Background: and objective: Current literature review fails to disclose any series describing the use of two-port vitrectomy in adult patients. This study was performed to determine the feasibility and efficacy of pars...Background: and objective: Current literature review fails to disclose any series describing the use of two-port vitrectomy in adult patients. This study was performed to determine the feasibility and efficacy of pars plana vitrectomy surgery using two (rather than three or four)-port access for treatment of diabetic patients with nonclearing vitreous haemorrhage due to retinal neovascularization. Design: Interventional prospective case series: to measure ability to allow for long-term resolution of chronic uncomplicated vitreous haemorrhage in diabetic patients, and to study the frequency and nature of complications associated with this technique. Methods: Two-port pars plana vitrectomy (with endolaser treatment and membrane delamination if necessary) was performed in a prospective series of 12 consecutive diabetic patients with nonclearing vitreous haemorrhage due to retinal neovascularization. Results: Successful removal of vitreous haemorrhage resulted in all patients. No visually significant intraoperative complications occurred. Best postoperative visual acuity correlated with lenticular and macular perfusion status. Conclusion: Two-port pars plana vitrectomy is an efficient (and potentially safer and faster) alternative to the standard three-port vitrectomy in selected patients.展开更多
PURPOSE: To introduce a new non-trocar system for 25-gauge transconjunctival pars plana vitrectomy(PPV). DESIGN: Study of a new surgical instrument. METHODS: This new non-trocar syst em for 25-gauge transconjunctivalP...PURPOSE: To introduce a new non-trocar system for 25-gauge transconjunctival pars plana vitrectomy(PPV). DESIGN: Study of a new surgical instrument. METHODS: This new non-trocar syst em for 25-gauge transconjunctivalPPVconsists of a contact lens ring featuring f our projections containing 1.0-mm diameter holes located 3.0 mm from the ring e dge, a wedge-shaped 25-gauge infusion cannula, and two plugs. RESULTS: The rin g is fixed with 7-0 silk sutures at the 3-and 9-o’clock positions on the lim bus. Using the 25-gauge needle, three conjunctival and scleral incisions (n=3) are made at the projection holes located inferotemporally, superonasally, and su perotemporally. No intra-or postoperative complications were encountered in 14 patients treated by this non-trocar 25-gauge transconjunctival PPV. CONCLUSION : Using the system introduced here, 25-gauge transconjunctival PPVcan be perfor medwithout suturing sclerotomies and without intra-or postoperative complicatio ns.展开更多
Purpose: To describe the technique and outcome of pars plana vitreous aspiration during penetrating keratoplasty (PK)-combined with cataract extraction (CE) and intraocular lens (IOL) implantation (triple procedure) t...Purpose: To describe the technique and outcome of pars plana vitreous aspiration during penetrating keratoplasty (PK)-combined with cataract extraction (CE) and intraocular lens (IOL) implantation (triple procedure) to prevent positive vitreous pressure and its associated complications. Design: Nonrandomized prospective noncomparative interventional case series. Participants: Sixty-five patients who underwent triple procedures between June 2001 and September 2003. Methods: Triple procedures performed on all 65 patients consisted of PK, extracapsular CE, and IOL implantation with standard techniques. After nonpenetrating trephination, anterior vitreous tappingwas performedwith a 23-gauge needle on a 5-ml syringe over the pars plana 3.5 mm posterior to the limbus in the superotemporal quadrant. Main Outcome Measures: Preoperative best-corrected visual acuity (BCVA), volume of aspirated liquefied vitreous, intraoperative and postoperative complications, and postoperative BCVA at 3 and 6 months. Results: Corneal scarring with cataract was the most common indication for surgery. Preoperative BCVA ranged from 20/160 to light perception. Aspirated vitreous volume varied from 0.3 to 1.5 ml, averaging 1.0 ml. No case had evidence of positive vitreous pressure during surgery. The mean follow-up period was 9.6±2.6months (range,6-24). Postoperative complications consisted of graft rejection in 4 cases (6.2%), primary graft failure in 3 (4.6%), and secondary glaucoma in 1 (1.5%). Of the patients, 70.8%had a postoperative BCVA of ≥20/160 at 6 months. Vitreous hemorrhage, retinal tearing, and detachment were not observed. Conclusions: Pars plana anterior vitreous tapping is a safe adjunct for triple procedures to prevent positive vitreous pressure and its associated complications.展开更多
Background: Rhegmatogenous retinal detachments (RRD) with inferior breaks are usually treated by scleral buckling (SB) or pars plan a vitrectomy (PPV) or a combination of both methods. However, applying a SB duri ng P...Background: Rhegmatogenous retinal detachments (RRD) with inferior breaks are usually treated by scleral buckling (SB) or pars plan a vitrectomy (PPV) or a combination of both methods. However, applying a SB duri ng PPV may produce a risk of choroidal haemorrhage. Following a recent pilot stu dy showing that such cases can be safely treated by PPV without SB the authors r e examined their management of RRD in which inferior breaks were present. Metho ds: All patients had a detached vitreous and a complex configuration of retinal breaks. A case control study was performed to analyse the surgical methods and results of PPV on 48 consecutive patients with RRD associated with inferior brea ks and 48 age/sex matched controls who underwent PPV for RRD without inferior br eaks. Exclusion criteria were giant retinal tears, retinal dialysis, trauma, pro liferative vitreoretinopathy (PVR) grade B or higher, schisis detachments, and e yes that had been operated previously for RRD. A simple algorithm was followed t o manage patients with inferior breaks. All patients underwent a standard three port PPV with intraocular gas tamponade without supplementary SB. Patients were asked to posture face up or right or left side down for 1 week. Results: 39 of t he 48 patients (81.3%) with inferior breaks were treated successfully with one operation. 41 of 48 patients (85.4%) control patients achieved primary success. The final success rate was 95.8%in both groups. There was no statistical diffe rence between the two groups. When all the cases of RRD were analysed (including external plomb/non drain procedures) the primary success rate was 89%and fina l success rate 97.5%Conclusions: This study has shown that acceptable success r ates can be achieved using PPV alone to treat RRD with inferior breaks. Complica tions are minimised and patients in this high risk group have an 81%chance of p rimary success. Pars plana vitrectomy and gas will successfully reattach the ret ina and a supplementary SB, to support the inferior retina, is unnecessary as th e intraocular gas, and face up or, right or left side down positioning will tamp onade breaks satisfactorily.展开更多
文摘Background: and objective: Current literature review fails to disclose any series describing the use of two-port vitrectomy in adult patients. This study was performed to determine the feasibility and efficacy of pars plana vitrectomy surgery using two (rather than three or four)-port access for treatment of diabetic patients with nonclearing vitreous haemorrhage due to retinal neovascularization. Design: Interventional prospective case series: to measure ability to allow for long-term resolution of chronic uncomplicated vitreous haemorrhage in diabetic patients, and to study the frequency and nature of complications associated with this technique. Methods: Two-port pars plana vitrectomy (with endolaser treatment and membrane delamination if necessary) was performed in a prospective series of 12 consecutive diabetic patients with nonclearing vitreous haemorrhage due to retinal neovascularization. Results: Successful removal of vitreous haemorrhage resulted in all patients. No visually significant intraoperative complications occurred. Best postoperative visual acuity correlated with lenticular and macular perfusion status. Conclusion: Two-port pars plana vitrectomy is an efficient (and potentially safer and faster) alternative to the standard three-port vitrectomy in selected patients.
文摘PURPOSE: To introduce a new non-trocar system for 25-gauge transconjunctival pars plana vitrectomy(PPV). DESIGN: Study of a new surgical instrument. METHODS: This new non-trocar syst em for 25-gauge transconjunctivalPPVconsists of a contact lens ring featuring f our projections containing 1.0-mm diameter holes located 3.0 mm from the ring e dge, a wedge-shaped 25-gauge infusion cannula, and two plugs. RESULTS: The rin g is fixed with 7-0 silk sutures at the 3-and 9-o’clock positions on the lim bus. Using the 25-gauge needle, three conjunctival and scleral incisions (n=3) are made at the projection holes located inferotemporally, superonasally, and su perotemporally. No intra-or postoperative complications were encountered in 14 patients treated by this non-trocar 25-gauge transconjunctival PPV. CONCLUSION : Using the system introduced here, 25-gauge transconjunctival PPVcan be perfor medwithout suturing sclerotomies and without intra-or postoperative complicatio ns.
文摘Purpose: To describe the technique and outcome of pars plana vitreous aspiration during penetrating keratoplasty (PK)-combined with cataract extraction (CE) and intraocular lens (IOL) implantation (triple procedure) to prevent positive vitreous pressure and its associated complications. Design: Nonrandomized prospective noncomparative interventional case series. Participants: Sixty-five patients who underwent triple procedures between June 2001 and September 2003. Methods: Triple procedures performed on all 65 patients consisted of PK, extracapsular CE, and IOL implantation with standard techniques. After nonpenetrating trephination, anterior vitreous tappingwas performedwith a 23-gauge needle on a 5-ml syringe over the pars plana 3.5 mm posterior to the limbus in the superotemporal quadrant. Main Outcome Measures: Preoperative best-corrected visual acuity (BCVA), volume of aspirated liquefied vitreous, intraoperative and postoperative complications, and postoperative BCVA at 3 and 6 months. Results: Corneal scarring with cataract was the most common indication for surgery. Preoperative BCVA ranged from 20/160 to light perception. Aspirated vitreous volume varied from 0.3 to 1.5 ml, averaging 1.0 ml. No case had evidence of positive vitreous pressure during surgery. The mean follow-up period was 9.6±2.6months (range,6-24). Postoperative complications consisted of graft rejection in 4 cases (6.2%), primary graft failure in 3 (4.6%), and secondary glaucoma in 1 (1.5%). Of the patients, 70.8%had a postoperative BCVA of ≥20/160 at 6 months. Vitreous hemorrhage, retinal tearing, and detachment were not observed. Conclusions: Pars plana anterior vitreous tapping is a safe adjunct for triple procedures to prevent positive vitreous pressure and its associated complications.
文摘Background: Rhegmatogenous retinal detachments (RRD) with inferior breaks are usually treated by scleral buckling (SB) or pars plan a vitrectomy (PPV) or a combination of both methods. However, applying a SB duri ng PPV may produce a risk of choroidal haemorrhage. Following a recent pilot stu dy showing that such cases can be safely treated by PPV without SB the authors r e examined their management of RRD in which inferior breaks were present. Metho ds: All patients had a detached vitreous and a complex configuration of retinal breaks. A case control study was performed to analyse the surgical methods and results of PPV on 48 consecutive patients with RRD associated with inferior brea ks and 48 age/sex matched controls who underwent PPV for RRD without inferior br eaks. Exclusion criteria were giant retinal tears, retinal dialysis, trauma, pro liferative vitreoretinopathy (PVR) grade B or higher, schisis detachments, and e yes that had been operated previously for RRD. A simple algorithm was followed t o manage patients with inferior breaks. All patients underwent a standard three port PPV with intraocular gas tamponade without supplementary SB. Patients were asked to posture face up or right or left side down for 1 week. Results: 39 of t he 48 patients (81.3%) with inferior breaks were treated successfully with one operation. 41 of 48 patients (85.4%) control patients achieved primary success. The final success rate was 95.8%in both groups. There was no statistical diffe rence between the two groups. When all the cases of RRD were analysed (including external plomb/non drain procedures) the primary success rate was 89%and fina l success rate 97.5%Conclusions: This study has shown that acceptable success r ates can be achieved using PPV alone to treat RRD with inferior breaks. Complica tions are minimised and patients in this high risk group have an 81%chance of p rimary success. Pars plana vitrectomy and gas will successfully reattach the ret ina and a supplementary SB, to support the inferior retina, is unnecessary as th e intraocular gas, and face up or, right or left side down positioning will tamp onade breaks satisfactorily.
