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ABSTRACT: To compare duration and efficacy of the dexamethasone (DEX) intravitreal implant in vitrectomized (pars plana vitrectomy [PPV] group) and non-vitrectomized eyes (control group) with macular edema related to central retinal vein occlusion (CRVO).
Eyes that received the DEX implant for CRVO related to macular edema were included in a retrospective chart review. Outcomes measured were best-corrected visual acuity (BCVA) and central macular thickness (CMT).
Fifteen eyes were included in the study. Eight of 15 eyes had prior vitrectomy. Mean BCVA was 20/160 in both groups. Baseline mean CMT was 550 μm (PPV group) and 556 μm (control group, P = .70), and improved to 307.5 μm (PPV group) and 316.3 μm (control group) (P = .90) after implant. The BCVA was 20/125 (PPV group) and 20/200 (control group) (P = .60). Time to next procedure was similar in both groups.
This retrospective study shows similar CMT reductions with DEX implant treatment for CRVO-related macular edema in vitrectomized and non-vitrectomized eyes.
Ophthalmic surgery, lasers & imaging retina. 01/2013; 44(1):28-33.
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ABSTRACT: PURPOSE:: To describe fundus autofluorescence (FAF) characteristics associated with choroidal osteomas and their secondary complications. METHODS:: Retrospective descriptive case series of six eyes of five patients with choroidal osteomas. Findings of FAF correlated with visual acuity, clinical features, lesion characteristics, and findings from other imaging modalities. RESULTS:: All 6 choroidal osteomas (100%) had totally or partially calcified, orange portions that were isoautofluorescent. Partial decalcification also produced areas of hyperautofluorescence and granular hypoautofluorescence corresponding to overlying retinal pigment epithelium mottling in 3 eyes (50%). Total decalcification with retinal pigment epithelial atrophy produced decreased FAF in 2 eyes (33%). Serous retinal detachment was present in 3 eyes (50%). When the overlying retinal pigment epithelium was viable, hyperautofluorescence as a result of elongation of the outer segments of photoreceptor was observed. In one eye where geographic atrophy of the retinal pigment epithelium was present, FAF was decreased even in the presence of serous retinal detachment. Portions of three partially or totally decalcified osteomas within the treatment field of photodynamic therapy for choroidal neovascularization were hypoautofluorescent. Four eyes (67%) had reduced foveal FAF and visual acuity <20/20, while both eyes with foveal isoautofluorescence had normal (20/20) visual acuity. CONCLUSION:: Calcified portions of choroidal osteomas not previously treated with photodynamic therapy were isoautofluorescent. Decalcification and secondary complications of serous retinal detachment, choroidal neovascularization, and geographic atrophy altered foveal autofluorescence and were associated with reduced visual acuity.
Retina (Philadelphia, Pa.) 06/2012; · 2.93 Impact Factor
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ABSTRACT: The purpose of this study was to report the observed outcomes of anticoagulated patients undergoing transconjunctival sutureless vitrectomies using subconjunctival anesthesia without preoperative cessation of anticoagulation and antiplatelet (AC/AP) agents.
A retrospective chart review was performed on patients taking AC/AP agents who were undergoing transconjunctival sutureless vitrectomies with subconjunctival anesthesia between January 2007 and June 2009. Intra- and postoperative complications (such as massive hemorrhage), anatomical results, satisfactory analgesia (informed by patients and recorded by surgeon), anatomical results, and visual acuity were documented.
Sixty-three surgeries were performed on 56 eyes of 52 patients. Thirty-two patients were taking aspirin and clopidogrel, 18 were taking warfarin, 5 were taking clopidogrel, 3 were taking aspirin and warfarin, 2 were taking acetylsalicylic acid and dipyridamole, and 1 was taking warfarin and clopidogrel. All patients had satisfactory analgesia. No intraoperative complications occurred. Seven eyes (13%) had postoperative vitreous hemorrhage. Overall, 79% of patients had improved postoperative visual acuity, 16% of patients had unchanged visual acuity, and 5% of patients had worse visual acuity at last follow-up visit.
Medical disease requiring systemic AC/AP therapy is often present in patients with vitreoretinal disease. Transconjunctival sutureless vitrectomies using subconjunctival anesthesia may be a safe and effective surgical option in select patients in whom cessation of AC/AP and/or delayed ophthalmic intervention is imprudent.
Retina (Philadelphia, Pa.) 01/2012; 32(5):905-11. · 2.93 Impact Factor
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ABSTRACT: To assess the long-term outcomes of intravitreal bevacizumab (IVB) in the treatment of choroidal neovascularization (CNV) secondary to presumed ocular histoplasmosis syndrome (POHS).
Retrospective, comparative case series.
Interventional series of 150 eyes in 140 patients treated for subfoveal or juxtafoveal CNV secondary to POHS from January 2006 to January 2010.
Intravitreal bevacizumab monotherapy or combination IVB and verteporfin photodynamic therapy (IVB/PDT).
Visual acuity (VA) at 12 and 24 months was analyzed. Secondary outcome measures included the number of injections per year and treatment-free intervals.
A total of 117 eyes received IVB monotherapy, and 34 eyes underwent combination IVB/PDT treatment. For all patients, the average pretreatment logarithm of minimum angle of resolution (logMAR) was 0.63 (Snellen equivalent 20/86) with a 12-month logMAR VA of 0.45 (Snellen equivalent 20/56) and a 24-month logMAR VA of 0.44 (Snellen equivalent 20/55). The mean follow-up was 21.1 months with an average of 4.24 IVB injections per year. There was no significant difference in initial VA, VA at 12 months, VA at 24 months, or number of eyes with a 3-line gain between the IVB monotherapy and IVB/PDT groups. Thirty-eight percent (39/104) of eyes gained 3 lines or more, and 81.2% (84/104) of subjects had maintained or improved their starting VA at 1 year. The proportion of subjects maintaining a 3-line gain in VA was relatively preserved at 2 years (29.8%, 17/57) and 3 years (30.3%, 10/32) follow-up. There was no increase in the proportion of subjects losing 3 lines or more over 3 years of follow-up.
There is no significant difference in VA outcomes between IVB monotherapy versus IVB/PDT combination therapy. The use of IVB alone or in combination with PDT results in significant visual stabilization in the majority of patients with CNV secondary to POHS.
Ophthalmology 11/2011; 119(2):327-32. · 5.45 Impact Factor
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ABSTRACT: To report outcomes and complications of 25-gauge pars plana vitrectomy (PPV) for patients with complications of proliferative diabetic retinopathy (PDR).
Retrospective, interventional, consecutive case series of 174 eyes undergoing primary 25-gauge PPV for PDR from 2006 to 2009. Primary outcomes were visual acuity changes and rates of postoperative complications.
Visual acuity improved from 20/187 before to 20/69 after surgery (P < .0001). Postoperative vitreous hemorrhage occurred in 38.7% of eyes and 10.4% of all eyes required another PPV for non-clearing vitreous hemorrhage. Complications included limited choroidal effusion (5.2%), rhegmatogenous retinal detachment (4.6%), hypotony, rubeosis, and ocular hypertension (4.1%), neovascular glaucoma (2.3%), hyphema (1.2%), and phthisis bulbi (0.6%).
The authors found 25-gauge PPV to be effective for vitreous removal and membrane dissection. The spectrum and frequency of complications were similar to those reported for 20-gauge PPV for PDR. In the surgical management of PDR, 25-gauge PPV is an alternative.
Ophthalmic Surgery Lasers and Imaging 09/2011; 42(6):474-80. · 0.62 Impact Factor
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Ophthalmology 07/2011; 118(7):1482.e1-3. · 5.45 Impact Factor
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ABSTRACT: To present the outcomes of Boston type I keratoprosthesis (KPro) implantation in combination with pars plana vitrectomy (PPV) and silicone oil for the treatment of hypotony in prephthisical eyes.
Interventional case series. Thirteen eyes of 13 patients underwent Boston type I KPro implantation, pars plana vitrectomy, and silicone oil placement. Concurrent retinal detachment repair, membrane peel, or intraocular lens explantation were performed if necessary. Inclusion criteria for surgery were eyes with visual acuity worse than 20/400, previous failed penetrating keratoplasty, corneal opacification, visually significant or worsening hypotony, and visual acuity 20/200 or worse in the fellow eye. Outcome measures included Snellen best-corrected visual acuity, anatomic retinal attachment, and complications.
At the final follow-up (mean, 24 months; range, 5-66 months), visual acuity was improved in 10 of 13 eyes (77%), stable in 2 of 13 eyes (15%), and decreased in 1 of 13 eyes (8%). All eyes had attached retina with no progression to phthisis bulbi. No intraoperative complications occurred. Postoperative complications included retroprosthetic membrane (7 of 13), KPro melt (1 of 13), KPro leak (1 of 13), KPro infection (1 of 13), vitreous hemorrhage (1 of 13), and retinal detachment (1 of 13).
Boston type I KPro implantation in combination with pars plana vitrectomy and intraocular silicone oil fill can improve vision in most prephthisical eyes with hypotony. Structural findings can also improve.
Cornea 06/2011; 30(10):1105-9. · 1.73 Impact Factor
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ABSTRACT: Background: Since being introduced in 2002, 25-gauge transconjunctival sutureless vitrectomy techniques continue to gain popularity among vitreoretinal surgeons and are being used in the management of increasingly complex surgical patients.
Methods: In this report, we report a patient in whom a magnetized 25-gauge intraocular pick was used to facilitate removal of a metallic intraocular foreign body with 25-gauge transconjunctival sutureless vitrectomy without enlarging a sclerotomy wound.
Results: The magnetized 25-gauge intraocular pick allowed for removal of the intraocular foreign body through a posterior capsulorhexis and a standard cataract wound. “In the bag” placement of the posterior chamber intraocular lens resulted in a perfectly reconstructed pseudophakic anterior segment.
Conclusion: The authors suggest that a magnetized 25-gauge pick may be a useful adjunct in the management of selected patients with a magnetic intraocular foreign body.
Retinal Cases & Brief Reports 12/2010; 5(4):330-332.
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ABSTRACT: To compare 20-, 23-, and 25-gauge pars plana vitrectomy (PPV) for repair of primary pseudophakic rhegmatogenous retinal detachment.
One hundred eyes of 94 pseudophakic patients who underwent primary rhegmatogenous retinal detachment repair with 20-, 23-, or 25-gauge transconjunctival PPV without scleral buckling were included. The medical records were retrospectively reviewed and the corresponding demographic information, preoperative ophthalmic diagnoses, surgical management, and postoperative course and treatment were recorded.
Retinal detachment repair was performed by one of four surgeons. All eyes underwent primary vitrectomy using either 20-, 23-, or 25-gauge vitrectomy instruments, a wide-angle viewing system, endolaser photocoagulation, and gas or silicone oil tamponade. Single surgery anatomical success was 25 of 28 eyes (89.3%) for 20-gauge, 24 of 27 eyes (88.9%) for 23-gauge, and 42 of 45 eyes (93.3%) for 25-gauge PPV. There was no statistical difference in single operation success or final visual acuity results between the groups and 100% of patients achieved final reattachment.
Twenty-, 23-, and 25-gauge instruments are equally effective options for primary repair of pseudophakic rhegmatogenous retinal detachment.
Ophthalmic Surgery Lasers and Imaging 12/2010; 42(2):107-13. · 0.62 Impact Factor
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ABSTRACT: Purpose: To describe the mechanical failure of a 25-gauge vitreous cutter intraoperatively and the management of this complication.
Methods: An observational case report of a 39-year-old Type 1 diabetic woman with proliferative retinopathy who underwent pars plana vitrectomy with 25-gauge instrumentation.
Results: Breakage of the 25-gauge vitreous cutter occurred during delamination of a dense fibrovascular plaque. The cutter was successfully removed via the trocar as a single unit. The patient recovered with no sequelae.
Conclusions: Breakage of 25-gauge instrumentation intraoperatively is a very rare event. This case constitutes only the second reported complication as such. However, it is easily managed and can result in few, if any, adverse sequelae.
Retinal Cases & Brief Reports 12/2009; 4(3):274-275.
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ABSTRACT: To evaluate the outcomes and complications of surgical management with 25-gauge pars plana vitrectomy (PPV) and silicone oil (SO) tamponade in complex vitreoretinal diseases.
Retrospective review of a consecutive, interventional case series at a single center.
Thirty-five eyes of 35 patients were included in the study. The indications for vitrectomy included tractional retinal detachment (11 eyes), macular hole (6 eyes), proliferative vitreoretinopathy or recurrent retinal detachment (9 eyes), neovascular glaucoma (3 eyes), giant retinal tear (3 eyes), and pathologic myopia with epiretinal membrane or macular hole (3 eyes). All patients underwent 25-gauge PPV with either 1,000-centistoke (n = 31) or 5,000-centistoke (n = 4) SO tamponade infused through a 24-gauge angiocatheter. No intraoperative complications were noted. The median preoperative visual acuity was counting fingers (range, 20/50 to light perception). The median postoperative visual acuity after a median follow-up of 6 months (range, 1-19 months) was 20/200 (range, 20/30 to light perception). A small subconjunctival SO bleb was identified in two patients. Recurrent retinal detachment occurred in three patients. No significant complications relating to the use of SO in the setting of 25-gauge PPV occurred.
Advances in 25-gauge PPV instrumentation have enabled expanding indications for 25-gauge PPV. 25-Gauge PPV with SO tamponade is safe and efficient and can be considered in the surgical management of complex vitreoretinal disease.
Retina 04/2007; 27(3):296-303. · 2.81 Impact Factor
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Retina 07/2005; 25(4):395-404. · 2.81 Impact Factor
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ABSTRACT: 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 > or =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.
Ophthalmology 01/2005; 111(12):2246-53. · 5.45 Impact Factor
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American Journal of Ophthalmology 01/2004; 136(6):1193-4; author reply 1194-6. · 4.22 Impact Factor
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Retina 03/2002; 22(1):106-8. · 2.81 Impact Factor
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ABSTRACT: Rhegmatogenous retinal detachments asso-ciated with proliferative vitreoretinopathy, giant retinal tears, ocular trauma, proliferative diabetic retinopathy, or necrotizing retinitis are considered more complex than those with-out these factors. The aim of the current review is to address the surgical outcomes and complications of 23-gauge pars plana vitrecto-my with scleral buckling (23GPPV/SB) for repair of these complex retinal detachments. This retrospective study involved 54 eyes of 53 patients who underwent 23GPPV/SB between July 2007 and September 2009. Preoperative diagnosis, surgical technique, preoperative and postoperative visual acuities, intraopera-tive and postoperative complications, and anatomic reattachment rates were examined. Fifty-four eyes of 53 patients were reviewed in this study and indications for surgery varied. Mean logarithm of the minimal angle of reso-lutionn(logMAR) pre-and post-operative visu-alacuities were 1.166 (20/293) and 0.780 (20/120), respectively, which led to a statisti-cally significant improvement in logMAR (P=0.0165). Single operation and final reat-tachment rates were 87% (47 of 54 eyes) and 100%, respectively. Postoperative complica-tions included choroidal effusion/hemorrhage (14.8%, 8 of 54 eyes) and vitreous hemorrhage (11.1%, 6 of 54 eyes). Other more infrequent complications included hyphema (9.3%, 5 of 54 eyes), hypotony (5.6%, 3 of 54 eyes) and ocular hypertension > 35 mmHg (3.7%, 2 of 54 eyes). A total of 31.5% (17 of 54 eyes) of patients had a complication in the postoperative time peri-od, but 58.8% of these resolved spontaneously without requiring an intervention. 23GPPV/SB may be considered for complex retinal detach-ment repair with good anatomic reattachment rates, but with relatively high complication rates.
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Retina (Philadelphia, Pa.) 29(10):1536-7. · 2.93 Impact Factor
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ABSTRACT: To evaluate 25-gauge pars plana vitrectomy (PPV) for primary repair of rhegmatogenous retinal detachment (RRD).
This retrospective, consecutive case series included 42 eyes of 41 patients who underwent primary repair of RRD utilizing transconjunctival 25-gauge PPV without scleral buckling at the Cincinnati Eye Institute from July 2004 through January 2007.
The medical records were retrospectively reviewed, and the corresponding demographic data, preoperative ophthalmic diagnoses, surgical management, and postoperative course and treatment were recorded. Main outcome measures included single surgery anatomical success, preoperative and postoperative visual acuity, and complications.
Most patients had pseudophakic RRD (36 [85.7%] of 42 eyes). The crystalline lens was present in the remaining 6 eyes (14.3%). Of 42 eyes, 28 (66.7%) had macula-on RRD, while 14 (33.3%) had macula-off RRD. Four surgeons contributed to this study, and 25-gauge PPV instrumentation, a wide-angle viewing system, endolaser photocoagulation, and gas tamponade were used in each case. The single surgery anatomical success rate was 92.9% (39 of 42 eyes). For eyes with macula-on RRD, best-corrected visual acuity was 20/50 (0.43 logMAR [logarithm of the minimum angle of resolution]) preoperatively and 20/30 (0.23 logMAR) postoperatively (P = 0.24). For eyes with macula-off RRD, best-corrected visual acuity was 5/200 (1.56 logMAR) preoperatively and 20/30 (0.23 logMAR) postoperatively (P = 0.001). Three eyes required additional surgery for final reattachment. Final reattachment was achieved in 100% of patients (mean follow-up, 8 months).
Twenty-five-gauge PPV with laser retinopexy and gas tamponade is effective for primary repair of RRD. The single operation anatomical success rate is comparable with rates reported for primary vitrectomy with 20-gauge instrumentation, scleral buckling, and combined vitrectomy/scleral buckling.
Retina 28(7):931-6. · 2.81 Impact Factor
