Effectiveness and safety of early lens extraction during par plana vitrectomy for proliferative diabetes retinopathy with mild cataract:a randomized clinical trial

●AIM:To evaluate the effectiveness and safety of early lens extraction during pars plana vitrectomy(PPV)for proliferative diabetic retinopathy(PDR)compared to those of PPV with subsequent cataract surgery.●METHODS:This multicenter randomized controlled trial was conducted in three Chinese hospitals on patients with PDR,aged>45y,with mild cataracts.The participants were randomly assigned to the combined(PPV combined with simultaneously cataract surgery,i.e.,phacovitrectomy)or subsequent(PPV with subsequent cataract surgery 6mo later)group and followed up for 12mo.The primary outcome was the change in best-corrected visual acuity(BCVA)from baseline to 6mo,and the secondary outcomes included complication rates and medical expenses.●RESULTS:In total,129 patients with PDR were recruited and equally randomized(66 and 63 in the combined and subsequent groups respectively).The change in BCVA in the combined group[mean,36.90 letters;95%confidence interval(CI),30.35–43.45]was significantly better(adjusted difference,16.43;95%CI,8.77–24.08;P<0.001)than in the subsequent group(mean,22.40 letters;95%CI,15.55–29.24)6mo after the PPV,with no significant difference between the two groups at 12mo.The overall surgical risk of two sequential surgeries was significantly higher than that of the combined surgery for neovascular glaucoma(17.65%vs 3.77%,P=0.005).No significant differences were found in the photocoagulation spots,surgical time,and economic expenses between two groups.In the subsequent group,the duration of work incapacity(22.54±9.11d)was significantly longer(P<0.001)than that of the combined group(12.44±6.48d).●CONCLUSION:PDR patients aged over 45y with mild cataract can also benefit from early lens extraction during PPV with gratifying effectiveness,safety and convenience,compared to sequential surgeries.

Endoscopy-assisted vitrectomy for severe ocular penetrating trauma with corneal opacity

AIM:To assess the utility and efficiency of endoscopyassisted vitrectomy(EAV)for the treatment of corneal opacity in severe ocular trauma.METHODS:Patients who underwent fundus examination using a preoperative slit lamp and intraoperative endoscopy,followed by EAV and additional surgery were retrospectively recruited.Silicone oil removal and penetrating keratoplasty were used in selected eyes at postoperative follow-ups.Outcome measurements included the best corrected visual acuity(BCVA),intraocular pressure(IOP),findings of endoscopic fundus examination,and postoperative complications.RESULTS:Twenty-one eyes with severe ocular trauma and corneal opacity were followed up for 24-36mo.Retinal detachment(RD)and vitreous haemorrhage(VH)were identified in 16 eyes(76.2%),RD only in four eyes(19.0%),and VH combined with intraocular foreign body in one eye(4.8%).All eyes underwent at least three surgeries.Stage-Ⅰ surgeries involved wound closure(100%),lens extraction(76.2%),and anterior vitrectomy(14.3%).Stage-Ⅱ surgeries involved scleral buckling(28.6%),membrane peeling(47.6%),retinal laser photocoagulation(100%)and silicone oil tamponade(100%)using EAV.Stage-Ⅲ surgeries were conducted using endoscopy including silicone oil removal(52.4%),retinal laser photocoagulation(52.4%)and penetrating keratoplasty(28.6%).Nearly all eyes showed improvements in BCVA and IOP.Although there were no severe complications,glaucoma was noted in one eye,chronic hypotony in another eye,and band keratopathy in three eyes.CONCLUSION:EAV is an effective adjunct for restoring ocular anatomical structures and visual function in the case of corneal opacity after severe ocular trauma.

Differential distribution of fibrovascular proliferative membranes in 25-gauge vitrectomy for proliferative diabetic retinopathy

AIM:To analyze the distribution of fibrovascular proliferative membranes(FVPMs)in proliferative diabetic retinopathy(PDR)patients that treated with pars plana vitrectomy(PPV),and to evaluate the outcomes separately.METHODS:This was a retrospective and cross-sectional study.Consecutive 25-gauge(25-G)PPV cases operated for PDR from May 2018 to April 2020.According to the FVPMs images outlined after operations,subjects were assigned into three groups:arcade type group,juxtapapillary type group,and central type group.All patients were followed up for over one year.General characteristics,operation-related variables,postoperative parameters and complications were recorded.RESULTS:Among 103 eyes recruited,the FVPMs distribution of nasotemporal and inferiosuperioral was significantly different(both P<0.01),with 95(92.23%)FVPMs located in the nasal quadrants,and 74(71.84%)in the inferior.The eyes with a central FVPM required the longest operation time,with silicon oil used in most patients,generally combined with tractional retinal detachment(RD)and rhegmatogenous RD,the worst postoperative bestcorrected visual acuity(BCVA)and the highest rates of recurrent RD(all P<0.05).FVPM type,age of onset diabetes mellitus,preoperative BCVA,and combined with tractional RD and rhegmatogenous RD were significantly associated with BCVA improvement(all P<0.05).Compared with the central type group,the arcade type group had higher rates of BCVA improvement.CONCLUSION:FVPMs are more commonly found in the nasal and inferior mid-peripheral retina in addition to the area of arcade vessels.Performing 25-G PPV for treating PDR eyes with central FVPM have relatively worse prognosis.

Effects of vitrectomy combined with internal limiting membrane peeling in patients with diabetic macular edema

BACKGROUND Diabetic macular edema(DME),a chronic microvascular complication of diabetes,is a leading cause of visual impairment and blindness.Pars plana vitrectomy(PPV)can restore the normal macular structure and reduce macular edema,whereas internal limiting membrane(ILM)peeling is used to treat tractional macular diseases.Despite the advantages,there is limited research on the combined effects of PPV with ILM peeling.AIM To observe the effects of PPV combined with ILM peeling on postoperative central macular thickness(CMT),best-corrected visual acuity(BCVA),cystoid macular edema(CME)volume,and complications in patients with DME.METHODS Eighty-one patients(92 eyes)diagnosed with DME at the Beijing Shanqu Liangxiang Hospital between January and December 2022 were randomly divided to undergo PPV alone(control group:41 patients,47 eyes)or PPV+ILM peeling(stripping group:40 patients,45 eyes);a single surgeon performed all surgeries.The two groups were compared preoperatively and 1 and 3 months postoperatively.RESULTS Preoperatively,both groups had comparable values of CMT,BCVA,and CME volume(P>0.05).After surgery(both 1 and 3 months),both groups showed significant reductions in CMT,BCVA,and CME volume compared to preoperative levels,with the stripping group showing more significant reductions compared to the control group(P<0.05).Further repeated-measures ANOVA analysis for within-group differences revealed significant effects of group and time,and interaction effects for CMT,BCVA,and CME volume(P<0.05).There were no significant differences in the incidence of complications between the groups(retinal detachment:control=2,stripping=1;endophthalmitis:Control=4,stripping=1;no cases of secondary glaucoma or macular holes;χ^(2)=0.296,P=0.587).CONCLUSION PPV with ILM peeling can significantly improve the visual acuity of patients with DME,reduce CMT,and improve CME with fewer complications.

Investigation and analysis of negative emotion in patients with diabetic retinopathy after vitrectomy

BACKGROUND As the incidence of diabetes continues to increase,the number of patients with diabetic retinopathy(DR)also increases each year.After undergoing vitrectomy for DR,patients often experience negative emotional problems that negatively affect their recovery.AIM To investigate negative feelings in patients with DR after vitrectomy and to explore related influencing factors.METHODS A total of 146 individuals with DR who were accepted for treatment at The Third People’s Hospital of Changzhou from May 2021 to April 2023 were recruited to participate in this study.All patients underwent vitrectomy.The self-rating anxiety scale(SAS)and self-rating depression scale(SDS)were used to assess the degree of anxiety and depression 2-3 days after the operation.The participants were divided into a healthy control group and a negative emotion group.The patients’general demographic characteristics and blood glucose levels were collected.Logistic regression analysis was used to analyze the factors influencing negative feelings post-operation.Pearson’s correlation coefficient was used to analyze the association between SAS scores,SDS scores,and blood glucose levels.RESULTS The control group included 85 participants.The negative emotion group comprised 40 participants with anxiety,13 with depression,and eight with both.Logistic regression showed that being female(OR=3.090,95%CI:1.217-7.847),a family per capita monthly income of<5000 yuan(OR=0.337,95%CI:0.165-0.668),and a longer duration of diabetes(OR=2.068,95%CI:1.817-3.744)were risk factors for negative emotions in patients with DR after vitrectomy(P<0.05).The concentrations of fasting plasma glucose(FPG),2-hour postprandial glucose(2hPG),and glycated hemoglobin(HbA1c)in the negative emotion group exceeded those in the control group(P<0.05).SAS scores were positively associated with FPG(r=0.422),2hPG(r=0.334),and HbA1c(r=0.362;P<0.05).SDS scores were positively correlated with FPG(r=0.218)and 2hPG(r=0.218;P<0.05).CONCLUSION Sex,income level,and duration of diabetes were factors that influenced negative emotions post-vitrectomy.Negative emotions were positively correlated with blood glucose levels,which can be used to develop intervention strategies.

Pharmacological adjuvants for diabetic vitrectomy surgery

Diabetic vitrectomy is a highly intricate surgical procedure performed during the advanced stages of diabetic retinopathy(DR).It is used to treat conditions such as tractional or combined retinal detachment,vitreous hemorrhage,and subhyaloid hemorrhage,which are all severe manifestations of proliferative DR.The results of the surgery are uncertain and variable.Vitreoretinal surgery has made significant progress since the early stages of vitrectomy.In the past ten years,advancements in intravitreal pharmacotherapy have emerged,offering new possibilities to improve the surgical results for our patients.Within the realm of medical terminology,an"adjunct"refers to a pharmaceutical or substance employed to aid or expedite the primary therapeutic intervention for a particular ailment.Their introduction has broadened the range of therapeutic choices that are accessible prior to,during,and following surgical procedures.This review article will specifically analyze the pharmacological adjuncts used in diabetic vitrectomy surgery,with a focus on their role in facilitating or aiding specific steps of the procedure.The implementation of this system of categorization offers benefits to the surgeon by allowing them to foresee potential difficulties that may occur during the surgical procedure and to choose the appropriate pharmacological agent to effectively tackle these challenges,thus enhancing surgical success rates.

Clinical outcomes of 25-gauge vitrectomy surgery for vitreoretinal diseases: comparison of vitrectomy alone and phaco-vitrectomy

AIMTo compare the clinical outcomes of combined 25-gauge pars plana vitrectomy (PPV) and phacoemulsification/posterior chamber intraocular lens (PC-IOL) implantation with vitrectomy alone surgery in patients with various vitreoretinal diseases.METHODSA total of 306 eyes (145 with PPV alone and 161 with phaco-vitrectomy) were enrolled in this retrospective analysis. The surgical approach was 25-gauge PPV combined with phacoemulsification and PC-IOL implantation at the same time in eyes in phaco-vitrectomy group and only PPV in eyes in vitrectomy alone surgery group. The main outcome measures were postoperative clinical outcomes included anterior chamber inflammation, changes in intraocular pressure (IOP) and best corrected visual acuity (BCVA).RESULTSThe most common postoperative complication was anterior chamber reaction which has higher incidence in phaco-vitrectomy group (P<0.001). The mean postoperative 1st day IOP of vitrectomy alone group was significantly lower than that of phaco-vitrectomy group (16.3±5.8 mm Hg vs 17.8±8.1 mm Hg, respectively, P=0.02). Hypotony (IOP≤8 mm Hg) was not different between groups in the postoperative 1st day (P>0.05). The mean preoperative visual acuity was not different between groups (1.6±0.9 logMAR vs 1.8±0.9 logMAR, respectively, P>0.05). However, the mean visual acuity was decreased in vitrectomy alone group at the final visit compared to phaco-vitrectomy group (1.2±0.8 logMAR, 0.9±0.7 logMAR, respectively P<0.05).CONCLUSIONTwenty-five gauge PPV combined with phacoemulsification surgery is a safe and efficient procedure, which can be preferred in phacic patients with a variety of vitreoretinal diseases compared to vitrectomy alone. Despite improved outcomes, this approach is not free of limitations as anterior chamber complications especially with combined surgery.

25-gauge transconjunctival diagnostic vitrectomy in suspected cases of intraocular lymphoma: a case series and review of the literature

AIM:To report the cytology results of 25-gauge transconjunctival(25G-TSV)diagnostic vitrectomy in cases suspicious for intraocular lymphoma(IOL),and compare the results to those reported in the literature.METHODS:Clinical and cytopathological records of 18vitreous biopsy specimens obtained via 25G-TSV diagnostic vitrectomy in 12 patients suspicious for IOL were reviewed retrospectively.A review of the literature in regards to the diagnostic yields of vitreous specimens obtained via 25-gauge and 20-gauge diagnostic vitrectomy in suspected cases of IOL was performed.RESULTS:Eighteen eyes from 12 patients with clinical suspicion of IOL underwent diagnostic 25G-TSV.The cytopathological investigations demonstrated IOL in 15eyes(83.3%).Vitreous analysis was non-diagnostic in 3eyes(16.7%).CONCLUSION:Twenty-five-gauge diagnostic vitrectomy yields adequate sample for cytological evaluation of the vitreous in cases suspicious for IOL.The diagnostic results of the 25G-TSV in the current study are superior to those reported for 20-gauge vitrectomy but equivalent to those reported for 25G-TSV in the published literature.

Endoscope-assisted vitrectomy

Ocular endoscopes enable ophthalmologists to observe any part of the retina without any limitations, including those caused by corneal opacities, the rim of the intraocular lens, cortical remnants, capsular opacities, a small pupil, and vitreous opacities. Moreover, ocular endoscopes enable the management of peripheral lesions without scleral indentation and are compatible with microincision vitrectomy surgery. The enlarged view under the endoscope, as obtained by drawing towards the lesion, appears to be another advantage. Rhegmatogenous retinal detachment with undetectable retinal breaks, trauma, endophthalmitis, scleral wounds with incarceration of the vitreous, and microcornea are indications for endoscopic vitrectomy. The combination of endoscopy and a wide-angle viewing system could compensate for the deficiencies of each technique and achieve more effective and safer surgical maneuvers. Endoscopy skills appear to be a great advantage for vitreoretinal surgeons;however, because endoscopies require a learning curve, becoming familiar with the handling of the endoscope through stepby-step learning is necessary.

Vitrectomy, lensectomy and silicone oil tamponade in the management of retinal detachment associated with choroidal detachment

AIM: To report the results of combined vitrectomy, lensectomy and silicone oil (SO) tamponade in treating primary rhegmatogenous retinal detachment (RRD) associated with choroidal detachment (CD). · METHODS: A retrospective, consecutive and case series study of 21 subjects with concurrent RRD associated with CD was conducted. All subjects underwent a standard three -port 20G pars plana vitrectomy (PPV) with lensectomy and silicone oil tamponade. Mean follow -up time was 8 months (rang from 4 to 19 months). The primary and final anatomic success rate, visual acuity and final intraocular pressure (IOP) were recorded and analyzed. ·RESULTS: Of 21 subjects, 8 were women and 13 were men. Age at presentation ranged from 22 to 75 years (mean 57.4 years). The presenting vision ranged from light perception to 0.15. The initial IOP ranged from 3mmHg to 12mmHg (mean 6.2mmHg). All eyes were phakic except one pseudophakic. No intraocular lens was implanted during the primary surgical intervention. Fifteen of 21 (71.4%) eyes had retina reattached after one operation. Six eyes had recurrent inferior retinal detachment due to proliferation. Five of them were successfully reattached after one or more additional operations. Mean IOP at final follow -up was 15.2mmHg (range from 8mmHg to 20mmHg). One case declined for further operation. The final reattachment rate was 95.2%. Visual acuity improved in 19 (90.5%) eyes, was unchanged in 1 (4.8%) eye and decreased in 1 (4.8%) eye.·CONCLUSION: Combination of vitrectomy, lensectomy and silicone tamponade is an effective method in treating RRD associated with CD, reducing the incidence of postoperative hypotony.

Combined treatment of phacoemulsification and single-port limited pars plana vitrectomy in acute angle-closure glaucoma

AIM: To evaluate the efficacy of combined treatment of phacoemulsification(PE) and micro-incisional single-port transconjunctival limited pars plana vitrectomy(PPV) in acute angle-closure glaucoma(AACG).METHODS: A retrospective study included 26 patients who underwent PE diagnosed with AACG. Among them, 16 patients(16 eyes) underwent PE alone, 10 patients(10 eyes) underwent combined limited vitrectomy and PE. Then we compared intraocular pressure(IOP), anterior chamber angle, anterior chamber depth, central corneal thickness and corneal endothelial cell count before and after surgery, and effective PE time during cataract surgery.RESULTS: Effective PE time was shorter in the combined surgery group than in the single surgery group(P=0.040). There was no statistically significant difference in IOP and best-corrected visual acuity between the two groups postoperatively. At 6 mo postoperatively, there was no difference in the anterior chamber angle, anterior chamber depth, and central corneal thickness between two groups, but corneal endothelial cell count was higher in the combined surgery group than in the single surgery group(P=0.046). No complication such as vitreoretinal disease, endophthalmitis, bullous keratopathy was noted.CONCLUSION: Combined micro-incisional single-port transconjunctival limited PPV and PE are more effective and safer than PE alone because of less operation time and fewer complications for management of AACG.

Posterior scleral reinforcement combined with vitrectomy for myopic foveoschisis

AIM： To investigate the effects of posterior scleral reinforcement （PSR） combined with vitrectomy for myopic foveoschisis. ~ METHODS： Thirty-nine highly myopic eyes of 39 patients with myopic foveoschisis underwent PSR combined with vitrectomy. Best corrected visual acuity （BCVA）, refraction error, and the foveal thickness by optical coherence tomography （OCT） were recorded before and after the surgery, and complications were noted. RESULTS： The follow-up period was 12mo, and the main focus was on the results of the 12-month follow-up visit. The mean preoperative BCVA was 0.96±0.43 IogMAR. At the final follow-up visit, the mean BCVA was 0.46± 0.28 IogMAR, which significantly improved compared with the preoperative one （P =0.003）. The BCVA improved in 33 eyes （84.62%）, and unchanged in 6 eyes （15.38%）. At the end of follow-up, the mean refractive error was -15.13 ±2.55 D, and the improvement was significantly compared with the preoperative one （-17.53±4.51 D） （P= 0.002）. Twelve months after surgery, OCT showed complete resolution of the myopic foveoschisis and a reattachment of the fovea in 37 eyes （94.87%） and partial resolution in the remained two eyes （5.13%）. The foveal thickness was obviously reduced at 12-month follow-up visit （196.45±36.35um） compared with the preoperative one （389,32±75.56um） （P=0.002）. There were no serious complications during the 12mo follow-up period. CONCLUSION： PSR combined with vitrectomy is a safe and effective procedure for myopic foveoschisis with both visual and anatomic improvement.

Enzymatic vitrectomy for diabetic retinopathy and diabetic macular edema

The aim of this paper is to determine the role of enzymatic vitrectomy performed by intravitreal injection of autologous plasmin enzyme(APE)in the management of diabetic retinopathy and diabetic macular edema(DME).Diabetic patients with proliferative diabetic retinopathy or DME and evident posterior hyaloid adherence to the retinal surface were included.All cases were treated with an initial intravitreal injection of APE and reevaluated one month later,measuring changes in best-corrected visual acuity(BCVA),macular thickness and the status of the posterior hyaloid.A second APE injection was performed in cases with no evident posterior vitreous detachment(PVD)after the initial treatment.Sixty-three eyes were included in the present review.A complete PVD appeared in 38%of cases(24 eyes)after one injection of plasmin and the total increased to 51%(32 eyes)after the second injection,separated at least by one month.The central macular thickness improved in all cases(100%)and BCVA in89%.Finally,in 50%of eyes with proliferative diabetic retinopathy,a high reduction of new vessels regression was observed.Enzymatic vitrectomy could be considered a good therapeutic alternative in diabetic retinopathy and macular edema.

Angiogenesis-related cytokines in serum of proliferative diabetic retinopathy patients before and after vitrectomy

AIM: To evaluate serum concentrations of angiogenesis-related cytokines in proliferative diabetic retinopathy (PDR) before and after vitrectomy. METHODS: Serum samples were collected from 30 PDR patients with varying severity before and after vitrectomy. Serum concentrations of vascular endothelial growth factor (VEGF), pigment epithelium-derived factor (PEDF), interleukin-8 (IL-8) and interferon-inducible protein-10 (IP-10) were determined by enzyme-linked immunosorbent assays(ELISA). RESULTS: Serum concentrations of VEGF, PEDF, IL-8 and IP-10 were significantly higher in PDR patients than that in controls, respectively (P<0.05). VEGF concentration decreased significantly in postoperative samples than that in preoperative samples (P<0.05). The concentrations of PEDF, IL-8 and IP-10 did not exhibit significant changes after vitrectomy. CONCLUSION: Elevated cytokines levels in serum may be diagnostically useful in PDR. Angiogenesis-related cytokines play important roles in the development of PDR, and would instruct the risk assessment of pathogenetic condition in PDR patients.

Long-term outcome of highly myopic foveoschisis treated by vitrectomy with or without gas tamponade

AIM：To evaluate the long-term safety and efficacy of vitrectomy and internal limiting membrane（ILM）peeling with or without gas tamponade for highly myopic foveoschisis.METHODS：We performed an open-label,observerblinded clinical trial of 85 patients with myopic foveoschisis between 2000 and 2012.Patients were randomly allocated to one of two groups,those who received vitrectomy and ILM peeling without gas tamponade（no-gas group）or those who with gas tamponade（gas group）and follow up at least 5y.RESULTS：Visual acuity of gas group improved from0.82±0.33 to 0.79±0.73 in 6mo,improved to 0.71±0.67 in 1y and within this range in the following 4y.Visual acuity of no-gas group improved from 0.81±0.46 to 0.78±0.66 in 6mo,improved to 0.70±0.65 in 1y.The finial visual acuity of two groups were significantly increased compared with the baseline（P〈0.05）.The visual acuity was improved in 35 of40 eyes（87.5%）in gas group and 29 of 33 eyes（87.9%）in no-gas group,while there were no significant differences between gas group and no-gas group in the visual acuity.The foveoschisis on optical coherence tomography（OCT）completely resolved in 5 of 40 eyes in 1mo,14 eyes in 6mo and 40 eyes in 1y in the gas group.While the foveoschisis completely resolved in 4 of 33 eyes in 1mo,10 eyes in 6mo and 33 eyes in 1y in the no-gas group.CONCLUSION：Vitrectomy and ILM peeling without gas tamponade appears to be as effective in the treatment of myopic foveoschisis as vitrectomy and ILM with gas tamponade.However,eyes treated with no-gas tamponade showed more rapid resolution of myopic foveoschisis.

Comparison of persistent submacular fluid in different preoperative macular status after vitrectomy for rhegmatogenous retinal detachment

AIM： To compare the incidence of persistent submacular fluid（SMF） and visual outcome after pars plana vitrectomy（PPV） for rhegmatogenous retinal detachment（RRD） in different preoperative macular status according to optical coherence tomography（OCT）.METHODS： A non-randomized, retrospective review was performed for patients who underwent successful PPV for RRD. OCT exams were taken preoperatively and 1 mo after surgery, until SMF disappeared. According to the preoperative macular status on OCT, patients were divided into two groups： macula-off RRD（Group A） and maculaon RRD（Group B）. In Group A, there were two subgroups： macula partly detached（Group A1） and macula totally detached（Group A2）. The main outcome measures were the presence of SMF on OCT 1 mo after surgery, and the preoperative and postoperative best corrected visual acuities（BCVA）, among the different groups and depending on the presence or absence of persistent SMF.RESULTS： A total of 139 eyes of 139 patients were included in the study. Persistent SMF at 1 mo after surgery was 15.8%（22/139）, all occurring in Group A（22/101）; Group B had no SMF at 1 mo after surgery（0/38, P=0.002）. The incidence of persistent SMF at 1 mo after surgery in Group A1 was 50%（14/28）, and in Group A2 was 11.0%（8/73, P〈0.001）. Significant differences were shown between the presence and absence of persistent SMF on foveolaoff RRD, the preoperative BCVA, the 1 mo postoperative BCVA, and the degree of the BCVA improvement from 1 mo postoperatively to the final follow-up（P〈0.05）. However, there were no significant differences in the final BCVA（P〉0.05）.CONCLUSION： Persistent SMF after PPV for retinal detachment is associated with preoperative macular status. Macula-uninvolving RRD shows no persistent SMF after PPV. Macular partly detached RRD has a higher incidence of SMF than macula totally detached RRD after PPV. The persistence of SMF may be responsible for the delayed visual recovery, whereas there were no significant differences in the final visual acuity.

Efficacy and necessity of prophylactic vitrectomy for acute retinal necrosis syndrome

AIM: To compare the efficacy of prophylactic vitrectomy for acute retinal necrosis syndrome(ARN) with routine treatment in Chinese patients, thereby investigate the necessity of prophylactic vitrectomy for ARN. METHODS: Thirty patients (37 eyes) were retrospectively included in this study. The eyes were divided into 2 groups by treatment, including routine treatment, which consisted of antiviral medication and vitrectomy after retinal detachment (RD) (n=21), and prophylactic vitrectomy, which consisted of antiviral medication and vitrectomy for the prevention of RD performed during the active inflammatory phase (n=16). The extent of necrosis was determined by fundus photographs at the time of presentation (for eyes with mild vitreous opacity) or the drawings in the operation records. Necrosis of the 37 eyes was divided into 3 grades, including peripheral, middle-peripheral and extensive. The follow-up period ranged from 8 to 57 months. Differences in visual acuity and necrosis between groups were identified using independent samples t-test. RESULTS: Necrosis was more extensive in the routine treatment group than in the prophylactic vitrectomy group (P<0.05). In the routine treatment group, conservative treatment improved necrosis and prevented RD in 6 eyes (29%). Seven eyes (33%) obtained anatomical success, but retinal redetachment occurred in 8 eyes (57%). There were also 5 eyes (24%) developed ocular hypotony or atrophy. Ten eyes (48%) achieved equal or increased visual acuity. In the prophylactic vitrectomy group, RD occurred in 2 eyes (13%). Twelve eyes (75%) were completely anatomically successful, and 10 eyes underwent silicone oil removal. Only one eye (6%) became ocular hypotony. Fourteen eyes (88%) achieved equal or increased visual acuity. The prophylactic vitrectomy group achieved better vision trends than the routine treatment group (P<0.05). Eyes with peripheral necrosis had better visual outcomes than those with mid-peripheral (P<0.05) or extensive (P<0.05) necrosis. However, there was no significant difference between eyes with mid-peripheral and extensive necrosis (P=0.3008) CONCLUSION: Prophylactic vitrectomy can prevent RD and improve the prognosis of ARN, making it an option for cases with rapidly progressing necrosis despite antiviral treatment and cases with moderate to extensive necrosis and severe vitreous opacity.

Cyclopexy versus vitrectomy combined with intraocular tamponade for treatment of cyclodialysis

AIM:Tocomparetheeffectsandcomplicationsof direc cyclopexy (DC) versus vitrectomy, endophotocoagulation, and gas/silicone oil endotamponade (VEE) treatment in patients with cyclodialysis and persistent hypotony.METHODS: This is a prospective, comparative, non-randomized clinical trial which includes 52 patients with cyclodialysis and persisting hypotony. Fifty-two patients suffering from cyclodialysis and persistent hypotony in one eye were divided into 2 groups (groups DC and VEE) and treated, respectively, with direct cyclopexy or vitrectomy, endophotocoagulation, and gas/silicone oil endotamponade. The patients were followed up for 12 months. Assessments included best corrected visual acuity (BCVA), intraocular pressure (IOP), anterior chamber depth (ACD), anterior chamber volume (ACV) and subjective rating of the pain caused by the treatments.RESULTS: After a follow-up of 12 months, significan improvement was seen in postoperative mean BCVA, IOP, ACD and ACV in both treatment groups (which were not significantly different from each other). The success rates for the treatments were not significantly different (DC: 50.0% vs VEE: 62.5% , P =0.383). Postoperative morbidity of cataract and subjective pain rating were significantly higher in the VEE group vs the DC group (P =0.003 and P 【0.001 respectively).CONCLUSION: DC and VEE were effective surgica procedures in treating patients with cyclodialysis and persistent hypotony. Patients had better tolerance to DC treatment and VEE was more likely lead to cataract complications. Taking into consideration the ease of the operation, success rate, and patient comfort, DC treatment seems preferable to VEE treatment in patients with simple cyclodialysis. While VEE has the advantage of treating patients with cyclodialysis combined with vitreous hemorrhage.

Non-buckled vitrectomy for retinal detachment with inferior breaks and proliferative vitreoretinophathy

AIM: To investigate the efficacy of non-buckled vitrectomy with classical endotamponade agents in the treatment of primary retinal detachment (RD) complicated by inferior breaks and proliferative vitreoretinophathy (PVR). METHODS: A retrospective, consecutive and case series study of 40 patients with inferior break RD and PVR >= C1 was conducted. All patients underwent a standard 3-port 20-gauge pars plana vitrectomy (PPV) with gas or silicone oil tamponade without supplementary scleral buckling. The vitreous and all proliferative membrane were completely removed, and retinectomy was performed when necessary. The mean follow-up was 12.5 months. The primary and final anatomic success rate, visual acuity and complications were recorded and analyzed. RESULTS: Primary anatomic success rate was achieved in 35 of 40 eyes (87.5%) and the final anatomic success rate was 100%. The most common cause of redetachment was recurrent PVR. The best-corrected visual acuity (BCVA) at final follow-up was improved in 34 eyes (85%), remained stable in 1 eye (2.5%), and worsened in 5 eyes (12.5%). The mean visual acuity at final follow-up was improved significantly (P=0.000). CONCLUSION: This retrospective study provides evidence that vitrectomy without scleral buckling seemed to be an effective treatment for inferior break RD with PVR. With complete removal of vitreous and proliferative membranes and timing of retinectomy, the inferior breaks which complicated with PVR could be dosed successfully without additional sclera! buckling.

Vitrectomy combined with silicone oil tamponade in the treatment of severely traumatized eyes with the visual acuity of no light perception

AIM: To evaluate the efficacy of surgical treatment of vitrectomy combined with silicone oil tamponade in the treatment of severely traumatized eyes with the visual acuity of no light perception (NLP).METHODS: This was a retrospective uncontrolled interventional case-series of 19 patients of severely traumatized eyes with NLP who underwent vitrectomy surgery at the Affiliated Hospital of Medical College, Qingdao University (Qingdao, China) during a 3-year period. We recorded perioperative factors with the potential to influence functional outcome including duration from the injury to intervention; causes for ocular trauma; open globe or closed globe injury; grade of vitreous hemorrhage; grade of endophthalmitis; grade of retinal detachment; size and location of intraocular foreign body (IOFB); extent and position of retinal defect; grade of proliferative vitreoretinopathy (PVR); type of surgery; perioperative complications and tamponade agent. The follow-up time was from 3 to 18 months, and the mean time was 12 months.RESULTS: After a mean follow-up period of 12 months (3-18 months) 10.53% (2/19) of eyes had visual acuity of between 20/60 and 20/400, 52.63% (10/19) had visual acuity less than 20/400 but more than NLP, and 36.84% (7/19) remained NLP. Visual acuity was improved from NLP to light perception (LP) or better in 63.16% (12/19) of eyes and the rate of complete retinal reattachment was 73.68% (14/19). Good visual acuity all resulted from those patients of blunt trauma with intact eyewall (closed globe injury). The perioperative factors of poor visual acuity prognosis included delayed intervention; open globe injury; endophthalmitis; severe retinal detachment; large IOFB; macular defect; a wide range of retinal defects andsevere PVR.CONCLUSION: The main reasons of NLP after ocular trauma are severe vitreous hemorrhage opacity; refractive media opacity; retinal detachment; retinal and uveal damages and defects, especially defects of the macula; PVR and endophthalmitis. NLP after ocular trauma in some cases does not mean permanent vision loss. Early intervention of vitrectomy combined with silicone oil tamponade and achieving retinal reattachment of the remaining retina, may make the severely traumatized eyes regain the VA of LP or better.