Pars plana vitrectomy in chronic uveitis

Statistical analysis of 54 eyes with chronical endogenous uveitis, mostly juvenile, treated with simple or combined pars plana vitrectomy. Most striking is the high frequency of localized or combined cyclitis with good functional results, although complications of the disease (retinal detachment, vasculitis, PVR, macular damage) are extremely frequent in cyclitis, and this group also includes, three cases of postoperative phthisis. The best argument in favor of an chronic uveitis is the fact that an overwhelming majority of the patients were able to switch from rigorous systemic preoperative medication to simple eye drops or no treatment at all.     

Pars plana vitrectomy in uveitis]

A vitrectomy was performed in 30 eyes suffering from different forms of uveitis. An improvement of visual acuity was obtained in 29 cases and was explained by removal of vitreous haze and/or of the cataract, but not by the improvement of the inflammatory process.     

Pars plana vitrectomy in chronic uveitis

Sixty-eight patients (74 eyes) with chronic endogenous uveitis underwent pars plana vitrectomy. An increase in visual acuity was observed in 70% postoperatively. Visual results basically depended on the extent of previous damage to the macula. A lensectomy-vitrectomy was done in 23 eyes, while 51 eyes underwent merely a pars plana vitrectomy. The frequency and severity of uveitic relapses were diminished in virtually all cases.     

Pars plana vitrectomy in diabetic macular edema

Purpose: To ascertain the association between the improvement of diabetic macular edema and increased visual acuity after pars plana vitrectomy. Methods: From January 1994 to December 1996 we prospectively studied 18 patients (18 eyes, 7 women and 11 men, mean age 52 years, range 37–68) with type II diabetes and clinically significant macular edema. One group was composed of 9 patients presenting diffuse macular edema (DME); a second group with 9 patients presented cystoid macular edema (CME). All patients underwent pars plana vitrectomy. Results: Preoperative Snellen visual acuity was 20/143 in DME and 20/441 in CME. In both groups vision increased to 20/136 and 20/205, respectively, postoperatively. For the DME this difference was statistically significant (p<0.05) at 1 month after the surgery, but vision decreased again after 10 months reaching preoperative values. Conclusions: Our results suggest that pars plana vitrectomy for diabetic macular edema may increase visual acuity in diffuse macular edema, although this increase is only short lived. This revised version was published online in July 2006 with corrections to the Cover Date.     

Pars plana vitrectomy in Borrelia burgdorferi endophthalmitis

BACKGROUND: Ocular manifestations of Lyme borreliose present with unusual forms of conjunctivitis, keratitis, optic nerve disease, uveitis, vitritis and rarely endophthalmitis. CASE REPORT: A 57-year-old man working as logger in Sax-ony-Anhalt suffering from an endophthalmitis on his left eye was referred to us. The vision of his left eye was intact light perception and hand motions. The slit-lamp examination revealed severe inflammation of the anterior chamber with hypopyon, posterior synechiae, and opacity of the posterior lens capsule. Funduscopy showed no red reflex, no retinal details. In the local hospital serum analysis was performed and showed in Western-Blot IgM- and IgG-antibodies against Borrelia burgdorferi. Despite of intravenous application of ceftriaxon for 14 days panuveitis persisted, and endophthalmitis developed when antibiotic therapy was finished. RESULTS: During pars plana vitrectomy a sharply delineated cystic lesion containing yellowish fluid was revealed, and creamy yellow fluid was aspirated. Microscopically in hematoxylineosin stained slides of the aspirate structures consistent with Borrelia burgdorferi were found. Postoperatively vision increased to 1/15. Despite of a second intravenous ceftriaxon treatment for 14 days we observed a retinal vasculitis in the follow up of 6 months. CONCLUSIONS: Despite intravenous ceftriaxon-therapy borrelia burgdorferi must have survived in the vitreous body. Further investigations are required with respect to the use of other antibiotics or immunosuppressives.     

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 vitreous amyloidosis

Thirty-six pars plana vitrectomies were performed on 30 eyes of 17 patients with biopsy-proven vitreous amyloidosis. Reopacification of the retrolental vitreous was the most common reason for vitrectomy revision, required in 24% of patients. Complications of amyloid or vitrectomy included retinal detachment requiring scleral buckling in 17% of eyes and glaucoma requiring filtering surgery in 17% of eyes. After a mean 35-month post-vitrectomy follow-up, 48% of eyes had visual acuities of 20/40 or better, and 32% of eyes had visual acuities between 20/50 and 20/100. Twenty percent of eyes had visual acuities of 20/200 or worse due either to persistent retinal detachment, open angle glaucoma, or residual opacification of the vitreous.     

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 in aphakic retinal detachments

Thirty-three cases of aphakic retinal detachment have been treated by pars plana vitrectomy and retinopexy. This procedure allowed us to lower the incidence of postoperative massive periretinal proliferation from 15,4%, in a series that was performed by a classical method, to 6% in the pars plana treated group.Presented at the XIIIth Meeting of the Jules Gonin Club, Córdoba, 29 March–2 April 1982.     

玻璃体切除术治疗眼后段外伤

目的 分析总结玻璃体切除术治疗眼后段外伤的效果。方法 应用玻璃体切除术及其联合手术治疗连续病例47例眼后段外伤。结果 术后视力提高25例,各例眼内异物成功摘出,化脓性眼内炎痊愈,血影细胞性青光眼眼压控制,35例视网膜保持平伏。结论 玻璃体切除术使伤及后段的眼球得到挽救并恢复一定的视力,是目前治疗眼后段外伤的有效方法。     

Pars plana vitrectomy in advanced coats' disease

Purpose

To report 5 cases of advanced Coats’ disease managed with pars plana vitrectomy and silicone oil tamponade.

Methods

Five patients with advanced Coats’ disease and serous or tractional retinal detachment underwent pars plana vitrectomy with internal drainage, endolaser photocoagulation and silicone oil tamponade. One patient had combined phacoemulsification-vitrectomy surgery. Of the 5 patients, 1 had intravitreal hemorrhage and a retinal macrocyst and 1 had a retinal cyst. Follow-up period was 1–6 years.

Results

All patients had improved visual acuity after surgery. No intraoperative or postoperative complications were observed in any of the patients. The retina was attached and the disease was stable in all patients during follow-up. Two patients had cataract formation, and in one of them the cataract was successfully managed with phacoemulsification surgery.

Conclusion

Pars plana vitrectomy, subretinal fluid drainage, and long-term silicone oil tamponade are effective methods in the management of advanced Coats’ disease. Early and prompt management can prevent visual loss and secondary complications.Key Words: Advanced Coats’ disease, Pars plana vitrectomy, Retinal detachment, Subretinal fluid drainage, Silicone oil tamponade, Phacoemulsification surgery     

Pars plana vitrectomy in proliferative diabetic retinopathy

In this contribution the authors present the results of treatment by pars plana vitrectomy in a consecutive series of 200 patients with proliferative retinopathy. Anatomical success was achieved in 82% of the cases of simple vitreous hemorrhages, in 63% and 67% respectively of the cases of traction detachment with or without vitreous hemorrhage, and in 55% of the cases of combined rhegmatogenous and traction detachment. Postoperative visual success was generally dependent on preoperative macular findings. Visual success was achieved in 71% of cases where the macula was attached preoperatively, as opposed to only 38% of the patients in whom it was preoperatively detached. Intraoperative retinal complications were less than 1% in cases of simple vitreous hemorrhage, rose to 13%-15% in cases of traction detachment and were quite common (32%) in cases of combined rhegmatogenous and traction detachment. A major goal of this paper was to show that anatomical and visual success as well as intraoperative complications were highly dependent on the degree of surgical difficulty and the stage of the disease. The results support the concept that vitreous surgery should be considered early in the late stages of proliferative diabetic retinopathy.     

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 for idiopathic vitreous floaters

BACKGROUND: The aim of this study was to evaluate the role of pars plana vitrectomy (PPV) in patients with persistent vitreous floaters (VF) in phakic (56.7 %) or pseudophakic (43.3 %) eyes. SUBJECTS AND METHODS: A retrospective study of 24 consecutive patients (30 eyes) who underwent a 2-port-PPV using indirect opthalmoscopy between 1992 and 2003 was carried out. Main outcome measures were postoperative visual acuity (PVA), incidence of postoperative complications and patient satisfaction, which has been assessed retrospectively using a detailed questionnaire. RESULTS: Symptoms resolved in all patients. PVA was significantly better (0.91 +/- 0.2 vs. 0.84 +/- 0.2 preoperative visual acuity) or equal in 25 patients (83.3 %). One pseudophakic patient (3.3 %) experienced a retinal detachment 48 months after surgery. In 5 of 17 phakic eyes (35 %) a cataract extraction had to be performed during the follow-up period. All patients were satisfied with their overall visual function. DISCUSSION: This study shows PPV to be a safe and effective primary treatment for visually disturbing VF. In spite of the small number of cases with a lower PVA (5 eyes/16.7 %), which in the most severe case corresponded to a reduction of VA from 1.0 to 0.6 due to a nuclear sclerosis of the lens, all patients were satisfied. As vitreoretinal complications may occur, a critical patient selection and a careful preoperative assessment of specific risks of vitrectomy are mandatory.     

Pars plana vitrectomy combined with penetrating keratoplasty

Pars plana vitrectomy combined with keratoplasty using a temporary keratoprosthesis is a surgical procedure used in patients with vitreoretinal disorders complicated by severe corneal opacification. Temporary keratoprostheses include the Landers type and Eckardt type. Use of the Eckardt temporary keratoprosthesis is superior because of a wider optical diameter and easier visualization of the peripheral fundus. However, one problem with this procedure is that many patients develop postoperative rejection and loss of transparency of the corneal graft. To maintain good transparency of the corneal graft after surgery, vitrectomy must be minimally invasive and postoperative anti-inflammation must be ensured.     

Pars plana vitrectomy for pseudophakic retinal detachment

BACKGROUND: Pars plana vitrectomy, usually without additional buckling procedures, is the first choice for repair of pseudophakic retinal detachment at the Lucerne Eye Hospital. PATIENTS AND METHODS: In a retrospective study we analyzed a consecutive series of 129 eyes (122 patients) treated for pseudophakic retinal detachment. All underwent a primary pars plana vitrectomy. 97 % had retrobulbar anaesthesia. SF6 was used in 93 %, Si-oil in 7 %. An additional encircling band was placed in 5 %. Mean age was 65 years (24 - 92, +/- 13). Minimal follow-up was 8 months (8 - 66, median 25). RESULTS: Mean duration of surgery was 90 minutes (50 - 140, +/- 15). Severe PVR grade C was present in 17 %. Breaks in the inferior part of the retina were found in 52 % - the localisation had no influence on the anatomical or functional outcome. A difference between preoperative and intraoperative findings was noted in 46 % (missed breaks or lattice degenerations etc.). For general medical reasons, Si-oil was not removed in 4 eyes. Complete reattachment after the first operation was achieved in overall 91 % (oil-left eyes were considered as failure); in 95 %, if the oil-left eyes were excluded from the study; in 93 %, if the eyes with encircling band were not counted; in 95 % without encircling-band and oil-left eyes; in 93 % without PVR-C cases; 95 % without encircling-band/oil-left/PVR-C eyes. Median final visual acuity was 1.0, if the macula was not detached preoperatively and 0.8, if the macula was detached. Intraocular pressure problems (> 30 mm Hg < 12 h and/or > 25 mm Hg > 36 h) were noted in 28 %. Prophylactic or therapeutic antiglaucomatous medication was applied in 58 %. 14 % showed a transient fibrin reaction in the anterior segment. Refraction and ocular motility were not influenced by the surgery. CONCLUSION: Primary vitrectomy for pseudophakic retinal detachment is safe and effective. Transient elevation of the intraocular pressure is a frequent postoperative complication.     

Pars plana vitrectomy in chronic uveitis in the child

In five children aged between 8 and 14, suffering from chronic recurrent uveitis of undetermined etiology, pars plana vitrectomy was performed in order to halt progression of the disease. Postoperatively there was a clear improvement in vision in all five patients, and in the follow-up period of 5 to 26 months there were no further recurrences of uveitis in the eyes which had been treated. These observations support the assumption that vitrectomy has a favorable effect not only in adults but also in children with therapy-resistant uveitis.     

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.