Vitrectomy, lensectomy and silicone oil tamponade in the management of retinal detachment associated with choroidal detachment

AIM: To report the results of combined vitrectomy, lensectomy and silicone oil (SO) tamponade in treating primary rhegmatogenous retinal detachment (RRD) associated with choroidal detachment (CD). · METHODS: A retrospective, consecutive and case series study of 21 subjects with concurrent RRD associated with CD was conducted. All subjects underwent a standard three -port 20G pars plana vitrectomy (PPV) with lensectomy and silicone oil tamponade. Mean follow -up time was 8 months (rang from 4 to 19 months). The primary and final anatomic success rate, visual acuity and final intraocular pressure (IOP) were recorded and analyzed. ·RESULTS: Of 21 subjects, 8 were women and 13 were men. Age at presentation ranged from 22 to 75 years (mean 57.4 years). The presenting vision ranged from light perception to 0.15. The initial IOP ranged from 3mmHg to 12mmHg (mean 6.2mmHg). All eyes were phakic except one pseudophakic. No intraocular lens was implanted during the primary surgical intervention. Fifteen of 21 (71.4%) eyes had retina reattached after one operation. Six eyes had recurrent inferior retinal detachment due to proliferation. Five of them were successfully reattached after one or more additional operations. Mean IOP at final follow -up was 15.2mmHg (range from 8mmHg to 20mmHg). One case declined for further operation. The final reattachment rate was 95.2%. Visual acuity improved in 19 (90.5%) eyes, was unchanged in 1 (4.8%) eye and decreased in 1 (4.8%) eye.·CONCLUSION: Combination of vitrectomy, lensectomy and silicone tamponade is an effective method in treating RRD associated with CD, reducing the incidence of postoperative hypotony.

Staged lensectomy and vitrectomy in the management of stage 5C retinopathy of prematurity with corneal opacification:long-term follow up

·AIM:To verify the feasibility and safety of staged lensectomy and vitrectomy in stage 5 C retinopathy of prematurity(ROP)with corneal opacification.·METHODS:This was a retrospective,interventional,consecutive case series.Twenty-two eyes of 18 stage 5 C ROP patients with corneal opacification were included.Regular combined lensectomy and vitrectomy were not prescribed due to the invisible fundus.Staged lensectomy and posterior vitrectomy were performed.The anatomical and visual outcomes were reviewed at the final follow-up visit.·RESULTS:The mean gestational age of ROP patients was29.3±1.6 wk(range:27-32 wk),comprising 8 males and 10 females.The average birth weight was 1363.0±300.0 g.All the eyes had corneal opacity and flat or disappeared anterior chambers pre-operatively.Two eyes had complicated cataract and 7 eyes had retrolental fibroplasia.Six eyes had posterior pupillary synechiae or membranes.Seven(31.8%)eyes had vascularly active retinas.The average interval between two procedures was 6.8±4.6 mo(2.5-18.5 mo).After surgeries,all the patients had normal anterior chambers.Fourteen eyes had clear corneas.The intraocular pressure of 3 eyes with glaucoma was controlled by medication.Two eyes had ocular phthisis.The retina was reattached in 3 eyes and partially attached in 11 eyes.Visual acuity ranged from no light perception to hand motion.·CONCLUSION:Staged lensectomy and vitrectomy are procedures that can halt progression to further complications and preserve some useful eyesight in stage5 C ROP patients with corneal opacification.The earlier the lensectomy is performed,the better the prognosis is.

Surgical treatment and visual outcomes of cataract with persistent hyperplastic primary vitreous

AIM：To evaluate the surgical treatment and visual outcomes of eyes with cataract and persistent hyperplastic primary vitreous（PHPV）.METHODS：This retrospective study included patients with cataract and PHPV treated with various strategies.Anterior PHPV was treated using phacoemulsification with underwater electric coagulation on posterior capsule neovascularization,posterior capsulotomy,anterior vitrectomy,and intraocular lens（IOL）implantation. Posterior PHPV was treated with lensectomy,posterior vitrectomy,retinal photocoagulation,and IOL implantation or silicone oil tamponade. Visual acuity（VA）,pattern visual evoked potential（P-VEP）,anatomic recovery,postoperative complications,and amblyopia outcome were examined.Subjects were followed-up for 3-48 mo after surgery.RESULTS：Of the 30 patients（33 eyes）with congenital cataract and PHPV included（average age,39.30±35.47mo）,9 eyes had anterior PHPV and 24 had posterior PHPV. Thirty-two eyes were surgically treated. Eyes with anterior PHPV received an IOL during one-stage（6 eyes）and twostage（3 eyes）implantation. Postoperative complications included retinal detachment（1 eye）and recurrent anterior chamber hemorrhage（1 eye）. In eyes with posterior PHPV,6 and 11 eyes received IOLs in one-and two-stage procedures,respectively. Silicone oil was retained in 2 eyes,and IOLs were not implanted in 4 eyes. VA significantly improved in 25 eyes following operations and 3-48 mo of amblyopia treatment. P-VEP P_（100） was improved following surgery in both PHPV types.CONCLUSION：Our surgical strategies are appropriate and effective for anterior and posterior PHPV. Early surgical intervention and amblyopia therapy result in positive treatment outcomes.

Two-stage procedure in the management of selected cases of keratoconus: clear lens extraction with aspherical IOL implantation followed by WFG-PRK

AIM： To assess the objective and subjective results of a two-stage procedure for management of keratoconus： clear lensectomy with aspherical intraocular lens（IOL） implantation followed by wave front-guided photorefractive keratotomy（WFG-PRK）.METHODS： This prospective interventional non-randomized study included patients aged 35 years old or more with grade I and II stable keratoconus, a clear visual axis, minimal corneal thickness（MCT） 420 μm or more and average keratometric reading（K） less than 54 diopter（D）. Refraction of all selected eyes should be-8.00 D sphere or more with less than-6.00 D cylinder and could be corrected two lines or more with spectacles or contact lenses. All studied eyes underwent a two-stage approach treatment： first refractive lens exchange and aspherical IOL implantation followed, after at least 3 mo, by WFGPRK. Pre and postoperative complete ophthalmological examination were performed. Topographical, visual and aberrometric results were recorded and evaluated during 6 mo follow up period. Moreover, patient satisfaction and other subjective outcomes were also analyzed.RESULTS： The 13 eyes of 11 patients diagnosed with stable keratoconus and aged from 39 to 49 y（42.4±6.2 y） were enrolled in the study. At baseline, 8 eyes had grade I and 5 eyes had grade II keratoconus. The manifest sphere was-10.3±4.2 D（ranged from-8.0 to-14.0 D） and the manifest cylinder was-4.2±1.2 D（ranged from-1.75 to-5.50 D）. After the two-stage procedure, sphere and cylinder reduced significantly to-0.43±0.22 D and-1.3±0.72 D respectively（P〈0.001）. There was also a highly significant improvement in the mean uncorrected distance visual acuity（UDVA） from logMAR 1.41±0.49 preoperatively to 0.51±0.16 postoperatively（P〈0.001） and the mean corrected distance visual acuity（CDVA） from 0.76±0.24 preoperatively to 0.49±0.13 after the operation（P〈0.001）. All aberrometric and mesopic vision parameters and most of the topographical indices demonstrated highly significant improvement that remains stable until the end of follow up. All recorded subjective data revealed a high degree of patient satisfaction.CONCLUSION： Two-stage approach（clear lens exchange with monofocal IOL followed by WFG-PRK） in selected cases of keratoconus is a safe, effective and highly predictable procedure with satisfactory visual and refractive results.