PURPOSE: To evaluate the benefit of pars plana vitrectomy (PPV) and removal of the internal limiting membrane (ILM) in eyes with diffuse diabetic macular edem a refractory to laser photocoagulation.DESIGN: Prospective...PURPOSE: To evaluate the benefit of pars plana vitrectomy (PPV) and removal of the internal limiting membrane (ILM) in eyes with diffuse diabetic macular edem a refractory to laser photocoagulation.DESIGN: Prospective, consecutive, interve ntional case series. METHODS: Diabetic patients with biomicroscopic, angiographi c, and tomographic evidence of diabetic macular edema persisting for at least 3 months after numerous sessions of macular photocoagulation were evaluated for in clusion. Patients with biomicroscopic evidence of epiretinal membrane or taut po sterior hyaloid, previous vitreoretinal surgery, or active proliferative diabeti c retinopathy were excluded. The main outcome measures were macular thickness, a s measured by optical coherence tomography (OCT) and visual acuity (VA). RESULTS : PPV with ILM removal was performed in 11 eyes of 10 patients (four men, six wo men; mean age=58.2 years). Six-month follow-up data were available for 10 eyes (91%). At 6 months postoperatively, central macular thickness had improved by at least 20%in eight of 11 eyes (mean preoperative thickness of 421 μm compare d with mean postoperative thickness of 188 μm; P=.007). Mean VA improved from 2 0/352 to 20/94 at 6 months (P=.002). By the most recent visit (range=6-20 month s postoperatively), VA had improved by at least 2 Snellen lines in 6 of 10 eyes treated with surgery alone. CONCLUSIONS: The early results of this ongoing study suggest that PPV with ILM removal may provide anatomic and visual benefit in so me eyes with chronic diabetic macular edema unresponsive or unamenable to additi onal laser photocoagulation.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
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 report a case of endophthalmitis after triamcinolone acetonide (TA )-assisted par plane vitrectomy (PPV). Methods: A 60-year-old Japanese man de veloped endophthalmitis after TA-assisted PPV for diabetic m...Purpose: To report a case of endophthalmitis after triamcinolone acetonide (TA )-assisted par plane vitrectomy (PPV). Methods: A 60-year-old Japanese man de veloped endophthalmitis after TA-assisted PPV for diabetic macular edema. Preop erative visual acuity was 20/200. Four days after surgery, endophthalmitis assoc iated with anterior chamber hypopyon was noticed; the patient’s vision had dete riorated to hand motion. In spite of severe cell infiltration, the ciliary injec tion and ocular pain were not significant. Results: The additional PPV with irri gation of cefazolin (40 μug/ml) and gentamicin (8 μug/ml) was performed. Endop hthalmitis resolved soon after this treatment. Staphylococcus epidermidis was de tected in the intravitreous samples. The patient’s visual acuity improved to 20 /100. Conclusion: Endophthalmitis may be a complication of TA-assisted PPV with unique signs and symptoms.展开更多
Purpose:To investigate intraocular lens(IOL)tilt and decentration following combined vitrectomy and pars plana lensectomy(PPL)with IOL implantation in patients with proliferative diabetic retinopathy.Methods:We follow...Purpose:To investigate intraocular lens(IOL)tilt and decentration following combined vitrectomy and pars plana lensectomy(PPL)with IOL implantation in patients with proliferative diabetic retinopathy.Methods:We followed 25 patients with proliferative diabetic retinopathy who underwent PPL and IOL(MA60BM)implantation at the time of pars plana vitrectomy(PPL group),and 25 patients who underwent phacoemulsification and IOL(MA60BM)implantation without vitrectomy(PE group).Intraocular lens tilt and decentration were evaluated quantitatively,using the anterior eye segment analysis system,approximately 12 months after surgery.Results:There was no significant difference in IOL tilt(p=0.47)or decentration(p =0.26)between the PPL and PE groups.Conclusions:The present study suggests that tilt and decentration of the IOL are acceptable in combined vitrectomy and pars plana lensectomy.展开更多
To determine the long- term efficacy of indocyanine green (ICG)- assisted retinal internal limiting membrane (ILM) peeling during macular hole repair. Retrospective, interventional, noncomparative case series. One hun...To determine the long- term efficacy of indocyanine green (ICG)- assisted retinal internal limiting membrane (ILM) peeling during macular hole repair. Retrospective, interventional, noncomparative case series. One hundred twenty- one eyes of 114 patients with stage 2, 3, or 4 idiopathic macular holes that underwent ICG- assisted macular hole repair during the period of August 1999 to January 2003. All eyes underwent a pars plana vitrectomy, including peeling of the posterior cortical hyaloid when necessary. Indocyanine green dye (0.5% ) was instilled over the macula, and after removal of the ICG, the retinal ILM was peeled. Medium- to long- acting gas tamponade was used in all cases, and all patients were asked to position themselves facedown for 1 to 2 weeks. Long- term postoperative anatomic results, visual acuity (VA), and complications. Patients were observed postoperatively for an average of 26 months (range, 12- 53). Anatomic closure of the macular hole was achieved in 118 eyes (98% ) with a single surgery. Reoperation was successful at closing 2 of the 3 macular holes that did not close initially. One macular hole reopened 16 months after the original surgery, and the patient has not yet undergone further surgery. Visual acuity improved by< 2 lines in 116 eyes (96% ). Mean visual improvement after surgery was 6 lines (range, 0- 14), and 96 eyes (79% ) achieved a final VA of 20/50 or better. There were no intraoperative or postoperative complications attributed to the use of ICG. Long- term follow- up of patients who underwent ICG- assisted ILM peeling for idiopathic macular hole repair demonstrates excellent anatomic and visual results.展开更多
文摘PURPOSE: To evaluate the benefit of pars plana vitrectomy (PPV) and removal of the internal limiting membrane (ILM) in eyes with diffuse diabetic macular edem a refractory to laser photocoagulation.DESIGN: Prospective, consecutive, interve ntional case series. METHODS: Diabetic patients with biomicroscopic, angiographi c, and tomographic evidence of diabetic macular edema persisting for at least 3 months after numerous sessions of macular photocoagulation were evaluated for in clusion. Patients with biomicroscopic evidence of epiretinal membrane or taut po sterior hyaloid, previous vitreoretinal surgery, or active proliferative diabeti c retinopathy were excluded. The main outcome measures were macular thickness, a s measured by optical coherence tomography (OCT) and visual acuity (VA). RESULTS : PPV with ILM removal was performed in 11 eyes of 10 patients (four men, six wo men; mean age=58.2 years). Six-month follow-up data were available for 10 eyes (91%). At 6 months postoperatively, central macular thickness had improved by at least 20%in eight of 11 eyes (mean preoperative thickness of 421 μm compare d with mean postoperative thickness of 188 μm; P=.007). Mean VA improved from 2 0/352 to 20/94 at 6 months (P=.002). By the most recent visit (range=6-20 month s postoperatively), VA had improved by at least 2 Snellen lines in 6 of 10 eyes treated with surgery alone. CONCLUSIONS: The early results of this ongoing study suggest that PPV with ILM removal may provide anatomic and visual benefit in so me eyes with chronic diabetic macular edema unresponsive or unamenable to additi onal laser photocoagulation.
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 report a case of endophthalmitis after triamcinolone acetonide (TA )-assisted par plane vitrectomy (PPV). Methods: A 60-year-old Japanese man de veloped endophthalmitis after TA-assisted PPV for diabetic macular edema. Preop erative visual acuity was 20/200. Four days after surgery, endophthalmitis assoc iated with anterior chamber hypopyon was noticed; the patient’s vision had dete riorated to hand motion. In spite of severe cell infiltration, the ciliary injec tion and ocular pain were not significant. Results: The additional PPV with irri gation of cefazolin (40 μug/ml) and gentamicin (8 μug/ml) was performed. Endop hthalmitis resolved soon after this treatment. Staphylococcus epidermidis was de tected in the intravitreous samples. The patient’s visual acuity improved to 20 /100. Conclusion: Endophthalmitis may be a complication of TA-assisted PPV with unique signs and symptoms.
文摘Purpose:To investigate intraocular lens(IOL)tilt and decentration following combined vitrectomy and pars plana lensectomy(PPL)with IOL implantation in patients with proliferative diabetic retinopathy.Methods:We followed 25 patients with proliferative diabetic retinopathy who underwent PPL and IOL(MA60BM)implantation at the time of pars plana vitrectomy(PPL group),and 25 patients who underwent phacoemulsification and IOL(MA60BM)implantation without vitrectomy(PE group).Intraocular lens tilt and decentration were evaluated quantitatively,using the anterior eye segment analysis system,approximately 12 months after surgery.Results:There was no significant difference in IOL tilt(p=0.47)or decentration(p =0.26)between the PPL and PE groups.Conclusions:The present study suggests that tilt and decentration of the IOL are acceptable in combined vitrectomy and pars plana lensectomy.
文摘To determine the long- term efficacy of indocyanine green (ICG)- assisted retinal internal limiting membrane (ILM) peeling during macular hole repair. Retrospective, interventional, noncomparative case series. One hundred twenty- one eyes of 114 patients with stage 2, 3, or 4 idiopathic macular holes that underwent ICG- assisted macular hole repair during the period of August 1999 to January 2003. All eyes underwent a pars plana vitrectomy, including peeling of the posterior cortical hyaloid when necessary. Indocyanine green dye (0.5% ) was instilled over the macula, and after removal of the ICG, the retinal ILM was peeled. Medium- to long- acting gas tamponade was used in all cases, and all patients were asked to position themselves facedown for 1 to 2 weeks. Long- term postoperative anatomic results, visual acuity (VA), and complications. Patients were observed postoperatively for an average of 26 months (range, 12- 53). Anatomic closure of the macular hole was achieved in 118 eyes (98% ) with a single surgery. Reoperation was successful at closing 2 of the 3 macular holes that did not close initially. One macular hole reopened 16 months after the original surgery, and the patient has not yet undergone further surgery. Visual acuity improved by< 2 lines in 116 eyes (96% ). Mean visual improvement after surgery was 6 lines (range, 0- 14), and 96 eyes (79% ) achieved a final VA of 20/50 or better. There were no intraoperative or postoperative complications attributed to the use of ICG. Long- term follow- up of patients who underwent ICG- assisted ILM peeling for idiopathic macular hole repair demonstrates excellent anatomic and visual results.
