Retinal breaks in small-gauge pars plana vitrectomy.
ABSTRACT To determine the frequency of peripheral iatrogenic retinal breaks in eyes undergoing small-gauge pars plana vitrectomy.
Prospective, single-center, noncomparative interventional case series.
A consecutive series of patients that underwent 23- or 25-gauge vitrectomy between July 2010 and the end of October 2010 were included in the study. We excluded patients with retinal detachment, dislocated crystalline lens from complicated cataract surgery, endophthalmitis, and previous history of eye trauma or vitrectomy. We recorded prospectively the frequency of all retinal breaks noted during surgery of patients undergoing 23- or 25-gauge vitrectomy. The indications for vitreoretinal surgery were recorded, as were the location of retinal breaks, the presence or absence of an intact posterior hyaloid, status of lens, method of retinopexy, and use of a tamponade, together with the onset of a rhegmatogenous retinal detachment during the 3-month follow-up interval. Main outcome was rate of entry site breaks in small-gauge vitrectomy.
We included 184 patients in this study. The mean age was 65.6 years (SD 13.2) and 46% were male. Retinal breaks occurred in 29 patients (15.7%) but breaks in only 6 (3.2%) were deemed to be related to the sclerotomies. Entry site breaks were not linked to the gauge of the instruments, but retinal breaks were more common in 23-gauge surgeries, although this was not statistically significant. One rhegmatogenous retinal detachment occurred in the postoperative period.
Entry site retinal breaks are not common in small-gauge vitrectomy.
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ABSTRACT: Posterior vitreous detachment (PVD) is a common phenomenon in the aging eye. However, this may be complicated by persistent symptomatic vitreomacular adhesions that exert tractional forces on the macula (vitreomacular traction; VMT). VMT itself may be associated with epiretinal membrane formation and the development of idiopathic macular holes (IMH). Such pathologies may cause visual disturbances, including metamorphopsia, photopsia, blurred vision, and decreased visual acuity, which impact an individual's quality of life. Technologies such as optical coherence tomography allow an increasingly more accurate visualisation of the macular anatomy, including quantification of macular hole characteristics, and this facilitates treatment decision-making. Pars plana vitrectomy remains the primary treatment option for many patients with VMT or IMH; for the latter, peeling of the inner limiting membrane (ILM) of the retina has shown improved outcomes when compared with no ILM peeling. The development of narrow-gauge transconjunctival vitrectomy systems has improved the rate of visual recovery following surgery. Ocriplasmin, by degrading laminin and fibronectin at the vitreoretinal interface, may allow induction of PVD in a non-invasive manner. Indeed, clinical studies have supported its use as an alternative to surgery in certain patient populations. However, further research is still needed with respect to greater understanding of the pathophysiology underlying the development of VMT and IMH.Eye (London, England) 10/2013; 27(S1):S1-S21. · 1.97 Impact Factor
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ABSTRACT: To describe rhegmatogenous retinal detachment (RD) surgery. National Ophthalmology Database study. A total of 3403 eyes from 3321 patients undergoing primary RD surgery. Participating centers prospectively collected clinical data using a single electronic medical record system, with automatic extraction of anonymized data to a national database, from 2002 to 2010. Description of the primary procedures performed, intraoperative complication rate, and proportion of eyes undergoing subsequent RD or cataract surgery. We undertook an exploratory analysis of change in visual acuity (VA) using the data available. Of 3403 operations, 2693 (79.1%) were pars plana vitrectomy (PPV), 413 (12.1%) were retinopexy with a scleral buckle (SB), and 297 (8.7%) were PPV with an SB (PPV-SB). For PPV and PPV-SB, 18.8% were with hexafluoroethane, 12.1% were with perfluoropropane, 43.1% were with sulfahexafluoride, 1.8% were with air, 17.9% were with silicone oil, and 10.7% were with cataract surgery. Within 1 year of vitrectomy, 52.1% of phakic eyes had undergone cataract surgery. For all RD operations combined (and excluding cataract surgery complications), 5.1% had 1 or more intraoperative complication, 13.0% underwent further RD surgery, and 8.3% had silicone oil in situ at last review. The RD reoperation rate was 13.3%, 12.3%, and 14.5% for PPV, SB, and PPV-SB, respectively. For 961 eyes with a baseline and final VA measurement, the median presenting logarithm of the minimum angle of resolution VA improved from 1.0 to 0.5 (20/200-20/63) after a median follow-up of 0.6 years. These results may help vitreoretinal surgeons to benchmark their intraoperative complication rate and reoperation rate and to compare their surgical techniques with their peers'. They suggest that the benefits of RD surgery greatly outweigh the risks. Proprietary or commercial disclosure may be found after the references.Ophthalmology 08/2013; · 5.56 Impact Factor
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ABSTRACT: The periphery of the vitrectomised eye is the site of retinal breaks in 1 to 15% of cases. These breaks must be looked for and treated to avoid retinal detachment. They are more frequent in the presence of fragile lesions in high myopia, or vitreoretinal traction. They can be related to vitreous incarceration in a sclerotomy site or with the movements of the vitrectomy probe. Traction is proportional to aspiration rate, and inversely proportional to the distance between the cutter and the vitreous base. Twenty-three- or 25-gauge transconjunctival vitrectomy seems to decrease the risk of vitreous incarceration and peripheral retinal tear.Journal francais d'ophtalmologie 02/2014; · 0.51 Impact Factor