy-related complications following PPV in selected cases.     

Ultrasound biomicroscopy study of direct and oblique 25-gauge vitrectomy sclerotomies

PURPOSE: To study 25-gauge sclerotomy healing process in vivo with ultrasound biomicroscopy (UBM) in direct and oblique incisions. DESIGN: Prospective interventional case series report. METHODS: At our institution, we performed UBM studies on 53 sclerotomies during the first 30 days after 25-gauge vitrectomy, looking for conjunctival bleb development, sclerotomy healing signs, and vitreous incarceration in the wound. RESULTS: Echographical healing signs were completed in 77% of patients by day 15 with no differences between direct and oblique sclerotomies. By day 30, all but one sclerotomy were closed. Conjunctival blebs developed over 64% of direct sclerotomies, and 25% of oblique (P = .0059), but all resolved spontaneously by day 15. Vitreous incarceration appeared in 72% of sclerotomies. CONCLUSIONS: Twenty-five gauge sclerotomies heal by day 15 in most cases with no difference between direct and oblique sclerotomy construction. Conjunctival blebs developed more frequently over direct than oblique sclerotomies.     

扁平部玻璃体切割手术巩膜切口玻璃体禁闭引起周边部玻璃体牵拉

为了解玻璃体切割手术后，在扁平部巩膜切口处由玻璃体禁闭引起的周边部玻璃体牵拉，同时解释由该周边部玻璃体牵拉引起视网膜裂孔及脱离的发生原因。选择１５例非复杂性玻切手术病人，研究在扁平部巩膜切口处周边部玻璃体与视网膜的关系，观察方法包括，在巩膜压迫器及眼内照明辅助下通过手术显微镜观察或眼内窥镜直接观察。结果：通过眼内窥镜观察发现，所有病人均存在由于玻璃体禁闭而产生的玻璃体对周边部视网膜牵拉，单纯用手术显微镜观察的方法是不可靠的。结论：玻璃体在玻切手术切口处禁闭是经常发生的，在普通的扁平部玻切手术术后，周边部视网膜存在的玻璃体牵拉可引起潜在的视网膜裂孔和脱离，应该尽快发明一种手术技术来解决这一问题。