Combined pars plana vitrectomy–scleral buckle versus pars plana vitrectomy for proliferative vitreoretinopathy

The purpose of the study is to evaluate the surgical outcomes of combined pars plana vitrectomy–scleral buckle (PPV–SB) versus pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment complicated with proliferative vitreoretinopathy (PVR). One thousand one hundred and seventy four patients with rhegmatogenous retinal detachment surgery between January 2002 and December 2013 were retrospectively reviewed. Patients with grade C PVR treated with either combined PPV–SB or PPV alone were included in the study. Study outcomes included single surgery anatomic success rate and postoperative visual outcome at 12 months postoperatively. Seventy-seven patients with grade C PVR were identified for analysis. At the end of 12-month follow-up, 80.5 % eyes (33/41) in the PPV–SB group and 58.3 % eyes (21/36) in the PPV group achieved single surgery anatomical success. In a multiple logistic regression model, none of the baseline variables (age, gender, macula status, grade of PVR, extent of detachment, presence of vitreous hemorrhage, lens status, status of high myopia) nor types of retinal detachment surgery (use of scleral buckle, barrier endolaser, 360 degree endolaser, cryopexy, retinectomy, tamponade agent, phacoemulsification) had significant effect on single surgery anatomical success. The post-treatment mean logMAR visual acuity of the PPV–SB group was 1.58 ± 0.58 and the PPV group was 1.57 ± 0.61. There was no significant difference in the postoperative visual acuity between the two groups (P = 0.849). For patients with grade C PVR, PPV–SB did not demonstrate a superiority over PPV alone in achieving single surgery anatomical success.     

Primary retinal detachment: scleral buckle or pars plana vitrectomy?

PURPOSE OF REVIEW: There remains no consensus among vitreoretinal surgeons regarding the optimal management of primary rhegmatogenous retinal detachment. In this article, fundamental principles are discussed and applied to recent clinical reports. RECENT FINDINGS: The consensus of the peer-reviewed literature appears to be that scleral buckling and primary pars plana vitrectomy may yield comparable single-operation success rates and visual acuity outcomes for a wide variety of rhegmatogenous retinal detachments. SUMMARY: No definitive prospective, randomized, multicenter trial compares scleral buckling with pars plana vitrectomy. The upcoming Scleral Buckling versus Primary Vitrectomy in Rhegmatogenous Retinal Detachment study may yield useful information in this regard. Even when this study is completed, the choice of surgical modality is complex and may be individualized for specific patients.     

Evaluation of anterior segment parameters using pentacam in silicone oil–injected patients after pars plana vitrectomy

Background:

The aim of this study is to evaluate anterior segment changes with Pentacam Scheimpflug camera after pars plana vitrectomy (PPV) and silicone oil injection.

Materials and Methods:

In all, 44 eyes of 44 patients who underwent PPV by one surgeon were evaluated with Pentacam preoperatively, first week, and first month after surgery. The patients were divided into two groups, eyes with silicone injection after PPV and eyes with PPV and no endotamponade. Main outcome measures were preoperative and postoperative anterior chamber volume (ACV), anterior chamber depth (ACD), anterior chamber angle (ACA), and central corneal thickness (CCT) obtained with pentacam.

Results:

Each group consisted of 22 patients. In both groups no significant difference was detected among preop and postop changes in ACV and ACA values (P > 0.05). The increase in ACD in silicone oil–injected group and the decrease in ACD in PPV group at postop 1 week were statistically significant (P < 0.05). The increase in CCT in silicone oil–injected group at postop 1 week and then decrease in postop 1 month were also significant (P < 0.05). Surgically induced astigmatism (SIA) was 3.7 Dioptry (D) in silicone oil–injected group and 2.4 D in PPV group at postop 1 week. SIA decreased to 1.7 D and 1.5 D, respectively, at postop 1 month. Changes in SIA were significant (P < 0.05).

Conclusion:

PPV effects cornea and anterior segment. Changes in cornea and anterior segment after PPV seem to return to preoperative values among 1 month after surgery.     

Is a tight patch necessary after trabeculectomy?

AIMS: To determine if post-trabeculectomy patching reduces the prevalence of shallow/flat anterior chambers and pain. METHODS: 435 eyes were prospectively randomised to either a double patch with tape or no patch with tape group. RESULTS: There was no statistically significant difference in flat or shallow anterior chamber rates or pain symptoms between the patch and no patch groups. CONCLUSION: There is no benefit to patching the post-trabeculectomy eye.     

【In Press】 Combined penetrating keratoplasty, pars plana vitrectomy and Ahmed glaucoma valve implant after open-globe injury: a challenging approach

ahmed glaucoma valve; glaucoma; open globe injury; pars plana vitrectomy; penetrating keratoplasty.     

First day review after uncomplicated phacoemulsification: is it necessary?

PURPOSE: To determine whether first day follow-up is necessary after routine uncomplicated phacoemulsification cataract surgery. METHODS: Data collected prospectively at day 1 postoperative review. RESULTS: In 510 consecutive cases, serious complications occurred in 8 (1.6%) (wound leak [4], corneal abrasion [2], iris prolapse [1], hyphema [1]). Intraocular pressure (IOP) >30 mmHg was found in 26 (5.1%) and was strongly associated with a diagnosis of pre-existing glaucoma or ocular hypertension (odds ratio [OR] 7.7). Symptoms of headache or ocular discomfort occurred in 40 (7.8%), mostly in association with raised IOP, and were also associated with pre-existing glaucoma or ocular hypertension (OR 4.7). Central corneal edema was found in 61 (12.0%). In the absence of corneal edema, IOP was >30 mmHg in only two cases (0.39%). CONCLUSIONS: Few sight-threatening complications were detected on the morning after an uncomplicated procedure. First day follow-up may be safely omitted if adequate patient counseling is undertaken and there is provision of adequate access to eye services. Review prior to discharge on the day of surgery would provide an opportunity to detect these few surgical complications and for counseling. A diagnosis of glaucoma or ocular hypertension is a risk factor for significantly raised next day IOP and these patients are more likely to experience postoperative discomfort. They may benefit from prophylactic treatment.     

Should associated intraoperative and/or postoperative photocoagulation be systematic during or after vitrectomy for proliferative diabetic vitreoretinopathy?

PURPOSE: To analyze the results of vitrectomy in proliferative diabetic vitreoretinopathy and to check whether systematic intra- and/or postoperative photocoagulation is necessary in most cases. PATIENTS AND METHODS: We retrospectively reviewed 108 patient records (137 eyes) of vitrectomy performed for complications of proliferative diabetic vitreoretinopathy between 1982 and 2000. Fifty-eight percent of the patients were women. The average age was 44 years. Sixty percent of the patients presented with diabetes type 1. Only 39% of the eyes had complete preoperative panretinal photocoagulation. Preoperative visual acuity was lower than 2/200 in 81% of eyes, 27% presenting initially with traction retinal detachment involving the macula. The surgical technique used was segmentation-delamination. Endodiathermy was necessary in 45% of the eyes and intraoperative photocoagulation was not performed. Postoperative complementary photocoagulation was carried out in only 9% of the eyes. RESULTS: Results were analyzed with an average follow-up of 66 months. Anatomical success was obtained in 69% of the eyes, with 55% visual improvement. These results were unchanging at long-term follow-up in 95% of the eyes studied. Iatrogenic retinal breaks were observed in 8% of the eyes. Postoperative complications were dominated by single (8%) or recurrent vitreous hemorrhage (8%). The rate of postoperative neovascular glaucoma was approximately 5%. These results are similar to the rates reported by other authors using intraoperative endophotocoagulation. CONCLUSION: Intra- and/or postoperative photocoagulation should not be systematic but reserved for management of iatrogenic retinal breaks and also for extensive panretinal photocoagulation in recurrent vitreous hemorrhage.     

Monovision: a refractive consideration in cataract surgery after vitrectomy?

Cataract is the most common complication of vitrectomising surgery in the phakic eye. Progressive nuclear sclerosis (NS) causes a myopic shift. This change in refractive status can predispose to the development of monovision in presbyopic individuals. Recognition of adaptation to monovision is important when undertaking sequential cataract surgery. Our case describes a patient whose adaptation to monovision was only recognised after its reversal. Predisposing factors are discussed and lessons highlighted.     

The early complications of cataract surgery: is routine review of patients 1 week after cataract extraction necessary?

OBJECTIVE: This study sought to define the nature and frequency of complications present 1 week after cataract surgery, to determine whether these complications are predictable, and to ascertain if patients undergoing cataract surgery require routine review at this time. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: One thousand consecutive patients undergoing cataract removal by either phacoemulsification or extracapsular extraction at a large teaching hospital between January 1996 and May 1998. Patients with both complicated and uncomplicated histories and surgeries were included. MAIN OUTCOME MEASURES: Nature and frequency of complications present 1 week after cataract surgery. RESULTS: At the routine 1-week visit, postoperative complications were observed in 41 of 1000 patients (4.1%). Twenty-one (51%) of these patients had a completely unremarkable history to that point, and whereas only four (19%) were symptomatic, 20 (95%) required a change to their postoperative management. The most significant unexpected complications were uveitis (seven cases), cystoid macular edema (four cases), and vitreous to the wound, exposed knots, and loose suture (one case of each). Complications were present in 20 of 257 (7.8%) patients with a preoperative or surgical risk factor, and there was a significant relationship between preoperative (P = 0.02), and combined preoperative and intraoperative risk factors (P = 0.001), and complications present at the 1-week review. The relationship between surgical risk factors and 1-week complications was not significant (P = 0.07). There were coexistent pathologic features in 19% of all eyes. Registrars performed 38% of surgeries, and 96% of cataracts were removed by phacoemulsification. Operative complications occurred in 6.7% of patients, most commonly a posterior capsule tear (4.4% of all cases). Complications were observed in 10% of eyes on the first postoperative day. Raised intraocular pressure was the complication in 88% of these patients. CONCLUSIONS: This study provides an overview of modern cataract surgery in a large teaching hospital and indicates that abandonment of routine 1-week review may result in the failure to detect significant postoperative complications.     

Prediction of postoperative visual acuity after vitrectomy for macular hole using deep learning–based artificial intelligence

Graefe's Archive for Clinical and Experimental Ophthalmology - To create a model for prediction of postoperative visual acuity (VA) after vitrectomy for macular hole (MH) treatment using...