Comparative study of combined vitrectomy with phacoemulsification versus vitrectomy alone for primary full-thickness macular hole repair.

BACKGROUND: To assess the effectiveness and safety of 23-gauge pars plana vitrectomy combined with phacoemulsification versus vitrectomy alone in patients over 50 years with primary full-thickness macular holes (FTMH). METHODS: We retrospectively reviewed the medical records related to 406 consecutive vitrectomies performed for primary FTMH. Phacovitrectomy was performed in 294 phakic eyes whereas vitrectomy alone in 112 pseudophakic eyes. The cases were divided into three groups according to the stage of the FTMH: stage 2 (n = 93), stage 3 (n = 270), or stage 4 (n = 43). The primary outcome measure was the closure of the FTMH. The secondary outcome measures were the evolution of visual acuity as well as intraoperative and postoperative complications. RESULTS: Neither the primary nor the secondary outcomes differed between phacovitrectomy and vitrectomy alone for all three stages. The FTMH were closed in 375 eyes (92.4 %) after a first operation. The closure rate was higher for stage 2 (96.8 %) than for stages 3 (91.1 %) or 4 (90.75 %), but not significantly (P = 0.189). The mean visual acuity increased significantly from preoperatively LogMAR 0.68 (± SD 0.2) to LogMAR 0.43 (± SD 0.24) at the end of the follow-up (p < 0.001). CONCLUSIONS: Combined 23-gauge pars plana vitrectomy with phacoemulsification for primary FTMH repair in patients over 50 years is as efficient and safe when compared with vitrectomy only. TRIAL REGISTRATION: The study was approved on 30th April 2020 by the local ethics committee (Ethikkommission Ostschweiz, EKOS 20/074; BASEC Nr. 2020-01033 ).

Multimodal imaging for detecting metamorphopsia after successful retinal detachment repair.

PURPOSE: To investigate the etiologies of metamorphopsia after successful retinal detachment repair. METHODS: In this retrospective study, we included patients who underwent pars plana vitrectomy (PPV) for macula-off rhegmatogenous retinal detachment (RRD). Patients were reviewed after 3 to 6 weeks. Best-corrected visual acuity (BCVA), fundus biomicroscopy, Amsler grid test, spectral-domain optical coherence tomography (SD-OCT), and fundus autofluorescence images (FAF) were obtained from all patients to visualize abnormalities in retinal layers and retinal rotation. RESULTS: A total of 50 eyes from 49 consecutive patients were included, of whom 12 (24%) complained of postoperative metamorphopsia. The main cause of metamorphopsia was retinal shift after RRD repair (p < 0.001). CONCLUSION: Distorted vision after macula-off RRD is a common and retinal shift was found to be the main reason patients experience metamorphopsia after a successful macula-off RRD repair.

The price for reduced light toxicity: Do endoilluminator spectral filters decrease color contrast during Brilliant Blue G-assisted chromovitrectomy?

BACKGROUND: Vitreoretinal surgeons have been slow to adopt the use of spectral filters for endoillumination to reduce retinal light toxicity. This study shows that spectral filters can be used without a loss in color contrast during brilliant blue G chromovitrectomy. METHODS: To evaluate the influence of intra operative spectral light filters on perceivable contrast during Brilliant Blue G chromovitrectomy, a prospective, observational clinical study was carried out on 59 consecutive Brilliant Blue G chromovitrectomy interventions in 59 patients admitted for macular holes, macular pucker or vitreomacular traction syndromes. Subsequent to peeling of the internal limiting membrane, six different illumination modes were enabled consecutively: mercury vapor, mercury vapor/xenon, and xenon followed by xenon combined with an amber, green or yellow spectral filter. Main outcome measure was the chromaticity spread between stained internal limiting membrane and unstained retina as a measure for the color contrast perceived by the human eye. RESULTS: Mean chromaticity scores were similar for all light sources: mercury vapor 7.97, mercury vapor/xenon 7.96 (p = 0.96), and xenon 7.41 (p = 0.55). Compared to xenon, the additional use of endoillumination spectral filters did not change contrast recognizability: Chromaticity scores were 9.38 for the amber filter (p = 0.13), 6.63 for the green and 7.02 for the yellow filter (p = 0.37 and 0.64, respectively). When comparing the different filters head-to-head, the amber filter was superior to the green filter (p = 0.03), while the yellow was intermediate and not significantly different from either the amber (p = 0.08) or the green filter (p = 0.51). CONCLUSIONS: Color contrast perceptibility during Brilliant Blue G assisted chromovitrectomy is similar with mercury vapor, mercury vapor/xenon or xenon light sources. Spectral filters do not decrease color contrast recognizability. Head-to-head comparison shows a significant advantage for the amber over the green filter with respect to contrast generation, the yellow filter is intermediate. As spectral filters are known to greatly reduce retinal light toxicity, we suggest donor eye studies to validate whether the amber filter should be generally recommended for Brilliant Blue G chromovitrectomy.

Ocular injuries with a metallic foreign body in the posterior segment as a result of hammering: the visual outcome and prognostic factors.

PURPOSE: To evaluate the evolution of the best-corrected visual acuity (BCVA), to determine the prognostic factors, and to analyze the efficiency of the surgical procedures in the cases of ocular injuries caused by a metallic intraocular foreign body retained in the posterior segment as a result of hammering. METHODS: A retrospective review of 64 consecutive patients was conducted at the Cantonal Hospital St Gallen over a 15-year period. The pre-, intra-, and postoperative clinical parameters were assessed. The statistics were performed using Fisher's exact test and a multiple correspondence analysis. RESULTS: The mean initial BCVA was 20/138 (standard deviation, 20/112). The mean ocular trauma score was 3.03 (standard deviation, 0.83). In all cases, the removal of the intraocular foreign body was performed within 24 hours after the injury. In 45 patients (70.3%), further operations were performed during the mean follow-up of 54.4 months (standard deviation, 22.7 months). The mean final BCVA was 20/39 (standard deviation, 20/55). In 53 patients (82.8%), the final BCVA was 20/40 or more. In 8 patients (12.5%), the final BCVA was 20/200 or less because of a direct macular lesion caused by the intraocular foreign body (P < 0.001). CONCLUSION: Thanks to the improvement in the surgical procedures, the ocular injuries with a metallic intraocular foreign body in the posterior segment as a result of hammering have a good visual outcome unless the macula is involved.

Predictive Risk Factors for Retinal Redetachment Following Uncomplicated Pars Plana Vitrectomy for Primary Rhegmatogenous Retinal Detachment.

PURPOSE: To investigate clinical and surgical factors influencing the outcome after primary rhegmatogenous retinal detachment surgery. METHODS: A retrospective, single-centre, case-control study of 1017 eyes of 1017 consecutive patients with primary rhegmatogenous retinal detachment (RRD) who underwent pars plana vitrectomy (PPV), were included in the study. Analysed surgical factors were: combined procedure with phacoemulsification, type of retinopexy (cryocoagulation, endolaser, combined), type of tamponade (gas, silicone oil), and anatomical factors: primary proliferative vitreoretinopathy (PVR) and macular detachment at the time of surgery. RESULTS: Overall retinal re-detachment rate was 10.1%. The main reason for re-detachment was an insufficient retinopexy in 53.6%, followed by PVR (37.3%), and retinal detachment occurred at a different location caused by another break in 9.1%. No significant difference in the rate of re-detachment was found if a phacoemulsification with simultaneous IOL implantation was performed (p = 0.641). No significant difference between the various retinopexy techniques was found (p = 0.309). Risk factors re-detachment were primary PVR (p = 0.0003), silicone oil as initial tamponade (p = 0.0001) as well as macula off detachments (p = 0.034). CONCLUSIONS: The present study showed no significant difference between the types of retinopexy and if additional phacoemulsification was performed or not. Factors associated with a higher risk for re-detachment were detached macula at surgery, primary PVR and primary oil-filling.

Successful Treatment of Peripheral Proliferative Vitreoretinopathy with Cryocoagulation During Retinal Detachment Repair - A New Surgical Technique.

PURPOSE: To evaluate the effect of extrascleral cryocoagulation for the treatment of proliferative vitreoretinopathy (PVR) during retinal detachment repair. METHODS: Patients with a rhegmatogenous retinal detachment associated with peripheral PVR Grade C star-folds were included in this study and analysed retrospectively. In all patients, PVR star-folds were treated by extrascleral cryocoagulation. RESULTS: A total of six patients with a rhegmatogenous retinal detachment associated with at least one peripheral PVR star-fold were included in this study. Reattachment of the retina was successfully achieved in all patients. CONCLUSION: This novel and simple technique for the treatment of localized PVR using extrascleral cryocoagulation appears to be a safe and effective approach with favourable surgical success rates.

Correction to: Influence of Postoperative Posture on Macular Slippage after Macula-Off Retinal Detachment: A Randomized Controlled Trial.

The original article can be found online.

How to Prevent Retinal Shift after Rhegmatogenous Retinal Detachment Repair: A Prospective, Randomized Study.

PURPOSE: To evaluate the effect of intraoperative use of heavy liquid on retinal shift after retinal detachment repair. DESIGN: Prospective, randomized study. PARTICIPANTS: Patients who underwent pars plana vitrectomy for macula-off rhegmatogenous retinal detachment were included in the current study. METHODS: Patients were randomized into 2 groups: group A included patients in whom heavy liquid was used during the procedure and group B included patients in whom no heavy liquid was used. Group A and B patients were reviewed after 3 weeks and after 6 weeks, respectively, and fundus autofluorescence (FAF) images were obtained to visualize the retinal rotation. MAIN OUTCOME MEASURE: Postoperative macular shift, visualized with FAF. RESULTS: A total of 50 eyes from 49 patients were included. Overall, retinal shift was observed in 17 patients (34%). Patients in whom heavy liquid was used during the procedure showed significantly less macular shift after surgery (P = 0.049). There was a strong association between retinal shift and postoperative symptoms of metamorphopsia. Ten of 17 patients with retinal shift reported distorted vision (P < 0.001). CONCLUSIONS: The use of intraoperative heavy liquid seems to be associated with lower occurrence of retinal shift after retinal detachment repair.

Influence of Postoperative Posture on Macular Slippage after Macula-Off Retinal Detachment: A Randomized Controlled Trial.

INTRODUCTION: To evaluate the effect of postoperative posture on the retinal shift after retinal detachment repair. METHODS: Patients who underwent pars plana vitrectomy (PPV) for macula-off rhegmatogenous retinal detachment (RRD) were included prospectively in the current study. Patients were randomized into two groups: group A included patients who did a log roll postoperatively, and group B included patients who had to lie flat on their backs for 6 h postoperatively before moving into the end position. Patients in group A and patients in group B were reviewed after 3 weeks and after 6 weeks, respectively, and fundus autofluorescence images (FAF) were obtained to visualize the retinal rotation. RESULTS: The sample included 50 eyes from 49 patients. Retinal shift occurred after RRD repair in 17 patients (34%). There was no statistically significant difference between the two groups (p = 0.94). Postoperative macular shift occurred significantly less often (p = 0.049) in participants in whom heavy fluid was used in the procedure. Metamorphopsia was reported postoperatively by 10 of 17 patients with retinal shift (p < 0.001). CONCLUSION: In our study, postoperative posture did not significantly influence postoperative macular slippage after RRD repair. The use of intraoperative heavy liquid appears to be associated with a lower occurrence of retinal shift.

Contrast recognizability during brilliant blue G - and heavier-than-water brilliant blue G-assisted chromovitrectomy: a quantitative analysis.

PURPOSE: To evaluate the potential of heavier-than-water brilliant blue G (BBG-D(2) 0) to stain the internal limiting membrane (ILM) during chromovitrectomy. METHODS: In a nonrandomized, prospective, clinical multicentre study, 71 consecutive chromovitrectomy interventions in 71 patients were analysed. During routine 23-gauge vitrectomy, conventional 0.25 mg/ml BBG was employed in 21 and 0.25 mg/ml BBG-D(2) 0 in 50 patients. All interventions were videotaped. Post-operatively, video frames were viewed and dye performance assessed subjectively and objectively. Main outcome measure was the chromaticity difference between the stained ILM and the unstained underlying retina, measured by means of an objective and quantitative analysis method to describe colour contrast strengths as they are perceived by the human eye. RESULTS: Removal of the ILM was possible in all interventions without additional vital dyes. BBG-D(2) 0 readily sank to the retinal surface, while conventional BBG tended to swirl up throughout the vitreous cavity. Conventional BBG was removed either with active suction or with a flute needle. Brilliant blue G-D(2) 0 needed to be whirled up from the retinal surface with a flute needle before aspiration. Objective chromaticity measurements yielded a mean chromaticity score of 7.98 for BBG-D(2) 0 and 6.51 for BBG (p = 0.09). CONCLUSIONS: Brilliant blue G-D(2) 0 readily sinks to the retinal surface after injection and can be conveniently removed with a flute needle or active suction during chromovitrectomy. Based on the premises of the chromaticity measurements in this study, BBG's ILM staining capacity was not significantly improved through the recent revision its preparation, although a tendency towards slightly improved contrasts between the ILM and the underlying retina was observed.