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O'Riordan MM, McCabe GA, Kennelly KP. Early vitrectomy is indicated for both diffuse and dense vitreous haemorrhages of unknown aetiology. Ir J Med Sci 2023:10.1007/s11845-023-03573-6. [PMID: 37975994 DOI: 10.1007/s11845-023-03573-6] [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: 09/16/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Early vitrectomy for complete fundus-obscuring vitreous haemorrhage (VH) allows for prompt diagnosis and treatment of the cause. AIMS To analyse the causes of VH of unknown aetiology, whether partially fundus-obscuring or dense, and to determine the outcomes of early vitrectomy. METHODS A retrospective review of patients who underwent early vitrectomy within 10 days of symptom-onset for partially fundus-obscuring or dense VH of unknown origin. Patients with evidence of proliferative diabetic retinopathy in either eye or any other preoperatively diagnosed aetiology of VH were excluded. RESULTS 19 patients were included. Intraoperative diagnoses were: retinal tears without rhegmatogenous retinal detachment (RRD) (53%); peripheral localised RRD (32%); neovascularisation secondary to retinal vein occlusion (11%) and posterior vitreous detachment without a retinal break (5%). Patients with diffuse VH were as likely to have a retinal tear diagnosed as those with dense VH (88% vs 82%, respectively; p = 0.7). Mean VA improved from 1.26 LogMAR to 0.23 LogMAR postoperatively (p = 0.001). 1 patient (5%) developed a RRD one-year postoperatively. CONCLUSIONS In cases of diffuse or dense VH of unknown aetiology, an occult retinal tear should be suspected. Early vitrectomy should be strongly considered regardless of whether the fundal view is partially or completely obscured, to prevent progression to visually significant RRDs.
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Affiliation(s)
- Matthew M O'Riordan
- Department of Ophthalmology, University Hospital Limerick, Limerick, Ireland.
| | - Grace A McCabe
- Department of Ophthalmology, University Hospital Limerick, Limerick, Ireland
| | - Kevin P Kennelly
- Department of Ophthalmology, University Hospital Limerick, Limerick, Ireland
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Li H, Niu Y, Rong A, Bi Y, Xu W, Cui H. Effect of Adjunctive Intravitreal Conbercept Injection at the End of 25G Vitrectomy on Severe Proliferative Diabetic Retinopathy: 6-Month Outcomes of a Randomised Controlled Trial. Ophthalmol Ther 2023; 12:1173-1180. [PMID: 36752956 PMCID: PMC10011228 DOI: 10.1007/s40123-023-00664-6] [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: 11/23/2022] [Accepted: 01/20/2023] [Indexed: 02/09/2023] Open
Abstract
INTRODUCTION This study aimed to evaluate the effect of pre-operative versus pre-operative plus post-operative intravitreal conbercept (IVC) injection on severe proliferative diabetic retinopathy (PDR). METHODS This was a prospective, comparative and randomised study. A total of 84 patients who underwent vitrectomy for severe PDR were included in this study. Patients were randomly divided into control (41 eyes) and experiment (43 eyes) groups. Patients in the experiment group received adjunctive pre-operative and post-operative IVC injection, whereas patients in the control group only received pre-operative IVC injection. The incidence of post-operative vitreous haemorrhage (POVH), best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were determined. RESULTS The incidence of early POVH was significantly different between the two groups, but no significant difference was observed between groups at 3 and 6 months. In the experiment group, the BCVA was significantly improved 1 month after surgery when compared with the control group (p 0.019). There was no marked difference in the mean post-operative BCVA at 3 and 6 months between groups (p 0.063 and 0.082). CRT was significantly lower in the experiment group than in the control group at 1 and 3 months after surgery (p 0.037 and 0.041), but there was no significant difference at 6 months (p 0.894). CONCLUSION Additional IVC injected at the end of surgery improves the POVH and BCVA at the early stage after surgery in severe PDR, but this benefit is absent at 6 months. Further studies are needed to investigate the effect of IVC at the end of vitrectomy. TRIAL REGISTRATION chictr.org.cn identifier: ChiCTR2200060735. Retrospectively registered, register date: 9 June 2022.
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Affiliation(s)
- Houshuo Li
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, 389 Xincun Road, Shanghai, 200065, China
| | - Yunli Niu
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, 389 Xincun Road, Shanghai, 200065, China
| | - Ao Rong
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, 389 Xincun Road, Shanghai, 200065, China
| | - Yanlong Bi
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, 389 Xincun Road, Shanghai, 200065, China
| | - Wei Xu
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, 389 Xincun Road, Shanghai, 200065, China
| | - Hongping Cui
- Department of Ophthalmology, Shanghai East Hospital, School of Medicine, Tongji University, 150 Jimo Road, Shanghai, 200120, China.
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Qurban Q, Kamil Z, Tebha SS, Zaidi ZA, Said M, Zehra SF, Ali S, Sethar S. Ocular manifestations in a patient with Dandy-Walker malformation: A case report. Radiol Case Rep 2021; 17:812-815. [PMID: 35024082 PMCID: PMC8733037 DOI: 10.1016/j.radcr.2021.12.027] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/03/2021] [Accepted: 12/13/2021] [Indexed: 12/03/2022] Open
Abstract
We present a unique case of a ten-month-old boy with a protruding left globe and vitreous haemorrhaging, and later being diagnosed as a case of a dandy-walker syndrome (DWS) with buphthalmos and vitreous haemorrhage. Treatment is depending on the symptoms reported, thus close monitoring and a multidisciplinary approach are essential. We would like to recommend that even if there are no cardinal symptoms of DWS, paediatric patients with ocular signs should have Dandy walker Malformation (DWM) considered as a differential diagnosis.
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Affiliation(s)
- Qirat Qurban
- Department of Ophthalmology, Jinnah Medical and Dental College, Karachi, Pakistan
| | - Zeeshan Kamil
- Department of Ophthalmology, Jinnah Medical and Dental College, Karachi, Pakistan
| | - Sameer Saleem Tebha
- Department of Neurosurgery and Neurology , Jinnah Medical and Dental College, Karachi, Pakistan
| | - Zain Ali Zaidi
- Department of Medicine and Allied, Jinnah Medical and Dental College, Karachi, Pakistan
| | - Maahirah Said
- Department of Medicine, Ziauddin University, Karachi, Pakistan
| | - Samar Fatima Zehra
- Department of Medicine, Jinnah Medical and Dental College, Karachi, Pakistan
| | - Sajjad Ali
- Department of Medicine, Ziauddin Medical University, Karachi, Pakistan,Corresponding Author.
| | - Sehrish Sethar
- Department of Radiology, Jinnah Medical and Dental College, Karachi, Pakistan
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Zarei M, Mahmoudi A, Hadi A, Riazi-Esfahani H. Intrusion of episcleral buckles: report of two cases and brief review. Int J Retina Vitreous 2020; 6:7. [PMID: 32292595 PMCID: PMC7144050 DOI: 10.1186/s40942-020-00210-7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 02/24/2020] [Indexed: 11/10/2022] Open
Abstract
Background The authors report two cases of the scleral buckles intrusion and erosion that presented many years after primary surgery with vitreous haemorrhage in one of them. Although the erosion/intrusion of a silicone scleral buckle (SB) is rare, it may have serious consequences and optimal management can be challenging. Therefore, this diagnosis should be considered if attributable signs and symptoms including vitreous haemorrhage occurred after scleral buckling. The authors briefly review the literature on clinical presentation and management of the episcleral silicone buckling erosion and intrusion. Case presentation Case 1: A 48-year-old woman with a history of scleral buckling for an inferior rhegmatogenous retinal detachment presented with visual loss in her right eye. A vitreous haemorrhage was observed. After Close observation, Partial resolution of haemorrhage revealed an intruded sponge segment in inferior vitreous cavity. Case 2: A 26-year-old man was referred for retinal evaluation. Twenty years earlier, he had undergone lensectomy for bilateral childhood cataract. Ten years ago, he had developed an aphakic RRD in the left eye. The detachment was managed with pars plana deep vitrectomy, endolaser, an encircling silicone band, and silicone oil injection. On examination an eroded band was noted. Conclusion Although the erosion/intrusion of a silicone episcleral buckle is rare, it may have serious consequences and optimal management can be challenging. Unnecessarily destructive techniques may predispose the eye to this complication and should be avoided. Patients who have a history of SB need lifelong follow-up and this diagnosis should be considered if attributable signs and symptoms occurred.
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Affiliation(s)
- Mohammad Zarei
- Retina service, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, South Karegar Street, Tehran, 1336616351 Iran
| | - Alireza Mahmoudi
- Retina service, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, South Karegar Street, Tehran, 1336616351 Iran
| | - Abdollah Hadi
- Retina service, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, South Karegar Street, Tehran, 1336616351 Iran
| | - Hamid Riazi-Esfahani
- Retina service, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, South Karegar Street, Tehran, 1336616351 Iran
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Baumann C, Iannetta D, Coupland SE, Groenewald C, Vishwanath M, Heimann H. Spontaneous Necrosis of a Large Choroidal Melanoma: Unusual Presentation in a 49-Year-Old Male. Ocul Oncol Pathol 2019; 6:174-179. [PMID: 32509762 DOI: 10.1159/000501522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 04/15/2019] [Revised: 06/17/2019] [Indexed: 01/23/2023] Open
Abstract
Purpose To demonstrate a case of massive vitreous haemorrhage obscuring the underlying diagnosis of a large mixed-cell choroidal melanoma which had undergone spontaneous necrosis. Case Report A 49-year-old man in good general health suddenly lost vision in his right eye due to an extensive vitreous haemorrhage 1 day after a workout at the gym. He reported good vision prior to that without any symptoms of flashes, floaters, or shadows. He was referred to the vitreoretinal department of a tertiary eye hospital, where he presented with a drop in vision to light perception only in the right phakic eye. Pars plana vitrectomy was performed in the right eye, which revealed intraoperatively massive retinal ischemia and choroidal haemorrhage, but no obvious tumour mass that could have been biopsied. The vitrectomy cassette specimen was sent for histopathology, where "ghost-like" melanoma cells were identified. The eye was subsequently enucleated, revealing an extensively necrotic and haemorrhagic choroidal melanoma of mixed cell type with only small viable tumour foci at the base and almost complete lysis of the detached retina. Conclusion Some uveal melanomas (UMs) undergo spontaneous necrosis due to rapid growth, with the centre of the tumour outstripping its established blood supply in the "watershed area" of the eye, and becoming hypoxic with associated necrosis of intraocular structures. Such UMs are often associated with haemorrhage and/or inflammation and usually cause significant destruction of ocular tissues, resulting in enucleation as the only treatment option.
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Affiliation(s)
- Carmen Baumann
- St Paul's Eye Unit, Vitreoretinal Department and Liverpool Ocular Oncology Centre, Royal Liverpool University Eye Hospital, Liverpool, United Kingdom.,Manchester Royal Eye Hospital, Manchester, United Kingdom
| | - Danilo Iannetta
- St Paul's Eye Unit, Vitreoretinal Department and Liverpool Ocular Oncology Centre, Royal Liverpool University Eye Hospital, Liverpool, United Kingdom
| | - Sarah E Coupland
- Cellular Pathology, Liverpool Clinical Laboratories, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - Carl Groenewald
- St Paul's Eye Unit, Vitreoretinal Department and Liverpool Ocular Oncology Centre, Royal Liverpool University Eye Hospital, Liverpool, United Kingdom
| | | | - Heinrich Heimann
- St Paul's Eye Unit, Vitreoretinal Department and Liverpool Ocular Oncology Centre, Royal Liverpool University Eye Hospital, Liverpool, United Kingdom
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Heinrich D, Bohnacker S, Nasseri MA, Feucht N, Lohmann CP, Maier M. [Intraoperative optical coherence tomography in explorative vitrectomy in patients with vitreous haemorrhage-a case series]. Ophthalmologe 2019; 116:261-6. [PMID: 29450624 DOI: 10.1007/s00347-018-0665-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND High-resolution spectral domain optical coherence tomography (SD-OCT) is a gold standard technique for diagnosis, management and monitoring of patients with vitreoretinal diseases. Preoperative diagnostics for evaluation of intraocular and retinal status in patients with vitreous haemorrhage are limited, thus final therapeutic decisions can only be made during explorative vitrectomy. We evaluated the use of intraoperative SD-OCT (iSD-OCT) as a real-time additional diagnostic tool during explorative vitrectomy in patients with vitreous haemorrhage. METHODS We report on 9 patients (11 eyes) with vitreous haemorrhage. Preoperative ultrasound was performed to evaluate intraocular status. Subsequently, an explorative 23G pars plana vitrectomy was performed under visualisation with the OPMI Lumera 700 surgical microscope (Carl Zeiss Meditec, Jena, Germany) equipped with a fully integrated iSD-OCT device (Rescan 700, Carl Zeiss Meditec, Jena, Germany) as a real-time diagnostic tool. RESULTS In all patients, intraoperative iSD-OCT allowed real-time evaluation of the preretinal, intraretinal and subretinal structures in addition to the intraoperative en face image. The further surgical strategy, i. e. necessity for peeling of epiretinal membranes (ERM) or of the inner limiting membrane (ILM), application of intravitreal medication and selection of the appropriate tamponade, was based on and optimised according to the iSD-OCT images. CONCLUSION Intraoperative iSD-OCT is highly useful as an additional intraoperative diagnostic tool in patients with vitreous haemorrhage. In addition to the en face microscope image, it facilitates intraoperative real-time diagnosis and aids therapeutic decision-making during surgery.
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Salazar-Quiñones L, Arcos-Villegas G, Valverde-Megías A, Flores-Moreno I, Méndez-Fernández R, Díaz-Valle D. Vitreous haemorrhage a rare manifestation of retinal astrocytic hamartoma: a paediatric case report. ACTA ACUST UNITED AC 2019; 94:449-52. [PMID: 31202691 DOI: 10.1016/j.oftal.2019.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 04/10/2019] [Accepted: 04/30/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Retinal astrocytic hamartoma is generally an asymptomatic benign tumour that may or may not be associated with the tuberous sclerosis complex. Haemorrhage is a rare presentation. CASE REPORT The case concerns a 12-year-old patient with "a black spot" vision in the upper temporal hemifield of the right eye, who referred a similar episode 2 years ago. The anterior pole was normal in the slit lamp. A mass of translucent white-yellow peri-papillary appearance and vitreous peri-papillary haemorrhage was observed in funduscopy. The autofluorescence, fluorescence angiography, and optical coherence tomography characteristics were all compatible with retinal astrocytic hamartoma. Complementary studies (serology and X-rays) and the complete clinical examination rule out associated systemic involvement. The patient was followed-up closely until the vitreous haemorrhage was reabsorbed. CONCLUSION Vitreous haemorrhage is a rare complication of Retinal astrocytic hamartoma and funduscopic exploration is difficult. Systemic involvement should be ruled out.
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Brent AJ, El-Khayat AR, Peart SAM, Banerjee S. A Case Report of Conservative Management for a Roller-Coaster-Related Vitreous Haemorrhage. Ophthalmol Ther 2018; 7:191-5. [PMID: 29524202 DOI: 10.1007/s40123-018-0124-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The purpose of this report is to describe the case and management of an unexplained vitreous haemorrhage that occurred after repeated roller-coaster riding. The authors inadvertently demonstrate the value of observation over immediate surgery in certain situations and review the literature on vitreoretinal and other ocular complications after roller-coaster riding. A 26-year-old male presented 12 h after riding high-velocity roller-coasters with a left vitreous haemorrhage. A hazy view of the retina and B-scan revealed a bullous area of superior-temporal retinal lifting. A diagnosis of a presumed macula-on retinal detachment was made and the patient was listed for a pars plana vitrectomy retinal detachment repair. An abnormal clotting result, which was subsequently found out to be erroneous, ultimately delayed the procedure. During this delay the vision and retinal view improved to an extent whereby the diagnosis of a retinoschisis with an intraretinal cyst was made and surgery was avoided. The patient regained 6/6 vision, without the need to undergo surgery. Historically the management of an unexplained vitreous haemorrhage was observation with serial B-scans. The current evidence and practice for treating unexplained vitreous haemorrhage have since moved towards early surgical intervention. The authors highlight that despite the current trend, a place remains for conservative management for selected cases.
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Tayyab H, Khan AA, Javaid RMM. Clinical outcome of 23g Trans-Conjunctival pars plana vitrectomy - a prospective comparison of Phaco-Vitrectomy with only vitrectomy in phakic eyes. Pak J Med Sci 2017; 33:1123-1127. [PMID: 29142550 PMCID: PMC5673719 DOI: 10.12669/pjms.335.13430] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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] [Indexed: 11/15/2022] Open
Abstract
Objective To evaluate the effectiveness and safety profile of combined phacoemulsification with 23G pars plana vitrectomy when compared to pars plana vitrectomy alone in phakic patients. Methods This study was performed at Al-Ehsan Eye Hospital (tertiary care eye hospital in Lahore, Pakistan) from January 2016 to August 2016. A total of 40 eyes in two equal groups of 20 eyes each, were enrolled in this prospective study. Group-A underwent combined phaco-vitrectomy, whereas Group-B underwent vitrectomy only for various vitreoretinal pathologies. We evaluated the safety of combined surgery, intra-operative and postoperative complications and short term surgical outcome. Results The most common reason for vitreoretinal intervention was rhegmatogenous retinal detachment followed by vitreous haemorrhage in combined study population. There was statistically significant difference in best corrected visual acuity pre-operatively and post operatively within the groups and between the groups. The most significant immediate post operative observation in Group-A was enhanced anterior chamber inflammation as compared to Group-B, whereas most signification observation in Group-B was development of visually significant cataract (35%) at 6 months follow-up. There was no other significant sequel or complication difference between both groups. Conclusions Combined phaco-vitrectomy is a safe and effective procedure with minimum complication profile and it avoids the need of subsequent cataract surgery.
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Affiliation(s)
- Haroon Tayyab
- Dr. Haroon Tayyab, FCPS (Ophth), FCPS (Vitreoretinal Ophthalmology), FICO, Department of Ophthalmology, King Edwards Medical University - Mayo Hospital, Lahore, Pakistan
| | - Asad Aslam Khan
- Prof. Dr. Asad Aslam Khan, (SI) - MS (Ophth), PhD, Department of Ophthalmology, King Edwards Medical University - Mayo Hospital, Lahore, Pakistan
| | - Rana Muhammad Mohsin Javaid
- Dr. Rana Muhammad Mohsin Javaid, FCPS, Department of Ophthalmology, King Edwards Medical University - Mayo Hospital, Lahore, Pakistan
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Martín-Avià J, Romero-Aroca P. Analysis of the vitreoretinal surgery learning curve. Arch Soc Esp Oftalmol 2017; 92:251-256. [PMID: 27601080 DOI: 10.1016/j.oftal.2016.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 07/05/2016] [Accepted: 07/13/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To describe intra- and post-operative complications, as well as the evolution of the surgical technique in first 4years of work of a novice retina surgeon, and evaluate minimal learning time required to reduce its complications, deciding which pathologies should still be referred to higher level hospitals, until further experience may be achieved. METHODS A study was conducted on patients that had undergone vitreoretinal surgery by a novice surgeon in Tarragona between 23rd October 2007 and 31st December 2011. The primary diagnosis, surgeon learning time, surgical technique, intra-operative and post-operative complications were recorded. RESULTS A total of 247 surgeries were studied. The percentage of use of 20G and 23G calibres during the time, marks a change towards trans-conjunctival surgery from the ninth trimester (98 surgeries). Surgical complications decreased towards twelfth trimester (130 surgeries) with an increase in the previous months. CONCLUSIONS The shift towards 23G technique around 100 surgeries is interpreted as greater comfort and safety by the surgeon. Increased surgical complications during the following months until its decline around 130 surgeries can be interpreted as an 'overconfidence'. It is arguable that the learning curve is slower than what the surgeon believes. An individual analysis of the complications and surgical outcomes is recommended to ascertain the status of the learning curve.
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Affiliation(s)
- J Martín-Avià
- Servicio de Oftalmología, Xarxa Sanitària i Social de Santa Tecla, Tarragona, España.
| | - P Romero-Aroca
- Servicio de Oftalmología, Hospital Universitari Sant Joan, Institut d'Investigació Sanitària Pere Virgili [IISPV], Universitat Rovira i Virgili, Reus, Tarragona, España
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Sultan Z, Rizvi SF, Qureshi FM, Mahmood SA. Role of bevacizumab in the prevention of early postoperative haemorrhage after 25-gauge microincision vitrectomy surgery. Pak J Med Sci 2016; 32:1184-1187. [PMID: 27882018 PMCID: PMC5103130 DOI: 10.12669/pjms.325.10362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To evaluate the effect of preoperative intravitreal bevacizumab injection on the incidence of postoperative haemorrhage and visual prognosis, in patients undergoing 25-gauge micro incision vitrectomy surgery (MIVS) for diabetic vitreous haemorrhage. Methods: One hundred and twenty two eyes of 122 patients of diabetic retinopathy of both genders and aged over 18 years, who presented with non-resolving vitreous haemorrhage were enrolled for this study. All patients received an intravitreal injection of 1.25 mg/0.05 mL bevacizumab (Avastin) which was followed one week later by 25-gauge sutureless micro incision vitrectomy surgery. Main outcomes measured were best corrected visual acuity (BCVA) assessed with logMAR and post-operative vitreous haemorrhage. Follow ups were up to six months post-operatively. IBM SPSS 21 was used for data analysis. Result: A total of 122 patients were included; 78 (63.9%) males and 44 (36.1%) females. Mean age at the time of surgery was 51.4 ± 13.66 years. The mean preoperative BCVA was 1.64 ± 0.427 logMAR which improved to 0.57 ± 0.253 logMAR at 12 months post-operatively (p-value < 0.001). Recurrent vitreous haemorrhage was seen in four patients (3.28%). one1 week before 25-gauge vitrectomy helps to reduce the incidence of early post-vitrectomy haemorrhage in diabetic patients.
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Affiliation(s)
- Zaheer Sultan
- Dr. Zaheer Sultan, FCPS. LRBT Free Base Eye Hospital, Korangi 2 ½, Karachi, Pakistan
| | - Syed Fawad Rizvi
- Dr. Syed Fawad Rizvi, FCPS. LRBT Free Base Eye Hospital, Korangi 2 ½, Karachi, Pakistan
| | - Faisal Murtaza Qureshi
- Dr. Faisal Murtaza Qureshi, FRCS. LRBT Free Base Eye Hospital, Korangi 2 ½, Karachi, Pakistan
| | - Syed Asaad Mahmood
- Dr. Syed Asaad Mahmood, MBBS. LRBT Free Base Eye Hospital, Korangi 2 ½, Karachi, Pakistan
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Narayanan R, Mithal K, Jalali S, Chhablani JK, Mathai A, Ali MH. Vitreous haemorrhage in massive hemorrhagic polypoidal choroidal vasculopathy: clinical characteristics and surgical outcomes: Vitreous hemorrhage in PCV. Int J Retina Vitreous 2015; 1:25. [PMID: 27847618 PMCID: PMC5088469 DOI: 10.1186/s40942-015-0025-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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: 08/14/2015] [Accepted: 11/02/2015] [Indexed: 11/10/2022] Open
Abstract
Background To report the outcomes of vitreous hemorrhage (VH) associated with hemorrhagic polypoidal choroidal vasculopathy (PCV). Methods A retrospective study of 28 eyes of 27 consecutive patients of hemorrhagic PCV with VH, which were managed surgically between January 2003 and December 2011, was performed. All patients underwent pars plana vitrectomy for VH associated with PCV. The main outcome measure was best-corrected visual acuity (BCVA) at baseline, at 1, 3 and 6 months post operatively and at last follow up. Results The visual acuity measured on early treatment diabetic retinopathy study (ETDRS) chart improved in 16 eyes (57.1 %) by two or more lines, remained unchanged in nine eyes (32.1 %) and decreased in three (10.7 %) after surgery when compared to baseline VA. The mean baseline VA was 2.69 ± 0.57 logMAR units (<20/2000) which improved to 1.65 ± 0.93 logMAR units (20/800) at 1 month post operative visit and was sustained at 1.72 ± 1.12 (20/800) with an improvement of 0.96 logMAR units (p < 0.001, 95 % CI 0.54–1.37). The average postoperative follow up was for 14.2 months (range 1–84). The complications noted in postoperative follow up were cataract (n = 10), macular scaring (n = 9), organised dehemoglobinised blood (n = 7), retinal tear or detachment (n = 5), recurrent VH (n = 3) and choroidal detachment (n = 1). Conclusion Majority of patients with loss of vision due to VH secondary to hemorrhagic PCV have sustained improvement in visual acuity following surgery.
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Affiliation(s)
- Raja Narayanan
- Srimati Kanuri Santhamma Retina Vitreous Centre, L V Prasad Eye Institute, L V Prasad Marg, Banjara Hills, Hyderabad, Andhra Pradesh 500 034 India
| | - Kopal Mithal
- Srimati Kanuri Santhamma Retina Vitreous Centre, L V Prasad Eye Institute, L V Prasad Marg, Banjara Hills, Hyderabad, Andhra Pradesh 500 034 India
| | - Subhadra Jalali
- Srimati Kanuri Santhamma Retina Vitreous Centre, L V Prasad Eye Institute, L V Prasad Marg, Banjara Hills, Hyderabad, Andhra Pradesh 500 034 India
| | - Jay Kumar Chhablani
- Srimati Kanuri Santhamma Retina Vitreous Centre, L V Prasad Eye Institute, L V Prasad Marg, Banjara Hills, Hyderabad, Andhra Pradesh 500 034 India
| | - Annie Mathai
- Srimati Kanuri Santhamma Retina Vitreous Centre, L V Prasad Eye Institute, L V Prasad Marg, Banjara Hills, Hyderabad, Andhra Pradesh 500 034 India
| | - Md Hasnat Ali
- Department of Biostatistics, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, India
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Abstract
Objective: To assess the visual outcome and complications of 25-gauge micro incision vitrectomy surgery (MIVS) in diabetic vitreous haemorrhage. Methods: This Quasi Experimental study was conducted at LRBT, Tertiary eye care hospital Karachi, from February 2012 to January 2013. Sixty eyes of sixty patients with uncontrolled type II diabetes mellitus (DM) were included. There were 43 (71.7%) males and 17 (28.3%) females. Age range was 40 – 60 years. All randomly selected patients underwent 25-gauge sutureless micro incision vitrectomy surgery for diabetic vitreous haemorrhage. Main outcomes measured were best corrected visual acuity (BCVA) assessed with logMAR and post-operative complications. Follow ups were at one day, one week, one month, three months and six months post-operatively. Result: Best corrected visual acuity (BCVA) gradually improved in majority of subjects in each subsequent follow up visit. Preoperative visual acuity was 1.023 ±0.226 logMAR, which was improved after final follow up to 0.457±0.256 and P-value was < 0.001. Five patients developed recurrent vitreous haemorrhage during study period, one patient developed cataract (1.7%), one (1.7%) had ocular hypotony defined as intraocular pressure < 5 mmHg and one (1.7%) developed endophthalmitis. Conclusion: 25-gauge micro incision vitrectomy surgery (MIVS) is an effective sutureless parsplana vitrectomy surgery which has good visual outcome in diabetic vitreous haemorrhage with minimum manageable complications.
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Affiliation(s)
- Burhan Abdul Majid Khan
- Dr. Burhan Abdul Majid Khan, FCPS (Ophth). Ophthalmologist, LRBT Free Base Eye Hospital, Korangi 2 ½, Karachi, Pakistan
| | - Syed Fawad Rizvi
- Dr. Syed Fawad Rizvi, FCPS (Ophth), MCPS (Ophth). Chief Consultant Ophthalmologist, LRBT Free Base Eye Hospital, Korangi 2 ½, Karachi, Pakistan
| | - Syed Asaad Mahmood
- Dr. Syed Asaad Mahmood, MBBS, FCPS-I (Ophth). Resident, LRBT Free Base Eye Hospital, Korangi 2 ½, Karachi, Pakistan
| | - Washoo Mal
- Dr. Washoo Mal, FCPS (Ophth). Assistant Ophthalmologist, LRBT Free Base Eye Hospital, Korangi 2 ½, Karachi, Pakistan
| | - Shakir Zafar
- Dr. Shakir Zafar, FCPS (Ophth), MCPS (Ophth). Consultant Ophthalmologist, LRBT Free Base Eye Hospital, Korangi 2 ½, Karachi, Pakistan
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14
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Almendárez JE, Vargas DM, González C, Takane M, Koga W. Ultrasound findings in ocular trauma. Arch Soc Esp Oftalmol 2015; 90:572-7. [PMID: 26601724 DOI: 10.1016/j.oftal.2015.07.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 06/29/2015] [Accepted: 07/01/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the frequencies of various eye and/or orbital disorders by ultrasound examination in patients with ocular trauma. MATERIALS AND METHODS This prospective and descriptive study was conducted on 100 patients with ocular trauma treated in the Conde de Valenciana Institute from March to November 2014. Ultrasound examination was performed primarily using ultrasound B mode, with standardised A mode only used as correlation method. Age, gender, type of trauma, and various ultrasound findings were recorded. RESULTS Ocular trauma was more frequent in men (83%) compared to women (17%). The left eye was affected in 55%, and right eye in 45%, with 55% being open traumas and 45% blunt traumas. Most cases were young patients with a mean age of 33.7 years, with the group between 41 to 50 years being the most affected. Among the most frequent injuries found was the vitreous haemorrhage (45%) and posterior hyaloid detachment (38%), followed by retinal detachment (32%), and choroidal detachment (18%). CONCLUSION Ultrasound remains as the investigation method of choice in patients with ocular trauma, since it is a simple, cheap and non-invasive study, and can be very useful in providing diagnostic and prognostic information. This study demonstrated that trauma is more common in young men, with vitreous haemorrhage as the most common finding.
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Affiliation(s)
- J E Almendárez
- Departamento de Ecografía, Instituto de Oftalmología Conde de Valenciana, México, Distrito Federal, México.
| | - D M Vargas
- Departamento de Ecografía, Instituto de Oftalmología Conde de Valenciana, México, Distrito Federal, México
| | - C González
- Departamento de Ecografía, Instituto de Oftalmología Conde de Valenciana, México, Distrito Federal, México
| | - M Takane
- Departamento de Ecografía, Instituto de Oftalmología Conde de Valenciana, México, Distrito Federal, México
| | - W Koga
- Departamento de Ecografía, Instituto de Oftalmología Conde de Valenciana, México, Distrito Federal, México
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15
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Mishra A, Baranwal VK, Patra VK, Chaudhary B. A rare mode of golf related eye injury: Freak accidents do occur! Med J Armed Forces India 2014; 70:192-4. [PMID: 24843211 DOI: 10.1016/j.mjafi.2013.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Accepted: 02/03/2013] [Indexed: 11/24/2022] Open
Affiliation(s)
- Avinash Mishra
- Classified Specialist (Ophthalmology), Military Hospital Ahmedabad, Gujarat-380003, India
| | - V K Baranwal
- Senior Advisor (Ophthalmology), Command Hospital (Central Command), Lucknow, India
| | - V K Patra
- Senior Advisor (Ophthalmology), Military Hospital Secunderabad, India
| | - B Chaudhary
- Commandant, Military Hospital Ahmedabad, Gujarat, India
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16
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Al-Thowaibi A, Kumar M, Al-Matani I. An overview of penetrating ocular trauma with retained intraocular foreign body. Saudi J Ophthalmol 2011; 25:203-5. [PMID: 23960924 DOI: 10.1016/j.sjopt.2011.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [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: 11/06/2010] [Revised: 01/01/2011] [Accepted: 01/02/2011] [Indexed: 11/17/2022] Open
Abstract
Penetrating trauma is one of the common causes of ocular morbidity world wide. Violation of the globe integrity, also known as a ruptured globe is an ocular emergency that universally threatens vision. Prompt recognition and management is prudent. Here we report a case of a 26-year-old-female, university teacher, who presented with pain and sudden loss of vision in the left eye of 2 h duration subsequent to a test tube blast in the chemical laboratory. Examinations revealed a ruptured globe with vitreous haemorrhage and an intraocular glass foreign body in the left eye. Primary repair was done with good post operative visual recovery. We report this case to emphasize that protective measures should be taken to prevent such eye traumas.
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Affiliation(s)
- Awwadh Al-Thowaibi
- Department of Ophthalmology, Alhad Military Hospital, Taif, Saudi Arabia
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