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
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
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.
