A Population-Based Analysis of Long-Term Costs and Adverse Events after Pneumatic Retinopexy and Pars Plana Vitrectomy

PURPOSE

To comprehensively examine the cost effectiveness, reattachment rate, and complications of pneumatic retinopexy (PnR) compared with pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) within a universal health care system.

DESIGN

Population-based, multicenter, consecutive, retrospective longitudinal cohort analysis.

SUBJECTS

We identified consecutive adults aged ≥ 50 years requiring surgery for primary RRD over a 20-year interval between April 1, 2002, and March 31, 2022. Initial surgery was considered the index date for analyses.

INTERVENTION

Pneumatic retinopexy was compared with PPV in all analyses.

MAIN OUTCOME MEASURES

The primary analysis investigated the mean annualized health care costs comparing PnR to PPV over the 2 years after initial surgery. Secondary analyses examined the primary reattachment rate and complications.

RESULTS

In total, 25 665 eligible patients were identified, with 8794 undergoing PnR and 16 871 undergoing PPV. The mean patient age was 65 years and 39% were women. The mean annualized cost after PnR was $8924 and $11 937 after PPV (mean difference, $3013; 95% confidence interval, $2533-$3493; P < 0.001). The primary reattachment rate at 90 days after PnR was 83% and after PPV was 93% (P < 0.001). The risk of cataract or glaucoma surgery was lower after PnR, and the frequency of ophthalmology clinic visits, intravitreal injections, and anxiety was higher after PnR. Hospitalizations and long-term disability were less frequent after PnR.

CONCLUSIONS

Pneumatic retinopexy, when compared with PPV, was associated with lower long-term health care costs. Pneumatic retinopexy appeared to be effective, safe, and inexpensive, thus offering a viable option for improving access to RRD repair in appropriately selected cases.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

[Clinical course of pars planitis in patients treated with selective photocoagulation]

INTRODUCTION

Pars planitis is an intermediate uveitis with bilateral and asymmetric presentation. The etiology is unknown and pathogenesis is unclear. Treatment follows the algorithm of Foster, which includes selective photocoagulation. The mechanism of action of photocoagulation is still unknown.

MATERIAL AND METHODS

An observational, longitudinal, ambispective cohort study was performed with the objective of evaluating the course of inflammation in patients with pars planitis treated with a selective argon laser.

RESULTS

The study included 29 patients (10 female and 19 male) diagnosed with pars planitis and were treated with selective laser. The mean age of onset was 11.77 years. Eighteen (62.1%) patients were not immunosuppressed at the time of receiving the selective laser, and 11 (37.9%) were taking immunosuppressants. Indications for selective laser were; following the algorithm, 19 (65.55%), vitreous hemorrhage 7 (24.1%), vitrectomy 2 (6.98%), and neovascularization 1 (3.4%). The mean time for inflammation reduction was 5.9 months, and 17 patients (58.6%) had no relapse. Visual acuity showed improvement post-laser (OD P=.025 and OI P=.022). There was also an improvement in vitreous cells.

CONCLUSION

Selective laser was effective in 58.6%% of patients.

Laser photocoagulation in intermediate uveitis associated with retinoschisis

PURPOSE

To describe cases of pars planitis associated with retinoschisis, in which laser photocoagulation was carried out.

METHODS

Retrospective review.

RESULTS

Three pars planitis cases were associated with retinoschisis and underwent laser photocoagulation. All cases were idiopathic. Retinoschisis was located in the inferior retinal quadrants in all cases and all of them were in bullous formation. None of the cases developed retinal detachment.

CONCLUSION

As well as posterior vitreous detachment, or peripheral retinal tears, retinoschisis may accompany pars planitis. Laser photocoagulation of the pars plana is effective in these cases both as a treatment and to prevent sight-threatening complications like retinal detachment.

Evaluation of limbal and pars plana silicone oil removal in aphakic eyes

PURPOSE

To compare limbal and pars plana silicone oil removal (SOR) in aphakic eyes and to evaluate the acute effect of silicone oil flow to the corneal endothelium.

METHODS

Sixteen aphakic patients with silicone oil endotamponade requiring SOR were recruited for this prospective study and randomly scheduled for limbal or pars plana SOR. The central corneal thickness (CCT), visual acuity (VA) and intraocular pressure were measured preoperatively, on the first postoperative day and 4 months after surgery. Endothelial cell density (ECD) was measured preoperatively and at the end of follow-up. The in vitro study was performed on ten enucleated porcine eyes. Corneoscleral discs were prepared and fixed on artificial anterior chamber followed by 2.5-mm limbal incision and 5-ml silicone oil injection in six cases and 5 ml balanced salt solution (BSS) in four cases.

RESULTS

The ECD decreased by 239.2 ± 86.7 (13.9%) and 86.7 ± 22.4 cells/mm(2) (5%) after limbal (n = 8) and pars plana SOR (n = 8), respectively (p < 0.001 for both). The difference between the groups was significant (p < 0.001). A significant increase in CCT and corresponding decrease in VA was noted on the first postoperative day using both procedures. At the end of follow-up, the CCT and VA were comparable to initial values. Postoperative hypotony (≤6 mmHg) was observed more frequently after limbal SOR. In the experiment, lamellar abrasions of corneal endothelium were observed after silicone oil injection, whereas no changes were observed after BSS injection.

CONCLUSION

Limbal SOR causes more considerable damage to the corneal endothelium than the pars plana approach because of mechanical abrasion.

Pars plana surgical capsulotomy for posterior capsular opacification (PCO)

OBJECTIVE

To evaluate the safety and efficacy of pars plana surgical posterior capsulotomy in pseudophakic adults.

METHODS

This prospective interventional case series was conducted at Sindh Govt Lyari General Hospital Karachi and Al- Noor Eye Hospital Karachi from June 2006 to May 2008. Complete ophthalmic examination of anterior and posterior segment was performed including assessment of type of posterior capsular opacification, measurement of intraocular pressure. Visual acuity, measurement of intraocular pressure and any unwanted complications were analyzed.

RESULTS

Seventy six (43.18%) patients were operated on both eyes. Mean age was 62.01 +/- 13.02 years. There were 104 (59.1%) females and 72 (40.9%) males. Visual acuity at presentation was found to be 6/9 to 6/18 in 130 (59.1%)eyes, 6/18 to 6/60 in 81(36.8%) and below 6/60 in 9 (4.1%) eyes. A significant reduction in intraocular pressure (13.8, +/- 1.4, P = 0.000) was noted on second post operative day. Intraoperative complication included subconjuctival haemorrhage in 22 (10%) eyes, pin head haematoma at the entry site in 7 (3.2%) eyes, pea head haematoma at the entry site in 8 (3.6%) eyes, minor grade of vitreous haemorrhage in 9 (4.1%) cases. Insufficient capsular opening was noted in 8 (3.6%) eyes. Clinically evident macular oedema in 4 (1.8%) eyes. We found no case of endophthalmitis or retinal detachment.

CONCLUSION

Surgical posterior capsulotomy is a safe and effective procedure in experienced hands and could be adopted in place of YAG laser.

[Vitrectomy surgery for the treatment of the vitreo-retinal complications of the pars planitis]

OBJECTIVE

To evaluate the effect of pars plana vitrectomy in the management of patients with pars planitis.

METHODS

A retrospective analysis of the clinical course, post-operative complications and recurrent uveal inflammation following pars plana vitrectomy in patients with pars planitis.

RESULTS

The study included 22 eyes of 19 patients. The mean follow-up was 55.7 (± 39.6) months (range 7 - 144 months). The surgical indications were, persistent vitreous opacities in 10 eyes, vitreous haemorrhage in 9 eyes, and epiretinal membrane in 3 eyes. There was an improvement in the clinical course of the uveitis in 19 of the 22 eyes (86.4%), allowing the suspension of the systemic treatment in 16 patients. An improvement of the visual acuity was observed in 20 eyes (90.9%). The most common post-operative complications were, lens opacities in 9 eyes (40.9%), and glaucoma in 4 eyes (18.2%).

CONCLUSIONS

The results of this study suggest that pars plana vitrectomy has a beneficial effect on the course and visual function of patients with vitreo-retinal complications associated with pars planitis.

Pars plana vitrectomy and internal limiting membrane peeling for macular oedema secondary to retinal vein occlusion: a pilot study

INTRODUCTION

Macular oedema is the main cause of visual impairment following retinal vein occlusion. The purpose of this study was to evaluate the anatomical and functional outcome of pars plana vitrectomy and internal limited membrane (ILM) peeling for macular oedema secondary to retinal vein occlusion.

CLINICAL PICTURE

This pilot study is a prospective nonrandomised series of 11 eyes of 11 patients with macular oedema secondary to retinal vein occlusion. The best-corrected visual acuity (BCVA), foveal thickness on optical coherence tomography, fundus fluorescein angiography (FFA) and multifocal electroretinography were evaluated.

TREATMENT AND OUTCOME

All 11 patients underwent pars plana vitrectomy with ILM peeling. The mean postoperative follow-up was 13.5 months (range, 1.5 to 24). The mean thickness at the foveal centre decreased from 794 +/- 276 microm preoperatively to 373 +/- 150 microm, 302 +/- 119 microm, 249 +/- 203 microm and 185 +/- 66 microm at 1 week, 1 month, 3 months and the final visit postoperatively, respectively (all P <0.001, paired t- test, compared to preoperative thickness). Postoperative FFA demonstrated markedly reduced leakage in the macular region. At the final visit, BCVA improved 2 lines or more in 72.7% (8/11) of patients and was unchanged in 27.3% (3/11) patients. Complications included cataract in 7 patients and vitreous haemorrhage, recurrence of macular oedema and visual field defect in 1 case each.

CONCLUSION

Pars plana vitrectomy and ILM peeling rapidly reduced the macular oedema caused by retinal vein occlusion, with improvement in BCVA.

Comparing fibrin glue to sutures for conjunctival closure in pars plana vitrectomy

PURPOSE

To evaluate whether fibrin glue causes less postoperative pain, discomfort and work inaptitude in conjunctival closure following 20 gauge pars plana vitrectomy than sutures.

DESIGN

Retrospective study.

METHODS

A questionnaire was sent in 2006 to 506 patients who underwent 20 gauge pars plana vitrectomy in 2004 at the University Hospital, Leuven, Belgium. Patients were asked about their postoperative pain and discomfort of the eye and the duration of their work inaptitude.

RESULTS

Our results showed a shorter duration of the eye being reddish (p-value 0.0471), discomfort of the eye (p-value 0.0376) and using an ointment (p-value 0.0105) in the glue group. The glue group used less ointment (p-value 0.0038) and independent workers had a shorter work inaptitude after receiving glue (p-value 0.0292). If patient had vitrectomy without cerclage, they had less pain on the first postoperative day when having received glue (p-value 0.0340).

CONCLUSIONS

Fibrin glue causes less postoperative pain, discomfort and work inaptitude for closure of conjunctival wounds in 20 gauge pars plana vitrectomy than sutures. Fibrin glue appears in our hands to be a better alternative to sutures for closure of conjunctival wounds in 20 gauge pars plana vitrectomy.

Phacoemulsification with intraocular lens implantation in cases of pars planitis

PURPOSE

To analyze the results of phacoemulsification cataract surgery with implantation of posterior chamber intraocular lenses (IOLs) of different biomaterials in eyes with pars planitis.

SETTING

Medical and Vision Research Foundations, Sankara Nethralaya, Chennai, India.

METHODS

The records of 86 patients (100 eyes) with pars planitis who had phacoemulsification with IOL implantation between January 1997 and April 2003 were retrospectively analyzed. The eyes were divided into 3 groups depending on IOL biomaterial: poly(methyl methacrylate) (PMMA) (n=32), heparin-surface-modified PMMA (n=39), or acrylic (n=29). The postoperative visual outcome and complications in each group were analyzed.

RESULTS

Forty-seven patients were men and 39, women. The mean age was 38 years (range 10 to 65 years) and the mean follow-up, 19.67 months (range 3.00 to 54.53 months). At the final follow-up, 91 eyes (91%) had better visual acuity than preoperatively; 79 had an improvement of 2 or more Snellen lines, 12 had an improvement of 1 Snellen line, 4 had no change, and 5 had a decrease as a result of reactivation of the pars planitis and progression of cystoid macular edema (CME). Significant posterior capsule opacification occurred in 10 eyes (10%), CME in 50 eyes (50%), reactivation of pars planitis in 51 eyes (51%), IOL deposits in 29 eyes (29%), IOL decentration in 1 eye (1%), and anterior capsule fibrosis in 14 eyes (14%). The most frequent cause of poor visual recovery was CME, submacular fibrosis, and epiretinal membrane. There was no statistically significant difference in these complications between the 3 groups.

CONCLUSIONS

Phacoemulsification with IOL implantation in eyes with pars planitis was safe and led to good visual outcomes in most cases. The factors in surgical success were control of inflammation, meticulous surgery, in-the-bag IOL implantation, and vigilant postoperative care.

[Combined surgery, phacoemulsification, implantation of intraocular lens and pars plana vitrectomy]

PURPOSE

To evaluate the effectiveness, technical feasibility and incidence of complications after combining pars plana vitrectomy, phacoemulsification and intraocular lens implantation.

MATERIAL AND METHODS

The results of combined vitreoretinal and cataract surgery in 100 eyes of 96 patients were retrospectively and prospectively analyzed. The mean follow-up period was 8.4 months. All patients had clinically significant lens opacities and vitreoretinal pathology requiring pars plana vitrectomy. Indications for vitreoretinal surgery included: persistent vitreous haemorrhage (28 eyes), vitreous hemorrhage combined with tractional retinal detachment (50 eyes), tractional retinal detachment without vitreous haemorrhage caused by proliferative diabetic retinopathy (7 eyes), rheumatogenous retinal detachment with proliferative vitreoretinopathy (10 eyes) and dislocated crystalline lens in the vitreous (5 eyes).

RESULTS

Postoperatively, best corrected visual acuity improved in 81 eyes (81%)- by two lines or more in 31 eyes (31%) - by less than two lines in 50 eyes (50%). In 14 eyes (14%) visual acuity was unchanged and was worse in 5 cases (5%). Postoperative complications included fibrin reaction, posterior synechias of the iris, vitreous hemorrhage, neovascular glaucoma, posterior capsule opacification, redetachment of retina.

CONCLUSIONS

Our cases confirm previous study, that performing phacoemulsification, IOL implantation and vitrectomy in one operation is safe and allows visual recovery with good technical results.

[Pars plana vitrectomy with corneal transplantation -- combined procedure]

The aim of our study is to present own observations with Eckardt temporary keratoprosthesis, during combined pars plana vitrectomy and corneal transplantation. We operated on two aphakic patients with unclear corneas and retinal detachment--I case, phthisis bulbi after recurrent uveitis--II case. Eckardt temporary keratoprosthesis was sutured to the corneal bed with 4 or 6 Ethilon 10.0 bites, pars plana vitrectomy was performed followed by corneal transplantation and silicone oil tamponade. We obtained good transplant clarity only in the I case, in the II case because of hipotony and persistent contract of silicone oil with cornea, transplant was cloudy and collapsed with small exception in the central area. After 3-rd month we noticed local retinal detachment in the periphery, which was suppressed with laser photocoagulations. We think, that Eckardt temporary keratoprosthesis gives possibility to do vitrectomy in patients with undear cornea, which was in the past impossible. However, combined procedure requires surgical skills in both: anterior and posterior segments of the eye.

Vitrectomy for pars planitis complicated by vitreous hemorrhage: visual outcome and long-term follow-up

PURPOSE

To characterize the visual results of vitrectomy for nonclearing vitreous hemorrhage in pars planitis.

METHODS

Case series.

RESULTS

All six eyes (100%) had a visual acuity of 20/200 or less preoperatively. Postoperatively, five eyes (83%) improved to a final visual acuity of better than 20/30, and one eye improved to 20/100. The poorer vision of the latter patient was attributed to cystoid macular edema. Postoperative follow-up range was from 1.3 to 9 years (mean, 4.2 years).

CONCLUSION

A substantial long-term benefit is seen in patients with pars planitis treated with vitrectomy for nonclearing vitreous hemorrhage. A larger case series will be needed to confirm whether such excellent outcomes can be expected.

[Pars plana vitrectomy in cases of endophthalmitis non-responding to antibiotic therapy]

The aim of the study is the evaluation of the results of pars plana vitrectomy in the cases of endophthalmitis unresponding to antibiotictherapy.

MATERIAL AND METHODS

The procedure of pars plana vitrectomy was carried out in 7 patients treated preoperatively by intraocular injections of antibiotics because of endophthalmitis at Ophthalmological Department of Medical University in Wrocław in the years 1996-1998. The age of patients was 33-88 years (mean 67). The postoperative follow up was 6 to 28 months.

RESULTS

Endophthalmitis resulted in all cases from cataract surgery. The positive microbiological traces were in 4 cases. In 3 cases pathogenic microbes were Staphylococcus epidermidis, in 1 Staphylococcus aureus and Micrococcus. In all patients the symptoms of inflammatory process disappeared after vitrectomy. In 5 patients we achieved the full visual acuity (0.8-1.0), in 1 patient bullous kerathopathy developed and in 1 phthisis bulbi.

CONCLUSIONS

Vitrectomy may lead to good functional outcome in 70% of postoperative endophthalmitis.

Ultrasound biomicroscopy in the diagnosis and management of pars planitis caused by caterpillar hairs

PURPOSE

To report the use of ultrasound biomicroscopy in the detection of caterpillar hairs in the pars plana in a patient with unilateral pars planitis.

METHOD

Ultrasound biomicroscopic imaging of the anterior segment of the eye.

RESULTS

Ultrasound biomicroscopy located a hair in the posterior chamber at the first visit and five more in the pars plana 1 month later. This finding was confirmed intraoperatively.

CONCLUSION

Ultrasound biomicroscopy is useful in the diagnosis and management of unilateral pars planitis of uncertain cause.

Vitrectomy for vitreous opacification in Fuchs' heterochromic uveitis

PURPOSE

To assess the role of pars plana vitrectomy (PPV) for symptomatic vitreous opacification in a series of patients with Fuchs' heterochromic uveitis (FHU).

METHODS

A retrospective review was undertaken of 13 patients with FHU who underwent vitrectomy for vitreous opacification between April 1989 and December 1998.

RESULTS

An improvement in visual symptoms was recorded in all patients, 9 of 13 (69%) demonstrating at least a 2 line increase in Snellen visual acuity. All but one patient attained 6/9 or better visual acuity post-operatively. Surgery was uneventful and did not appear to exacerbate any existing intraocular inflammation.

CONCLUSION

From this series we conclude that PPV has an important role in the management of patients with FHU who present with symptomatic vitreous opacification.

[Pars plana vitrectomy in the treatment of endophthalmitis]

PURPOSE

To assess the effectiveness of vitrectomy in the treatment of patients with endophthalmitis.

MATERIAL AND METHODS

Ten patients with endophthalmitis were qualified for treatment with vitrectomy via pars plana of a cilliary body. Endophthalmitis was diagnosed as resulting from previous: ECCE + I in 3 patients, penetrating bulb injury in 3 patients, penetrating keratoplasty in 1 patient; 3 other patients suffered from endogenous endophthalmitis. In all patients prior to surgical procedure samples of the vitreous were collected for bacteriology and mycology tests.

RESULTS

In 9 cases the surgery was followed by intravitreal administration of 1 or 2 antibiotics. In 1 case an antibiotic was added to the infusion solution. In all patients the following data were analyzed together with the result of a surgical procedure: cause of endophthalmitis, visual acquity directly before and after the procedure and over the follow-up period (from 6 months to 3 years), time delay between the onset of endophthalmitis and vitrectomy performed.

CONCLUSION

Vitrectomy performed via pars plana of a cilliary body is an effective method of treatment in cases of endophthalmitis. In patients with endophthalmitis early performed vitrectomy, followed by adequate adjuvant pharmacotherapy determine the chances for good postoperative prognosis.

[Pars plana vitrectomy in the treatment of endophthalmitis]

The aim of the study was to present and assess the results obtained after performing vitrectomy in patients with endophthalmitis after cataract surgery and injuries of the eyeball.

MATERIAL

The study material comprised 22 patients: 16 patients with endophthalmitis after cataract surgery, 4 after eyeball injuries and 2 after fistula operations.

EFFECTS

After vitrectomy we obtained in most patients an improvement of visual acuity and reduction of inflammatory symptoms. 10 days after operation in half of the patients the visual acuity was from 2/50 to 5/50, in 27.2% from 5/30 to 5/10.

Results of peripheral laser photocoagulation in pars planitis

PURPOSE

To determine the effect of peripheral retinal laser photocoagulation (PLP) on visual acuity, intraocular inflammation, and other ocular findings, including retinal neovascularization in eyes with pars planitis.

METHODS

A retrospective chart review of eyes with pars planitis that had undergone PLP.

RESULTS

Twenty-two eyes in 17 patients with pars planitis had undergone treatment with PLP at 2 centers. The mean age at the time of treatment was 19.3 years. Following treatment, mean follow-up was 16.3 months (range, 6 to 37 months). Mean visual acuity was 20/60 preoperatively and 20/50 postoperatively. This level of improvement was not statistically significant (P > .10), but there was a statistically significant decrease in the use of corticosteroids between the preoperative examination and the last postoperative examination (86% versus 27%, P < .05). There was also a statistically significant decrease in vitritis at the last follow-up (P = .0008) and a decrease in neovascularization of the vitreous base (P = .03) and in clinically apparent cystoid macular edema (P = .02). Epiretinal membranes were noted in 23% of eyes preoperatively and in 45% of eyes postoperatively. Only one of these epiretinal membranes was considered to be visually significant. One eye developed a tonic dilated pupil, which slowly improved.

CONCLUSIONS

Although the long-term natural history of clinical findings in pars planitis is not well documented, PLP appears to decrease the need for corticosteroids while stabilizing visual acuity. It also appears to decrease vitreous inflammation. PLP has few complications and should be considered in patients with pars planitis who are unresponsive or have adverse reactions to corticosteroids.

A fluorescein angiographic study of patients with pars planitis and peripheral exudation (snowbanking) before and after cryopexy

BACKGROUND

Transconjunctival cryopexy of the vitreous base is clinically effective in patients with steroid nonresponsive pars planitis who have peripheral neovascularization. Cryoablation of the region previously has been thought to eliminate the areas of permeable neovascular tissue, thus removing the focus of exudation. The authors report the first study of patients with refractory pars planitis in which fluorescein angiography of the inferior pars plana snowbanks was performed both before and after cryopexy of the vitreous base.

METHODS

Twelve consecutive phakic eyes with pars planitis and prominent peripheral snowbanks had fluorescein angiograms of the pars plana. Clinical involvement was graded on the basis of visual acuity, levels of vitreous inflammation and cystoid macular edema, and on the extent of peripheral snowbanking. Transconjunctival cryopexy of the vitreous base was performed. Fluorescein angiography of the pars plana snowbanks was repeated 2 months after the procedure, and clinical involvement again was graded.

RESULTS

Early hyperfluorescence with late leakage was present in all eyes and was limited to the area of the pars plana snowbanks. After cryopexy of the vitreous base, all eyes demonstrated hypofluorescence and diminution of late-phase dye leakage in the treated areas. Eighty-three percent of all eyes demonstrated clinical improvement, consistent with previously reported studies.

CONCLUSION

Cryopexy of the vitreous base decreases peripheral exudation in patients with refractory pars planitis and snowbanking. This suggests that elimination of peripheral neovascular tissue may be directly related to clinical improvement in these patients.

[Results of pars plana vitrectomy in chronic uveitis in childhood]

During 1986-1991 vitreous surgery was performed in 5 girls and 8 boys (age range 2-15 years) with chronic uveitis. In 6 cases a combined lensectomy-vitrectomy was performed because cataract was present, so that the results generally refer to 19 eyes. We found a low rate of postoperative complications. During a follow-up period of 6 months to 5 years (average 2 years and 1 month), 12 of the 19 eyes showed a significant visual improvement. Preoperatively, 8 eyes were found to be affected by cystoid macular edema; in 7 of these cases remarkable regression of the edema was observed after surgery. In two-thirds of cases the intensity of the inflammation decreased, so that the dose of corticosteroids could be reduced postoperatively. Our results suggest that vitrectomy for chronic uveitis in children is a relatively safe and successful treatment. In order to prevent irreversible complications and amblyopia surgery should be performed in an early stage of the disease.

Pars planitis presenting with vitreous hemorrhage

A 31-year-old woman complained of a sudden, painless decrease in vision of the right eye. Ophthalmic examination demonstrated a vitreous hemorrhage in the right eye secondary to peripheral neovascularization. The left eye demonstrated findings consistent with pars planitis. Before this episode, vision was good in both eyes. Although rare, vitreous hemorrhage can occur in the setting of pars planitis and may be a presenting symptom. Pars planitis should be considered in the differential diagnosis of young patients with vitreous hemorrhage.

Intraocular lens implantation versus no intraocular lens implantation in patients with chronic iridocyclitis and pars planitis. A randomized prospective study

PURPOSE

The authors studied the safety of intraocular lens (IOL) implantation in patients with uveitis.

METHODS

The authors prospectively randomized 26 patients with chronic iridocyclitis (22 patients) or pars planitis (4 patients) to undergo IOL implantation or no IOL implantation at the time of cataract surgery.

RESULTS

There was no statistical difference in visual acuity results at 1 year between the two groups. There was a trend toward better visual acuity in patients with chronic iridocyclitis without IOLs. Cocoon-like dense fibrous membranes enveloped the IOL in two patients.

CONCLUSION

The authors conclude that IOLs are relatively safe in patients with chronic iridocyclitis but that only a much larger study could determine if the trend toward better visual acuity without an IOL was real.

Cataract extraction in patients with pars planitis

BACKGROUND

The authors analyzed the results of cataract surgery performed on patients with pars planitis from January 1985 through August 1992.

METHODS

One hundred twenty-six patients with pars planitis were evaluated and treated during this period. Cataracts that warranted surgery developed in 12 patients (18 eyes) from this tertiary referral population. These 12 patients were evaluated with respect to pars planitis duration, systemic disease association, treatment regimens, macular and disc pathology, and final visual result.

RESULTS

The average final visual acuity of these 18 eyes was 20/38, and 83% of the patients achieved a final visual acuity better than or equal to 20/40. The factors that limited visual recovery to this level were primarily macular and optic nerve pathology (cystoid macular edema [CME], macular epiretinal membrane, and optic atrophy). Control of inflammation required regional steroids in all patients, systemic steroids in ten patients, and immunosuppression in four patients. Posterior chamber lens implantation accompanied the surgery in 14 eyes (10 patients). Recurrent episodes of inflammation in two patients (3 eyes) resulted in accumulation of deposits on the posterior chamber intraocular lens (IOL) surface. Deposits were removed by a YAG laser lens "polishing" session.

CONCLUSION

Absolute control of inflammation in patients with pars planitis through a stepladder approach may reduce the incidence of cataract development, and can certainly improve visual rehabilitation after cataract extraction. Implantation of a posterior chamber lens can be well tolerated in selected cases.

A combined anterior and posterior approach to cataract surgery in patients with chronic uveitis

Although several recent papers have focused on the results of cataract surgery in patients with uveitis, little has been published on specific surgical techniques that are most appropriate to such cases. We have found that a combined anterior and posterior approach using extracapsular techniques (usually phacoemulsification) and pars plana vitrectomy, with or without intraocular lens placement, is best suited for selected uveitis patients who have cataract, vitreous opacities, and cystoid macula edema. This paper discusses the surgical techniques that we have found to be best for the management of these cases.

[Use of transconjunctival cryoapplication in chronic pars planitis with involvement of peripheral retina and choroid]

The transconjunctival cryoapplication was performed in 8 patients (13 eyes) with the recurrent pars planitis and the simultaneous involvement of peripheral retina and choroid. Before the surgery, the peripheral fundus of the eye was examined with the Goldmann three-mirror lens and afterwards, the cryoapplication of lesions was performed. The topical treatment, dexamethasone and indomethacin drops, followed the surgery only. In all cases the inflammation disappeared but the macular edema and vitreal exudation regressed slowly. The considerable improvement of visual acuity was achieved in 8 eyes (61%). So far, the results of the observations are satisfactory and they entitle the authors to carry on the application of the treatment mentioned above.

Cryopexy in pars planitis

Cryotherapy has been reported to be of benefit in pars planitis. We studied 16 eyes with classic pars planitis unresponsive to corticosteroid therapy. Eight eyes continued with systemic and periocular steroid therapy, and in the remaining eight eyes transconjunctival cryopexy of the peripheral retina and vitreous base was done as an additional procedure. At 6 months four of the eyes that received cryopexy showed an improvement in Snellen visual acuity, and in the other four the acuity was unchanged; none of the eyes showed any vitreous base neovascularization. Among the eyes that received steroid therapy only, the acuity was unchanged in five, improved in one and reduced in two.

Treatment of pars planitis with cryotherapy

Cryotherapy was performed on 28 eyes exhibiting massive exudates (snowbank) over the pars plana and the ora serrata. Twenty-six patients ranging in age from 8 to 52 years were treated and then followed up for a median of 34 months. Eleven eyes needed repeat cryotherapy. After cryotherapy, retinal vasculitis and vitreous opacities decreased in most eyes. Although only 3 of 5 eyes with a snowbank greater than 90 degrees and treated over 1 year from the onset achieved visual acuity of 20/25 or better, all 12 eyes with a snowbank smaller than 60 degrees and treated within 3 months after the onset maintained a visual acuity of 20/25 or better. The prognosis was not different from the 20 eyes that received systemic steroid treatment and the 8 eyes that received no systemic steroids. We recommend cryotherapy as the primary treatment for pars planitis with a snowbank.