A novel predictor of persistent ocular hypotony after pars plana vitrectomy for rhegmatogenous retinal detachment: The initial intraocular pressure difference between the eye with RRD and the fellow eye

ABSTRACT Purpose: To evaluate the predictive value of initial intraocular pressure difference of the detached and fellow eyes of patients with complex rhegmatogenous retinal detachment on postoperative persistent ocular hypotony. Methods: This retrospective observational study included 538 eyes of 538 unilateral complex rhegmatogenous retinal detachment patients with a proliferative vitreoretinopathy grade of C-1 or higher, treated with silicone oil endotamponade following pars plana vitrectomy. The patients were divided into Group A (patients having silicone oil removal without ocular hypotony; n=504) and Group B (patients with persistent ocular hypotony following silicone oil removal [n=8, 23.5%] and with retained silicone oil [n=26, 76.5%] due to the risk of persistent ocular hypotony; total n=34). Ocular hypotony was defined as an intraocular pressure of <6 mmHg on two or more occasions. Patients' demographics, including age, sex, and follow-up time, and ocular characteristics, including ocular surgical and trauma history, initial and final best-corrected visual acuity, intraocular pressure and initial intraocular pressure difference of the detached and fellow eyes, and anatomical success rates and postoperative complications, were retrospectively collected from the electronic patient files. Results: The initial intraocular pressure was significantly lower in the detached eyes of Group B than in Group A (8.3 ± 3.5 vs. 12.9 ± 3.3, p<0.001). Also, the initial intraocular pressure difference was significantly higher in Group B than in Group A (8.9 ± 3.2 vs. 2.2 ± 2.7mmHg, p<0.001). The receiver operating characteristic curve analysis showed that the cutoff value of the initial intraocular pressure difference was 7.5mmHg for the risk of persistent ocular hypotony. The most influential factors on postoperative persistent ocular hypotony in the binary logistic regression analysis were the initial intraocular pressure difference and the need for a retinectomy. Conclusion: In eyes with complex rhegmatogenous retinal detachment treated with pars plana vitrectomy and silicone oil tamponade, the initial intraocular pressure difference could be of value in predicting postoperative persistent ocular hypotony and could guide surgeons on the decision of silicone oil removal.

Long-Term Functional Outcomes of Retinal Detachment Due to Acute Retinal Necrosis: A Case Series.

Objectives: To evaluate the long-term anatomical and functional prognosis of patients with retinal detachment (RD) secondary to acute retinal necrosis (ARN) treated with pars plana vitrectomy (PPV). Methods: This retrospective case series included 21 eyes from 21 patients with RD secondary to ARN. The study analyzed vitreous or aqueous biopsy results, the impact of antiviral therapy, time to retinal detachment, changes in visual acuity (VA), and anatomical and surgical outcomes. All cases underwent 23-gauge PPV with silicone oil tamponade, and an episcleral encircling band was used in 11 cases. All patients received systemic antiviral therapy at diagnosis. Results: Retinal reattachment was achieved in 91% of cases during follow-up, with an average follow-up period of 39.5 ± 36.8 months. The average time from ARN diagnosis to RD onset was 33.3 ± 27.5 days. VZV was detected in 10 eyes through PCR analysis. Significant differences in visual prognosis were found between macula-off and macula-on RD (p = 0.048). Eyes with optic nerve head inflammation had worse final VA (p = 0.010). No significant difference was observed between preoperative VA and VA at the end of follow-up (p = 0.665). Conclusions: VZV was the primary virus associated with ARN-related RD. Early involvement of the macula and optic nerve in retinitis negatively impacted the final visual prognosis.

Efficacy and safety of the OZil phacoemulsification handpiece in dropped lens fragment surgery: a randomized controlled trial.

Objective: Phacoemulsification is the predominant method for cataract surgery, but complications like lens nuclei dislodgment into the vitreous cavity pose significant risks, including inflammation, glaucoma, retinal tears, and vision loss. Traditional management involves pars plana vitrectomy with phacofragmentation, which can increase the risk of retinal damage due to repulsive forces. This study tests whether the OZil phacoemulsification handpiece, employing torsional movement, offers a safer alternative by minimizing repulsive forces and reducing surgical duration compared to the traditional phacofragmatome. Methods: This prospective study, conducted in a tertiary care hospital in eastern India from January to June 2023, enrolled 40 patients with nucleus dislocation during cataract surgery. Patients were randomized into Group 1 (traditional phacofragmatome) and Group 2 (OZil handpiece). Primary objectives included comparing the duration of surgery and intraoperative complications. Secondary objectives assessed postoperative best-corrected visual acuity (BCVA), surgical site safety, and cystoid macular edema (CME) incidence. Results: Group 2 demonstrated significantly shorter surgical durations (110±2.54 seconds) compared to Group 1 (152±2.23 seconds, p < 0.001). The frequency of nucleus falls was considerably lower in Group 2 (p < 0.001). Postoperative BCVA and CME incidence showed no significant differences between groups. Multiple regression analysis confirmed the OZil handpiece significantly reduced surgical duration (ß = -0.40, p < 0.001) without compromising safety. Discussion: The OZil handpiece's rotational cutting mechanism offers a significant advantage in reducing surgical time while improving the followability of lens fragments, as compared to the traditional phacofragmatome. It addresses one of the key limitations of phacofragmentation by minimizing fragment displacement, where repulsive forces can complicate the procedure. Although both techniques showed similar safety profiles, the OZil handpiece's operational efficiency makes it a promising alternative for managing posteriorly displaced lens fragments in complex cases. Conclusions: The OZil phacoemulsification handpiece significantly enhances surgical efficiency and safety in nucleus drop surgeries. Its integration into existing phacofragmatome systems can lead to major advancement in the ophthalmic surgical armamentarium, ensuring improved patient care.

New prefilled syringe aflibercept design. A cause of symptomatic IOP spike after aflibercept PFS?

Objective: To describe ocular hypertension cases after using a new aflibercept prefilled syringe and to assess the main characteristics of these eyes and their possible association with intraocular pressure (IOP) changes. Methods: Case series. We reported all the cases of ocular hypertension following aflibercept prefilled syringes (PFS) treatment in our department between April 2021 and December 2023. Results: A total of 4183 eyes were treated with aflibercept PSF. Thirteen transitory IOP elevations were observed immediately after injection (0.3%). Two eyes had an IOP between 30-35 mmHg, five eyes had an IOP between 36-55 mmHg and three eyes had an IOP > 56 mmHg. The mean IOP was 45.5 mmHg±11.33. Only six eyes needed anterior chamber paracentesis (37.5%). The other patients were treated conservatively (ocular massage and/or IOP-lowering drops). The mean IOP after treatment was 15.71 mmHg±7.20. Visual acuity improved after treatment in all the patients. Discussion: Compared with other injectors, reports have indicated a higher incidence of moderate and severe IOP spikes with aflibercept PSF. The European Medicine Agency (EMA) has associated this significant increase with incorrect syringe handling, leading to higher injection volumes. Although plunger misalignment seems to play a role in the IOP spikes, some other characteristics of this new injector could play a role. Factors such as syringe diameter, plunger alignment, and injection force may contribute to this issue. The reason some authors found no significant differences in IOP elevation after IVI, with aflibercept PFS, could be due to variations in patient characteristics, which may also play an important role in post-IVI pressure changes. Conclusions: Intraocular pressure spikes after aflibercept PFS can be explained by injector characteristics. The PFS of aflibercept has a domed plunger. Incorrect alignment between the base of the plunger and the black dosing line could cause an increase in the injected volume. Furthermore, the wider syringe diameter of aflibercept PFS could imply a larger injection force, increasing the risk of IOP elevation. Patient characteristics, such as previous VPP, axial length, or glaucoma history, may also play a role. Further studies are required to develop an ideal intravitreal syringe.

Petaloid technique and prognostic significance of macular hole shapes by optical coherence tomography for full thickness macular hole.

Surgical advancements for full-thickness macular hole (FTMH) treatment include vitrectomy, membrane peeling, and the inverted flap technique (IFT). IFT, which involves inverting the internal limiting membrane (ILM) flap over the macular hole (MH) or into the MH, improves success rates and visual recovery. However, issues like mis-aspiration during flap handling have been problematic. We introduce the petaloid technique, to position the ILM flap under air during FTMH surgery to evaluate its outcomes. This retrospective study included 28 eyes, with a mean minimum linear diameter (MLD) 472.04 ± 199.7 µm and basal diameter (BD) of 834.95 ± 593.54 µm. Primary closure of MH was achieved in 96.42% of patients, with 3.57% showing persistent MH during the 6-month follow-up. The VA improved significantly from preoperative levels at each postoperative stage, with notable increases at 3 months (0.86 ± 0.49 logMAR; p = 0.0132) and 6 months (0.77 ± 0.41 logMAR; p = 0.000081). The new closure patterns showed Type A in 28.6%, B in 14.3%, C in 28.6%, and D in 25%. Among different types of closure patterns, although VA improved in all types, significant improvement in VA was noted for type A and type C, with notable improvements at the 6-month follow-up for Type A (0.60 ± 0.23 logMAR; p = 0.02) and at the 1-month follow-up for Type C (0.62 ± 0.28 logMAR; p = 0.02). For macular hole retinal detachment in 5 eyes, the average preoperative VA was 1.86 ± 0.19 logMAR, while the final mean postoperative VA showed a significant improvement to 1.1 ± 0.40 logMAR (p = 0.021, paired t-tests). Retinal reattachment was achieved in all cases (5/5) without recurrent detachment post-silicone oil removal. For the prognostic significance of MH shapes identified by OCT, it can be concluded that the shape of macular holes significantly influences visual acuity outcomes at 6 months post-surgery (p = 0.037). The shape of macular holes, particularly Flask-shaped, significantly impacts visual acuity compared to other shape. The modified petaloid technique for treating FTMH proved safe and effective, with no significant complications noted.

Combined Epiretinal Proliferation and Internal Limiting Membrane Inverted Flap for the Treatment of Large Macular Holes.

We are presenting a new method for the treatment of large macular holes (MHs) with the use of an inverted flap consisting of both internal limiting membrane (ILM) and epiretinal proliferation (EP). A prospective interventional case series was conducted from September 2021 to January 2023. MH patients with coexistent EP visualized preoperatively in macula optical coherence tomography and with a MHs minimum linear diameter larger than 400 microns underwent standard pars plana vitrectomy with the creation of an inverted petaloid flap (consisting of both ILM and EP) and gas tamponade. Sixteen eyes were included in our case series. MHs closure was successful in all the eyes with a single procedure. The preoperative minimum linear diameter was 707.63 (±164.02 µm), and the preoperative best corrected visual acuity was 1.11 ± 0.52. The postoperative BCVA was 0.51 ± 0.20 (p = 0.01) at 6 weeks postoperatively, and the final BCVA was 0.45 ± 0.20 (p = 0.008). EP can be safely combined with ILM for the creation of an inverted, petaloid flap to cover and facilitate the closure of large MHs.

Multilayered Inverted Internal Limiting Membrane Flap Technique in Optic Disc Pit Maculopathy.

Objectives: To evaluate the anatomical and visual outcomes of the multilayered inverted internal limiting membrane (ML-ILM) flap technique in the treatment of optic disc pit maculopathy (ODPM). Materials and Methods: In this retrospective interventional case series, medical records and macular spectral-domain optical coherence tomography images of patients who underwent combined pars plana vitrectomy with ML-ILM flap surgery for ODPM were analyzed. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) at postoperative 6 months were compared with baseline findings. Intraoperative and postoperative complications, fluid resolution time, and recurrence during follow-up were recorded. Results: Five eyes of 5 patients with ODPM were included in the study. According to the preoperative macular fluid characteristics, 2 patients had only intraretinal fluid, while 3 patients had intraretinal and subretinal fluid. The preoperative median BCVA was 1.0 logarithm of the minimum angle of resolution (logMAR) (range, 1.0-1.3 logMAR), and the CMT was 560 µm (range, 452-667 µm). At the 6-month postoperative follow-up, the median BCVA was 0.40 logMAR (range, 0.1-0.7 logMAR), and CMT was 315 µm (range, 265-326 µm) (p=0.042 and p=0.043, respectively). During the 6-month follow-up period, no recurrence or full-thickness macular hole formation was observed. Conclusion: The ML-ILM flap technique is a preferable surgical option to achieve both high anatomical and functional success and flap stabilization.

Predictive Factors for Structural and Functional Outcomes of 25-Gauge Pars Plana Vitrectomy (PPV) for the Removal of Posterior Intraocular Foreign Bodies (IOFBs): A Retrospective Data Analysis From North India.

PURPOSE: To identify predictive factors for structural and functional outcomes of 25-gauge pars plana vitrectomy (25G PPV) for removal of posterior segment intra-ocular foreign body (IOFB). METHODOLOGY: A retrospective data analysis was performed for patients undergoing 25G PPV for removal of posterior segment IOFB between August 2019 to June 2021. Necessary demographic details and data regarding pre-operative ophthalmic examination were recorded. Similarly, intraoperative surgical details were recorded. Postoperative outcome measures included final best corrected visual acuity (BCVA), retinal status, and epiretinal membrane formation at the last follow-up visit. A univariate analysis was applied to find the association of various independent variables with functional and structural outcomes. RESULTS: Thirty-nine patients were included in the study, with 37 males and two females. The mean age of the study group was 30.5+10.8 years. The most common zone of open globe injury was zone 1. Most of the impactions of IOFB were seen outside the macular area. Preoperative BCVA was 2.23+0.58 logarithm of the Minimum Angle of Resolution (logMAR), which improved significantly to 1.01+0.53 in the postoperative period (p-value <0.001). Anatomical success was achieved in 92.3% of patients at one year follow-up. The presence of impacted IOFB, associated endophthalmitis and IOFB >4mm were associated with poor visual outcomes (univariate analysis; p-value <0.05). None of the factors affected the anatomical success rates. CONCLUSION: The presence of impacted IOFB, associated endophthalmitis, and large IOFB (>4mm) were associated with poor visual outcomes with 25G PPV for removal of IOFB.

Cost Analysis of Scleral Buckle and Pars Plana Vitrectomy for Retinal Detachment Surgery.

Background and Objective: To compare the cost and utility of scleral buckle (SB) and pars plana vitrectomy (PPV) techniques for repairing moderately complex rhegmatogenous retinal detachment (RRD). Patients Materials and Methods: A cost-utility analysis was conducted using data from the Primary Retinal Detachment Outcomes Study (PRO) and a study conducted by the author. Total costs, patient utility over a lifetime, and cost per quality-adjusted life year (QALY) were calculated for each surgical procedure. Results: The cost of scleral buckle surgery was €287.93, with an estimated lifetime QALY of 7.49. Costs per QALY were €38.44. According to the PRO study and Belin et al, total costs were $5975, with a lifetime QALY of 5.4 and costs per QALY of $1106. The cost of pars plana vitrectomy (PPV) was €1468.26, with an estimated lifetime QALY of 6.84 and costs per QALY of €214.65. Based on the PRO study and Belin et al, total costs were $8125, with a lifetime QALY of 4.7 and costs per QALY of $2196. Conclusion: Repairing moderately complex RRD presents a highly cost-effective profile for both SB and PPV techniques, well below recommended QALY thresholds. SB demonstrated a slightly more favorable profile compared to PPV.

Secondary acute angle closure glaucoma after 25-gauge pars plana vitrectomy for a macular hole: a case report.

BACKGROUND: Posterior synechiae of the iris rarely cause secondary angle-closure glaucoma after pars plana vitrectomy, mainly reported in cases with high postoperative inflammation. The face-down position with gas tamponade can cause acute angle-closure glaucoma in phakic eyes owing to relative pupillary block. This report presents a rare case of pseudophakic eye with secondary acute angle-closure glaucoma after 25-gauge pars plana vitrectomy and long-term vitreous gas tamponade for a macular hole. CASE PRESENTATION: A 61-year-old Japanese female patient presented with a chief complaint of right-sided visual impairment that had persisted for several months. Slit-lamp examination revealed deep anterior chamber and moderate nuclear sclerotic cataracts in both eyes. The axial length of the eye was 23.53 mm right eye and 24.05 mm left eye, and the fundus examination revealed a full-thickness macular hole (stage 3) in the right eye. The patient underwent simultaneous cataract surgery and pars plana vitrectomy with 7-mm diameter 3-piece monofocal intraocular lens implantation, internal limiting membrane peeling, and air tamponade. There were no complications during surgery. Due to non-closure of the macular hole, a second pars plana vitrectomy with internal limiting membrane inverted flap and SF6 gas tamponade was performed 13 days later. The patient maintained face-down position after both surgeries, and 6 days after the second surgery, intraocular pressure was elevated to 53 mmHg, and acute angle-closure glaucoma with iris bombe was diagnosed in the right eye. A laser peripheral iridotomy was performed, resulting in a deepened anterior chamber, normalized intraocular pressure, and a closed macular hole. CONCLUSIONS: This case presents a rare occurrence of secondary acute angle-closure glaucoma in a pseudophakic eye after 25-gauge minimally invasive pars plana vitrectomy and SF6 gas tamponade for macular hole. The cause was presumed to be posterior synechiae of the iris or relative pupillary block due to forward pushing of the intracapsular intraocular lens by vitreous gas. In cases where surgery is repeated without achieving macular hole closure, necessitating long-term face-down position, where vitreous gas is retained for an extended period, or when a large-diameter intraocular lens is implanted, secondary acute angle-closure glaucoma should be considered. This applies even when the 25-gauge pars plana vitrectomy is performed not for a highly invasive proliferative diabetic retinopathy but for macular hole repair, especially if the patient has a pseudophakic eye.

Demographic, Clinical, and Surgical Risk Factors of Pars Plana Vitrectomy (PPV) for Neovascular Glaucoma (NVG) Development in Type 2 Diabetes Mellitus Patients.

INTRODUCTION: Neovascular glaucoma (NVG) is a severe type characterized by forming new blood vessels on the iris and the anterior chamber angle, often resulting from ischemic retinal diseases. Pars plana vitrectomy (PPV) is a standard surgical procedure for treating various retinal and vitreous conditions. Understanding the risk factors associated with NVG development following PPV is crucial for improving patient outcomes. OBJECTIVE: To identify and evaluate demographic, clinical, and surgical risk factors associated with developing NVG following PPV. PATIENTS AND METHODS: A prospective cohort study was conducted over two years, involving 60 type 2 diabetes mellitus (T2DM) patients (31 males and 29 females; mean age 60.48±9.63 years) who underwent PPV at the Eye Clinic and Department of Clinical Immunology, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina. Patients were thoroughly informed about the study, and written informed consent was obtained. Comprehensive data collection included demographic information, medical history, preoperative and postoperative eye examinations, and intraoperative details. Statistical analyses were performed using IBM SPSS Statistics for Windows, Version 21 (Released 2012; IBM Corp., Armonk, New York, United States). RESULTS:  Within 12 months postoperatively, 17 patients (28.3%) developed NVG. Significant preoperative risk factors for NVG included prolonged duration of T2DM (p=0.037), elevated preoperative intraocular pressure (IOP) (p=0.024), and higher levels of vascular endothelial growth factor (VEGF) (p=0.011). Intraoperative factors, such as sharp dissection (p=0.000) and operative complications (p=0.004), were also significantly associated with NVG development. Multivariate logistic regression analysis identified prolonged T2DM duration (OR 1.132, p=0.023), increased preoperative IOP (OR 1.192, p=0.029), elevated VEGF levels (OR 1.002, p=0.016), and intraoperative sharp dissection (OR 0.114, p=0.006) as independent risk factors. CONCLUSIONS: Multiple preoperative and intraoperative factors influence the development of NVG post-PPV. Prolonged T2DM duration, elevated preoperative IOP, high VEGF levels, and specific intraoperative techniques significantly increase the risk of NVG. These findings underscore the importance of careful preoperative assessment and tailored intraoperative strategies to mitigate NVG risk in PPV patients.

The role of vitreous cortex remnants in secondary macular hole formation and spontaneous closure following vitrectomy for rhegmatogenous retinal detachment.

BACKGROUND: Macular hole (MH) formation after rhegmatogenous retinal detachment (RRD) surgery is rare, and in most cases, additional surgical procedures are required to repair MH. Spontaneous closure of the MH is even rarer. In this study, we aimed to report a series of cases of spontaneous closure of the secondary MH and provide a review of the literature. METHODS: We retrospectively collected the cases of secondary MH formation following vitrectomy in RRD patients followed by spontaneous closure. Ophthalmological data at presentation and during follow-up were collected and analyzed. RESULTS: We reported a total of three RRD patients aged 31,67,12 years, including two females and one male. The three patients underwent pars plana vitrectomy (PPV) with either silicone oil tamponade or air tamponade. Optical coherence tomography (OCT) revealed a second full-thickness MH formation with remnant vitreous cortex bridging in the macular region during early follow-up. Observations of the cases revealed subsequent remnant vitreous cortex traction remission and spontaneous closure of MH during follow-up, although with subsequent thin macular and abnormal macular structure. CONCLUSION: The progression of secondary MH formation in the cases may be related to vitreomacular traction (VMT) by the posterior vitreous cortex remnant after PPV, and the release of VMT may help the spontaneous closure of the MH after PPV for RRD.

Intravitreal indocyanine green is toxic to the retinal cells.

BACKGROUND: Indocyanine green (ICG) is widely used to stain the epiretinal membranes and internal limiting membranes during the pars plana vitrectomy (PPV). This study aims to evaluate the effect of ICG on rat retinas and various retinal cell lines, including ARPE-19 cells, rMC-1 cells, BV2 cells, HRMECs and R28 cells. METHODS: ICG solutions were prepared and diluted with glucose solution (GS) according to the standard clinical protocols. The retinal cell lines, including ARPE-19 cells, rMC-1 cells, BV2 cells, HRMECs and R28 cells, were treated with the following solutions: normal glucose (NG, 5 mM), GS-1 (92.5 mM glucose), GS-2 (185.02 mM glucose), ICG-1 (92.5 mM glucose + 0.43 mM ICG), or ICG-2 (185.02 mM glucose + 0.86 mM ICG) for durations of 15 or 30 min. In vivo, the right eyes of the rats were intravitreally injected with ICG-1 or ICG-2 (2 µL), while the left eyes were intravitreally injected with GS-1 or GS-2, served as the osmotic controls, for 30 min or 60 min. The rats intravitreally injected with an equivalent volume of NG or 1x phosphate-buffered saline (1x PBS) were served as the normal control or vehicle control. The cell viability was measured with the Cell Counting Kit-8 (CCK-8), while the cell death in retinal cryosections was detected with the TUNEL assay. RESULTS: The viabilities of the different retinal cell lines involved in this study were significantly reduced by both ICG-1 and ICG-2 treatments at both time points, with ICG-2 resulting in lower cell viability compared to the NG group and the osmotic control group. Additionally, GS-2 treatment also exhibited a decrease in retinal cell viabilities in vitro. To further confirm these results, intravitreal injection of ICG or GS induced more apoptotic cell death in rat retinas as evidenced by the TUNEL assay. CONCLUSIONS: The exposure of ICG or its solvent leads to an augmented retinal cell death, which is directly proportional to the concentration and duration of exposure, both in vivo and in vitro. Caution should be exercised during vitrectomy procedures involving ICG administration during clinical practice. It is recommended to advocate for lower concentrations of ICG with reduced exposure time during ocular surgeries.

Corneal stromal lenticule transplantation for the treatment of congenital optic disc pit maculopathy : a case report and review.

BACKGROUND: Congenital optic disc pit (ODP) is a relatively uncommon congenital anomaly of the optic disc, which seriously affects the patient's vision when combined with optic disc pit maculopathy(ODP-M). Currently, the treatment of ODP-M remains a clinical challenge and a focus of research. CASE PRESENTATION: A boy had a pit in the inferotemporal segment of the optic disc with ODP-M. Optical Coherence Tomography(OCT) showed ODP and serous retinal detachment. He was treated with pars plana vitrectomy(PPV), followed by Corneal Stromal Lenticule (CSL) sealing and C3F8 tamponade. In the end, significant anatomical improvement was achieved, and the Best Corrected Visual Acuity(BCVA) was improved. CONCLUSIONS: The CSL transplantation may be a viable therapeutic option for improving ODP-M with stable anatomical and functional result. However, more cases and longer follow-up are needed to confirm the safety and effectiveness of the technology.

Adverse Events Associated With 3 Vitrectomy Platforms Reported to the US FDA MAUDE Database.

Purpose: To identify and describe adverse events (AEs) observed with real-world use of the following 3 vitrectomy platforms: Constellation (Alcon), Enhancing Visual Acuity (EVA, Dutch Ophthalmic Research Center), and Stellaris (Bausch + Lomb). Methods: All reports submitted to the US Food and Drug Administration's Manufacturer and User Facility Device Experience (MAUDE) database between January 2010 and November 2021 that were associated with the 3 vitrectomy platforms were analyzed. Each report was reviewed for AEs or consequences and the type of complication noted. Duplicates and reports with an inadequate narrative to categorize the event were excluded. A descriptive analysis was performed for the prevalence of device-specific issues within each platform. Results: The analysis included 2534 reports (1738 Constellation, 117 EVA, 679 Stellaris). Overall, the most commonly reported complications involved the vitrectomy probe (n = 957 [37.8%]) and the central processing unit (n = 368 [14.5%]). Differences in the distribution of AEs among the platforms were noted, with vitrectomy probe issues being the most reported events for the Constellation and Stellaris and infusion issues for the EVA. Infusion issues most frequently led to reports of patient harm with the Constellation (31/1738 [1.8%]) and EVA (7/116 [6.0%]), while issues with the vitrectomy probe were reported with the Stellaris (11/679 [1.6%]). Conclusions: An analysis of real-world data in the MAUDE database highlighted the spectrum of device-specific AEs of greatest relevance to surgical practice. Familiarity with potential device complications will help minimize harm to patients.

Intravitreal Antibiotics versus Early Vitrectomy plus Intravitreal Antibiotics for Post-Injection Endophthalmitis: an IRIS® Registry (Intelligent Research in Sight).

PURPOSE: To determine if intravitreal injection of antibiotics alone versus early pars plana vitrectomy (PPV) plus injection of intravitreal antibiotics predicted better or worse visual outcomes for patients with endophthalmitis after anti-vascular endothelial growth factor (anti-VEGF) injections. DESIGN: Retrospective cohort study PARTICIPANTS: Patients developing endophthalmitis after receiving an intravitreal anti-VEGF injection from the American Academy of Ophthalmology IRIS® Registry between 2016 and 2020. METHODS: Inclusion criteria were endophthalmitis diagnosis within 1 to 28 days after anti-VEGF injection and a recorded visual acuity (VA) at baseline, on the day of diagnosis, and post-treatment. Patients in the Injection Only group underwent intravitreal injection of antibiotics alone and in the Early Vitrectomy group received PPV with intravitreal antibiotics or intravitreal injection followed by PPV within 2 days of diagnosis. Patients were excluded if they had cataract surgery during the study, intravitreal steroids before endophthalmitis, or intermediate/posterior uveitis or cystoid macular edema. The study created a 1:1 matched cohort using Mahalanobis Distance Matching, accounting for the differences in VA at baseline and diagnosis. MAIN OUTCOME MEASURES: Post-treatment logMAR VA RESULTS: 1,044 patients diagnosed with post-injection endophthalmitis met the inclusion and exclusion criteria. In the unmatched cohort, there were 935 patients in the Injection Only and 109 in the Early Vitrectomy group. In 1:1 matched cohort 218 patients (109 in each group) were included; the median logMAR VAs were 0.32 [20/40-20/50] at baseline, 0.88 [∼20/150] at diagnosis, and 0.57 [20/70-20/80] post-treatment. There were no statistically significant differences in the visual outcomes between the two matched treatment groups (b = 0.05, p = 0.23); including the subgroup of patients with VA worse than 1.0 logMAR (b = 0.05, p = 0.452). CONCLUSIONS: There was no significant difference in final VA outcomes between patients receiving Injection Only and those treated with Early Vitrectomy for post-injection endophthalmitis. The findings support the use of either treatment strategy.

A Recurrent Case of Full-Thickness Macular Hole After Successful Closure With Primary Vitrectomy and Epiretinal Proliferation Embedding.

Epiretinal proliferation (EP) is thought to be glial cell proliferation arising from the inner retina, seen in cases of lamellar or full-thickness macular holes (FTMH). Embedding EP within the macular hole is considered supportive for FTMH closure and functional recovery. We report a recurrent case of FTMH that was successfully closed after primary vitrectomy with the EP embedding technique. In the primary surgery, internal limiting membrane (ILM) peeling was avoided to reduce the potential risk of retinal nerve fiber layer damage associated with glaucoma. The FTMH was successfully closed, with complete recovery of macular layer structures. However, over one year later, the FTMH reopened, slightly dislocated from the position of the embedded EP scar. The reopened FTMH was closed again after the second surgery using the ILM inverted flap technique. This case indicates that macular hole closure with EP might not sufficiently support the tissue repair of FTMH as a new hole can form if tangential traction of the ILM remains.

Temperature control during pars plana vitrectomy.

PURPOSE: To evaluate the impact of temperature-controlled pars plana vitrectomy (PPV) on structural and functional outcomes in a rabbit eye model in vivo. METHODS: Ten healthy New Zealand White rabbits underwent temperature-controlled PPV in the right eye (group A), using a device specifically designed to heat the infusion fluid/air and integrated into the vitrectomy machine, and conventional PPV in the left eye (group B). Both eyes received ophthalmic examination and electroretinography (ERG) before and 1 week postoperatively. After 1-week ERG, rabbits were enucleated and then sacrificed. Histological and immunohistochemical examinations were performed on enucleated eyes and expression of glial fibrillary acidic protein (GFAP) and vimentin investigated. RESULTS: Postoperatively, only group B showed significantly decreased amplitude and increased latency of a-wave at 3 cd·s/m2 (p = 0.001 and 0.005, respectively). Significant increase of b-wave latency at 0.01 cd·s/m2 was detected in both groups (p = 0.019 and 0.023, respectively). Postoperatively, amplitude of oscillatory potentials (OPs) increased significantly in group A (p = 0.023) and decreased in group B. In both groups, OPs latency significantly increased at 1-week test (P < 0.05). A greater number of eyes without structural retinal alterations was detected in group A compared to group B (6 vs 5, respectively). GFAP expression was higher in group B than group A, even if the difference was not statistically significant. CONCLUSION: Temperature-controlled PPV resulted in more favorable functional and structural outcomes in rabbit eyes compared with conventional PPV, supporting the potential beneficial role of the intraoperative management of intraocular temperature in vitreoretinal surgery.

Factors affecting the development of cystoid macular edema following pars plana vitrectomy with silicone oil placement: a retrospective cohort study.

BACKGROUND: Cystoid macular edema (CME) can develop following silicone oil placement in complex vitreoretinal surgeries, contributing to poor visual outcomes. In this study, we investigated the clinical and surgical characteristics associated with the development of CME following the use of silicone oil (SO) in pars plana vitrectomy (PPV) surgeries. METHODS: We conducted a retrospective chart review of patients who underwent implantation of SO during PPV from 2010 to 2020 by a single surgeon. Patient demographics, type of oil, duration of oil tamponade, retinectomy size, diabetic status, lens status, prior panretinal photocoagulation, visual acuity, and incidence of CME were reviewed. RESULTS: This study included 43 eyes from 40 patients who underwent SO tamponade for retinal detachment (RD) surgery. The mean duration of SO tamponade was 15.7 ± 12.7 months (range: 1-58 months). The most common indication for surgery was diabetic tractional RD (32.7%), followed by traumatic RD (16.3%) and rhegmatogenous RD with proliferative vitreoretinopathy (11.6%). Of the 43 eyes, 18 (41.9%) developed CME for the first time after PPV with SO placement, with 8 (44%) resolving within a year of oil removal. The mean duration for the development of CME was 9 months. A logistic regression model showed that a scleral buckle procedure and poor initial vision were statistically significant factors for predicting the development of CME (ORs: 11.65 and 16.06, respectively). Overall, 91% of the patients had stable or improved vision after surgery. CONCLUSIONS: The use of a scleral buckle procedure and poor initial vision are significant factors for predicting CME following silicone oil tamponade in PPV surgeries, with 41.9% of patients developing CME with an average duration of 9 months. Recognizing such factors can lead to early monitoring and prompt management of CME. MEETING PRESENTATION: Partial analyses were presented at the ASRS 2020 conference. CLINICAL TRIAL NUMBER: Not applicable.

Retinal displacement following direct versus indirect fluid exchange in pars Plana vitrectomy for rhegmatogenous retinal detachment.

PURPOSE: To compare the occurrence and characteristics of retinal displacement following direct perfluorocarbon liquid (PFCL)-silicone oil (SO) exchange versus indirect PFCL for air and air for SO exchange methods during pars plana vitrectomy (PPV) in patients with rhegmatogenous retinal detachment (RRD). METHODS: A comparative case series study was conducted on 58 eyes with recent RRD, undergoing standard three-port PPV with SO tamponade. Fluid exchange was performed using either direct or indirect methods. Postoperatively, a comprehensive ophthalmic examination and fundus autofluorescence (FAF) imaging were conducted at one month. The presence, amount, and direction of retinal displacement were assessed based on FAF imaging and compared between the direct and indirect fluid exchange groups. RESULTS: FAF imaging at one month revealed retinal displacement in 41.4% of eyes in the direct group and 62.1% in the indirect group, with no statistical difference between them (P = 0.537). However, the mean displacement was significantly higher in the indirect group (282.61 ± 110.83 µm) compared to the direct group (220.33 ± 39.67 µm, P = 0.04). The direction of displacement (downward or upward) did not differ significantly between the groups (P = 0.093). CONCLUSIONS: While the occurrence and location of postoperative retinal displacement did not significantly differ between direct and indirect fluid exchange methods during PPV for RRD, eyes treated with the direct method exhibited lower mean displacement compared to the indirect method. These findings suggest potential benefits of the direct exchange approach in minimizing retinal displacement following surgery.