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.

Rhegmatogenous retinal detachment associated with massive spontaneous suprachoroidal hemorrhage and prognosis of pars plana vitrectomy

AIM:To describe the clinical characters of rhegmatogenous retinal detachment(RRD) associated with massive spontaneous suprachoroidal hemorrhage(SSCH). To evaluate optimal timing and prognosis of pars plana vitrectomy.METHODS:A retrospective review of 6 cases(6 eyes)of RRD and massive SSCH among 3772 cases of RRD was conducted. All of 6 patients were treated with twenty-gauge vitrectomy, suprachoroidal blood drainage,phacoemulsification(PHACO) or lensectomy and silicon oil tamponade. The clinical characters, intraoperative findings and treatment outcomes were reported.RESULTS:In the 6 affected eyes of 6 patients(3 men and 3 women; mean age, 53.83y; range 34-61y),preoperative visual acuity ranged from faint light perception(LP) to counting finger(CF). The average interventional duration from visual decreased to surgery was 12.8 d(range 9-15d). All eyes were associated with high myopia and the mean ocular length was 30.32 mm(range 28.14-32.32 mm). Choroidal hemorrhage were successfully drained in the operation of all 6 eyes.Intraoperative findings showed there were multiple retinal breaks in all 6 eyes and in 4 eyes breaks were along supratemporal and/or infratemporal retinal vascular arcade, especially in the edge of chorioretinal atrophy areas. These patients were followed up from 6 to 34mo(Mean, 23.5mo). The best-corrected visual acuity after surgery varied from CF to 20/100, with improvement in 5eyes(83.33%) and no change in 1 eye(16.67%). Ocular hypertension ocurred in 1 eye(16.67%), which wassuccessfully treated by silicon oil removal combined with trabeculectomy. In 4 eyes, tractional retinal detachment caused by proliferative vitreoretinopathy(PVR) appeared and a secondary surgery of pre-retinal membrane peeling and silicon oil retained were performed. In 4eyes, silicon oil cannot be removed. The initial and final reattachment rates were 33.33% and 66.67%, respectively.CONCLUSION:RRD associated with massive SSCH is an extremely rare event. The most common risk factor is long axial length. Vitrectomy and choroidal blood drainage can effectively remove suprachoroidal hemorrhage and promote retinal reattachment in these eyes. However, silicon oil could not be removed in most eyes and final visual acuities are generally poor.

Combined pars plana vitrectomy and Baerveldt glaucoma implant placement for refractory glaucoma

AIMTo evaluate outcomes of combined pars plana vitrectomy and Baerveldt glaucoma implant (PPV-BGI) placement for refractory glaucoma.METHODSThe medical records of 92 eyes (89 patients) that underwent PPV-BGI were retrospectively reviewed, including 43 eyes with neovascular glaucoma (NVG) and 49 eyes with other types of glaucoma (non-NVG).RESULTSOutcome measures were visual acuity (VA), intraocular pressure (IOP), glaucoma medical therapy, complications, and success [VA&#x0003e;hand motions (HM), IOP&#x02265;6 mm Hg and &#x02264;21 mm Hg, no subsequent glaucoma surgery]. Cumulative success rates for the non-NVG group and NVG group were 79% and 40% at 1y, respectively (P=0.038). No difference in the rates of surgical success were found between pars plana and anterior chamber tube placement. Preoperative IOP (mean&#x000b1;SD) was 30.3&#x000b1;11.7 mm Hg in the Non-NVG group and 40.0&#x000b1;10.6 mm Hg in the NVG group, and IOP was reduced to 15&#x000b1;9.5 mm Hg in the non-NVG group and 15&#x000b1;10.5 mm Hg in the NVG at 1y. Number of glaucoma medications (mean&#x000b1;SD) decreased from 2.7&#x000b1;1.3 in the non-NVG group and 2.8&#x000b1;1.3 in the NVG group preoperatively to 0.76&#x000b1;1.18 in the non-NVG group and 0.51&#x000b1;1.00 in the NVG group at 1y. Improvement in VA of &#x02265;2 Snellen lines was observed in 25 (27%) eyes, although only 33% of non-NVG eyes and 2.3% of NVG eyes maintained VA better than 20/200 at 1y. Nonclearing vitreous hemorrhage was the most common postoperative complication occurring in 16 (17%) eyes, and postoperative suprachoroidal hemorrhages developed in 5 (5.4%) eyes.CONCLUSIONPPV-BGI is a viable surgical option for eyes with refractory glaucoma, but visual outcomes are frequently poor because of ocular comorbidities, especially in eyes with NVG. The location of tube placement does not influence surgical outcome and should be left to the discretion of the surgeon.

Air tamponade and without heavy liquid usage in pars plana vitrectomy for rhegmatogenous retinal detachment repair

AIM： To report the results of rhegmatogenous retinal detachment（RRD） repair after pars plana vitrectomy（PPV） without operative use of heavy liquid, and utilizing air tamponade in selected cases.METHODS： RRD patients without severity of proliferative vitreoretinopathy C2 or more underwent PPV without operative use of heavy liquid, and utilizing air tamponade were consecutively enrolled. Alternative postoperative facedown position or lateral position was required for 3-5 d.RESULTS： Totally 36 eyes of 36 patients（24 males, 66.7%） aged 53.8±10.9 y underwent this modified surgery. The mean number of retinal break was 2.1±1.3. Most of the eyes（29, 80.6%） had retinal detachment involving more than one quadrant. Twenty-two（61.1%） eyes with cataract had combined phacoemulsification and intraocular lens implantation. The mean follow up time was 4.6±1.8 mo. Two eyes with retinal redetachment underwent a second retinal repair surgery with silicone oil tamponade, yielding the primary reattachment rate to 94.4%（34/36）. Six（16.7%） eyes had intraocular pressure higher than 25 mm Hg. The visual acuity（logMAR） improved from 0.98±0.74 preoperatively to 0.52±0.31 postoperatively（P〈0.001）. CONCLUSION： The success rate of this modified retinal repair surgery is comparable with traditional surgery. This technique can be considered for certain retinal detachment patients, since its apparent advantages included lower surgical complications, reduced surgery expenditure, shorter time for postoperative facedown position, and avoiding silicone oil removal surgery.

Prognosis value of Chinese Ocular Fundus Diseases Society classification for proliferative diabetic retinopathy on postoperative visual acuity after pars plana vitrectomy in type 2 diabetes

AIM: To compare the postoperative visual acuity among eyes with proliferative diabetic retinopathy(PDR) of different stages after pars plana vitrectomy(PPV) in type 2 diabetic patients. METHODS: A retrospective study was conducted for PDR eyes undergoing PPV in type 2 diabetic patients. All patients were divided into three groups based on Chinese Ocular Fundus Diseases Society(COFDS) classification for PDR: Group A(primary vitreous hemorrhage), Group B(primary fibrovascular proliferation) and Group C(primary vitreous hemorrhage and/or fibrovascular proliferative combined with retinal detachment). The postoperative visual acuity and the change between postoperative and preoperative visual acuity were compared among three groups. The associated risk factors for postoperative visual acuity were analyzed in the univariate and multiple linear aggression. RESULTS: In total, 195 eyes of 195 patients were collected in this study, including 71 eyes of 71 patients in Group A, 75 eyes of 75 patients in Group B and 49 eyes of 49 patients in Group C. The eyes in Group A got better postoperative best-corrected visual acuity(BCVA) compared to the eyes in Group B and C(0.48±0.48 vs 0.89±0.63, P<0.001;0.48±0.48 vs 1.04±0.67, P<0.001;respectively). The eyes in Group A got more improvement of BCVA compared to the eyes in Group B and C(1.07±0.70 vs 0.73±0.68, P=0.004;1.07±0.70 vs 0.77±0.78, P=0.024;respectively). In the multiple linear regression analysis, primary fibro-proliferative type(β=0.194, 95%CI=0.060-0.447, P=0.01), retinal detachment type(β=0.244, 95%CI=0.132-0.579, P=0.02), baseline log MAR BCVA(β=0.192, 95%CI=0.068-0.345, P=0.004), silicone oil tamponade(β=0.272, 95%CI=0.173-0.528, P<0.001) was positively correlated with postoperative log MAR BCVA. Eyes undergoing phacovitrectomy had better postoperative BCVA(β=-0.144, 95%CI=-0.389 to-0.027, P=0.025). CONCLUSION: PDR eyes of primary vitreous hemorrhage type usually have better visual acuity prognosis compared to primary fibrovascular proliferation type and retinal detachment type. COFDS classification for PDR may have a high prognostic value for postoperative visual outcome and surgical management indications.

Epiretinal membrane following pars plana vitrectomy for rhegmatogenous retinal detachment repair

AIM: To determine the rate and possible contributors for post-pars plana vitrectomy(PPV) epiretinal membrane(ERM) in patients treated for rhegmatogenous retinal detachment(RRD). METHODS: This prospective, nonrandomized study comprised 47 consecutive patients(47 eyes) with acute RRD treated with 23 G post-PPV. All participants were followed prospectively for 6 mo for the development of ERM using spectral domain optical coherence tomography. Preoperative and intraoperative data were collected by questionnaires to surgeons. Main outcome measure was the percentage of the ERM formation following post-PPV for RRD. RESULTS: ERM developed postoperatively in 23 eyes(48.9%), none necessitated surgical removal. There was a statistically significant difference between patients with and without ERM postoperatively in preoperative best corrected visual acuity(median log MAR 1.9 vs 0.3, respectively;P=0.003) rate of macula-off(69.6% vs 37.5%, respectively, P=0.028), and rate of ≥5 cryo-applications(55.6% and 18.8%, respectively, P=0.039). ERM developed mainly between the 1st and 3rd months of follow-up. Macula-off status increased the risk of ERM, with the odds ratio of 3.81(P=0.031). CONCLUSION: ERM is a frequent post RRD finding, and its development is associated with macula-off RRD.

How will Benthic Foraminifera Respond to Warming and Changes in Productivity ?: A Laboratory Culture Study on Cymbaloporetta plana

Anthropogenic activities are likely to cause global warming. Global warming will affect marine productivityand thus food availability for marine organisms. Both the seawater temperature and food availability affect benthicforaminifera, the most abundant marine calcareous microorganisms. Therefore, a laboratory culture experiment wasconducted on Cymbaloporetta plana to understand the coupled effect of temperature(25°C, 27°C, 30°C) and food(102±5,203±9, 305±14, 407±18, 508±23 diatom cells). At all temperatures, growth increased with increase in food. The specimenssubjected to 27°C temperature attained the maximum growth and those subjected to 25°C were the smallest. All specimensfed with 508±23 cells reproduced, 0 irrespective of temperature. Of all the specimens without food, 40% at 27°C and 20% at25°C reproduced, whereas specimens subjected to 30°C did not reproduce. The 100% rate of reproduction at 27°C suggeststhat it is the optimum temperature for growth and reproduction. All the specimens at 30°C and without additional food,died, whereas at 25°C and 27°C, the mortality rate was 80% and 60%, respectively. The limited growth and reproductionwith decreasing food clearly indicates that food availability also controls the growth and reproduction of shallow waterbenthic foraminifer C. plana. Therefore, warming coupled with decreasing productivity is likely to severely affect thegrowth and abundance of shallow water benthic foraminifera.

Simultaneous pars plana vitrectomy,panretinal photocoagulation,cryotherapy,and Ahmed valve implantation for neovascular glaucoma

AIM:To describe and evaluate the efficacy of Ahmed glaucoma valve implantation(AGV)combined with pars plana vitrectomy(PPV)in a single surgical act for the treatment of advanced neovascular glaucoma(NVG).METHODS:Retrospective observational case series included 51 eyes from 50 patients with severe NVG treated with PPV,AGV,and panretinal photocoagulation and/or cryotherapy in a single surgical act during a 13-year period(2005-2018).Preoperative,intraoperative and postoperative data at day 1 and months 1,3,6,21,and 24 were systematically collected.Definition of surgical success was stablished at IOP between 6 and 21 mm Hg with or without topical treatment.RESULTS:Main indications for surgery were NVG secondary to proliferative diabetic retinopathy(39.2%)and central retinal vein occlusion(37.3%).Mean(±SD)preoperative IOP was 42.0±11.2 mm Hg decreasing to 15.5±7.1 mm Hg at 12 mo and 15.8±9.1 mm Hg at 24 mo of follow up.Cumulative incidence of success of IOP control was 76.0%at first postoperative month,reaching 88.3%at 6 mo.Prevalence of successful IOP control at long term was 74.4%at 12 mo and 71.4%at 24 mo.Eye evisceration for unsuccessful NVG management was required in 1 case(2.0%).CONCLUSION:Combination of AGV implantation and PPV in a single act may be a suitable option for severe forms of NVG in a case-by-case basis for effective IOP control and a complete panretinal photocoagulation.

Comparison of postoperative anterior segment changes associated with pars plana vitrectomy with and without vitreous base shaving

AIM:To compare changes in anterior segment topography and axial length(AL)evaluated with Pentacam and IOL Master after pars plana vitrectomy(PPV)performed with and without vitreous base shaving.METHODS:This prospective study included patients who underwent PPV or phacoemulsification+PPV(Phaco+PPV)for various indications.Patients who underwent total posterior hyaloid detachment and excessive vitreous base shaving with scleral indentation were referred to as complete PPV(c-PPV).The patients whom posterior hyaloid was separated as far as the posterior arcades and vitreous base shaving with scleral depression was not performed were classified as the partial PPV(p-PPV)group.All patients underwent detailed ophthalmologic examinations preoperatively and lwk,I,and 3mo postoperatively.Changes in the anterior chamber depth(ACD),anterior chamber volume(ACV),iridocorneal angle(ICA)f central corneal thickness(Cd),and keratometric measurements(K1 and K2)were evaluated with Pentacam HR.Changes in the AL measurements were analyzed with IOL Master.RESULTS:A significant increase in ACD was observed in c-PPV cases(P=0.02),but this increase was not significant in the p-PPV group(P=0.053).In contrast,ICA increased significantly in the c-PPV group(P=0.02)but decreased in the p-PPV group(P=0.09).BCVA was significantly improved in the c-PPV group from week 1(P<0.001)while the increase in the p-PPV group reached significance at 3mo(P=0.035).Cd increased in the first week and later returned to baseline in both groups.No significant differences in the other parameters were observed between the groups,and there were no significant changes in intraocular pressure,ACV,AL,K1 or K2 values(P>0.05 for all).CONCLUSION:Incomplete posterior hyaloid excision and not removing the vitreous base in PPV surgeries may create a more stable anterior chamber,thus preventing the downward movement of the lens-iris diaphragm,and may cause ciliary body retraction,thereby reducing ICA.Awareness of these effects can provide some amount of guidance to physicians in selecting the appropriate PPV procedure and preempting surgical complications.

Pars Plana Vitrectomy versus Combined Scleral Buckling—Pars Plana Vitrectomy for Phakic Rhegmatogenous Retinal Detachment with Inferior Breaks

Aims: To compare the results of pars plana vitrectomy (PPV) and combined scleral buckling—PPV (SB/PPV) in phakic rhegmatogenous retinal detachments with inferior breaks. Methods: Randomized, prospective, clinical controlled trial of forty consecutive phakic eyes with primary rhegmatogenous retinal detachment, associated with inferior breaks and not complicated by proliferative vitreoretinopathy ≥grade C, to either PPV (group 1) or combined SB/PPV (group 2). Results: At 6 months follow up the primary reattachment rate was 100% (20/20 cases) in group 2 and 70% (14/20 cases) in the group 1, the difference being statistically significant (p = 0.027). The best corrected visual acuity improved significantly from a preoperative mean of 1.65 ± 1.13 (Range: 0.6 to 3) to a mean of 0.45 ± 0.11 (Range: 0.3 to 0.6) in the group 2 and in the group 1 improved from a preoperative mean of 2.34 ± 0.92 (Range: 0.48 to 3) to a mean of 0.668 ± 0.20 (Range: 0.48 to 1), the difference between the two groups being statistically significant (p = 0.001). Conclusion: Anatomical and functional success rates are significantly better with the use of a scleral explant during PPV for uncomplicated forms of phakic rhegmatogenous retinal detachments with inferior breaks.

Analysis of postoperative ocular surface changes and intervention effect after pars plana vitrectomy in meibomian gland dysfunction dry eye patients

AIM:To observe ocular surface changes after phacovitrectomy in patients with mild to moderate meibomian gland dysfunction(MGD)-type dry eye and track clinical treatment response using a Keratograph 5M and a Lipi View interferometer.METHODS:Forty cases were randomized into control group A and treatment group B;the latter received meibomian gland treatment 3d before phacovitrectomy and sodium hyaluronate before and after surgery.The average non-invasive tear film break-up time(NITBUTav),first noninvasive tear film break-up time(NITBUTf),non-invasive measured tear meniscus height(NTMH),meibomian gland loss(MGL),lipid layer thickness(LLT)and partial blink rate(PBR)were measured preoperatively and 1wk,1 and 3mo postoperatively.RESULTS:The NITBUTav values of group A at 1wk(4.38±0.47),1mo(6.76±0.70),and 3mo(7.25±0.68)were significantly lower than those of group B(7.45±0.78,10.46±0.97,and 11.31±0.89;P=0.002,0.004,and 0.001,respectively).The NTMH values of group B at 1wk(0.20±0.01)and 1mo(0.22±0.01)were markedly higher than those of group A(0.15±0.01 and 0.15±0.01;P=0.008 and P<0.001,respectively);however,there was no difference at 3mo.The LLT of group B at 3mo[91.5(76.25-100.00)]significantly exceeded that of group A[65.00(54.50-91.25),P=0.017].No obvious intergroup difference was found in MGL or PBR(P>0.05).CONCLUSION:Mild to moderate MGD dry eye worsens in the short term after phacovitrectomy.Preoperative cleaning,hot compresses,and meibomian gland massage as well as preoperative and postoperative sodium hyaluronate promote the rapid recovery of tear film stability.

Comment on concurrent removal of intravitreal lens fragments after phacoemulsification with pars plana vitrectomy prevents development of retinal detachment

I read with interest the article entitled ＂Concurrent removal of intravitreal lens fragments afterphacoemulsification with pars plana vitrectomy prevents development of retinal detachment＂ by Chalam et al . In this study, none of the patients developed retinal detachment （RD） during the one-year follow-up after concurrent removal lens fragments following phacoemulsification with pars plana vitrectomy （PPV）. The authors suggested that concurrent PPV for retained lens fragments after cataract surgery might prevent development of rhegmatogenous retinal detachment （RRD）, because early PPV prevents development of intraocular inflammation and inhibits vitreous contraction, a common cause of retinal tears and detachment.

Pars plana vitrectomy relieves the depression in patients with symptomatic vitreous floaters

AIM:To investigate the depressive state among the patients with symptomatic vitreous floaters(SVF),as well as its change after SVF removal via vitrectomy surgery.METHODS:Twenty-eight eyes of 28 patients who underwent 27-gauge pars plana vitrectomy(PPV)for SVF were included.Thirty-nine eyes of 39 age-and gendermatched healthy volunteers without SVF were also recruited as a healthy control.Center for Epidemiologic Studies Depression(CES-D)was used to assess volunteers and patients’depression(before and 1 wk after PPV).RESULTS:The CES-D score was 18.3±8.6 for patients,and was 12.4±6.0 for healthy control(P=0.003).Patients were significantly more likely to be in a depressive state(53.6%,defined as CES-D score≥16)than the healthy control(20.5%,P=0.005).For patients with SVF,the CES-D score was negatively correlated with their age(rs=-0.42,P=0.025).After PPV,both the CES-D score(11.9±5.4 vs 18.3±8.6,P<0.001)and proportion of depressive state(18.5%vs 53.6%,P=0.005)were significantly decreased.CONCLUSION:This study suggests that symptoms of vitreous floaters have an apparently negative impact on patients’psychological state.The PPV can effectively relieve the depressive state for patients with SVF.

The outcomes of pars plana vitrectomy without endotamponade for tractional retinal detachment secondary to proliferative diabetic retinopathy

AIM:To evaluate the outcomes of pars plana vitrectomy(PPV) without the use of an ocular tamponade in patients having tractional retinal detachment(TRD) secondary to proliferative diabetic retinopathy(PDR).METHODS:It was an interventional study conducted at the Department of Ophthalmology,B.V.Hospital,Bahawalpur,Pakistan,from July 2011 to July 2012.A total of 75 patients(84 eyes) having TRD secondary to PDR were treated by PPV without using an ocular tamponade.All patients included in the study had a tractional retinal detachement secondary to proliferative diabetic retinopathy but didn’t have or develop retinal breaks before or during the study period.The surgical procedure included a PPV combined with the removal of the tractional retinal membranes and the application of endolaser photocoagulation to the retina.The mean follow-up period was 12 months. RESULTS:Successful retinal reattachement was observed in 78 of the operated eyes(92.8%).In these patients,the retina remained attached till the end of the one year follow-up period.Improvement in best corrected visual acuity(BCVA) was seen in 63 eyes(75%).The visual acuity remained unchanged in 9 eyes(10.7%).Mean improvement in BCVA was 2.00 +1.24 at baseline to 1.24+1.22(P【0.05) at the end of the followup period.CONCLUSION:In the absence of the retinal breaks,a TRD secondary to PDR can be successfully treated by pars plana vitrectomy without the use of an ocular tamponade.

Endophthalmitis caused by Bacteroides fragilis after pars plana vitrectomy and treatment approach

Rationale:Endophthalmitis is an uncommon but serious ocular infection often resulting in probable visual loss.Bacteroides fragilis is a rare cause of endophthalmitis.Patient concerns:A 46-year-old male patient complained of eye pain and low vision after pars plana vitrectomy.Diagnosis:Bacteroides fragilis endophthalmitis after pars plana vitrectomy was diagnosed.Interventions:Pars plana vitrectomy and silicone oil implantation were performed.Outcomes:Early treatment and choice of tamponade in endophthalmitis after pars plana vitrectomy may possibly prevent evisceration and progression of endophthalmitis.Lessons:Bacteroides fragilis can be seen in cases of endophthalmitis after pars plana vitrectomy.

Via pars plana anterior iris enclavation IOL fixation

AIM:To describe a via pars plana anterior iris enclavation intraocular lens(IOL)fixation techniqueMETHODS:A total of 35 consecutive aphakic vitrectomised patients(average age 71.12±10.12 y)underwent pars plana vitrectomy(PPV)and via pars plana anterior iris enclavation IOL fixation.RESULTS:The mean preoperative best corrected visual acuity(BCVA)was 0.11±0.14 log MAR,the mean postoperative BCVA was 0.07±0.11 log MAR.The preoperative mean spherical equivalent was 7.22±4.21 D.The final mean spherical equivalent was-0.25±0.15 D.No eyes had hypotony,retinal or choroidal detachment or endophthalmitis.CONCLUSION:This technique may be a safe and useful in the case of aphakia,and a prospective study would be useful to confirm this findings.

23-Gauge Pars Plana Vitrectomy Alone by a Bimanual Technique for the Removal of Dense Posteriorly Dislocated Crystalline Lens

Background: We sought to verify the efficacy and safety of transconjunctival 23-gauge pars plana vitrectomy (PPV) alone by our bimanual technique for the removal of dense posteriorly dislocated crystalline lens. Methods: A retrospective, noncomparative, interventional study of 31 consecutive cases of patients who underwent 23-gauge PPV alone for the removal of dense posteriorly dislocated crystalline lens following complicated cataract surgeries using our bimanual technique was conducted. The main outcomes measured included best-corrected visual acuity (BCVA), preoperative intraocular pressure (IOP), postoperative IOP and postoperative complications. Results: In all 31 cases included in this study, those dense posteriorly dislocated crystalline lenses were successfully removed. The enrolled patients consisted of 17 males and 14 females with a mean age of (75.84 ± 6.17) years (range 59 - 90). The mean follow-up length was (7.61 ± 1.87) months with a range of 6 months to 1 year. The mean preoperative BCVA was 0.22 ± 0.11 logMAR system, and the postoperative BCVA was 0.33 ± 0.07 logMAR system after 6 months of follow-up. The mean operative time was 46.32 ± 4.80 minutes with a range of 38.00 to 57.00 minutes. All of the conjunctival incisions self-closed within the first week with no wound leakage or hemorrhage. The postoperative complications were relatively rare. Conclusions: The removal of dense posteriorly dislocated crystalline lens might be a challenge for micro-incision vitrectomy. Our bimanual technique was proved to be an effective and safe method for those particular dense lenses using 23-gauge alone.

Combined pars plana vitrectomy and suture less scleral fixation of foldable intraocular lens:single surgery visual rehabilitation of dislocated lens/intraocular lens

Background:To evaluate efficacy and safety of combined pars plana vitrectomy(PPV)and scleral fixated intraocular lens(SFIOL)surgery as a single procedure.Methods:Retrospective interventional case series done at a tertiary eye care center in Northern India.Eleven patients who underwent combined PPV and SFIOL surgery were included and analyzed retrospectively.Results:Mean age of the patients was 43.36±15.12 years(range,22-64 years).Eight were male.Mean baseline best corrected visual acuity(BCVA)was 0.78±0.63 logMAR units while the mean post-operative BCVA at 6 months follow-up was 0.37±0.29 logMAR units,the visual gain being statistically significant(P=0.021).None of the patients had a drop in BCVA with nine patients having final BCVA better than 0.48 logMAR units.Choroidal detachment(CD)was the only notable complication,seen in three patients.Other complications included two cases of intraoperative retinal breaks,a case each of reversible corneal edema,ocular hypertension and cystoid macular edema.Conclusions:Combined PPV and SFIOL is an efficacious procedure for managing IOL/lens dislocation and aphakia in a single surgery.There may be short-term reversible complications with no impact on final visual gain.

Late-onset Lens Particle Glaucoma as a Consequence of Posterior Capsule Rupture after Pars Plana Vitrectomy

Purpose:To report the treatment of late-onset lens particle glaucoma associated with posterior capsule rupture during pars plana vitrectomy.Methods:Case report.Results:A 33-year-old man had severe pain and impaired vision in the left eye after vitrectomy,associated with white fleck-like particles circulating in the anterior chamber.The intraocular pressure.(IOP).was 38 mmHg.The anterior lens capsule was intact,however,lens particle glaucoma was diagnosed by the slit-lamp examination,B-mode ultrasonography and ultrasound biomicroscopy (UBM).The lens material was removed by irrigation-aspiration after the patient remained face down for two hours to facilitate precipitation of the lens material from the vitreous into the anterior chamber.IOP after the procedure was 21 mmHg.Conclusion:Posterior lens capsule may be disrupted during vitrectomy.Although the anterior lens capsule is intact,lens particle glaucoma should be considered when IOP increases with particulate matter circulating in the anterior chamber.Surgical removal of this material may be sufficient to control IOP without the need for additional glaucoma surgery.

Diagnostic Ultrasound and Pars Plana Vitrectomy in Endophthalmitis

Purpose: To compare the results by B-scan ultrasonography and findings in pars plana vitrectomy, and assess the diagnostic value of B-scan ultrasonography in endophthalmitis.Methods: Thirty eyes of 30 subjects diagnosed as endophthalmitis were selected, who undergone preoperative B-scan ultrasonography. The result of pars plana vitrectomy was recorded. The above two results were compared.Results: On the evaluation of vitreous and retinal states in the patients with endophthal-mitis, the sensitivity of ultrasound was 90%～100%, and the specificity was 79%～100%. Poorer preoperative visual acuity was related with retinal detachment and retinal dissolution. The preoperative visual acuity in eyes with local vitreous opacity was better than with diffuse vitreous opacity.Conclusion: Comparison of the results of B-scan ultrasonography and the findings in pars plana vitrectomy showed B-scan ultrasonography is highly sensitive,specific, and is very helpful in the evaluation of endophthalmitis. B-scan ultrasonography can not only supply much information in the diagnosis of endophthalmitis but also inspect its trends and changes, which is helpful in the selection of treatment and planning the time of surgery.