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Reding M, Loya A, Weng CY. Treatment of Proliferative Diabetic Retinopathy in 2023. Int Ophthalmol Clin 2024; 64:71-82. [PMID: 38146882 DOI: 10.1097/iio.0000000000000511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
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2
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Mohan S, Sadeghi E, Mohan M, Iannetta D, Chhablani J. Suprachoroidal Hemorrhage. Ophthalmologica 2023; 246:255-277. [PMID: 37660688 DOI: 10.1159/000533937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/27/2023] [Indexed: 09/05/2023]
Abstract
Suprachoroidal hemorrhage (SCH) refers to the accumulation of blood in the suprachoroidal space, a relatively uncommon but significant complication that can occur spontaneously, during ophthalmic surgery, or as a consequence of ocular trauma. If left undiagnosed and untreated, SCH can lead to severe vision loss or even blindness. Therefore, it is crucial for ophthalmologists to have a thorough understanding of this complication, taking proactive measures to prevent it during surgery and being knowledgeable about effective management strategies for patients with SCH. This review article aimed to provide a comprehensive overview of SCH, covering its risk factors, diagnostic approaches, and the best practices for its management. By enhancing awareness and knowledge in this area, we can improve patient outcomes and minimize the impact of SCH in ophthalmic practice.
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Affiliation(s)
- Sashwanthi Mohan
- Department of Ophthalmology, Medcare Eye Centre, Al Safa, Dubai, United Arab Emirates
- Department of Education and Research, Rajan Eye Care, Chennai, India
| | - Elham Sadeghi
- Department of Ophthalmology, Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Danilo Iannetta
- Ophthalmology Unit, IRCSS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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3
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Schönbach EM, Freeman WR. Choroidal Detachment After Intravitreal Injection of Faricimab. JAMA Ophthalmol 2023; 141:e231067. [PMID: 37733048 DOI: 10.1001/jamaophthalmol.2023.1067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
This case report discusses a diagnosis of choroidal detachment and suprachoroidal hemorrhage in a patient aged 70 years after an uneventful intravitreal injection of faricimab for neovascular age-related macular degeneration.
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Affiliation(s)
- Etienne M Schönbach
- Jacobs Retina Center at the Shiley Eye Institute, University of California, San Diego, San Diego
| | - William R Freeman
- Jacobs Retina Center at the Shiley Eye Institute, University of California, San Diego, San Diego
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Doi Y, Muraoka Y, Tsujikawa A. Evaluation of the Efficiency and Safety of a 27-Gauge 20,000 Cuts per Minute Vitreous Cutter. Clin Ophthalmol 2023; 17:2037-2043. [PMID: 37483843 PMCID: PMC10362866 DOI: 10.2147/opth.s418371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/23/2023] [Indexed: 07/25/2023] Open
Abstract
Purpose The aim of this study was to evaluate the efficiency and safety of a 27-gauge (G) 20,000 cuts per minute (cpm) vitreous cutter in clinical settings. Patients and Methods This was a retrospective and observational study of 40 eyes of 40 patients with idiopathic epiretinal membrane (ERM). Twenty patients (20 eyes) were treated using a 27G 10,000-cpm vitreous cutter (Advanced ULTRAVIT® Probe, Alcon), whereas the remaining 20 patients (20 eyes) were treated using a 27G 20,000-cpm cutter (Hypervit® dual-blade probe, Alcon). All the surgeries were performed by the same surgeon (YM). The time from the start of vitrectomy to the start of ERM peeling was independently measured by two separate examiners using digital videos of each surgery. The average duration of vitrectomy was calculated for each patient. Additionally, the data of the patients in the two groups were extracted from their medical and surgical records and compared. Results The time from the initiation of vitrectomy until the start of ERM peeling was 184 ± 56.9 and 152 ± 39.5 s for the 10,000-cpm and 20,000-cpm groups, respectively. The duration of vitrectomy was significantly shorter in the 20,000-cpm group than in the 10,000-cpm group (p = 0.041). Postoperative vitreous hemorrhage was observed in one patient in the 10,000-cpm group, whereas no complications were observed in the 20,000-cpm group. Conclusion In a clinical setting, the 27G 20,000-cpm vitreous cutter may have a higher safety profile and higher efficacy for vitreous removal than that of the 27G 10,000-cpm vitreous cutter.
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Affiliation(s)
- Yuta Doi
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuki Muraoka
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akitaka Tsujikawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Fan J, Hudson JL, Pakravan P, Lazzarini TA, Lin BR, Fan KC, Yannuzzi NA, Sridhar J, Townsend JH, Berrocal AM, Smiddy WE, Vanner EA, Flynn Jr HW. Outcomes in Patients with Suprachoroidal Hemorrhage After Anterior Segment Surgery. Clin Ophthalmol 2022; 16:4199-4205. [PMID: 36544898 PMCID: PMC9762989 DOI: 10.2147/opth.s379557] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 11/07/2022] [Indexed: 12/23/2022] Open
Abstract
Objective The purpose of the current study is to report outcomes of suprachoroidal hemorrhage (SCH) after anterior segment surgery at a single institution, and to identify clinical features associated with visual prognosis. Methods and Analysis Retrospective consecutive case series of patients with SCH occurring after anterior segment surgery. Results The study includes 112 eyes of 112 patients between 2014 and 2020. There were 76 cases of non-appositional SCH versus 36 cases of appositional SCH. The mean presenting visual acuity for patients with non-appositional versus appositional SCH was 2.03 logMAR (SD 0.78) versus 2.39 logMAR (SD 0.43), respectively. Visual acuity outcomes generally remained poor at last follow-up: 64 (58%) patients had a visual acuity (VA) of ≤ 20/200, including 19 (17%) with light perception (LP), and 11 (10%) with no light perception (NLP). Regarding management of non-appositional versus appositional SCH, observation was selected in 46 (61%) vs 12 (33%), delayed drainage in 14 (18%) vs 15 (42%), delayed pars plana vitrectomy in 16 (21%) vs 13 (36%), and VA at last follow-up was 1.2 versus 1.86 logMAR (p=0.002). In patients that were observed, both appositional SCH (p=0.01) and duration of apposition (p=0.04) were correlated with worse outcome. Conclusion Appositional SCH was associated with poorer visual outcomes compared to non-appositional SCH. Observation remains a reasonable management strategy for non-appositional SCH.
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Affiliation(s)
- Jason Fan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Julia L Hudson
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Parastou Pakravan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Thomas A Lazzarini
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Benjamin R Lin
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Kenneth C Fan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Nicolas A Yannuzzi
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Jayanth Sridhar
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Justin H Townsend
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Audina M Berrocal
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - William E Smiddy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Elizabeth A Vanner
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Harry W Flynn Jr
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA,Correspondence: Harry W Flynn Jr, Bascom Palmer Eye Institute, 900 NW 17th St, Miami, FL, 33136, USA, Email
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Yokoyama S, Mori T, Sugioka Y, Torii T, Mitamura H, Matsuda T, Sato H, Yoshida N, Kaga T. Endoscope-Assisted Vitrectomy Without Scleral Buckling in Retinal Detachment. Ophthalmol Retina 2022; 6:748-750. [PMID: 35513238 DOI: 10.1016/j.oret.2022.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Sho Yokoyama
- Department of Ophthalmology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, 1-1-10 Sanjo, Minami-ku, Nagoya-city, Aichi, Japan.
| | - Toshio Mori
- Department of Ophthalmology, Iida Municipal Hospital, 438 Hachiman-cho, Lida-city, Nagano, Japan
| | - Yuki Sugioka
- Department of Ophthalmology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, 1-1-10 Sanjo, Minami-ku, Nagoya-city, Aichi, Japan
| | - Toshiki Torii
- Department of Ophthalmology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, 1-1-10 Sanjo, Minami-ku, Nagoya-city, Aichi, Japan
| | - Hayato Mitamura
- Department of Ophthalmology, Iida Municipal Hospital, 438 Hachiman-cho, Lida-city, Nagano, Japan
| | - Taisuke Matsuda
- Department of Ophthalmology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, 1-1-10 Sanjo, Minami-ku, Nagoya-city, Aichi, Japan
| | - Hiroyuki Sato
- Satoh Yuya Eye Clinic, 1-6-23 Itsutsubasi, Aoba-ku, Sendai-city, Miyagi, Japan
| | - Norihiko Yoshida
- Department of Ophthalmology, Japanese Red Cross Gifu Hospital, 3-36 Iwakura-cho, Gifu-city, Gifu, Japan
| | - Tatsushi Kaga
- Department of Ophthalmology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, 1-1-10 Sanjo, Minami-ku, Nagoya-city, Aichi, Japan
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Williams KJ, Scholle T, Leung EH. Management of Serous and Hemorrhagic Choroidal Detachments and Complications. Int Ophthalmol Clin 2022; 62:119-130. [PMID: 35752890 DOI: 10.1097/iio.0000000000000436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zhang T, Wei Y, Zhang Z, Chi W, Feng L, Xiang W, Wang L, Fang D, Shi Y, Zhang S. Intraoperative choroidal detachment during small-gauge vitrectomy: analysis of causes, anatomic, and visual outcomes. Eye (Lond) 2022; 36:1294-1301. [PMID: 34155369 PMCID: PMC9151711 DOI: 10.1038/s41433-021-01605-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/13/2021] [Accepted: 05/11/2021] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION To investigate the incidence and causes of intraoperative choroidal detachment (CD) during small-gauge vitrectomy, as well as the anatomic and visual outcomes. METHODS We retrospectively reviewed the medical records of 1026 consecutive patients who underwent small-gauge vitrectomy from June 2017 to December 2018 at Zhongshan Ophthalmic Centre, Guangzhou, China. Data on the presence, location, and extent of intraoperative CD and its relationship to the infusion cannula were collected. Patient demographic characteristics and postoperative anatomic and visual outcomes were also assessed. RESULTS A total of six cases were found to have intraoperative CD, including two with serous CD, three with limited haemorrhagic CD, and one with CD caused by inadvertent perfusion of gas during air/fluid exchange. Retraction of the infusion cannula and acute ocular hypotony were found to be the main causes of intraoperative CD in five out of the six cases. The best-corrected visual acuity of all cases significantly improved after the surgery. CONCLUSION The incidence of intraoperative CD during small-gauge vitrectomy is low; the predominant causes are retraction of the infusion cannula and acute ocular hypotony. Immediate awareness and timely closure of the incision may contribute to a better surgical prognosis.
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Affiliation(s)
- Ting Zhang
- grid.12981.330000 0001 2360 039XState Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Yantao Wei
- grid.12981.330000 0001 2360 039XState Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Zhaotian Zhang
- grid.12981.330000 0001 2360 039XState Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Wei Chi
- grid.12981.330000 0001 2360 039XState Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Lujia Feng
- grid.12981.330000 0001 2360 039XState Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Wu Xiang
- grid.12981.330000 0001 2360 039XState Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Li Wang
- grid.12981.330000 0001 2360 039XState Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Dong Fang
- grid.12981.330000 0001 2360 039XState Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Yunhong Shi
- grid.12981.330000 0001 2360 039XState Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Shaochong Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China. .,Shenzhen Eye Hospital, Shenzhen Eye Institute, Jinan University, Shenzhen, China.
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Nepita I, Stocchino A, Dodero A, Castellano M, Ferrara M, Romano MR, Repetto R. Dynamic Pressure Measurements During Vitrectomy in a Model of the Eye. Transl Vis Sci Technol 2022; 11:21. [PMID: 35583885 PMCID: PMC9123487 DOI: 10.1167/tvst.11.5.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To accurately evaluate pressure changes during vitrectomy in a rigid model of the vitreous chamber and to test the efficiency of the EVA phacovitrectomy system (Dutch Ophthalmic Research Center) in terms of compensation of intraocular pressure variations. Methods We tested 23-, 25-, and 27-gauge double-blade vitreous cutters in both vented global pressure control and automatic infusion compensation (AIC) modes in a vitreous chamber model, mimicking the real surgical procedure. Balanced salt solution and artificial vitreous, similar to the real vitreous body, were used. We tested both standard-flow (SF) and high-flow (HF) infusion systems, varying the infusion pressure between 20 and 40 mm Hg. In each experiment, flow rate was also measured. Results Pressure drop was rapidly and efficiently compensated when 23- and 25-gauge cutters were used in AIC mode, with infusion pressures ranging between 30 and 55 mm Hg. The 27-gauge cutter was less efficient in compensating pressure variations. Pressure fluctuations related to the high-frequency motion of the cutter blade were small compared to the overall pressure variations. The use of the HF infusion system resulted in larger flow rates and lower pressure changes compared to the SF infusion system. Conclusions Despite the rigid material of the model, the present pressure measurements are in line with previous studies performed on porcine eye. The use of AIC mode compensates intraoperative pressure drops efficiently, with both 23- and 25-gauge cutters. The HF infusion system is more efficient than the SF infusion system. Translational Relevance The AIC infusion mode efficiently compensates intraoperative pressure drops, in both 23- and 25-gauge experimental vitrectomy. The HF infusion system resulted in larger flow rate and lower pressure changes.
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Affiliation(s)
- Irene Nepita
- Nanoscopy and NIC@IIT, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Alessandro Stocchino
- Department of Civil and Environmental Engineering, Hong Kong Polytechnic University, Hong Kong
| | - Andrea Dodero
- Adolphe Merkle Institute, University of Fribourg, Fribourg, Switzerland.,Department of Chemistry and Industrial Chemistry, University of Genoa, Genoa, Italy
| | - Maila Castellano
- Department of Chemistry and Industrial Chemistry, University of Genoa, Genoa, Italy
| | | | - Mario R Romano
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy.,Ophthalmology Department, Humanitas Gavazzeni-Castelli, Bergamo, Italy
| | - Rodolfo Repetto
- Department of Civil, Chemical and Environmental Engineering, University of Genoa, Genoa, Italy
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Kishore K, Hariprasad SM, Mungee S. Perioperative Antiplatelet Agents and Anticoagulants in Vitreoretinal Surgery. Ophthalmic Surg Lasers Imaging Retina 2022; 53:71-78. [PMID: 35148217 DOI: 10.3928/23258160-20220128-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Clinical characteristics and mortality rates for suprachoroidal hemorrhage: seven-year experience at a tertiary eye center. Graefes Arch Clin Exp Ophthalmol 2021; 260:949-956. [PMID: 34523070 DOI: 10.1007/s00417-021-05290-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/07/2021] [Accepted: 06/17/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To investigate comorbidities and medications associated with acute (ASCH) and delayed (DSCH) suprachoroidal hemorrhage (SCH), and to explore visual outcomes and mortality following SCH. METHODS Retrospective review of SCH cases diagnosed at a tertiary center between 2013 and 2019. Demographics, history, surgery type, visual acuity, intraocular pressure (IOP), and mortality data were reviewed. RESULTS Fifty eyes of 50 patients experienced SCH related to surgery: 15 (30%) ASCH and 35 (70%) DSCH. Glaucoma surgery was the most common preceding surgery, and SCH was more likely to be delayed in glaucoma surgery relative to other surgeries (p = 0.001). The proportions of patients on anticoagulant, antiplatelet, or NSAID medications were 30% (n = 15), 52% (n = 26), and 12% (n = 6), respectively. The mean preoperative IOP was 25.0 ± 10.2 mmHg. The mean final best corrected visual acuity did not significantly differ between DSCH and ASCH (logMAR 1.92 vs. 2.36; p = 0.39). After controlling for pre-drainage visual acuity, final visual acuity was not statistically significantly different between eyes that were drained versus those that were not drained (p = 0.06). Of all 50 patients, the mortality rate was 12% with a mean time to mortality after SCH of 754 ± 564 days for those who died. CONCLUSION DSCH was more common than ASCH, with glaucoma surgery being the most common procedure to result in SCH. Visual outcomes and mortality rate were comparable between ASCH and DSCH. Further research is needed regarding the role of surgical drainage on improving visual outcomes in eyes with SCH.
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Mo B, Li SF, Liu Y, Zhou J, Wang SL, Shi XY. Suprachoroidal hemorrhage associated with pars plana vitrectomy. BMC Ophthalmol 2021; 21:295. [PMID: 34380451 PMCID: PMC8356403 DOI: 10.1186/s12886-021-02062-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 07/26/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose To analyze the characteristics, related risk factors, and prognosis of suprachoroidal hemorrhage (SCH) associated with pars plana vitrectomy (PPV). Methods Cases of SCH associated with PPV excluding trauma were retrospectively analyzed in Beijing Tongren Hospital between January 2010 and June 2020. The data collected included general data, myopia status, axial length, state of the crystalline lens, SCH onset time, range, treatment method, visual prognosis, and methods of operation and anesthesia. Patients were divided into those with SCH related to the first PPV (Group 1), and SCH related to second intraocular surgery in the vitrectomized eye (Group 2). Patients were also classified by the SCH onset time into either the expulsive suprachoroidal hemorrhage group (ESCH) and the delayed suprachoroidal hemorrhage group (DSCH). The general data, related risk factors, and the visual prognosis of SCH in the different groups were analyzed. Results SCH associated with PPV was studied in 28 cases with an incidence of 0.06 %; 16 males and 12 females. The mean age of the patients was (53.51 ± 10.21) years old, the mean follow-up time was (24.94 ± 14.60) days, and the mean axial length was (28.21 ± 3.14) mm. Of these cases, 21 were classified as high myopia, 25 as aphakia/ pseudophakic, and 7 as focal hemorrhage. Silicone oil removal occurred in 12 cases (43 %). Patients in Group 2 were younger than Group 1 (P = 0.005). In terms of treatment and prognosis, 5 eyes were simply closely observed, 4 were given single suprachoroidal drainage, 15 were given suprachoroidal drainage combined with silicone tamponade, 2 underwent anterior chamber puncture, and 2 gave up treatment. A follow-up vision: NLP ~ 20/30; among them, 2 eyes with NLP (7.14 %), 6 of ≥ 20/200 (21.43 %). The final outcomes presented a significantly positive correlation with baseline vision but no significant correlation with age or axial length. Conclusions SCH has a higher incidence rate after a second intraocular surgery in a vitrectomized eye which is associated with the lack of vitreous support and easier fluctuation of intraocular pressure. SCH associated with PPV is more localized and has a relatively good prognosis; high myopia and aphakic/ pseudophakic eyes are risk factors. Active treatment can effectively improve visual prognosis. Trial registration Retrospective case series study, not applicable.
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Affiliation(s)
- Bin Mo
- Beijing Tongren Hospital, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing Tongren Eye Center, Capital Medical University, No. 1 Dong Jiao Min Xiang, Eastern District, 100730, Beijing, China
| | - Song-Feng Li
- Beijing Tongren Hospital, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing Tongren Eye Center, Capital Medical University, No. 1 Dong Jiao Min Xiang, Eastern District, 100730, Beijing, China.
| | - Yi Liu
- Beijing Tongren Hospital, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing Tongren Eye Center, Capital Medical University, No. 1 Dong Jiao Min Xiang, Eastern District, 100730, Beijing, China
| | - Jun Zhou
- Beijing Tongren Hospital, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing Tongren Eye Center, Capital Medical University, No. 1 Dong Jiao Min Xiang, Eastern District, 100730, Beijing, China
| | - Shao-Li Wang
- Beijing Tongren Hospital, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing Tongren Eye Center, Capital Medical University, No. 1 Dong Jiao Min Xiang, Eastern District, 100730, Beijing, China
| | - Xiang-Yu Shi
- Beijing Tongren Hospital, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing Tongren Eye Center, Capital Medical University, No. 1 Dong Jiao Min Xiang, Eastern District, 100730, Beijing, China.
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Petrarca R, Soare C, Wong R, Desai R, Neffendorf J, Simpson A, Jackson TL. Intravitreal ranibizumab for persistent diabetic vitreous haemorrhage: a randomised, double-masked, placebo-controlled feasibility study. Acta Ophthalmol 2020; 98:e960-e967. [PMID: 31674134 DOI: 10.1111/aos.14282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 09/28/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE To determine the feasibility of a definitive study of intravitreal ranibizumab to promote the clearance of persistent diabetic vitreous haemorrhage and thereby avoid vitrectomy. METHODS This randomised, double-masked, placebo-controlled feasibility study recruited 24 participants with persistent diabetic vitreous haemorrhage listed for pars plana vitrectomy. Participants were randomised to a single 0.5-mg intravitreal ranibizumab injection or a single subconjunctival saline injection. The primary outcome measure was the number of participants requiring pars plana vitrectomy at week 7. RESULTS Eight of 12 participants (66.7%) in the ranibizumab group required vitrectomy at week 7 versus 12 of 12 (100%) in the placebo group (absolute risk reduction 33.3%, 95% confidence interval 2.1-70.7%; p = 0.09). One additional eye in the ranibizumab group required vitrectomy by 12 months. Mean visual acuity letter score at 12 months was 72.7 ± 12.3 in the ranibizumab group and 75.1 ± 10.1 in the placebo group. Safety was similar across groups. CONCLUSION Intravitreal ranibizumab may reduce the likelihood of proceeding to vitrectomy in patients with persistent, dense diabetic vitreous haemorrhage. Further studies appear feasible and justified.
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Affiliation(s)
- Robert Petrarca
- School of Life Science and Medicine King's College London London UK
- Department of Ophthalmology King's College Hospital London UK
| | - Cristina Soare
- Department of Ophthalmology King's College Hospital London UK
| | - Roger Wong
- Department of Ophthalmology St. Thomas’ Hospital London UK
| | - Riti Desai
- Department of Ophthalmology King's College Hospital London UK
| | - James Neffendorf
- School of Life Science and Medicine King's College London London UK
- Department of Ophthalmology King's College Hospital London UK
| | - Andrew Simpson
- School of Life Science and Medicine King's College London London UK
- Department of Ophthalmology King's College Hospital London UK
| | - Timothy L. Jackson
- School of Life Science and Medicine King's College London London UK
- Department of Ophthalmology King's College Hospital London UK
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14
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Shinkai Y, Yoneda K, Sotozono C. Ex Vivo Comparison of Intraocular Pressure Fluctuation During Pars Plana Vitrectomy Performed Using 25- and 27-Gauge Systems. Ophthalmic Res 2020; 65:210-215. [PMID: 33011731 DOI: 10.1159/000511948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 09/17/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The purpose of this study was to compare intraoperative intraocular pressure fluctuation using different aspiration systems and 25- and 27-gauge vitreous surgery probes. METHODS Ex vivo, pars plana, 25- and 27-gauge vitreous surgery was performed on four porcine eyes, and IOP fluctuations were evaluated. We performed three-port vitrectomy using the Constellation® Vision or the EVA® Phaco-Vitrectomy system. Each 20-s experiment was conducted five times for each set of conditions, each with the same substituted balanced salt solution. Real-time intraoperative intraocular pressure measurement was performed at the distal end of the infusion tube. Intraocular pressure was measured during core vitrectomy; core vitrectomy with fluid aspiration; peripheral vitreous shaving with scleral indentation; and fluid-gas exchange. The Mann-Whitney U test was used to evaluate statistical significance. RESULTS Mean ± standard deviation intraoperative intraocular pressure fluctuation during 25- and 27-gauge core vitrectomy were 15.9 ± 1.6 mmHg and 11.9 ± 1.4 mmHg, respectively (P < 0.05), using the Constellation system; 23.2 ± 1.4 mmHg and 14.1 ± 0.7 mm Hg, respectively (P < 0.001), using the EVA vacuum mode; and 15.0 ± 0.5 mmHg and 11.5 ± 1.4 mmHg, respectively (P < 0.05), using the EVA flow mode. The smallest intraoperative intraocular pressure fluctuations during core vitrectomy with fluid aspiration, peripheral vitreous shaving with scleral indentation, and fluid-gas exchange, were all achieved using the 27-gauge EVA flow mode; these values were 14.2 ± 0.4 mmHg, 35.7 ± 0.9 mmHg, and 6.4 ± 0.2 mmHg, respectively. CONCLUSION Regardless of the aspiration system, intraoperative intraocular pressure fluctuation was lower during 27-gauge than during 25-gauge vitrectomy. The 27-gauge EVA flow mode produced optimal intraoperative intraocular pressure stability.
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Affiliation(s)
- Yoichiro Shinkai
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuhito Yoneda
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Chie Sotozono
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Hu Z, Qian H, Fransisca S, Gu X, Ji J, Wang J, Liu Q, Xie P. Minimal internal limiting membrane peeling with ILM flap technique for idiopathic macular holes: a preliminary study. BMC Ophthalmol 2020; 20:228. [PMID: 32539696 PMCID: PMC7296741 DOI: 10.1186/s12886-020-01505-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/03/2020] [Indexed: 11/17/2022] Open
Abstract
Background Internal limiting membrane (ILM) peeling increases the idiopathic macular hole (IMH) closure rate but causes the inner retina dimplings. This study is to introduce a method to minimally peel the ILM, and with the ILM flap to ensure the IMH closure. Methods Twelve consecutive IMH eyes were treated with the minimal ILM peeling with ILM flap technique. The ILM around the MH is peeled off in an annular shape with a width of approximately 200 to 300 μm. A tongue-shape ILM flap is created in the superior retina and the inferior margin of ILM is not peeled off. The ILM flap is then inverted to cover the MH, followed by fluid-air exchange and air or silicon tamponade. Spectral domain-optical coherence tomography (SD-OCT) and en face OCT for morphological assessment, best corrected visual acuity (BCVA) and multifocal electroretinogram (ERG) for functional evaluation were performed at baseline and at each postoperative follow-up. Results All the 12 eyes achieved macular hole closure on SD-OCT after surgery (100%). At baseline, the mean preoperative BCVA was 0.83 ± 0.33 and it improved to 0.39 ± 0.28 postoperatively (p < 0.001). En face OCT showed the inner retinal dimplings were localized only in superior ILM-free retinas (7 eyes). The mERG response density in the central (R1), para-central (R2), R1/R2 ring ratios were remarkably improved at the last follow-up (p = 0.001, p = 0.033, p = 0.018, respectively). Conclusions The minimal ILM peeling with ILM flap technique can achieve favorable MH closure with less inner retinal dimplings and has promising visual recovery for IMH eyes.
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Affiliation(s)
- Zizhong Hu
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, Jiangsu, 210029, People's Republic of China
| | - Huiming Qian
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, Jiangsu, 210029, People's Republic of China
| | - Silvia Fransisca
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, Jiangsu, 210029, People's Republic of China
| | - Xunyi Gu
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, Jiangsu, 210029, People's Republic of China
| | - Jiangdong Ji
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, Jiangsu, 210029, People's Republic of China
| | - Jianan Wang
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, Jiangsu, 210029, People's Republic of China
| | - Qinghuai Liu
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, Jiangsu, 210029, People's Republic of China
| | - Ping Xie
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, Jiangsu, 210029, People's Republic of China.
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Chen AF, He X, Nirwan RS, Sridhar J, Kuriyan AE. Perioperative Management of Anticoagulants in Ocular Surgeries. Int Ophthalmol Clin 2020; 60:3-15. [PMID: 32576719 PMCID: PMC7334869 DOI: 10.1097/iio.0000000000000316] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Use of anticoagulant therapy has increased in patients presenting for ophthalmic surgery over the past decade. The decision of whether or not to discontinue anticoagulant medications prior to ophthalmic surgeries is nuanced and ultimately based on multiple factors including the type of surgery and the patient’s comorbidities and risk profile. In the setting of cataract surgery, no increased risk of bleeding with anticoagulation was observed in a large prospective study, which suggests that anticoagulation should not be interrupted for the average-risk patient on anticoagulation. In other types of ophthalmic surgery, expert opinion and studies are divided on the perioperative management of anticoagulant therapy. Preoperative thromboembolic risk stratification, intraoperative techniques to minimize bleeding, and postoperative management are also reviewed to generate more comprehensive recommendations on ophthalmic perioperative management of anticoagulation.
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Affiliation(s)
- Alexander F. Chen
- Flaum Eye Institute, University of Rochester Medical Center, Rochester, NY
| | - Xu He
- Flaum Eye Institute, University of Rochester Medical Center, Rochester, NY
| | - Rajinder S. Nirwan
- Flaum Eye Institute, University of Rochester Medical Center, Rochester, NY
| | | | - Ajay E. Kuriyan
- Flaum Eye Institute, University of Rochester Medical Center, Rochester, NY
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Spontaneous suprachoroidal hemorrhage in a high myopia patient with rhegmatogenous retinal detachment: a case report and literature review. Biosci Rep 2019; 39:BSR20181454. [PMID: 31160485 PMCID: PMC6591562 DOI: 10.1042/bsr20181454] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 05/04/2019] [Accepted: 05/31/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose: To report a rare case of spontaneous suprachoroidal hemorrhage (SSCH) in a high myopia patient with rhegmatogenous retinal detachment (RRD) and successful treatment.Methods: We present a case of SSCH that occurred in a 73 woman with high myopia with RRD and discuss the results of a systemic review of the literature published from 1999 to 2017.Results: Phacoemulsification without intraocular lens implantation and vitrectomy combined with silicone oil injection was performed and retinal detachment and choroidal detachment were reattached after oil removed. In the literature review, we found that among a total of 36 patients (37 eyes), acute secondary glaucoma was a complication in 70.3% (26 eyes) of the cases, and over half of the cases (24 eyes, 64.9%) were treated with surgery. Eighteen cases (50%) were characterized by systemic hypertension and 21 cases (58.3%) had abnormal hemostasis. Age-related macular degeneration (ARMD) was the most common (12 eyes, 32.4%) ocular disease and was followed by glaucoma (7 cases, 18.9%). Visual acuity was classified as hand motion (HM) or worse in 25 eyes (out of 34 eyes, 73.5%) at initial presentation and in 25 eyes (out of 36 eyes, 69.4%) upon final examination. Nine cases experienced significant visual improvement, including six that underwent vitrectomy.Conclusion: Advanced age, systemic anticoagulation, and hypertension are strong risk factors. RRD associated with massive SSCH is an extremely rare event. Vitrectomy and choroidal blood drainage can effectively remove suprachoroidal hemorrhage (SCH) and promote retinal reattachment in these eyes. However, the final visual prognosis usually remains poor.
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Uzel MM, Citirik M, İlhan Ç, Tekin K. The impact of duration on the recurrence of rhegmatogenous retinal detachment: optimal cutoff value. Int Ophthalmol 2018; 39:2089-2095. [DOI: 10.1007/s10792-018-1045-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 11/12/2018] [Indexed: 11/29/2022]
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Sosuan GMN, Eleazar-Verde JT, Mercado GJV, Arroyo MH. Retinoblastoma presenting as haemorrhagic choroidal detachment in a 10-year-old girl. BMJ Case Rep 2018; 2018:bcr-2018-226149. [PMID: 30361451 PMCID: PMC6202964 DOI: 10.1136/bcr-2018-226149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2018] [Indexed: 11/03/2022] Open
Abstract
To report a case of retinoblastoma presenting as haemorrhagic choroidal detachment in a 10-year-old girl. The patient, apparently well, presented with sudden blurring of vision in the setting of blunt trauma. On examination and ocular ultrasound, haemorrhagic choroidal detachment was suspected. She underwent external drainage via sclerostomies. The haemorrhage resolved ultrasonographically, but the vision did not improve. Five months postoperatively, she presented with sudden eye pain, lid swelling and proptosis. The ancillary workups were consistent with panophthalmitis and was treated as such. Six months postoperatively, the pain and lid swelling persisted; hence, the painful near absolute eye was enucleated. The histopathology revealed small round blue cells with necrosis consistent with retinoblastoma. Immunohistochemistry was positive for synaptophysin and negative for S100 confirming retinoblastoma. Retinoblastoma is the most common intraocular malignancy in children. The importance of increased awareness of its various presentations is of utmost importance to prevent life-threatening and vision-impairing complications.
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Affiliation(s)
- George Michael Ngo Sosuan
- Department of Ophthalmology and Visual Sciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Jazel T Eleazar-Verde
- Department of Ophthalmology and Visual Sciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Gary John V Mercado
- Department of Ophthalmology and Visual Sciences, College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Milagros H Arroyo
- Department of Ophthalmology and Visual Sciences, College of Medicine, University of the Philippines Manila, Manila, Philippines
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ACUTE INTRAOPERATIVE SUPRACHOROIDAL HEMORRHAGE DURING SMALL-GAUGE PARS PLANA VITRECTOMY. Retin Cases Brief Rep 2018; 12 Suppl 1:S9-S11. [PMID: 29155697 DOI: 10.1097/icb.0000000000000659] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To report the intraoperative occurrence of acute intraoperative suprachoroidal hemorrhage during small-gauge pars plana vitrectomy. METHOD A review of a surgical patient who developed acute intraoperative suprachoroidal hemorrhage during small-gauge pars plana vitrectomy because of bucking under general anesthesia. RESULTS A 32-year-old obese woman with proliferative diabetic retinopathy and traction retinal detachment in the left eye who developed intraoperative suprachoroidal hemorrhage during small-gauge pars plana vitrectomy because of bucking under general anesthesia while doing endolaser under air infusion. The pressure was immediately elevated to stabilize the hemorrhage without sclerotomy creation, and then gas (14% C3F8) was injected, with subsequent face-down positioning. The patient subsequently developed proliferative vitreoretinopathy, requiring additional surgery. The final visual acuity at 14-month follow-up was hand motions with a reattached retina in the left eye. CONCLUSION Valsalva-induced suprachoroidal hemorrhage during pars plana vitrectomy under general anesthesia may result in sight-threatening visual consequences. Current small-gauge vitrectomy techniques using valved cannulas may allow for better intraoperative management of this complication through control of the intraocular pressure in a closed system.
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Influence of Surgical Procedures and Instruments on the Incidence of Suprachoroidal Hemorrhage during 25-gauge Pars Plana Vitrectomy. Ophthalmol Retina 2018; 2:888-894. [PMID: 31047220 DOI: 10.1016/j.oret.2018.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 01/09/2018] [Accepted: 01/17/2018] [Indexed: 11/22/2022]
Abstract
PURPOSE To evaluate the influence of surgical procedures and instruments that are associated with intraocular pressure (IOP) fluctuations on the incidence of suprachoroidal hemorrhage (SCH) during 25-gauge pars plana vitrectomy (25G-PPV), and to investigate the clinical features of SCH during 25G-PPV. DESIGN Retrospective, comparative case series. PARTICIPANTS A total of 3034 cases that underwent initial 25G-PPV at a single surgical center. METHODS Univariate analysis was performed to evaluate the relationships between the incidence of SCH during 25G-PPV and the surgical procedures and instruments that were associated with IOP fluctuations. The participants were divided into 4 groups that underwent the following procedures: neither fluid-air exchange nor vitreous shaving under scleral depression (group 1, n = 1144); fluid-air exchange alone (group 2, n = 463); vitreous shaving under scleral depression alone (group 3, n = 639); and both procedures (group 4, n = 788). The incidence of SCH in each group was compared. The clinical features and surgical outcomes of SCH during 25G-PPV were also investigated. MAIN OUTCOME MEASURES The incidence of SCH during 25G-PPV and the clinical features and surgical outcomes of SCH during 25G-PPV. RESULTS The incidence of SCH was significantly higher in cases that underwent fluid-air exchange (P = 0.0047) or vitreous shaving under scleral depression (P = 0.0157). There were no significant relationships between the incidence of SCH and the use of surgical instruments. The incidence of SCH in group 4 (8/788, 1.02%) was significantly higher than that in groups 1 (1/1144, 0.09%), 2 (0/463, 0%), and 3 (0/639, 0%) (P = 0.01). Almost all SCH cases were localized, and there were no cases of SCH involving the posterior pole. Of all the SCH cases, only one case required reoperation for retinal redetachment. No cases required secondary surgical management for SCH. CONCLUSIONS There remains a slight risk of SCH during 25G-PPV in cases that require both fluid-air exchange and vitreous shaving under scleral depression. Even if SCH occurs during 25G-PPV, the surgical outcomes after SCH may not be substantially worse.
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Feretis E, Mourtzoukos S, Mangouritsas G, Kabanarou SA, Inoba K, Xirou T. Secondary Management and Outcome of Massive Suprachoroidal Hemorrhage. Eur J Ophthalmol 2018; 16:835-40. [PMID: 17191189 DOI: 10.1177/112067210601600608] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To present the results of secondary surgical treatment of five patients with massive suprachoroidal hemorrhage (MSCH), which occurred intraoperatively, postoperatively, or following ocular trauma. METHODS Five patients presenting with MSCH were included in this study during or after phacoemulsification surgery (1 patient), glaucoma surgery (1 patient), combined glaucoma and phacoemulsification surgery (2 patients), and after traumatic sclera rupture (1 patient). Diagnosis was confirmed by ophthalmoscopy and B-scan ultrasonography. Pre-existing risk factors and distance visual acuity were documented. All cases received medical therapy and underwent secondary surgical intervention with radial sclerotomies combined with vitrectomy, use of perfluorocarbon, and silicone oil. Postoperative assessment included visual acuity measurement, ocular examination, and ultrasonography. RESULTS In all cases, anatomic restoration of ocular structures was achieved. Distance visual acuity improved in all cases (preoperative Snellen visual acuity ranged from light perception to hand motions; postoperative Snellen visual acuity ranged from 0.05 to 0.3). The mean follow-up period was 17 months. CONCLUSIONS In general, despite the advanced surgical techniques, the prognosis of MSCH remains guarded and the visual outcome poor. However, secondary surgical treatment with combined radial sclerotomies and vitrectomy should be considered in order to minimize the damaging effect and maximize the anatomic and functional restoration.
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Affiliation(s)
- E Feretis
- Department of Ophthalmology, Red Cross Hospital, Athens, Greece
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Antiplatelet and anticoagulant agents in vitreoretinal surgery: a prospective multicenter study involving 804 patients. Graefes Arch Clin Exp Ophthalmol 2018; 256:461-467. [DOI: 10.1007/s00417-017-3897-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 11/08/2017] [Accepted: 12/29/2017] [Indexed: 01/07/2023] Open
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Bandivadekar P, Gupta S, Sharma N. Intraoperative Suprachoroidal Hemorrhage After Penetrating Keratoplasty: Case Series and Review of Literature. Eye Contact Lens 2017; 42:206-10. [PMID: 25996421 DOI: 10.1097/icl.0000000000000164] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe four cases of intraoperative suprachoroidal hemorrhage (SCH) during penetrating keratoplasty and to review the literature. METHODS Cases with intraoperative SCH during penetrating keratoplasty over 3-year period were reviewed. The parameters evaluated were ocular and systemic risk factors, intraoperative details, and postoperative outcomes. A review of literature of intraoperative SCH during penetrating keratoplasty was also conducted. RESULTS Of the 543 cases that underwent penetrating keratoplasty for optical indications during the study period, four cases developed intraoperative SCH, which is an incidence of 0.73%. Suprachoroidal hemorrhage occurred in the following cases: failed pediatric graft, donor eye in a case of contralateral autokeratoplasty, Marfan syndrome with aphakic bullous keratopathy who had undergone multiple ocular surgeries, and a case of healed keratitis with corneoiridic scar. The mean age, axial length, and intraocular pressure were 32.75±22.17 years (range, 4-57 years), 23.29±2.12 mm (range, 20.38-25.2 mm), and 16.25±3.86 mm Hg (range, 16-20 mm Hg), respectively. Postoperatively, two eyes had a best-corrected visual acuity (BCVA) of counting fingers. The third case had BCVA of light perception (LP), and fourth eye had no LP. CONCLUSION The visual outcomes in cases of open-sky penetrating keratoplasty with SCH continue to be abysmally poor. The importance of thoroughly informing the patient about this complication cannot be underrated.
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Affiliation(s)
- Pooja Bandivadekar
- Department of Ophthalmology (P.B., N.M.), Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India; and Department of Ophthalmology (S.G.), Armed Forces Medical College, Pune, India
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Intraoperative electrophysiological evaluations of macular function during peripheral scleral indentation. Sci Rep 2016; 6:35164. [PMID: 27762313 PMCID: PMC5071826 DOI: 10.1038/srep35164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 09/26/2016] [Indexed: 11/08/2022] Open
Abstract
Scleral indentation is widely used to examine the peripheral fundus, however it can increase the intraocular pressure (IOP) to high levels which can then affect retinal function. We evaluated the effects of scleral indentation on the macular function electrophysiologically. Intraoperative focal macular electroretinograms (iFMERGs) were recorded with and without controlling the IOP in 7 eyes. Without IOP control, the IOP increased from 21.7 ± 4.9 to 92.7 ± 20.2 mmHg significantly (P = 0.020) and the amplitudes of the b-wave (from 6.29 ± 1.160 to 3.71 ± 1.98 uV, P = 0.007), on-photopic negative response (from 2.29 ± 0.99 to 0.72 ± 0.47 uV, on-PhNR, P = 0.005), and d-wave (from 2.57 ± 0.41 to 1.64 ± 0.69 uV, P = 0.007) decreased significantly soon after beginning the indentation. All values returned to the baseline levels after releasing the indentation. In the eyes with IOP controlled, the IOP and the amplitude of all components did not change significantly during and after the indentation except the on-PhNR amplitude which was significantly reduced during the indentation. The changes in the iFMERGs and macular function caused by scleral indentation were transient and reversible. The changes can be minimized by controlling the IOP.
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Bozkurt TK, Miller KM. Suprachoroidal hemorrhage during femtosecond laser assisted cataract surgery. Am J Ophthalmol Case Rep 2016; 4:45-46. [PMID: 29503923 PMCID: PMC5757486 DOI: 10.1016/j.ajoc.2016.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 08/21/2016] [Accepted: 08/29/2016] [Indexed: 11/18/2022] Open
Abstract
Purpose To describe a case of suprachoroidal hemorrhage that occurred during femtosecond laser assisted cataract surgery (FLACS). Observations A 67-year-old woman with high myopia underwent FLACS. Following two unsuccessful attempts at docking due to interface air bubbles, the third attempt was successful. Laser treatment and cataract surgery proceeded uneventfully until intraocular lens (IOL) implantation. While positioning the IOL within the capsular bag, the anterior chamber began to shallow, intraocular pressure became high by palpation, and the optic of the IOL prolapsed partially out of the bag. A segmental suprachoroidal hemorrhage was identified in the superior peripheral retina by intraoperative indirect ophthalmoscopy. Following an hour of waiting in the recovery room, the anterior chamber deepened and the intraocular pressure was low enough to position the IOL centrally within the bag. Her subsequent postoperative course was uneventful. Conclusions and Importance To our knowledge, this is the first report of suprachoroidal hemorrhage during FLACS. We speculate that repeated sudden drops in intraocular pressure associated with multiple undockings triggered the suprachoroidal hemorrhage in this case.
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Affiliation(s)
| | - Kevin M. Miller
- Corresponding author. Kolokotrones Chair in Ophthalmology, Stein Eye Institute, 300 Stein Plaza, 2nd Floor, UCLA, Los Angeles, CA, 90095-7000, USA.Kolokotrones Chair in OphthalmologyStein Eye Institute300 Stein Plaza2nd FloorUCLALos AngelesCA90095-7000USA
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Ghoraba HH, Zaky AG, Ellakwa AF. Long-term follow-up of vitrectomy, with or without 360° encircling buckle, for rhegmatogenous retinal detachment due to inferior retinal breaks. Clin Ophthalmol 2016; 10:1145-51. [PMID: 27382248 PMCID: PMC4922796 DOI: 10.2147/opth.s102082] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective The aim of this study was to report and compare the anatomic and functional results of primary vitrectomy with and without 360° encircling scleral buckle (SB) for the treatment of rhegmatogenous retinal detachment (RRD) due to inferior retinal break(s). Background A variety of options, including SB, pars plana vitrectomy (PPV) with or without SB, and pneumatic retinopexy have been described as methods to repair RRDs. The use of additional SB with vitrectomy for RRD associated with inferior breaks has been a recent controversy after the introduction of transconjunctival cannula systems. Patients and methods A retrospective, interventional, comparative case study was performed. In this study, we reviewed 105 consecutive patients who underwent vitrectomy for primary RRD with inferior retinal break(s) at the vitreoretinal center, performed by a single surgeon. Ninety four patients (94 eyes) were followed up for at least 4 months after silicon oil removal (SOR), and were analyzed. They were divided into two groups: group I included 50 patients who underwent PPV alone + silicon oil (SO); and group II included 44 patients who underwent PPV with 360° SB + SO. The essential parameters were single-operation success rate (SOSR) before SOR, incidence of retinal redetachment after SOR, and final visual acuity. Results SOSR was obtained in 89 eyes (47 [94%] in group I and 42 [95.5%] in group II). From overall 59 phakic retinal detachments (RDs), SOSR was obtained in 56 eyes (30 in group I [93.8%] and 26 in group II [96.3%]) while from overall 35 aphakic or pseudophakic RDs, SOSR was obtained in 33 eyes (17 in group I [94.4%] and 16 in group II [94.1%]). Retinal redetachments after SOR occurred in three patients in group I and two patients in group II. Visual acuity improvement was greater in group I than in group II before SOR. Conclusion Both surgical procedures had similar reattachment rates. The addition of 360° SB to PPV + SO might not have additional benefits in patients with RD due to inferior retinal break.
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Affiliation(s)
- Hamouda Hamdy Ghoraba
- Ophthalmology Department, Faculty of Medicine, Tanta University, Tanta; Opthalmology Department, El Magrabi Eye Hospital, Tanta
| | - Adel Galal Zaky
- Ophthalmology Department, Faculty of Medicine, Menoufia University, Cairo, Egypt
| | - Amin Faisal Ellakwa
- Ophthalmology Department, Faculty of Medicine, Menoufia University, Cairo, Egypt
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Reibaldi M, Longo A, Romano MR, Cennamo G, Mariotti C, Boscia F, Bonfiglio V, Avitabile T. Delayed Suprachoroidal Hemorrhage After Pars Plana Vitrectomy: Five-Year Results of a Retrospective Multicenter Cohort Study. Am J Ophthalmol 2015; 160:1235-1242.e1. [PMID: 26344581 DOI: 10.1016/j.ajo.2015.08.035] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 08/23/2015] [Accepted: 08/24/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE To determine the incidence, risk factors, and outcomes of delayed suprachoroidal hemorrhage after vitrectomy. DESIGN Retrospective multicenter cohort study. METHODS All consecutive patients who underwent primary vitrectomy, from January 2009 to December 2014, at 4 tertiary vitreoretinal centers in Italy were enrolled. Patient demographics and systemic, ophthalmic, operative, and postoperative data from all centers were extracted from the electronic record system using standardized data collection forms. All eyes that developed delayed suprachoroidal hemorrhage within 48 hours of the end of the vitrectomy were identified as the delayed suprachoroidal hemorrhage group; all other eyes that underwent vitrectomy in the same period, without delayed suprachoroidal hemorrhage, were considered the control group. RESULTS From a total of 4852 vitrectomy procedures, 39 cases of delayed suprachoroidal hemorrhage (0.8%) were identified. Multivariable logistic regression showed that significant risk factors for developing delayed suprachoroidal hemorrhage included advancing age (odds ratio [OR], 2.22; P < .001), longer axial length (OR, 2.57; P < .001), presence of rhegmatogenous retinal detachment (OR, 3.27; P = .005), extensive intraoperative photocoagulation (OR, 4.94; P < .001), and emesis postoperatively (OR, 24.39; P < .001). Decision-tree analysis showed that the stronger predictors of delayed suprachoroidal hemorrhage were emesis postoperatively (P < .001) and extensive intraoperative photocoagulation (P < .001). After a mean follow-up of 27 ± 8 months, the best-corrected visual acuity decreased from 1.3 preoperatively to 1.6 logarithm of minimal angle of resolution at last follow-up (P < .001). CONCLUSIONS Delayed suprachoroidal hemorrhage occurs in 0.8% of vitrectomized eyes. The main risk factors are postoperative emesis and intraoperative extensive photocoagulation.
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Laube T, Brockmann C, Bornfeld N. Massive suprachoroidal hemorrhage: Surgical management and outcome. GMS OPHTHALMOLOGY CASES 2015; 5:Doc10. [PMID: 27625954 PMCID: PMC5015633 DOI: 10.3205/oc000032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Objective: To describe options for vitreoretinal surgery in the management of massive suprachoroidal hemorrhage (SCH). Methods: Visual acuity (VA), ocular findings, timing of surgical intervention, surgical procedures, and outcomes of four patients diagnosed with massive SCH and admitted to the University Eye Clinic Essen were reviewed retrospectively. Results: Four eyes of four patients (mean age, 82 years; range, 74–89 years) were studied. In three cases the occurrence of SCH was related to cataract surgery and occurred intra- or postoperatively. One patient developed spontaneous SCH of unclear origin. Three patients had a history of arterial hypertension; one eye had high myopia, two patients suffered from cardiovascular diseases, and two patients had glaucoma. Postoperative follow up of the patients ranged from 5 to 29.5 months (mean, 19.6 months). Transscleral drainage of SCH was in all cases combined with pars plana vitrectomy, use of heavy liquids (perfluorodecalin) and silicone oil tamponade. The mean time interval from hemorrhage to surgical intervention was 16.5 days (range 5–29 days). Preoperative VA of all eyes was light perception. Two patients achieved a final postoperative visual acuity of 20/20 and 20/320, respectively, one patient improved to hand motion, and one patient resulted in no light perception. Conclusions: Surgical interventions including transscleral drainage of SCH, vitrectomy, and silicone oil tamponade are valuable options in the management of massive SCH to save the eye and possibly improve the otherwise extreme poor prognosis.
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Affiliation(s)
| | | | - Norbert Bornfeld
- Department of Ophthalmology, University Hospital, University of Duisburg-Essen, Essen, Germany
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Kim YJ, Park SH, Choi KS. FLUCTUATION OF INFUSION PRESSURE DURING MICROINCISION VITRECTOMY USING THE CONSTELLATION VISION SYSTEM. Retina 2015; 35:2529-36. [PMID: 26035515 DOI: 10.1097/iae.0000000000000625] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To measure fluctuations in infusion pressure and intraocular pressure (IOP) during vitrectomy performed using a flow-based IOP control system. METHODS Using 3 vitrectomized porcine eyes, the authors simultaneously measured infusion pressure and IOP during vitreous cutting and aspiration and after extraction of operative instruments in 23-gauge and 25-gauge system. The measurements were performed with the "IOP control" setting turned on or off. The efficacy of valved cannula and a built-in "IOP control limit" module in attenuation of infusion pressure fluctuation was evaluated. RESULTS At set pressure of 30 mmHg and 60 mmHg, the mean infusion pressure levels were 43.7 mmHg and 78.7 mmHg in the vitreous cutting mode, 67.4 mmHg and 101.2 mmHg in the aspiration mode, and 72.8 mmHg and 115.8 mmHg after extraction of the operative instrument, respectively, when the 23-gauge system was used. Use of valved cannulas effectively attenuated fluctuations in both infusion pressure and IOP. When the IOP control limit setting was "on," the compensatory infusion pressure increase was markedly limited and similar to the set pressure level when the IOP control limit was set at Level 2. Similar results were obtained when a 25-gauge system was used. CONCLUSION Infusion pressure increased markedly during vitrectomy using a flow-based IOP control system.
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Affiliation(s)
- Yong Joon Kim
- Department of Ophthalmology, Soonchunhyang University College of Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
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Brillat E, Rouberol F, Palombi K, Quesada JL, Bernheim D, Albaladejo P, Aptel F, Romanet JP, Chiquet C. A case–control study to assess aspirin as a risk factor of bleeding in rhegmatogenous retinal detachment surgery. Graefes Arch Clin Exp Ophthalmol 2015; 253:1899-905. [DOI: 10.1007/s00417-014-2900-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 12/10/2014] [Accepted: 12/15/2014] [Indexed: 11/30/2022] Open
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Gallice M, Rouberol F, Albaladejo P, Brillat Zaratzian E, Palombi K, Aptel F, Romanet JP, Chiquet C. [Managing antithrombotic therapy in vitreoretinal surgery]. J Fr Ophtalmol 2015; 38:61-73. [PMID: 25577431 DOI: 10.1016/j.jfo.2014.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 07/21/2014] [Accepted: 07/21/2014] [Indexed: 11/18/2022]
Abstract
Given the growing number of patients on antithrombotic therapy we are increasingly confronted with the management of this therapy before, during and after vitreoretinal surgery. In the absence of a consensus, the decision to withdraw antithrombotic therapy is based on the cardiovascular thromboembolism risk versus the theoretical risk of bleeding if the antithrombotic treatment is continued. As suggested by the literature, antiplatelet therapy (acetylsalicylic acid or clopidogrel) may be safely continued for vitreoretinal surgery, including retinal detachment repair. However, the risk/benefit ratio for patients being treated with two antiplatelet therapies is unknown. It appears that an International Normalized Ratio (INR) less than 3 for patients treated with anticoagulant therapy does not increase the perioperative risk of ocular bleeding. This risk has not been evaluated in patients treated by new antithrombotic therapies (prasugrel, ticagrelor as antiplatelet medication, or dabigatran, rivaroxaban, apixaban as anticoagulant therapy), and there is a need to study it further.
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Affiliation(s)
- M Gallice
- Clinique universitaire d'ophtalmologie, CHU de Grenoble, boulevard de la Chantourne, 38700 La Tronche, France; Université Joseph-Fourier, 621, avenue Centrale, 38041 Saint-Martin-d'Hères, France
| | - F Rouberol
- Centre ophtalmologique Kleber, 50, cours Franklin-Roosevelt, 69006 Lyon, France
| | - P Albaladejo
- Université Joseph-Fourier, 621, avenue Centrale, 38041 Saint-Martin-d'Hères, France; Département d'anesthésie-réanimation, CHU de Grenoble, boulevard de la Chantourne, 38700 La Tronche, France
| | - E Brillat Zaratzian
- Clinique universitaire d'ophtalmologie, CHU de Grenoble, boulevard de la Chantourne, 38700 La Tronche, France
| | - K Palombi
- Clinique universitaire d'ophtalmologie, CHU de Grenoble, boulevard de la Chantourne, 38700 La Tronche, France; Université Joseph-Fourier, 621, avenue Centrale, 38041 Saint-Martin-d'Hères, France
| | - F Aptel
- Clinique universitaire d'ophtalmologie, CHU de Grenoble, boulevard de la Chantourne, 38700 La Tronche, France; Université Joseph-Fourier, 621, avenue Centrale, 38041 Saint-Martin-d'Hères, France
| | - J-P Romanet
- Clinique universitaire d'ophtalmologie, CHU de Grenoble, boulevard de la Chantourne, 38700 La Tronche, France; Université Joseph-Fourier, 621, avenue Centrale, 38041 Saint-Martin-d'Hères, France
| | - C Chiquet
- Clinique universitaire d'ophtalmologie, CHU de Grenoble, boulevard de la Chantourne, 38700 La Tronche, France; Université Joseph-Fourier, 621, avenue Centrale, 38041 Saint-Martin-d'Hères, France.
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Zhang J, Zhu XH, Tang LS. Rhegmatogenous retinal detachment associated with massive spontaneous suprachoroidal hemorrhage and prognosis of pars plana vitrectomy. Int J Ophthalmol 2014; 7:850-4. [PMID: 25349805 DOI: 10.3980/j.issn.2222-3959.2014.05.20] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 02/11/2014] [Indexed: 11/02/2022] Open
Abstract
AIM To describe the clinical characters of rhegmatogenous retinal detachment (RRD) associated with massive spontaneous suprachoroidal hemorrhage (SSCH). To evaluate optimal timing and prognosis of pars plana vitrectomy. METHODS A retrospective review of 6 cases (6 eyes) of RRD and massive SSCH among 3772 cases of RRD was conducted. All of 6 patients were treated with twenty-gauge vitrectomy, suprachoroidal blood drainage, phacoemulsification (PHACO) or lensectomy and silicon oil tamponade. The clinical characters, intraoperative findings and treatment outcomes were reported. RESULTS In the 6 affected eyes of 6 patients (3 men and 3 women; mean age, 53.83y; range 34-61y), preoperative visual acuity ranged from faint light perception (LP) to counting finger (CF). The average interventional duration from visual decreased to surgery was 12.8 d (range 9-15d). All eyes were associated with high myopia and the mean ocular length was 30.32 mm (range 28.14-32.32 mm). Choroidal hemorrhage were successfully drained in the operation of all 6 eyes. Intraoperative findings showed there were multiple retinal breaks in all 6 eyes and in 4 eyes breaks were along supratemporal and/or infratemporal retinal vascular arcade, especially in the edge of chorioretinal atrophy areas. These patients were followed up from 6 to 34mo (Mean, 23.5mo). The best-corrected visual acuity after surgery varied from CF to 20/100, with improvement in 5 eyes (83.33%) and no change in 1 eye (16.67%). Ocular hypertension ocurred in 1 eye (16.67%), which was successfully treated by silicon oil removal combined with trabeculectomy. In 4 eyes, tractional retinal detachment caused by proliferative vitreoretinopathy (PVR) appeared and a secondary surgery of pre-retinal membrane peeling and silicon oil retained were performed. In 4 eyes, silicon oil cannot be removed. The initial and final reattachment rates were 33.33% and 66.67%, respectively. CONCLUSION RRD associated with massive SSCH is an extremely rare event. The most common risk factor is long axial length. Vitrectomy and choroidal blood drainage can effectively remove suprachoroidal hemorrhage and promote retinal reattachment in these eyes. However, silicon oil could not be removed in most eyes and final visual acuities are generally poor.
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Affiliation(s)
- Jie Zhang
- Department of Ophthalmology, the Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
| | - Xiao-Hua Zhu
- Department of Ophthalmology, the Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
| | - Luo-Sheng Tang
- Department of Ophthalmology, the Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
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Abstract
PURPOSE To evaluate the efficiency of treating selected cases of inferior retinal detachment in silicone oil-filled eyes using a supplemental scleral buckling with external drainage of subretinal fluid, versus performing a second vitreoretinal surgery and silicone oil endotamponade. METHODS A prospective interventional pilot study that was performed on silicone oil-filled eyes with inferior retinal detachment. Twenty-three eyes of 23 consecutive patients were alternatively distributed between 2 groups: Group A included 12 eyes treated with supplemental scleral buckling with drainage of subretinal fluid and without the removal of silicone oil, and Group B included 11 eyes treated with silicone oil removal, vitreoretinal surgery, and reinjection of silicone oil. The preoperative data included indications and details of primary vitreoretinal surgery, cause of retinal redetachment, subretinal fluid, grade of proliferative vitreoretinopathy, lens status, and the duration between primary vitreoretinal surgery and reoperation. The postoperative examination included the best-corrected visual acuity, retina status, proliferative vitreoretinopathy, silicone oil, and any reported complication. Follow-up examinations were scheduled at Day 1, weekly for 1 month, and monthly thereafter till the end of the follow-up period which extended for at least 2 months after silicone oil removal. RESULTS The average number of detached clock hours per eye was 2.7 in Group A and 2.4 in Group B, caused by a mean of 1.58 ± 0.80 break per eye in Group A and 1.48 ± 0.66 break per eye in Group B. The mean interval between the primary vitreoretinal surgery and the scleral buckling procedure in Group A patients was 2.83 ± 1.22 months (range, 1-5 months), while in Group B, the mean interval between the primary and the secondary vitreoretinal surgeries was 3.00 ± 1.61 months (range, 1-6 months). The mean operative time was statistically significantly (P < 0.05) shorter in Group A (38.7 ± 11.2 minutes) than in Group B (65.3 ± 15.1 minutes). The mean follow-up duration was 15.00 ± 3.22 months in Group A and 14.18 ± 2.99 months in Group B. After silicone oil removal, the retina was attached in 10 of the 12 eyes (83.3%) and redetached in 2 eyes (16.7%) in Group A, while in Group B, the retina was attached in 9 of the 11 eyes (81.8%) and redetached in 2 eyes (18.2%) after silicone oil removal. The mean logarithm of the minimum angle of resolution best-corrected visual acuity has improved from 1.82 ± 0.72 to 1.36 ± 0.52 in Group A patients (P > 0.05) and from 1.93 ± 0.74 to 1.55 ± 0.63 in Group B patients (P > 0.05) at the end of the follow-up duration. CONCLUSION For selected cases of inferior retinal detachment in silicone oil-filled eyes, supplemental scleral buckling could be as effective as a second vitreoretinal surgery. Scleral buckling could offer a faster, less invasive, and better economic alternative to repeated vitreoretinal surgery for treatment of such cases.
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Sugiura Y, Okamoto F, Okamoto Y, Hiraoka T, Oshika T. Intraocular pressure fluctuation during microincision vitrectomy with constellation vision system. Am J Ophthalmol 2013; 156:941-947.e1. [PMID: 23972313 DOI: 10.1016/j.ajo.2013.06.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Revised: 06/11/2013] [Accepted: 06/11/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate intraocular pressure (IOP) fluctuation during various vitrectomy maneuvers using the vitrectomy system (Alcon Constellation Vision System). DESIGN An experimental study as laboratory investigation. METHODS In porcine eyes, 23- and 25-gauge vitrectomy was performed, and IOP fluctuations were evaluated in vitreous cutting mode, in aspiration mode, and during scleral compression. The measurements were performed with the IOP control setting turned on or off. RESULTS Using the 23-gauge system with the IOP control setting turned on, IOP decreased from 30 to 23.7 mm Hg after starting vitreous cutting, and then returned to 30 mm Hg in 2.6 seconds. When the IOP control setting was turned off, IOP decreased to 19.1 mm Hg in 0.9 seconds, and remained at that pressure. Under aspiration at 650 mm Hg without cutting, IOP showed a sharp depression from 30 to 12.2 mm Hg, and then returned to 30.6 mm Hg in 2.6 seconds with the IOP control setting turned on. When the IOP control setting was turned off, IOP decreased to 2.2 mm Hg in 9.7 seconds, and did not recover. When the sclera was compressed without aspiration, IOP rapidly increased to 70-100 mm Hg, and then slowly decreased to 30 mm Hg in 3.5-4.0 seconds, with or without the IOP control system. Similar data were obtained with 25-gauge vitrectomy. CONCLUSIONS The IOP control system can attenuate IOP fluctuations during vitrectomy maneuvers. There was no significant difference in IOP fluctuations between 23- and 25-gauge systems.
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Goto T, Nakagomi T, Iijima H. A comparison of the anatomic successes of primary vitrectomy for rhegmatogenous retinal detachment with superior and inferior breaks. Acta Ophthalmol 2013; 91:552-6. [PMID: 22691313 DOI: 10.1111/j.1755-3768.2012.02455.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To compare the anatomic success between repair of rhegmatogenous retinal detachment (RRD) with superior breaks and repair of RRD with inferior breaks, by performing primary vitrectomy and using similar techniques and the same gas. METHODS Eighty-two consecutive eyes of 80 patients with RRD were included in this retrospective comparative study. The eyes were divided into two groups according to the location of the breaks: superior (n = 62) and inferior (n = 20). All the patients underwent a standard, 3-port, 20-gauge pars plana vitrectomy with 20% sulphur hexafluoride gas tamponade performed by the same surgeon. The main outcome measured was the primary anatomic reattachment at 3 months after surgery. RESULTS The primary anatomic success rate in the inferior group was significantly lower than that in the superior group (80% versus 98%, p = 0.012). In the inferior group, the primary anatomic success rate in patients whose symptoms lasted for more than 2 weeks was significantly lower than that in others (5/9 versus 11/11, p = 0.026). Multivariate logistic regression analysis identified inferior break as the only independent risk factor for redetachment (odds ratio, 11.88; p = 0.034). CONCLUSION The anatomic success of primary vitrectomy for RRD with inferior breaks is lower than that for RRD with superior breaks. In particular, the duration of symptoms longer than 2 weeks is associated with a worse outcome in patients who had RRD with inferior breaks.
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Affiliation(s)
- Teruhiko Goto
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Japan.
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Chandra A, Xing W, Kadhim MR, Williamson TH. Suprachoroidal hemorrhage in pars plana vitrectomy: risk factors and outcomes over 10 years. Ophthalmology 2013; 121:311-317. [PMID: 23870800 DOI: 10.1016/j.ophtha.2013.06.021] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Revised: 05/21/2013] [Accepted: 06/11/2013] [Indexed: 01/29/2023] Open
Abstract
PURPOSE To investigate the rate and risk factors of developing suprachoroidal hemorrhage (SCH) after pars plana vitrectomy (PPV) and the outcomes as a result. DESIGN Retrospective, comparative consecutive series. PARTICIPANTS A total of 5459 patients who underwent pars plana vitrectomies over 10 years in 3 surgical centers. METHODS All patient demographic, medical, and ophthalmic data and operative information from 3 vitreoretinal centers were entered prospectively into an electronic medical record. Univariate analysis was undertaken, comparing risk factors between cases (SCH) and controls. Multivariable logistic regression was performed to test for independence between the risk factors (P < 0.2 in univariate analysis) and SCH. MAIN OUTCOME MEASURES Risk factors for developing SCH. Visual outcome and development of complications. RESULTS A total of 5459 PPVs were undertaken for a wide range of indications. Fifty-six cases of PPV were complicated by SCH (1.03%). Multivariable logistic regression showed that significant risk factors for developing this included advancing age, (mean age, 69 years in cases and 60 years in controls; odds ratio [OR], 1.04; P = 0.001), male sex (76.8% of cases and 58.7% of controls; OR, 2.38; P = 0.008), presence of rhegmatogenous retinal detachment (RRD) (80.3% of cases and 52.5% of controls; OR, 5.92; P < 0.0001), presence of a dropped lens fragment (10.7% of cases and 4.5% of controls; OR, 6.94; P = 0.002), and the use of antiplatelet or anticoagulant drugs (33.9% of cases and 17.7% of controls; OR, 2.29; P = 0.007). Suprachoroidal hemorrhage was more common with increasing quadrants of RRD. The significant operative risk factor was application of an explant (25% of cases and 4.07% of controls; OR, 5.63; P < 0.0001). Phthisis (7.1% of cases and 0.9% of controls; P = 0.002, Fisher exact test) and glaucoma (14.3% of cases and 7.2% of controls; P = 0.044, chi-square test) were more common in cases than in controls. CONCLUSIONS The risk factors for developing intraoperative SCH during PPV are male sex, advancing age, RRD, a scleral explant, a dropped lens fragment, and the use of aspirin or warfarin. Patients with this complication have a greater risk of developing ocular hypertension requiring treatment and phthisis.
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Affiliation(s)
- Aman Chandra
- Vitreoretinal Department, Moorfields Eye Hospital, London, United Kingdom; Research & Development, Moorfields Eye Hospital, London, United Kingdom
| | - Wen Xing
- Research & Development, Moorfields Eye Hospital, London, United Kingdom
| | - Mustafa R Kadhim
- Vitreoretinal Department, Moorfields Eye Hospital, London, United Kingdom
| | - Tom H Williamson
- Department of Ophthalmology, Guy's & St. Thomas' Hospitals, London, United Kingdom.
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Postoperative choroidal hemorrhage shows elevated concentration of tissue plasminogen activator. Retin Cases Brief Rep 2012; 6:261-2. [PMID: 25389726 DOI: 10.1097/icb.0b013e3182247817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to report the levels of tissue plasminogen activator in liquefied suprachoroidal hemorrhage. METHODS An interventional case report of a 61-year-old woman who underwent drainage sclerotomy for choroidal hemorrhage. RESULTS A 61-year-old pseudophakic woman underwent pars plana vitrectomy and fluid-gas exchange for retinal detachment in her right eye and developed postoperative serous choroidal detachments with large hemorrhages. Drainage sclerotomy was performed 18 days after the initial development of suprachoroidal hemorrhage. Sample of the liquefied hemorrhage and serum sample collected during sclerotomy were tested for tissue plasminogen activator levels using the antibody tissue plasminogen activator-enzyme immunoassay test. Hemorrhage tissue plasminogen activator levels were three times the levels present in the serum. CONCLUSION Tissue plasminogen activator may be involved in the process of suprachoroidal hemorrhage liquefaction.
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ANATOMICAL AND VISUAL RESULTS OF TRANSCONJUNCTIVAL SUTURELES VITRECTOMY USING SUBCONJUNCTIVAL ANESTHESIA PERFORMED ON SELECT PATIENTS TAKING ANTICOAGULANT AND ANTIPLATELET AGENTS. Retina 2012; 32:905-11. [DOI: 10.1097/iae.0b013e31822f55c4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Seo SJ, Lee SJ, Park JM. Surgical Outcome and Significance of Silicone Oil Tamponade for Inferior Rhegmatogenous Retinal Detachment. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2012. [DOI: 10.3341/jkos.2012.53.9.1296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Sang Jin Seo
- Department of Ophthalmology, Maryknoll Hospital, Busan, Korea
| | - Soo Jung Lee
- Department of Ophthalmology, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jung Min Park
- Department of Ophthalmology, Maryknoll Hospital, Busan, Korea
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Ruiz-De-Gopegui E, Ascaso FJ, Del Buey MA, Cristóbal JA. [Effects of encircling scleral buckling on the morphology and biomechanical properties of the cornea]. ACTA ACUST UNITED AC 2011; 86:363-7. [PMID: 22040643 DOI: 10.1016/j.oftal.2011.05.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2010] [Revised: 03/20/2011] [Accepted: 05/25/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the effects of encircling scleral buckle (SB) on corneal biomechanical properties of the cornea and its morphological parameters. METHODS We prospectively examined twelve eyes diagnosed with vitreous haemorrhage undergoing pars plana vitrectomy (PPV), and fifteen eyes undergoing combined PPV and scleral buckle (PPV/SB) for repair of rhegmatogenous retinal detachment (RRD). Corneal biomechanical properties, including corneal hysteresis (CH) and corneal resistance factor (CRF), were measured with an Ocular Response Analyser (ORA) before and 1-month postoperatively. The ORA also determined the values of intraocular pressure (IOPg) and corneal compensated IOP (IOPcc). Finally, four morphological parameters of the cornea were measured with the Orbscan II topographer (Orbtek, Inc.): mean corneal power, thinnest corneal point (μm), and anterior chamber depth (ACD). RESULTS CH decreased significantly from 10.2+/-1.7mmHg to 7.6+/-1.1mmHg after PPV/SB (p=0.003), but not after PPV alone (9.8+/-3.2mmHg vs 11.6+/-2.7mmHg, P=.465). CRF did not change significantly after surgery in both groups. IOPg and IOPcc increased significantly in the PPV/SB group (P=.019 and P=.010, respectively) but not in PPV group (P=.715 and P=.273, respectively). Unlike the PPV group, values were significantly higher than IOPg values before (P=.001) and after surgery (P=.003) in the PPV/SB group IOPcc. Neither the PPV/SB group nor the PPV group showed any significant changes in the corneal morphological parameters after surgery (P>.05). CONCLUSIONS SB surgery leads to a change in the corneal biomechanical properties without altering corneal morphological parameters. It may cause an underestimation error in IOP measurement. PPV may be a less invasive surgical approach for the repair of noncomplex RRD than PPV/SB.
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TWENTY-THREE–GAUGE PARS PLANA VITRECTOMY, DENSIRON-68, AND 360° ENDOLASER VERSUS COMBINED 20-GAUGE PARS PLANA VITRECTOMY, SCLERAL BUCKLE, AND SF6 FOR PSEUDOPHAKIC RETINAL DETACHMENT WITH INFERIOR RETINAL BREAKS. Retina 2011; 31:686-91. [DOI: 10.1097/iae.0b013e3181f0d249] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rouberol F, Feldman A, Denis P, Romanet JP, Chiquet C. [Prospective study of 34 retinal detachments associated with giant retinal tear]. J Fr Ophtalmol 2010; 33:23-30. [PMID: 20061051 DOI: 10.1016/j.jfo.2009.11.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Accepted: 11/09/2009] [Indexed: 11/29/2022]
Abstract
PURPOSE To report the anatomical and functional outcomes of vitrectomy with silicone oil tamponade in the treatment of retinal detachment associated with giant retinal tears due to various factors. METHODS We prospectively followed 34 eyes of 33 patients with giant retinal tear. That underwent vitrectomy, injection of perfluorocarbon liquids and silicone oil tamponade. Scleral buckle was associated with vitrectomy in cases of inferior giant retinal tear; 26,5 % and 11,8 %, respectively, demonstrated pseudophakia and aphakia. Seven eyes (20,5 %) had a history of trauma (blunt injuries in four and a penetrating injury in three) and, 14 eyes (41,2 %) had severe myopia. One patient developed a bilateral giant retinal tear during the follow-up. RESULTS Retinal attachment was obtained in 33 (97 %) of 34 eyes, with a mean follow-up of 14,5+/-6 months. Retinal detachment reoccurred in four eyes (11,6 %) under silicone oil, in one eye (2,9 %) during the silicone removal, and in two eyes (5,8 %) after silicone removal and cataract surgery. Silicone oil was removed from all eyes (4,3+/-1 months). The most frequent postoperative complication was cataract in ten of 18 phakic eyes (55,5 %). Functional success with visual acuity 0,4 or better was obtained in 18 cases (52,96 %). CONCLUSION Pars plana vitrectomy with silicone oil tamponade proved to be highly effective in giant retinal tears in terms of the anatomical and functional results. The analysis of recurrent retinal detachment allowed us to refine the technique and to suggest scleral buckle in one case of inferior retinal tear with laser over 360 degrees .
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Affiliation(s)
- F Rouberol
- Centre Ophtalmologique Kleber, Lyon, France.
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Salyer DA, Beaudry N, Basavanthappa S, Twietmeyer K, Eskandari M, Denninghoff KR, Chipman RA, Park RI. Retinal Oximetry Using Intravitreal Illumination. Curr Eye Res 2009; 31:617-27. [PMID: 16877270 DOI: 10.1080/02713680600760493] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To demonstrate spectroscopic retinal oximetry measurements on arteries and veins in swine using intravitreal illumination. Retinal arterial and venous saturations are measured for a range of inspired O2 levels after pars plana vitrectomy. METHODS Pars plana vitrectomy and intravitreal manipulations were performed on two female American Yorkshire domestic swine. Light from a scanning monochromator was coupled into a fiberoptic intraocular illuminator inserted into the vitreous. The retinal vessels were illuminated obliquely, minimizing vessel glints. Multispectral images of the retinal vasculature were obtained as the swine's arterial blood oxygen saturation was decreased from 100% to 67% in decrements of approximately 10%. Retinal vessel spectra were used to calculate oxygen saturation in selected arteries and veins. Arterial oxygen saturations were calibrated using blood gas analysis on blood drawn from a Swan-Ganz catheter placed in the femoral artery. RESULTS Oblique illumination of retinal vessels using an intravitreal fiberoptic illuminator provided a substantial reduction in the central vessel glint usually seen in fundus images, thus simplifying the analysis of spectral data. The vessel shadows were displaced from the vessel image simplifying the light paths in the eye. Using a full spectral analysis simplified by the light path reductions, we calculated retinal vessel saturations. The reduction of glint allowed for increased accuracy in measuring retinal vessel spectral optical density. Abnormally low retinal venous oxygen saturations were observed shortly after pars plana vitrectomy. CONCLUSIONS Retinal oximetry using intravitreal illumination has been demonstrated. As a research tool, intravitreal illumination addresses several difficulties encountered when performing retinal oximetry with transcorneal illumination.
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Affiliation(s)
- David A Salyer
- Optical Sciences Center, University of Arizona, Tucson, Arizona 85721, USA.
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Li W, Zheng J, Zheng Q, Wu R, Wang X, Xu M. Clinical complications of Densiron 68 intraocular tamponade for complicated retinal detachment. Eye (Lond) 2009; 24:21-8. [DOI: 10.1038/eye.2009.57] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Wang LC, Yang CM, Yang CH, Huang JS, Ho TC, Lin CP, Chen MS. Clinical characteristics and visual outcome of non-traumatic suprachoroidal haemorrhage in Taiwan. Acta Ophthalmol 2008; 86:908-12. [PMID: 18631331 DOI: 10.1111/j.1755-3768.2008.01266.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE This study aimed to evaluate the clinical features and visual outcomes of non-traumatic suprachoroidal haemorrhage (SH) in Taiwan. METHODS We report a retrospective, non-comparative, interventional case series study carried out in an institutional setting. Thirty-nine eyes with non-traumatic SH were studied using a new system for grading the severity of SH. The aetiologies of SH were analysed. The correlations between grades and prognoses of SH were studied. Multiple logistic regression was used to assess factors associated with final visual outcome. RESULTS Conditions causing SH in the eyes considered in this study included cataract surgery (43.59%), age-related macular degeneration (AMD) (17.95%), filtering operation and vitrectomy (both 10.26%), scleral buckling (5.13%) and others. Twelve eyes (12/39, 30.77%) had a final visual outcome of no light perception. Only 12 eyes (12/39, 30.77%) had final visual acuity (VA) > 4/200. Grade of SH correlated significantly with need for surgical drainage and with final visual outcome (Spearman rank correlations 0.313 and - 0.408, p = 0.010 and p = 0.00317, respectively). 'Good' and 'poor' final VA was significantly associated with VA at the time of SH (multiple logistic regression coefficients 2.132 and - 2.809, p = 0.015 and p = 0.008, respectively), as well as initial retinal detachment (multiple logistic regression coefficients - 2.267 and 2.223, p = 0.036 and p = 0.006, respectively). Higher grades of SH and increased age were associated with poor final visual outcome (multiple logistic regression coefficients - 1.332 and - 0.122, p = 0.013 and p = 0.022, respectively). CONCLUSIONS Suprachoroidal haemorrhage is a devastating ocular problem. Complications of intraoperative surgery and AMD are common causes. The new SH grading system provides a simple method for evaluating the need for drainage and for predicting visual prognosis. Visual acuity and retinal detachment at the time of SH are major factors associated with good and poor final VA, respectively.
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Affiliation(s)
- Lu-Chun Wang
- Department of Ophthalmology, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
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