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Vitreoretinal Surgery (vitreoretinal + surgery)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Longterm results after phacovitrectomy and foldable intraocular lens implantation

ACTA OPHTHALMOLOGICA, Issue 8 2009
Wensheng Li
Abstract. Purpose:, This study aimed to evaluate the longterm results of phacovitrectomy and foldable intraocular lens (IOL) implantation in eyes with significant cataract and co-existing vitreoretinal diseases. Methods:, We carried out a retrospective study of 186 eyes of 149 patients with various vitreoretinal abnormalities and visually significant cataracts. Vitreoretinal surgery was combined with phacoemulsification and foldable IOL implantation. Main outcome measures were visual acuity (VA), preoperative data, and intraoperative and postoperative complications. Results:, The most common indications for surgery were non-diabetic vitreous haemorrhage and proliferative diabetic retinopathy. Preoperative vision ranged from 0.6 to light perception; postoperative vision ranged from 1.2 to no light perception. Postoperatively, in 162 eyes (87.1%) VA improved by , 3 lines on the decimal chart. In 14 eyes (7.5%), vision remained within 3 lines of preoperative levels and in 10 eyes (5.3%), vision had decreased by the last follow-up. Postoperative complications included elevated intraocular pressure and posterior capsule opacification, corneal edema, macular edema, fibrinous reaction, vitreous hemorrhage, corneal epithelial defects, anterior chamber hyphema, choroidal detachment, persistent macular hole, posterior synechiae, recurrent retinal detachment, rubeosis iridis, neovascular glaucoma. Conclusions:, Combined vitreoretinal surgery and phacoemulsification with foldable IOL implantation is safe and effective in treating vitreoretinal abnormalities co-existing with cataract. Based on extensive experience with the combined procedure, we suggest that combined surgery is recommended in selected patients with simultaneous vitreoretinal pathological changes and cataract. [source]

Vitreoretinal surgery in Behçet's disease with severe ocular complications

ACTA OPHTHALMOLOGICA, Issue 2 2001
Yusuf Özertürk
ABSTRACT. Purpose: To investigate effects of vitreoretinal surgery in Behçet's disease. Materials and Method: Vitreoretinal surgery was applied to 26 eyes of 21 patients with Behçet's disease. Preoperative and postoperative visual acuities, number and duration of attacks, anterior and posterior segment pathologies were evaluated. Results: The mean age of the patients was 33 years and female/male ratio was 6/15. The mean follow-up was 23 months. Visual acuity increased in 15 eyes (58%), did not change in 11 eyes (42%). In the postoperative period, there was a significant decrease in mean number of uveitis attacks compared to the preoperative period (p=0.001), as well as a significant decrease in the mean duration of uveitis attacks (p=0.001). In the postoperative follow-up, intravitreal haemorrhage in 2 eyes (8%), posterior subcapsular cataract in 5 eyes (19%) and corticonuclear cataract in 2 eyes (8%) were observed. Posterior capsular opacification (PCO) developed in 5 of 16 eyes (31%) having ECLE-IOL. CME continued in 3 eyes (12%). Conclusion: Vitreoretinal surgery has favourable effect on the visual and anatomic prognosis in Behçet's patients with severe ocular complications. [source]

3315: Transconjunctival sutureless 20G

ACTA OPHTHALMOLOGICA, Issue 2010
CJ POURNARAS
Purpose To evaluate a trocar system that allows the use of the regular 20-gauge vitrectomy instruments for a transconjunctival sutureless surgery for the treatment of various surgically treated vitreo-retinal pathologies. Methods The 20-gauge trocar system uses a 10° self-sealing tunneled incision made with trocars introduced with a inserter blade of 0.9 mm diameter. Incisions are radially made at 3.5 mm from the limbus and tunnels are made limbus-parallel. Evaluation of the surgical procedure, sclerotomies closure by OCT, anatomical and visual outcomes in various vitreoretinal pathologies treated in current vitreoretinal practice. Results Postoperative patient comfort and less eye inflammation are provided by the sutureless technique, allthough small conjunctival hemorrhage caused by the grasping forceps used to hold the eye during the insertion of the trocars may occur. The 20-gauge trocar system using 10° self-sealing tunneled incision remains very stable in the eye even during peripheral vitrectomy with indentation and they also decrease the surgical induced trauma at the entry sites. The use of nonflexible instruments, the same as in 20-gauge conventional vitrectomy, provides easy access to the entire periphery.thus the system can be used in almost all vitreoretinal surgeries. It allows the use of phragmatome and is easy to work even with 5,000 centistokes silicone oil. Conclusion In the era of sutureless surgeries, the 20-gauge trocar system is a safe, comfortable, convinient with current instrumentation and less expensive alternative to 25- and 23-gauge vitrectomy. [source]

Effect of topical steroids on corneal epithelial healing after vitreoretinal surgery

ACTA OPHTHALMOLOGICA, Issue 3 2006
Fatma Yülek
Abstract. Purpose:,Topical steroid use is usually avoided in cases of corneal epithelial defect. We evaluated the effect of topical steroid treatment on corneal epithelial healing after epithelial debridement in vitreoretinal surgery. Methods:,Our study population included 85 eyes undergoing vitreoretinal surgeries in our clinic. We prospectively compared the duration of corneal epithelial wound healing in 43 eyes in which topical dexamethasone was used with that in 42 eyes in which topical dexamethasone was not used in the early postoperative period after epithelial debridement. Factors that may retard corneal epithelial healing, including pre- and intraoperative topical solutions, median operative time, the presence of diabetes mellitus, prior ocular surgeries, pseudophakia, aphakia and the presence of intraocular gas or silicone oil in aphakic patients, were not significantly different between the two groups. Results:,The mean corneal epithelial defect closure time was 59.7 ± 2.6 hours (mean ± SEM) in the group receiving topical steroid treatment, and 61.9 ± 2.6 hours in the group that did not receive steroids. Conclusion:,Topical dexamethasone administered five times/day did not significantly retard corneal epithelial healing in subjects undergoing vitreoretinal surgery with postoperative topical steroid treatment, compared with subjects who did not receive steroid treatment. [source]

The effect on outcome of peribulbar anaesthesia in conjunction with general anesthesia for vitreoretinal surgery

ANAESTHESIA, Issue 3 2010
A. M. Ghali
Summary The purpose of this study was to evaluate peri-operative outcome after vitreoretinal surgery when peribulbar anaesthesia is combined with general anaesthesia. Sixty adult patients undergoing elective primary retinal detachment surgery with scleral buckling or an encircling procedure received either peribulbar anaesthesia in conjunction with general anaesthesia or general anaesthesia alone. For peribulbar anaesthesia a single percutaneous injection of 5,7 ml of local anaesthetic solution (0.75% ropivacaine with hyaluronidase 15 iu.ml,1) was used. The incidence of intra-operative oculocardiac reflex and surgical bleeding interfering with the surgical field, postoperative pain and analgesia requirements, and postoperative nausea and vomiting were recorded. In the block group there was a lower incidence of oculocardiac reflex and surgical bleeding intra-operatively. Patients in the block group also had better postoperative analgesia and a lower incidence of postoperative nausea and vomiting compared with the group without a block. The use of peribulbar anaesthesia in conjunction with general anesthesia was superior to general anaesthesia alone for vitreoretinal surgery with scleral buckling. [source]

1226: Techniques and complications of anaesthesia for vitreoretinal surgery and a new technique of local anaesthesia

ACTA OPHTHALMOLOGICA, Issue 2010
K GOMBOSArticle first published online: 23 SEP 2010
Purpose Since the 1970s, the methods of vitrectomy procedures in ophthalmology have changed due to technical developments. Consequently certain procedures are less painful and less time consuming. On the other hand, due the modern technology more difficult cases can be operated, which may result in increase the time and strain of the operation. Methods General anaesthesia (GA) is one possibility, but it may have lots of side effects, can cause serious life threatening complications, is time consuming, expensive and sometimes to organise general anaesthesia leads to delay of the operation, consequently possibly hindering the proper timing of it. Despite these, the GA seemed to be necessary when a longer procedure planned. Results Using our method we could avoid some of the well-known complications of RBA and PBA. Painless operations were provided and the surgeons were satisfied with the anaesthesia. The serum Lidocain level was lower in cRBA compared with the single dose technique. Moreover the presence of postoperative pain could be reduced by using anaesthesia via cannula. Conclusion The benefits and disadvantages of cRBA will be apparent only by the spread of the new technique, which could also contribute to its improvement. This method means a perspective for postoperative pain relief. Hopefully more widespread use of this method helps continuous regional techniques to find their well deserved place in ophthalmic anaesthesia. [source]

3416: Surgical therapy of macular edema

ACTA OPHTHALMOLOGICA, Issue 2010
CJ POURNARAS
Purpose Persistent macular oedema (ME) is the main cause of poor visual outcome during the evolution of retinal ischemic microangiopathies and traction related macular distortion. Among multiples treatment approaches, vitreoretinal surgery is applied with the goal to achieve the release of a traction related component of macular oedema . Methods Vitrectomy with peeling of the posterior hyaloid, epiretinal membranes, vitreoretinal tractions and/or internal limiting membrane removal, were studied in numerous nonrandomized cases series. Results Pars plana vitrectomy has been shown to reduce macular oedema with significant change in best corrected visual acuity, in epiretinal membranes, vitreoretinal traction syndrome and ischemic microangiopathies related macular thickening central, hemiretinal, branch retinal vein occlusion and diabetic macular edema). Evidence to date does not support any therapeutic benefit from radial optic neurotomy and arteriovenous crossing sheathotomy for BRVO and CRVO related macular oedema. Conclusion In the era of intravitreal injection of steroids and anti VEGF substances, vitrectomy seems to have a beneficial effect in traction related, selected pathologies associated to chronic macular edema. [source]

2123: Transferrin and transthyretin in vitreoretinal surgery

ACTA OPHTHALMOLOGICA, Issue 2010
C ARNDT
Purpose The concentration of transferrin in the vitreous is known to be higher than in plasma or aqueous humor. This has been related to a local synthesis of transferrin by the ciliary body. Increased levels have been found in vitro-retinal proliferation. A relationship between the level of transthyretin and the functional outcome has been previously reported. The purpose of the study was to look for a relation between transferrin and transthyretin. Methods Patients with epiretinal membrane and rhegmatogenous retinal detachment were prospectively enrolled. The vitreous samples were obtained without intraocular infusion. The levels of transferrine and transthyretin (prealbumin) were determined in all cases. Results In the group of patients with retinal detachment (n=18), two groups could be identified: the transferrin levels were either low between 40 and 70 mg/l with low transthyretin (<17,8 mg/l)(n=6) or high (>400 mg/l) with transthyretin levels between 200 and 400 mg/l (n=12). No relationship to any clinical parameters (extension of the detachment, onset of symptoms or degre of vitreo-retinal proliferation) could be demonstrated. In patients with epiretinal membranes (n=6), the transferrin levels <40 mg/l, transthyretin < 17,8 mg/l. Conclusion Increased transferrin seems to correlate with increased transthyretin levels in the vitreous. The clinical signification of this relationship remains to be demonstrated and probably requires a larger patient sample. [source]

Longterm results after phacovitrectomy and foldable intraocular lens implantation

Is there still a place for vitrectomy in the treatment of macular edema due to venous occlusion ?

ACTA OPHTHALMOLOGICA, Issue 2009
CJ POURNARAS
Purpose Persistent macular edema (ME) is the main cause of poor visual outcome in either non-ischemic BRVO or CRVO. Among multiples treatment approaches, vitreoretinal surgery with the goal to achieve the recanalisation of the occluded vessels and/or the resolution of ME, were proposed. Methods Vitrectomy with peeling of the posterior hyaloid and/or the internal limiting membrane,asociated to intravitreal (IVT) triamcinolone , neurotomy, sheathotomy, intravascular rtPA injection were studied in numerous nonrandomized cases series. Results Pars plana vitrectomy has been shown to reduce macular oedema and restore the normal foveal contour without significant change in best corrected visual acuity. In contrast, visual improvement occurs after vitrectomy for vitreous haemorrhage, epiretinal membrane formation and retinal detachment complicating BRVO. Evidence to date does not support any therapeutic benefit from radial optic neurotomy, optic nerve decompression, arteriovenous crossing sheathotomy or intravascular rtPA. Vitrectomy combined with IVT triamcinolone, induces a ME decrease rapidly and durably, without any improvement in visual acuity. Conclusion Vitrectomy with IVT triamcinolne seems to have a more durable effect than IVT triamcinolone alone.Vitrectomy, A-V sheathotomy combined with intravenous t-PA may offer benefits in BRVO. Despite uncertainty and open questions, surgical interventions are likely to be a therapeutic option for RVO in the future. Randomized and controlled studies are needed to confirm these results and to compare them to the natural course of the disease. [source]

Fluid dynamics in three 25-gauge vitrectomy systems: principles for use in vitreoretinal surgery

ACTA OPHTHALMOLOGICA, Issue 2 2008
Octaviano Magalhães Jr
Abstract. Purpose:, To compare infusion and extrusion fluid volumes with three 25-gauge vitrectomy systems. Methods:, The infusion and aspiration rates of 25-gauge systems from Alcon (Fort Worth, TX, USA), Bausch & Lomb (St Louis, MO, USA), and the Dutch Ophthalmic Research Centre (DORC, Zuidland, the Netherlands) were measured in vitro using balanced saline solution with different heights (40, 60, 80, 100, 120 cm) of infusion bottle, cutter velocities (800, 1100, 1500 cuts/ min) and aspiration powers (100, 200, 300, 400, 500 mmHg). Results:, The infusion flow velocities differed among the systems (p < 0.001 for all comparisons [p-values 0.0009,0.0001]). The aspiration rates of the Alcon and Bausch & Lomb systems were lower than that of the DORC system (p < 0.02 for all comparisons [p-values 0.018,0.002]). Conclusions:, Infusion and extrusion fluid rates differ among 25-gauge vitrectomy systems. These results may help to optimize ideal aspiration and infusion parameters among 25-gauge vitrectomy systems used to treat vitreoretinal diseases. [source]

IL-8 vitreous levels in proliferative diabetic retinopathy

ACTA OPHTHALMOLOGICA, Issue 2007
M GLOBOCNIK PETROVIC
Purpose: To determine the levels of interleukin 8 (IL-8) in the vitreous of patients with proliferative diabetic retinopathy (PDR) and the role of IL-8 as a marker of visual prognosis after vitrectomy. Methods: Vitreous fluid samples were obtained at vitreoretinal surgery from 71 patients with diabetes type 2 and PDR, and from 17 age-matched non-diabetic patients with a macular hole (control group). PDR was classified as active and inactive, and subdivided according to the extent of large vessel gliotic obliteration. The cytokine levels were measured by Cytometric Bead Array method. To determine the role of IL-8 as visual prognostic marker after vitrectomy we investigated whether the vitreous levels of IL-8 were associated with poor visual outcome. Poor outcome was defined by visual acuity less than 20/200 at least 8 months after vitrectomy. Clinical and preoperative eye characteristics (visual acuity, iris neovascularisation, vitreous hemorrhage, macular detachment, macular edema, active neovascularisation, neovascularisation of the disk, and the presence of panretinal photocoagulation) were additionally analyzed. Results: The vitreous levels of IL-8 were significantly higher in patients with PDR in comparison to the control (P<0.001), in eyes with higher extent of large vessel gliotic obliteration (P<0.001) and was not significantly higher in eyes with active neovascularisation (P=0.9). After multiple logistic regression analysis, vitreous level of IL-8 (P=0.028) and macular detachment (P=0.039) were predictors for the poor visual outcome after vitrectomy. Conclusions: The vitreous level of IL-8 was associated with the higher extent of large vessel gliotic obliteration and with the poor visual outcome after vitrectomy. [source]

Effect of topical steroids on corneal epithelial healing after vitreoretinal surgery

Computer-assisted training system for pars plana vitrectomy

ACTA OPHTHALMOLOGICA, Issue 6 2003
Jost B. Jonas
Abstract. Purpose:,To evaluate whether microsurgical steps in vitreoretinal surgery can be taught by a computer-assisted training system. Methods:,This prospective, randomized experimental study included 14 ophthalmic residents and medical students who were completely inexperienced in microsurgery. They were randomized into two groups. The study group underwent training programmes in a computer-assisted training system for simulation of pars plana vitrectomy. The control group did not participate in any in vitro training. In the second phase of the study, participants of both groups performed a pars plana vitrectomy in three pig eyes, which included picking a metallic foreign body from the retinal surface. Results:,The amount of retinal detachment and the number of retinal defects at the end of the vitrectomies were smaller, the time needed to remove the foreign body was shorter, the number of retinal lesions associated with the foreign body removal was lower, and the mark given was better in the trained study group than in the untrained group. The relatively small number of study participants did not allow the differences between the study and control groups to reach the 5% level of error probability. Conclusions:,In an animal model, training by a computer-based medical work station for simulation of pars plana vitrectomy showed better outcome measures for trained study participants compared with untrained study participants. Future studies may show whether further refinements of such training programmes will result in statistically significantly better results in surgical outcome parameters. [source]