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Benzerroug M, Marchand M, Coisy S, Briend B, Boussion B, Mazit C. 25-GAUGE VERSUS 27-GAUGE VITRECTOMY FOR MANAGEMENT OF VITREORETINAL DISEASES: A Large Prospective Randomized Trial. Retina 2024; 44:991-996. [PMID: 38237087 DOI: 10.1097/iae.0000000000004048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
PURPOSE To compare the safety and performance clinical outcomes of the 27-gauge (G) two-dimensional cutting vitrectomy probe versus a standard 25-G probe for retinal procedures. METHODS In this large randomized prospective study, all candidates for epiretinal membrane or macular hole surgery were randomized to the 27-G group or 25-G group. Outcome measures included surgery time, changes in best-corrected distance visual acuity, intraocular pressure, and central macular thickness between baseline and 1-month and 3-month follow-up time points. Moreover, intraoperative and postoperative complications were evaluated as well as the rate of sutureless vitrectomy. RESULTS A total of 463 patients were included in this study, 227 patients in the 27-G group and 236 patients in the 25-G group. A similar total surgery time was found between both groups ( P = 0.0911). Similar best-corrected distance visual acuity and central macular thickness changes were observed between baseline and the 1-month and 3-month follow-up visits. No significant differences were reported in intraoperative and postoperative complications rates. The rate of sutureless vitrectomy was 96.5% for the 27-G group and 91.1% for the 25-G group ( P = 0.0170). CONCLUSION These results suggest that 27-G vitrectomy probe is similar to 25-G probe in surgery time and complications, while decreasing the need for vitrectomy sutures.
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Affiliation(s)
- Mounir Benzerroug
- Anjou Retina Center, Angers, France ; and
- Le Mans General Hospital, Le Mans, France
| | | | | | | | | | - Chérif Mazit
- Anjou Retina Center, Angers, France ; and
- Le Mans General Hospital, Le Mans, France
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Gallo B, Khader R, Fajardo-Sanchez J, Sullivan P, Anikina E. Factors affecting anatomical and visual outcomes in Terson syndrome managed by surgery or observation. Eye (Lond) 2024:10.1038/s41433-024-03113-1. [PMID: 38740960 DOI: 10.1038/s41433-024-03113-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 04/08/2024] [Accepted: 04/24/2024] [Indexed: 05/16/2024] Open
Abstract
OBJECTIVES To investigate visual outcomes and prognostic factors of patients with Terson syndrome (TS) managed with observation or pars plana vitrectomy (PPV). METHODS retrospective review of medical records of 117 eyes from 81 patients (43 females) with TS. Main outcome measures were final best corrected visual acuity (BCVA), intraoperative findings and long-term sequelae. RESULTS 46 (39.3%) eyes were managed conservatively and 71 (60.7%) eyes underwent PPV. Median follow-up was 8.4 months. The PPV group had significantly worse (p < 0.001) baseline BCVA (median 2.3 versus 0.7 logMAR, Snellen equivalent 20/4000 versus 20/100). Final BCVA did not differ between the two groups (p = 0.38). Final BCVA ≥ 0.3 logMAR (20/40) in the surgery group was associated with post-operative retinal detachment (p = 0.013) and macular abnormalities (p = 0.014), and in the observation group with ocular comorbidity (p = 0.008). Retinal breaks were detected intraoperatively in 25 (35.2%) eyes and were associated with an interval longer than 3 months between ocular diagnosis and surgery (p = 0.04), but not with larger gauge instrumentation and posterior vitreous detachment. Incidence of ERM did not differ among patients managed conservatively and after PPV (p = 0.9) and between eyes undergoing early or delayed surgery (p = 0.09). The most common post-operative complications were cataract in 16 (22.5%) eyes and ERM in 8 (11.3%) eyes. CONCLUSIONS visual outcomes in TS are similar with both management strategies. Surgery allows faster and greater visual recovery but carries high risk of intraoperative retinal tears if delayed for longer than 3 months from initial presentation. ERM and retinal detachment are not correlated with timing of surgery or management strategy.
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Affiliation(s)
- Beatrice Gallo
- Royal Berkshire Hospitals NHS Foundation Trust, London Road, Reading, RG1 5AN, UK.
| | - Ramy Khader
- Royal Berkshire Hospitals NHS Foundation Trust, London Road, Reading, RG1 5AN, UK
| | | | - Paul Sullivan
- Moorfields Eye Hospital NHS Foundation Trust, City Road, London, EC1V 2PD, UK
| | - Evgenia Anikina
- Royal Berkshire Hospitals NHS Foundation Trust, London Road, Reading, RG1 5AN, UK
- Moorfields Eye Hospital NHS Foundation Trust, City Road, London, EC1V 2PD, UK
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Liu L, Hwang YS, Wu WC, Lai CC, Liu JH. Trocar blade-assisted skewer technique for phacoemulsification of a dislocated lens. Taiwan J Ophthalmol 2024; 14:129-132. [PMID: 38654995 PMCID: PMC11034686 DOI: 10.4103/tjo.tjo-d-22-00138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/05/2023] [Indexed: 03/02/2023] Open
Abstract
A posteriorly dislocated lens is often managed with a fragmatome through a pars plana approach because it is difficult to manage anteriorly. The lens often sinks to the surface of the retina or floats around in the vitreous cavity during pars plana lensectomy. Mechanical trauma can occur while removing the dislocated lens fragments. However, sometimes the lens can be confined to the anterior vitreous cavity even though the zonules are completely disrupted. It would be ideal if there was a simple way to stabilize and support the lens so that the lens could remain in the posterior chamber while phacoemulsification is performed through a corneal incision as usual. We describe a technique using a trocar blade to stabilize the lens while performing phacoemulsification through a corneal incision. We found it to be a useful and safe instrument to support the subluxated lens during phacoemulsification.
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Affiliation(s)
- Laura Liu
- Department of Ophthalmology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yih-Shiou Hwang
- Department of Ophthalmology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Chun Lai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Jorn-Hon Liu
- Department of Ophthalmology, Cheng Hsin General Hospital, Taipei, Taiwan
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Gonzalez-Lopez JJ, Arruza Santos ME, Leon Garcia J. Pars plana vitrectomy in patients aged 85 years and older: a single-centre, retrospective cohort study. Int Ophthalmol 2023; 43:4887-4896. [PMID: 37851142 PMCID: PMC10724084 DOI: 10.1007/s10792-023-02891-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 09/27/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE To describe the epidemiology, indications and surgical results of pars plana vitrectomy (PPV) in patients over 85 years of age. METHODS A retrospective cohort study was performed including all consecutive patients aged 85 years or older who underwent PPV between September 2018 and March 2022 in a single hospital in Madrid, Spain. Data on diagnosis, comorbidities, surgical indication, surgical details, surgical complications and surgical outcomes were collected from medical records. RESULTS A total of 124 eyes of 119 patients (56 males, 47.1%) underwent PPV. Median age was 87 years (range 85-96). The most common surgical indications were complications of cataract surgery in 34 patients (28.6%), macular epiretinal membrane in 32 (26.9%), and rhegmatogenous retinal detachment (RRD) in 12 (10.1%). Mean preoperative best corrected visual acuity (BCVA) was 13.33 ± 42.34 ETDRS letters and improved to 40.05 ± 41.04 letters at 3 months (p < 0.001). BCVA had improved in 68.82% of patients at 3 months. Patients with chronic kidney disease (CKD; p < 0.001), RRD (p = 0.003), ocular trauma (p = 0.001) and age-related macular degeneration (AMD; p = 0.002) showed worse BCVA at 3 months from surgery. Patients with better preoperative BCVA (p < 0.001), and those who underwent 25G PPV (p = 0.041) showed better visual outcomes. CONCLUSIONS PPV is an effective technique for improving visual acuity in patients aged 85 years and older with vitreoretinal diseases. Visual outcomes were better when patients had a better preoperative visual acuity and underwent 25G PPV. Patients with a previous diagnosis of AMD or CKD, and those undergoing surgery for ocular trauma or RRD had worse visual outcomes.
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Affiliation(s)
- Julio J Gonzalez-Lopez
- Ophthalmology Department, Hospital Universitario Ramón y Cajal, IRYCIS, Carretera de Colmenar Km 9, 100, 28034, Madrid, Spain.
- Surgery Department, Universidad de Alcala School of Medicine, Madrid, Spain.
| | - Maria E Arruza Santos
- Ophthalmology Department, Hospital Universitario Ramón y Cajal, IRYCIS, Carretera de Colmenar Km 9, 100, 28034, Madrid, Spain
| | - Jorge Leon Garcia
- Ophthalmology Department, Hospital Universitario Ramón y Cajal, IRYCIS, Carretera de Colmenar Km 9, 100, 28034, Madrid, Spain
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Guan L, Chen J, Tang Y, Lu Z, Zhang Z, Ji S, Li M, Liu Y, Li S, Liu H. 3D Visualization System-Assisted Vitrectomy for Rhegmatogenous Retinal Detachment: Leave Out the Perfluorocarbon Liquid. Ophthalmol Ther 2023; 12:1611-1619. [PMID: 36869993 PMCID: PMC10164104 DOI: 10.1007/s40123-023-00692-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 02/14/2023] [Indexed: 03/05/2023] Open
Abstract
INTRODUCTION Pars plana vitrectomy (PPV) is a primary strategy to restore vision for patients who have rhegmatogenous retinal detachment (RRD). Perfluorocarbon liquid (PFCL) is frequently used during PPV surgery. However, the unintended intraocular retention of PFCL may cause retina toxicity and thus lead to possible postoperative complications. In this paper, the experiences and surgical outcomes of a NGENUITY 3D Visualization System-assisted PPV are shown to evaluate the possibility of excluding the application of PFCL. METHODS A consecutive series of 60 cases with RRD were presented, all of whom had undergone 23-gauge PPV with the assistance of a three-dimensional (3D) visualization system. Among them, 30 cases used PFCL to assist the drainage of subretinal fluid (SRF), while the other 30 cases did not. Parameters including retinal reattachment rate (RRR), best-corrected visual acuity (BCVA), operation time, and SRF residual were compared between the two groups. RESULTS Baseline data showed no statistical significance between the two groups. At the last postoperative follow-up, the RRR of all the 60 cases reached 100% and best-corrected visual acuity (BCVA) gained significant improvement. The BCVA (logMAR) increased from 1.293 ± 0.881 to 0.479 ± 0.316 in the PFCL-excluded group, exhibiting better results than the PFCL included group, whose final BCVA was 0.650 ± 0.371. More importantly, excluding PFCL greatly reduced the operation time (decrease of 20%), therefore, avoiding possible complications caused by both the use of PFCL and the operation process. CONCLUSION With the assistance of the 3D visualization system, it is feasible to treat RRD and perform PPV without using PFCL. The 3D visualization system is highly recommendable, as not only can it achieve the same surgical effect without the assistance of PFCL, but also simplify the operation procedure, shorten the operation time, save costs, and avoid complications related to PFCL.
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Affiliation(s)
- Lina Guan
- The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou, China.,Department of Ophthalmology, Xuzhou First People's Hospital, Xuzhou, China.,Eye Disease Prevention and Treatment Institute of Xuzhou, Xuzhou, China
| | - Jiayu Chen
- The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou, China.,Department of Ophthalmology, Xuzhou First People's Hospital, Xuzhou, China.,Eye Disease Prevention and Treatment Institute of Xuzhou, Xuzhou, China
| | - Yu Tang
- The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou, China.,Department of Ophthalmology, Xuzhou First People's Hospital, Xuzhou, China.,Eye Disease Prevention and Treatment Institute of Xuzhou, Xuzhou, China
| | - Zhaolin Lu
- China University of Mining and Technology, Xuzhou, China
| | - Zhengpei Zhang
- The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou, China.,Department of Ophthalmology, Xuzhou First People's Hospital, Xuzhou, China.,Eye Disease Prevention and Treatment Institute of Xuzhou, Xuzhou, China
| | - Sujuan Ji
- The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou, China.,Department of Ophthalmology, Xuzhou First People's Hospital, Xuzhou, China.,Eye Disease Prevention and Treatment Institute of Xuzhou, Xuzhou, China
| | - Meili Li
- The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou, China.,Department of Ophthalmology, Xuzhou First People's Hospital, Xuzhou, China.,Eye Disease Prevention and Treatment Institute of Xuzhou, Xuzhou, China
| | - Yalu Liu
- The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou, China.,Department of Ophthalmology, Xuzhou First People's Hospital, Xuzhou, China.,Eye Disease Prevention and Treatment Institute of Xuzhou, Xuzhou, China
| | - Suyan Li
- The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou, China. .,Department of Ophthalmology, Xuzhou First People's Hospital, Xuzhou, China. .,Eye Disease Prevention and Treatment Institute of Xuzhou, Xuzhou, China.
| | - Haiyang Liu
- The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou, China. .,Department of Ophthalmology, Xuzhou First People's Hospital, Xuzhou, China. .,Eye Disease Prevention and Treatment Institute of Xuzhou, Xuzhou, China.
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Casparis H. What Defines Successful Surgery for Diabetic Tractional Retinal Detachment? JAMA Ophthalmol 2023; 141:195-196. [PMID: 36633861 DOI: 10.1001/jamaophthalmol.2022.5818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Heather Casparis
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
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Ben Ghezala I, Mariet AS, Benzenine E, Gabrielle PH, Baudin F, Quantin C, Creuzot-Garcher C. Incidence of rhegmatogenous retinal detachment following macular surgery in France between 2006 and 2016. Am J Ophthalmol 2022; 243:91-97. [PMID: 35907474 DOI: 10.1016/j.ajo.2022.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/07/2022] [Accepted: 07/15/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To report the incidence of postoperative rhegmatogenous retinal detachment after macular surgery in France between 2006 and 2016 and identify associated factors. DESIGN Nationwide population-based cohort study. METHODS All surgical procedures for an epiretinal membrane or a macular hole performed in France from January 1, 2006 to October 31, 2016 were identified in the French national administrative database (Programme de Médicalisation des Systèmes d'Information). We investigated the incidence of rhegmatogenous retinal detachment occurring within 90 days of a macular surgical procedure. RESULTS From January 1, 2006 to October 31, 2016, 152,034 macular surgical procedures for epiretinal membranes or macular holes were recorded in France. We identified 3,605 cases of rhegmatogenous retinal detachment occurring within 90 days of the procedure. The incidence of rhegmatogenous retinal detachment was 2.37% overall, 1.95% for epiretinal membrane surgery and 3.43% for macular hole surgery. In multivariable Poisson regression analysis, rhegmatogenous retinal detachment was associated with macular hole surgery (incidence rate ratio [IRR], 1.76; 95% CI, 1.63-1.90; P < .001), history of cataract extraction in the previous year (IRR, 1.20; 95% CI, 1.08-1.34; P = .001), age < 60 years (P < .001), and male gender (IRR, 1.63; 95% CI, 1.51-1.76; P < .001). CONCLUSIONS The incidence of rhegmatogenous retinal detachment within 90 days of macular surgery was 2.37% overall in France between 2006 and 2016 and it was higher for macular hole surgery than for epiretinal membrane surgery.
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Affiliation(s)
- Inès Ben Ghezala
- Ophthalmology Department, University Hospital, Dijon, France; Inserm, CIC 1432, Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, University Hospital, Dijon, France
| | - Anne-Sophie Mariet
- Inserm, CIC 1432, Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, University Hospital, Dijon, France; Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France, Bourgogne Franche-Comté University, Dijon, France; Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
| | - Eric Benzenine
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France, Bourgogne Franche-Comté University, Dijon, France
| | - Pierre-Henry Gabrielle
- Ophthalmology Department, University Hospital, Dijon, France; Eye and Nutrition Research Group, CSGA, UMR1324 INRAE, 6265 CNRS, Dijon, France
| | - Florian Baudin
- Ophthalmology Department, University Hospital, Dijon, France
| | - Catherine Quantin
- Inserm, CIC 1432, Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, University Hospital, Dijon, France; Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France, Bourgogne Franche-Comté University, Dijon, France; Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
| | - Catherine Creuzot-Garcher
- Ophthalmology Department, University Hospital, Dijon, France; Eye and Nutrition Research Group, CSGA, UMR1324 INRAE, 6265 CNRS, Dijon, France
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Pan Q, Gao Z, Chen X, Yang Z, Huang S, Hu X, Zheng J, Zhang Z. Outcomes of a novel bubble ultra-wide field viewing system for vitreoretinal surgery. Acta Ophthalmol 2022; 100:e1024-e1030. [PMID: 34403213 DOI: 10.1111/aos.15006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/31/2021] [Accepted: 08/04/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To report the clinical outcomes and evaluate the efficacy of a novel bubble ultra-wide field viewing system for vitreoretinal surgery. DESIGN Prospective, noncomparative, interventional case series. PARTICIPANTS One hundred and fifty-one eyes of 146 consecutive patients with proliferative diabetic retinopathy (PDR), vitreous haemorrhage originating from retinal vein occlusion (VH-RVO), epiretinal membrane (EM), macular hole (MH) or retinal detachment (RD) who underwent vitreoretinal surgery using the bubble ultra-wide field viewing system were included. METHODS A standard phacoemulsification was performed on each patient. Core humour and mid-peripheral vitreous humour were removed using a planoconcave lens. A suitably sized bubble was infused to attach to the posterior capsule or the anterior chamber depending on the integrity of the posterior capsule. The planoconcave lens and the air bubble formed the wide-angle viewing system, through which peripheral vitrectomy was performed. MAIN OUTCOME MEASURES Range of applications, field of view, model validation and complications were recorded. RESULTS The new ultra-wide field viewing system was successfully applied in all eyes, including 34 with PDR, 28 VH-RVO, 28 EM, 25 MH and 36 RD. Peripheral vitrectomy, local or panretinal laser photocoagulation, and removal of the peripheral proliferative membrane were successfully performed while viewing through this system. Maximum peripheral retinal area observable during the procedure was positively correlated with pupil diameter. Model analysis results showed that when the pupil diameter was 6 mm, the maximum field of view was approximately 128.1- 148.0 degrees with this system. Of 142 eyes, the main intraoperative complication was iatrogenic retinal breaks (IRBs) in 8 eyes (5.3%) and posterior capsule injury by vitreous cutter during bubble removal in 6 eyes (4.2%). The postsurgery mean best-corrected visual acuity (BCVA) (0.48 ± 0.39 logMAR) was significantly improved compared with the preoperative mean BCVA (1.60 ± 1.08 logMAR, p < 0.001). No incidents of postoperative choroidal detachment, secondary glaucoma or endophthalmitis were recorded. CONCLUSIONS For patients with lens excision or absence, vitreoretinal surgery can be successfully performed using the novel viewing system described here. The system is a safe, convenient and economical ultra-wide field viewing system with a wide range of applications.
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Affiliation(s)
- Qin‐tuo Pan
- Eye Hospital and School of Ophthalmology and Optometry Wenzhou Medical University Wenzhou China
| | - Zhi‐qiang Gao
- Eye Hospital and School of Ophthalmology and Optometry Wenzhou Medical University Wenzhou China
| | - Xu‐hao Chen
- Eye Hospital and School of Ophthalmology and Optometry Wenzhou Medical University Wenzhou China
| | - Zheng‐wei Yang
- Tianjin International Joint Research and Development Centre of Ophthalmology and Vision Science Eye Institute and School of Optometry Tianjin Medical University Eye Hospital Tianjin China
| | - Sheng‐hai Huang
- Eye Hospital and School of Ophthalmology and Optometry Wenzhou Medical University Wenzhou China
| | - Xu‐ting Hu
- Eye Hospital and School of Ophthalmology and Optometry Wenzhou Medical University Wenzhou China
| | - Jing‐wei Zheng
- Eye Hospital and School of Ophthalmology and Optometry Wenzhou Medical University Wenzhou China
| | - Zong‐duan Zhang
- Eye Hospital and School of Ophthalmology and Optometry Wenzhou Medical University Wenzhou China
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Vithalani NM, Basu S. Therapeutic Vitrectomy in the Management of Uveitis: Opportunities and Challenges. Semin Ophthalmol 2022; 37:820-829. [PMID: 35608546 DOI: 10.1080/08820538.2022.2078166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Pars plana vitrectomy (PPV) has been traditionally used for diagnostic tapping or for management of posterior segment complications, in uveitis. The anti-inflammatory potential of therapeutic PPV, independent of its role in managing uveitis complications, is yet to be realised completely. In this narrative review, we have described the indications, surgical technique, and outcomes of therapeutic PPV in the management of uveitis. METHODS Literature review of PubMed database for articles relating directly or indirectly, to the anti-inflammatory effect of therapeutic PPV in the management of uveitis. Of the 876 articles retrieved on initial review, only 37 articles were found to be relevant for the purpose of this review. RESULTS Therapeutic PPV is effective in controlling vitreous inflammation, improving visual outcomes and reducing the need for immunosuppressive medications in a wide range of infectious and non-infectious uveitis. Careful patient selection and meticulous surgical handling are mandatory. Post-operative complications include cataract progression, raised intraocular pressure, hypotony, retinal breaks, and worsening of cystoid macular edema. Despite being introduced more than 40 years ago, most data on therapeutic PPV remain retrospective. The possibility of therapeutic PPV replacing conventional medical therapy remains unknown. CONCLUSIONS Therapeutic PPV can control intraocular inflammation, independent of its role in managing posterior segment complications of uveitis. However, its exact place in the anti-inflammatory armamentarium against uveitis remains uncertain.
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Affiliation(s)
| | - Soumyava Basu
- Retina and Uveitis services, L V Prasad Eye Institute, Hyderabad, India
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Lee KH, Chung YR, Yeo S, Lee K. Is gas/air tamponade essential for eyes with small peripheral retinal breaks without detachment during vitrectomy? BMC Ophthalmol 2022; 22:186. [PMID: 35459110 PMCID: PMC9027820 DOI: 10.1186/s12886-022-02401-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/11/2022] [Indexed: 12/03/2022] Open
Abstract
Background To investigate the safety of vitrectomy with laser photocoagulation in eyes with small peripheral retinal breaks without air or gas tamponade. Methods Among patients who underwent vitrectomy for various retinal disorders, those with small peripheral retinal breaks treated by laser photocoagulation without air or gas tamponade were included in this study. Their medical records were assessed retrospectively, and we investigated the characteristics of small peripheral retinal breaks and the incidence of postoperative retinal detachment (RD). Results Thirty-one eyes of 31 patients who presented with small peripheral retinal breaks requiring endolaser photocoagulation during vitrectomy were included in this analysis. There were two cases of iatrogenic retinal breaks that occurred during vitrectomy, while others were preexisting lesions, including retinal tears, atrophic retinal holes, and retinal holes with lattice degeneration. There were no cases of RD during the follow-up period of at least 6 months. Conclusions Adequate laser treatment without gas or air tamponade may be sufficient during vitrectomy in cases with small peripheral retinal breaks without concurrent RD, along with complete removal of vitreoretinal traction. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-022-02401-2.
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Affiliation(s)
- Kyung Ho Lee
- Department of Ophthalmology, Ajou University School of Medicine, 164 World Cup-ro, Yeongtong-gu, Suwon, 16499, South Korea
| | - Yoo-Ri Chung
- Department of Ophthalmology, Ajou University School of Medicine, 164 World Cup-ro, Yeongtong-gu, Suwon, 16499, South Korea
| | - Suji Yeo
- Department of Ophthalmology, Ajou University School of Medicine, 164 World Cup-ro, Yeongtong-gu, Suwon, 16499, South Korea
| | - Kihwang Lee
- Department of Ophthalmology, Ajou University School of Medicine, 164 World Cup-ro, Yeongtong-gu, Suwon, 16499, South Korea.
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11
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Yokota H, Nagaoka T, Noma H, Ofusa A, Kanemaki T, Aso H, Hanazaki H, Yamagami S, Shimura M. Role of ICAM-1 in impaired retinal circulation in rhegmatogenous retinal detachment. Sci Rep 2021; 11:15393. [PMID: 34321574 PMCID: PMC8319174 DOI: 10.1038/s41598-021-94993-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 07/13/2021] [Indexed: 11/28/2022] Open
Abstract
Many studies have demonstrated that rhegmatogenous retinal detachment (RRD) leads to impaired retinal circulation. However, the involvement of inflammation in the RRD-induced worsening of retinal circulation was obscure. This retrospective observational study included 150 patients with primary RRD (macula-on, n = 63; macula-off, n = 87) who underwent 25-gauge microincision vitrectomy surgery (25G MIVS). Total retinal blood flow was represented by the mean blur rate (MBR) of the optic nerve head vessel, measured by laser speckle flowgraphy preoperatively and until 6 months postoperatively. Aqueous humor samples were obtained during surgery to determine cytokine concentrations by enzyme-linked immunosorbent assay. At 3 and 6 months postoperatively, there were no significant differences between eyes with macula-on RRD and fellow eyes. However, in macula-off RRD, MBR remained significantly lower in RRD eyes 6 months postoperatively (P < 0.05). Log-transformed levels of soluble intercellular adhesion molecule-1 (sICAM-1) were negatively correlated with relative MBR (r-MBR, RRD eye/fellow eye) before surgery (r = − 0.47, P = 0.01) in macula-on, but not macula-off, RRD. Six months postoperatively, r-MBR correlated significantly with sICAM-1 levels (r = − 0.36, P = 0.02) in macula-off RRD. ICAM-1 may play a role in RRD-induced deterioration of retinal circulation.
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Affiliation(s)
- Harumasa Yokota
- Division of Ophthalmology, Department of Visual Sciences, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi-ku, Tokyo, 173-8610, Japan.
| | - Taiji Nagaoka
- Division of Ophthalmology, Department of Visual Sciences, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Hidetaka Noma
- Department of Ophthalmology, Hachioji Medical Center, Tokyo Medical University, Tokyo, Japan
| | - Akemi Ofusa
- Department of Ophthalmology, Hachioji Medical Center, Tokyo Medical University, Tokyo, Japan
| | - Tomoe Kanemaki
- Department of Ophthalmology, Hachioji Medical Center, Tokyo Medical University, Tokyo, Japan
| | - Hiroshi Aso
- Division of Ophthalmology, Department of Visual Sciences, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Hirotsugu Hanazaki
- Division of Ophthalmology, Department of Visual Sciences, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Satoru Yamagami
- Division of Ophthalmology, Department of Visual Sciences, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Masahiko Shimura
- Department of Ophthalmology, Hachioji Medical Center, Tokyo Medical University, Tokyo, Japan
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Kawano S, Imai T, Sakamoto T. Scleral buckling versus pars plana vitrectomy in simple phakic macula-on retinal detachment: a propensity score-matched, registry-based study. Br J Ophthalmol 2021; 106:857-862. [PMID: 33514527 DOI: 10.1136/bjophthalmol-2020-318451] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/13/2021] [Accepted: 01/17/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND/AIMS To assess the anatomical and visual results of uncomplicated phakic macula-on retinal detachment (RD) in patients treated with pars plana vitrectomy (PPV) or scleral buckling (SB). METHODS A retrospective cohort of patients aged <65 years and diagnosed with uncomplicated phakic macula-on primary RD, who were registered in the Japan-Retinal Detachment Registry, was compiled between February 2016 and March 2017. We performed propensity score matching using preoperative findings and surgeon-related factors as covariates to account for relevant confounders. The primary outcome was anatomical failures at 6 months postoperatively, classified as follows: level 1, an inoperable state; level 2, anatomical recovery with silicone oil tamponade; and level 3, need for additional surgery to repair the detachments. The secondary outcome was change in best-corrected visual acuity (BCVA). RESULTS Of the 822 included patients, 552 underwent PPV and 270 underwent SB. After propensity score matching, 137 matched cases between the PPV and SB groups were analysed. The total proportion of surgical failures in the PPV group was higher than that in the SB group (risk difference, 0.10 (0.02 to 0.18), p=0.011, McNemar's test). Conversely, the change in BCVA was not significantly different between the two groups (logMAR units, -0.015 (-0.084 to 0.053), p=0.66, paired samples t-test). CONCLUSIONS Although the indications for PPV are becoming broader, PPV may not be the optimal approach for repairing all types of RD. Therefore, careful consideration is needed when selecting the right surgical technique for treating uncomplicated phakic macula-on RD cases.
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Affiliation(s)
- Sumihiro Kawano
- Ophthalmology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Takumi Imai
- Medical Statistics, Osaka City University Graduate School of Medicine School of Medicine, Osaka, Japan
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Naderi K, Allen F, Dowlut S, Karia N, Chandra A. The risk of rhegmatogenous retinal detachment following anterior vitrectomy during cataract surgery: with versus without pars plana vitrectomy. Graefes Arch Clin Exp Ophthalmol 2020; 258:2425-9. [DOI: 10.1007/s00417-020-04843-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/01/2020] [Accepted: 07/10/2020] [Indexed: 10/23/2022] Open
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