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.

Primary 23-gauge vitreoretinal surgery for rhegmatogenous retinal detachment

AIM: To report the effectiveness and safety of primary 23-Gauge (G) vitreoretinal surgery for rhegmatogenous retinal detachment (RRD). · METHODS: In this retrospective study, 49 eyes of 49 consecutive patients who underwent primary 23-G transconjunctival sutureless vitrectomy (TSV) for RRD between January 2007 and July 2009 at our institution were evaluated. · RESULTS: Mean follow-up time was 8.9±7.7 months (1-28 months). Retinal reattachment was achieved with a single operation in 47(95.9%) of 49 eyes. In two eyes (4.1%), retinal redetachment due to new breaks was successfully treated with reoperation using the 23-G TSV system. Mean logMAR visual acuity was 2.01±0.47 preoperatively and 1.3±0.5 postoperatively (P <0.001, Paired t -test). Mean preoperative intraocular pressure (IOP) was 14.1±2.8mmHg. Mean postoperative IOP was 12.3±3.6mmHg at 1 day, 13.1±2.1mmHg at 1 week, 14.3±2.2mmHg at 1 month. Iatrogenic peripheral retinal break was observed in 1 eye(2.0%) intraoperatively. No sutures were required to close the scleral or conjunctival openings, and no eyes required convertion of surgery to 20-G vitrectomy. · CONCLUSION: Primary 23-G TSV system was observed to be effective and safe in the treatment of RRD.

A modified approach to actively remove high viscosity silicone oil through 23-gauge cannula

AIM：To report a simple approach to actively remove high viscosity silicone oil through a 23-gauge cannula via pars plana.METHODS：Forty-eight eyes of 48 patients underwent silicone oil（5700 centistokes） removal（SOR） were enrolled.A section of blood transfusion set was prepared to connect a standard 23-gauge cannula and vitrectomy machine.Silicone oil was removed with suction of500-mm Hg vacuum through the cannula.Main outcome measures were SOR duration,number of sutured sites,intraocular pressure（IOP）,best-corrected visual acuity（BCVA）,and complications.RESULTS：Silicone oil was successfully removed in all cases.The mean SOR time was 5.70±0.85 min.Nine eyes（18.75%） needed suture partial sclerotomies.No intraoperative complications were noted.Transient hypotony（≤8 mm Hg） was seen in 3 eyes（6.25%） on postoperative day 1,but all resolved within 1wk.Retinal reattachment was achieved in all cases and no other postoperative complications were noted during 3-month following-up.BCVA at the final visit improved or stabilized in all patients comparing to the preoperative level.CONCLUSION：Active removal of high viscosity silicone oil through a 23-gauge instrument cannula jointed with blood transfusion set is a practical and reliable technique when considering two sides of efficacy and safety.

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.

Outcomes of transconjunctival sutureless 27-gauge vitrectomy for vitreoretinal diseases

AIM： To evaluate the safety and efficacy profile of 27-gauge （27G） pars plana vRrectomy （PPV） for the treatment of various vitreoretinal diseases. METHODS： The clinical outcomes of 61 eyes （58 patients） with various vitreoretinal diseases following 27G PPV were retrospectively reviewed. RESULTS： Surgical indications included rhegmatogenous retinal detachment （n=24）, full-thickness macular hole （n=12）, diabetic retinopathy （n=11）, vitreous hemorrhage （n=6）, Eales disease （n=4）, pathological myopia-related vitreous floater （n=2）, and macular epiretinal membrane （n=2）. The mean follow-up was 166.4±61.3d （range 98-339d）. The mean IogMAR best-corrected visual acuity （BCVA） improved from 1.7±1.1 [0.02 decimal visual acuity （VA） equivalent] preoperatively to 1.2±1.0 （0.06 decimal VA equivalent） at the last postoperative visit （P〈0.001）. The mean operative time was 49.gmin. With the exception of complicated cataract in one eye, no intraoperative complications were encountered. No case required conversion to conventional 20-, 23- or 25G instrumentation in all surgical maneuvers except for silicone oil infusion, which required a 25G oil injection syringe. Postoperative complications included transient ocular hypertension, vitreous hemorrhage, persistent intraocular pressure elevation, subconjunctival oil leakage, and recurrent retinal detachment. No cases of hypotony, endophthalmitis, and sclerotomy-related tears were observed. CONCLUSION： The current results suggest that 27G PPV system is a safe and effective treatment for various vitreoretinal diseases. When learning to perform 27G PPV,surgeons may encounter a learning curve and should gradually expand surgical indications from easy to pathologically complicated cases.

23G玻璃体切割术后早期高眼压的相关危险因素分析及处理

目的:分析23G玻璃体切割术后高眼压的发生率、特点及相关的危险因素,为处理及预防提供依据。方法:对于我院行23G玻璃体切割手术的患者146眼临床资料进行回顾分析,术后早期高眼压诊断标准为术后2wk内任一时间眼压测量值≥25mmHg。采用卡方检验进行统计学分析;对于术后早期高眼压患者根据眼压程度采用单一或联合降眼压药物治疗。结果:患者146眼中发生术后高眼压者42眼,占28.8%,平均出现自术后3.38d。单纯气换组、C3F8填充组及硅油填充组术后高眼压发生率分别为14.5%,33.3%和39.3%,C3F8组和硅油填充组与单纯气换组比较均有统计学意义;未行激光机冷冻处理组、部分视网膜光凝组、全视网膜光凝组及冷冻组术后早期高眼压的发生率分别为13.6%,27.4%,34.5%和35.7%,部分视网膜光凝组与未处理组相比较没有统计学意义,而其他两组与未处理组比较有统计学意义;不同原发病术后均有早期高眼压的发生,但分布不均衡。通过处理眼压均控制理想。结论:23G玻璃体切割术后早期高眼压的危险因素是多方面的,主要与眼内填充物、术中处理方式有关,不同原发病对于高眼压的影响在于其对术式的影响。术后早期高眼压多为一过性,合理药物治疗可控制。

黄斑裂孔手术和白内障手术同时进行或序贯进行的研究（英文）

目的:研究黄斑裂孔手术和白内障手术同时进行或序贯进行。方法:在大不里士发起了一项对黄斑裂孔和白内障患者的临床试验,研究了黄斑裂孔手术和白内障手术同时进行或序贯进行对这些患者的影响。研究中22例患者(A组)首先进行超声乳化术及人工晶状体植入手术,1mo后同时进行23G微创玻璃体切除术和视网膜内界膜剥除术。21例患者(B组)进行白内障超声乳化人工晶状体植入手术联合23G微创玻璃体切除术以及视网膜内界膜剥除术。结果:A组包括7例男性,15例女性;B组包括9例男性,12例女性(P=0.545)。A组和B组患者的平均年龄分别为66.63±4.75岁和67.71±4.99岁(P=0.472)。术后3mo,A组中2例患者,B组中5例患者黄斑裂孔未愈合(P=0.240);A组1例患者,B组4例患者并发葡萄膜炎(P=0.185);B组2例患者眼内压升高(P=0.233);A组2例患者,B组4例并发后囊混浊(P=0.412)。结论:两组相比,同时进行手术组产生并发症患者较多,但经统计学分析,术后疗效及并发症之间无统计学差异。

贝伐单抗辅助玻璃体切除治疗增生性糖尿病视网膜病变的观察

目的：评价术前贝伐单抗（ Bevacizumab）玻璃体内注射联合23 G经睫状体平坦部玻璃体切除术（ PPV）治疗增生性糖尿病性视网膜病变（ PDR）的临床效果。方法本研究为前瞻性研究。PDR 60例（60）眼随机分为两组,30眼PPV术前5~7 d贝伐单抗1.25 mg玻璃体体内注射为研究组；另30眼PPV术前玻璃体内未注药为对照组。主要比较两组的手术时间、眼压、黄斑厚度、视力和并发症。结果与对照组相比,研究组的手术时间明显缩短,医源性视网膜损伤的发生率明显降低,硅油注入明显减少,术后视力显著提高更明显（P〈0.05）；两组间眼压和黄斑厚度的差异无统计学意义。结论 PPV术前辅助应用贝伐单抗玻璃体内注射可以缩短手术时间,减少术中医源性视网膜损伤的发生率,提高了手术安全性和术后视力。