Eckardt Forceps Tip Widening for the Removal of Posterior Intraocular Foreign Bodies Bigger Than 1 mm.

PURPOSE: To propose a new technique with an "old" tool to allow for better intraocular foreign body (IOFB) grasping and manipulation during mininvasive vitreoretinal surgery. METHODS: The authors report herein their technique on seven eyes, diagnosed with posterior IOFBs, in which the surgery consisted of a 23-gauge vitrectomy, using, for IOFB grasping, a Grieshaber DSP 23-gauge Eckardt forceps, properly modified intraoperatively. Such result was achieved by enlarging the forceps opening bite, according to the IOFB size. RESULTS: In all patients, IOFBs were removed using the modified 23-gauge Grieshaber Eckardt forceps. In 6 cases, a combined phacovitrectomy was performed, and the IOFB expressed through the corneal phacoincision; in one phakic patient, the removal was performed through the sclerotomy, extended just as needed. CONCLUSION: The Grieshaber Eckardt forceps commonly used in MIVS can be used in IOFB surgery for a scleral or corneal removal. In case of IOFB bigger than 1 mm, enlarging the forceps bite according the IOFB size provides a firm and safe grip, allowing the surgeon to complete the surgery without switching to bigger and more traumatic instrumentation, reducing collateral damage and shortening the surgery time.

The Role of Silicone Oil in the Surgical Management of Endophthalmitis: A Systematic Review.

(1) Background: We aimed to systematically review the current literature to evaluate if in patients with postoperative endophthalmitis treated with pars plana vitrectomy, silicone oil tamponade could provide a useful contribution to the control and eradication of infection and if it could influence anatomical recovery and functional outcome. (2) Randomized controlled trials, cross-sectional studies, case series, and case reports published in the English language in peer-reviewed journals were included. No restriction was placed based on the study location. We used medical subject headings (MeSH) and text words. We searched MEDLINE (OVID and PubMed), Google Scholar, ISI Web of Science (Thom-on-Reuters), and the Cochrane Library (Wiley) from January 1995 to the present. To ensure literature saturation, we scanned the reference lists of included studies or relevant reviews identified through the search. Risk of Bias was assessed using the Newcastle-Ottawa scale for longitudinal studies and Cochrane risk-of-bias tool for randomized trials. (3) Results: abstracts of 75 articles were selected for full-text reading; after full-text reading, 44 articles were taken into consideration in the systematic review. 5 out of 7 in vitro experimental studies demonstrated antimicrobial activity against different species of bacteria and fungi. The use of SO as endotamponade associated with PPV led to better visual acuity and a lower rate of retinal detachment and the need for additional surgery. (4) Conclusions: Silicone oil reduces the risk of postoperative retinal detachment, especially in case of undetected retinal breaks, produces compartmentalization of the eye, may lead to early visual recovery, allows laser photocoagulation, prevents severe postoperative hypotony and has antimicrobic activity due to an inhibitory effect for several species of pathogens. Concerns regarding possible toxic effects on the retina and optic disc, compartmentalization and impaired washout of pathogen toxins have been reported. It may also influence intravitreal antibiotic distribution and clearance.

Twenty-Year Follow-Up of Excimer Laser Photorefractive Keratectomy: A Retrospective Observational Study.

INTRODUCTION: Photorefractive keratectomy (PRK) was introduced in the late 1980s to correct myopia. The purpose of this study was to assess its long-term efficacy and safety, analyzing patients with at least 20-year follow-up. METHODS: This retrospective observational study was carried out on 85 eyes of 54 patients (33 females) that underwent PRK between 1991 and 1998 (mean age 32.62 ± 9.74, range 18-55 years). Both preoperatively and postoperatively, patients underwent a complete ophthalmological evaluation, including uncorrected and corrected distance visual acuity, slit-lamp, intraocular pressure, dilated fundus, and corneal topographic examinations. The outcome assessment was made by comparing the preoperative refraction, as spherical equivalent, with the postoperative ones, taking into account the planned refractive correction. Safety and efficacy indices were also calculated. All the data were evaluated with a paired t test. RESULTS: The mean attempted correction as spherical equivalent was - 5.64 ± 3.01 D (range - 1.00 to - 15.00 D), while the mean achieved correction after 20 years was - 4.30 ± 3.13 D (range - 1.88 to - 14.25 D), with a significant statistical difference (p < 0.01). The mean expected refractive outcome was - 0.27 ± 0.81 D (range - 4.00 to + 1.25 D). The mean difference between achieved and attempted treatment was 1.33 ± 1.92 D (range - 4.25 to + 6.25 D), with a significant difference (p < 0.01). The safety index was 1.00 and the efficacy index was 0.63. CONCLUSION: The results provided by this study highlight that the procedure could be considered safe, with no long-term sight-threatening complications such as late ectasia or haze.