A Modified Suturing Technique to Produce Temporary Scleral Buckling Effect for Noncomplex Rhegmatogenous Retinal Detachment.

PURPOSE: To introduce a surgical technique for temporary scleral buckling of noncomplex rhegmatogenous retinal detachment using a combination of nonabsorbable and absorbable sutures that would induce minimal permanent refractive changes. METHODS: Twenty consecutive patients (20 eyes) with noncomplex rhegmatogenous retinal detachment were prospectively included. Scleral buckling was performed in all eligible subjects, and encircling buckling was added when necessary. The silicone elements were fixed on the sclera with 5-0 nonabsorbable sutures and tightened to form a ridge with 6-0 absorbable sutures. Best-corrected visual acuity, scleral ridge status, axial length, spherical diopter, and cylinder diopter were collected. RESULTS: All patients achieved primary retinal reattachment with significant improvement of best-corrected visual acuity after surgery. Scleral ridge was obvious and in situ at the 1-month follow-up but diminished at the 3-month follow-up. At the 1-month follow-up, axial length increased from 24.78 mm ± 2.14 mm preoperatively to 25.22 mm ± 2.11 mm, and cylinder diopter increased from -1.99 ± 1.03 to -2.95 ± 1.55 (both P < 0.001). At the 3-month follow-up, axial length, spherical diopter, and cylinder diopter decreased significantly compared with the values at the 1-month follow-up (all P < 0.05). No obvious complications were observed during the whole follow-up. Patients who underwent additional encircling buckling exhibited greater changes in axial length and cylinder diopter at the 1-month follow-up (both P < 0.001). CONCLUSION: The modified technique of scleral buckling with/without encircling buckling using both nonabsorbable and absorbable sutures offers a safe and effective option to repair noncomplex rhegmatogenous retinal detachment, which would offer an adequate temporary scleral buckling effect and induce minimal permanent refractive changes.

NDP-related retinopathies: clinical phenotype of female carriers.

BACKGROUND/AIMS: Norrin cysteine knot growth factor (NDP) located on the X chromosome, was previously reported to cause Norrie disease and familial exudative vitreoretinopathy (FEVR), which are blindness-causing ocular disorders, in males. In this study, we aimed to explore the clinical characteristics of female carriers with NDP mutations. METHODS: Twelve female carriers from 11 unrelated families with pathogenic NDP mutations were recruited. Clinical data were collected from the NDP carriers. Comprehensive ocular examinations, including best corrected visual acuity, slit lamp examination, fundus photography and fundus fluorescein angiography (FFA) were evaluated. Targeted gene or whole exome sequencing was performed in the probands, and Sanger sequencing was performed to confirm NDP mutations in female carriers. RESULTS: Of the 12 females, 1 (1/12, 8.3%) presented with decreased visual acuity and 11 (11/12, 91.7%) were asymptomatic. Based on the FFA, peripheral vascular changes were noted in 66.7% (16/24) of the eyes of 75.0% (9/12) of the carriers. A total of 33.3% (8/24) had typical FEVR phenotype, 33.3% (8/24) had mild vascular abnormalities and 33.3% (8/24) was unremarkable. In addition, predominant changes such as telangiectatic endings (66.7%), anomalous circumferential vessel (37.5%), supernumerary vascular branching (33.3%), fluorescein leakage (29.2%), avascular area (8.3%), retina fold (8.3%) and peripheral straightening of retinal vessels (33.3%) were noted. CONCLUSION: Although NDP-related retinopathy is an X-linked recessive disorder, most of the female carriers of NDP exhibited clinical features of FEVR. Thus, timely examinations and lifelong monitoring should be conducted in the NDP female carriers.

Skills assessment after a grape-based microsurgical course for ophthalmology residents: randomised controlled trial.

AIMS: To introduce and assess a course using grapes as training models for ophthalmology residents to acquire basic microsurgical skills. METHODS: Ophthalmology residents who were novices at microsurgery were included. Participants were randomised into a 1:1 ratio to a 4-hour training programme based on fruit models (group A) or virtual reality (VR) modulator and silicone suture pads (group B), respectively. Before and after training, questionnaires were designed to measure their self-confidence with ophthalmic operations and with their coming role as surgical assistants. After training, each participant provided their interest in further studying microsurgery and was assessed for their general competence of ophthalmic microsurgery on porcine eyes. RESULTS: Eighty-three participants were included, with 42 ones in group A and 41 ones in group B. After training, participants in group A performed better in the uniformities of the suture span (p<0.05), suture thickness (p<0.05) and tissue protection (p<0.05) during the corneal suturing assessment. The overall scores of corneal suturing and circular capsulorhexis in the porcine eye in group A were comparable to those in group B (p=0.26 and 0.87, respectively). Group A showed a more positive attitude to withstand the training for more than 4 hours (p<0.001), as well as a higher willingness to receive more times of the training in the future (p<0.001). CONCLUSIONS: Training models based on grapes are equal to VR simulators and silicon suture pads to provide solid training tasks for ophthalmology residents to master basic microsurgical skills, and might have advantages in lower economic cost, and easy availability. TRIAL REGISTRATION NUMBER: ChiCTR2000040439.

Update on the Phenotypic and Genotypic Spectrum of KIF11-Related Retinopathy.

Background: This study aimed to report the frequency of KIF11-mutations in a large familial exudative vitreoretinopathy (FEVR) population, extend the clinical spectrum of KIF11-associated retinopathy and compare KIF11-associated retinopathy to FEVR with mutations in other genes. Methods: Genetic data collected from 696 FEVR families were reviewed. The ocular phenotypes in patients with KIF11 mutations were analyzed and compared with those of FEVR patients with mutations in other genes (FZD4, TSPAN12, LRP5, NDP and JAG1). Results: In a cohort of 696 FEVR families, disease-causing KIF11 mutations were identified in 3.6% of families (25/696). Among 25 KIF11 mutations, 80% (20/25) carried variants of loss of function and 48% (12/25) of variants were de novo. The phenotypes were variable. Compared with FEVR with disease-causing mutations in other genes, chorioretinal dysplasia was observed in 44.2% (31/70) of eyes with KIF11-associated retinopathy and in only 1.3% (1/70) of eyes with FEVR with mutations in other genes (p < 0.01). Increase and straightening of peripheral vessels (ISPV) was observed in 17.1% (12/70) of eyes with KIF11-associated retinopathy, and in 50% (39/78) of eyes with FEVR with mutations in other genes (p < 0.01). Conclusions: The frequency of the KIF11 mutation in FEVR was 3.6% in our database. The manifestation of KIF11-associated retinopathy was variable and different from the phenotype in FEVR caused by other genes. Chorioretinal dysplasia, instead of retinal folds, was the dominant phenotype in KIF11-associated retinopathy. ISPV was rare in KIF11-associated retinopathy. Moreover, our study revealed that most pathogenic KIF11 mutations were de novo.

Intraocular Lens Fixation Technique Without Corneal Incision in Minimally Invasive Vitrectomized Eyes.

INTRODUCTION: To introduce a modified technique for primary/secondary intraocular lens (IOL) fixation without corneal incision in vitrectomized eyes. METHODS: Consecutive case series who had undergone previous or concomitant pars plana vitrectomy (PPV) to have primary/secondary IOL fixation were prospectively included. A self-sealing scleral incision was made underneath the superior scleral flap, through which the IOL was inserted into the anterior chamber. The suture tied with the IOL passed through the sclera to fix the IOL in the ciliary sulcus. Patients were followed up for at least 3 months. Main outcomes were best corrected visual acuity (BCVA), intraocular pressure (IOP), surgically induced astigmatism (SIA), and intraoperative and postoperative complications. RESULTS: A total of 31 patients were included in the study. The mean follow-up time was 5.35 ± 4.14 months. The BCVA (log MAR unit) improved from 0.97 ± 0.58 preoperative to 0.42 ± 0.36 postoperative (P < 0.001). Mean IOP remained unchanged (preoperative IOP 14.03 ± 2.90 mmHg, postoperative IOP 13.26 ± 3.46 mmHg, P = 0.130). The mean SIA was 0.91 ± 0.76 diopters. No obvious intraoperative and postoperative complications were observed. CONCLUSION: This method has favorable postoperative visual recovery and IOP control. This modified method could be taken into account as an option by surgeons in vitreoretinal surgery.

Intraoperative choroidal detachment during small-gauge vitrectomy: analysis of causes, anatomic, and visual outcomes.

INTRODUCTION: To investigate the incidence and causes of intraoperative choroidal detachment (CD) during small-gauge vitrectomy, as well as the anatomic and visual outcomes. METHODS: We retrospectively reviewed the medical records of 1026 consecutive patients who underwent small-gauge vitrectomy from June 2017 to December 2018 at Zhongshan Ophthalmic Centre, Guangzhou, China. Data on the presence, location, and extent of intraoperative CD and its relationship to the infusion cannula were collected. Patient demographic characteristics and postoperative anatomic and visual outcomes were also assessed. RESULTS: A total of six cases were found to have intraoperative CD, including two with serous CD, three with limited haemorrhagic CD, and one with CD caused by inadvertent perfusion of gas during air/fluid exchange. Retraction of the infusion cannula and acute ocular hypotony were found to be the main causes of intraoperative CD in five out of the six cases. The best-corrected visual acuity of all cases significantly improved after the surgery. CONCLUSION: The incidence of intraoperative CD during small-gauge vitrectomy is low; the predominant causes are retraction of the infusion cannula and acute ocular hypotony. Immediate awareness and timely closure of the incision may contribute to a better surgical prognosis.

Pars plana subcapsulotomy to remove condense subcapsular opacification in combined surgery of silicone oil removal and phacoemulsification.

PURPOSE: Because of the direct contact of intravitreal silicone oil (SO) with the subcapsular membrane, cataract is one of the main SO-related complications. In a group of patients, condense subcapsular opacification occurs, which adds difficulty and risk when having sequential treatment of it. The aim of the current study is to assess the long-term outcomes of pars plana subcapsulotomy to remove condense subcapsular opacification in combined surgery of SO removal and phacoemulsification. METHODS: Retrospective cohort study. Consecutive patients who were scheduled to have combined surgery of SO removal and phacoemulsification, and with condense subcapsular opacification were included. After phacoemulsification and SO removal, circular subcapsulotomy (diameter = 3-5 mm) was performed with a 23-/25-gauge vitrectomy probe on each subject during the combined surgery. Main outcomes were pre- and postoperative best-corrected visual acuity (BCVA), intra- and postoperative complications. RESULTS: One hundred and twenty patients (120 eyes) were included. Postoperative logMAR BCVA at day 1, week 1, month 1, and final follow-up examinations was 1.0 ± 0.5, 0.7 ± 0.4, 0.6 ± 0.4, and 0.6 ± 0.3, respectively. Statistically significant median differences of logMAR BCVA occurred between the preoperative examination and each postoperative follow-up examination (all p < 0.001). The sharpest median increase in logMAR BCVA occurred between the day 1 and week 1 postoperative examinations (p < 0.001). CONCLUSIONS: For condense subcapsular opacification caused by SO tamponade, pars plana subcapsulotomy with a 23-/25-gauge vitrectomy probe during combined surgery of SO removal and phacoemulsification is effective and safe to have surgical management of it. The systemic approach enables patients to experience rapid and long-lasting vision rehabilitation in a single procedure.

Knobloch Syndrome Associated with Novel COL18A1 Variants in Chinese Population.

Knobloch syndrome is an inherited disorder characterized by high myopia, retinal detachment, and occipital defects. Disease-causing mutations have been identified in the COL18A1 gene. This study aimed to investigate novel variants of COL18A1 in Knobloch syndrome and describe the associated phenotypes in Chinese patients. We reported six patients with Knobloch syndrome from four unrelated families in whom we identified five novel COL18A1 mutations. Clinical examination showed that all probands presented with high myopia, chorioretinal atrophy, and macular defects; one exhibited rhegmatogenous retinal detachment in one eye. Occipital defects were detected in one patient.

Construction of immune-related risk signature for uveal melanoma.

Uveal melanoma (UM) is the most frequent primary ocular tumour among adults. Here, we aimed to establish the immune cell-based signature to predict the overall survival (OS) of UM patients. The mRNA profile and matched clinical records of 80 UM patients were downloaded from The Cancer Genome Atlas (TCGA) database. CIBERSORT was used to verify the immune cell types of individuals. The univariate analysis found the CD8+ T cell, monocyte, CD4+ memory T cell (resting) and mast cell (resting) were significantly associated with the OS of UM patients. Subsequently, the LASSO Cox regression test was applied to establish the signature, by which the patients were separated into high- and low-risk subgroups. The Kaplan-Meier analyses found for these patients in the high-risk group had a poor survival rate than those in the low-risk group. The predictive value and stability were confirmed by the receiver operative characteristics curves. Pathway analyses found that the differentially expressed genes between the high- and low-risk subgroups were mainly centralised on immune response-related pathways. Further, the comparison of our signature with clinicopathological records confirmed its superiority and independence. In summary, we established an immune cell-based prognosis-predicting signature for UM patients, which will benefit the individual's treatment.

Distinct Serum and Vitreous Inflammation-Related Factor Profiles in Patients with Proliferative Vitreoretinopathy.

INTRODUCTION: Proliferative vitreoretinopathy (PVR), which is regulated by growth factors and cytokines, is the leading cause of failure in vitreoretinal surgery. In this study, we aimed to investigate the role of the human serum and vitreous inflammation-related factors in the development of proliferative vitreoretinopathy (PVR). METHODS: Blood and vitreous samples were obtained from patients undergoing pars plana vitrectomy. Inflammation-related factors were detected using an immunology multiplex assay on a Luminex® xMAP® platform. Patients with PVR and rhegmatogenous retinal detachment (RRD) were compared with macular hole (MH) or epiretinal membrane (ERM) patients without any other ocular or systemic disease. RESULTS: Thirty-six serum samples and 34 vitreous samples were obtained. Thirty-one different growth factors and cytokines were detected in serum samples. However, none of the circulating growth factors and cytokines were found to be different from the controls. Ten different growth factors and cytokines were measured in the vitreous samples. The concentration levels of PDGF-AA, TGF-α, VEGF, IL-6, IL-8, and TNFß were found to have significantly increased in the vitreous of PVR patients. CONCLUSION: Our study found that none of the circulating inflammation-related factors were changed in PVR or RRD patients, indicating the absence of a system inflammatory biomarkers to predict the development of proliferative vitreoretinopathy. As a supplement to previous research, the concentrations of PDGF-AA, TGF-α, VEGF, IL-6, IL-8, and TNFß were significantly upregulated in the vitreous of PVR patients. These factors should be considered for preventing PVR.

Effect of silicone oil on macular capillary vessel density and thickness.

The present study assessed changes in macular capillary vessel density and thickness associated with ocular silicone oil tamponade (SOT) following complex vitreoretinal surgery. A total of 23 patients who underwent pars plana vitrectomy combined with intravitreal SOT were retrospectively enrolled, and a single eye was assessed in each participant. Furthermore, 20 patients who required silicone oil removal (SOR) were included. The macular capillary vessel density and the foveal avascular zone (FAZ) area were analyzed using optical coherence tomography angiography (OCTA) and retinal thickness was assessed by OCT. The results demonstrated that the macular capillary vessel density of the superficial capillary plexus (SCP) and deep capillary plexus (DCP), the FAZ area and full retinal thickness were retained at a stable level following SOT (P>0.05), and also following SOR (P>0.05). Furthermore, the parafoveal (P=0.008), superior-hemi (P=0.007), temporal (P=0.015), superior (P=0.028) and nasal (P=0.002) inner retinal thickness decreased in the SOT group, whereas the inner retinal thickness was unaltered after SOR vs. baseline (P>0.05). In conclusion, silicone oil has no significant effect on macular capillary vessel density within a 6-month period but may compress and reduce the thickness of the inner retina.

Multicolor Scanning Laser Ophthalmoscopy Strengthens Surgeons' Preoperative Decision-Making and Intraoperative Performance on Epiretinal Membrane.

Purpose: To determine whether multicolor scanning laser ophthalmoscopy (MC-SLO) was better than color fundus photography (CFP) to enhance residents and specialists' preoperative decision-making and intraoperative performance on the epiretinal membrane (ERM). Methods: Consecutive patients with idiopathic ERM were recruited prospectively. All the patients underwent MC-SLO and CFP imagings and were randomized into MC-SLO (n = 20) and CFP (n = 20) groups. Preoperatively, residents and specialists were required to have ERM delineation and select an optimal location for initial ERM peeling independently, based on the MC-SLO (MC-SLO group) or CFP (CFP group) images. Intraoperative optical coherence tomography (iOCT) was introduced to evaluate the accuracy. Results: Preoperatively, residents and specialists acted more effectively in ERM delineation and selection of initial grasping location in the MC-SLO group (both P < 0.001). In the MC-SLO group, higher resident-specialist agreements were achieved in ERM delineation (P = 0.002) and selection of initial grasping location (P = 0.035). The iOCT revealed greater interobserver (iOCT-resident and iOCT-specialist) agreements of ERM delineation in MC-SLO group (P < 0.001 and = 0.027, respectively). Surgeons acted more effectively on completely peeling the ERM in the MC-SLO group (P < 0.001). Conclusions: MC-SLO provided a better visual reference for residents and specialists in ERM delineation and the selection of an initial grasping location for the surgery, compared with CFP. Translational Relevance: MC-SLO is able to help surgeons achieve better intraoperative performance and shorten the learning process for residents.

Integrated analyses identify potential prognostic markers for uveal melanoma.

Uveal melanoma (UM) is the most common primary intraocular malignant tumor in adults, which has a high rate of metastases and can induce vision loss and even death to the patients. To identify suitable prognostic markers of UM for the early detection or prognosis prediction would be an essential step toward successful management of the disease. Herein, we extracted the mRNA expression data along with the clinical information from The Cancer Genome Atlas (TCGA) database. A total of eight co-expression modules were constructed by 5,000 genes based on the weighted gene co-expression network analysis (WGCNA). We found the blue and yellow modules were significantly associated with clinical stage. The Cox regression analyses found the blue, yellow, green and brown modules were significantly associated with overall survival (OS), while the blue, yellow, brown, green and pink modules were significantly associated with recurrence-free survival (RFS). Furthermore, the hallmark pathway enrichment analyses found the genes encompassed in the blue, yellow, and brown modules were significantly enriched in critical pathways involved in tumorigenesis and progression process, such as EMT and KRAS pathways. The hub-genes in these three modules were visualized by Cytoscape software and further validated by an external Gene Expression Omnibus (GEO) dataset. Besides, the OS and RFS predicting signatures were constructed based on the validated hub-genes according to the LASSO Cox regression model. The UM patients were assigned to low-/high-risk population. The survival analyses indicated high-risk patients mostly had bad OS/RFS rate compared with the low-risk population. The receiver operating characteristic (ROC) curve proved the stability and superiority of the two signatures. To sum up, our findings provide a framework of co-expression network of UM and identify a series of biomarkers, which will benefit from improving the prognosis prediction of UM patients.

Development and Testing of a Mobile Phone App for Risk Estimation of Gas Volume Expansion and Intraocular Pressure Elevation in Patients With Intravitreous Gas or Air Tamponade: Interobserver Assessment Study.

BACKGROUND: Pars plana vitrectomy (PPV) with intravitreous tamponade of gas or air has been widely used for a series of vitreoretinal diseases. It is estimated that 100,000 patients per year undergo PPV globally, and half of them were subsequently tamponaded with gas or air. According to Boyle's law (P1V1=P2V2), patients with an intravitreous remnant of gas or air will be under high risk of intraocular pressure (IOP) elevation and subsequent vision loss owing to the expanded intravitreous gas or air when traveling post operation to a place with a significantly higher altitude. We always explain to patients why postoperative travel is potentially risky. Emergency cases of elevated IOP caused by postoperative traveling would sometimes come to surgeons. However, there have been few disease education or reference tools for both the surgeons and patients to have better communication. OBJECTIVE: The aim of this study was to introduce and evaluate a mobile phone app developed by surgeons (the authors) for preliminary risk estimation of volume expansion and IOP elevation in patients with intravitreous gas or air when traveling to a place of higher altitude. METHODS: The app was developed on the iOS and Android operating systems. Boyle's law (P1V1=P2V2) was the theoretical basis of the app. Intravitreous gas or air volume and altitude values were independent factors to deduce the risk report. Consecutive patients underwent vitrectomy, and those with an intravitreous remnant of gas or air were recruited. The surgeons judged the vertical height of the fluid/gas interface through the dilated pupil; the patients were instructed to judge it according to their visual field when looking straight ahead and line it out on a chart included in the app. Finally, all the patients were required to fill a Likert scale-based questionnaire with 2 main items to evaluate the participants' user experience and attitudes toward the app. RESULTS: A total of 50 patients were included (30 males and 20 females). All patients could independently operate the app to complete the test. The median heights of the fluid/gas interface independently judged by the surgeon and patients were 40% (range: 10%-75%) and 41% (range: 9%-78%), respectively (P=.63). The median altitude of the participants' destinations was 150.0 m (range: 0-3490 m). The Bland-Altman analysis revealed a good agreement between the surgeons' and patients' judgments (bias of -0.3%), with 95% limits of agreement of -5.8% to 5.3%. Overall, the Likert scale revealed a positive attitude from the patients toward the app. CONCLUSIONS: The app is reliable for patients to have preliminary risk estimation of intravitreous gas or air volume expansion and IOP elevation if travel to a place of higher altitude is planned. The surgeons could also use it as a platform for better disease communication.

Novel and easy techniques for 27-gauge silicone oil infusion and removal.

PURPOSE: To introduce novel and easy techniques for 27-gauge silicone oil (SO) infusion and removal. METHODS: Consecutive patients treated with 27-gauge pars plana vitrectomy (PPV) plus SO infusion (Infusion Group) and scheduled to have SO removal (Removal Group) were prospectively included, respectively. Patients in Infusion Group underwent 27-gauge PPV plus SO infusion. SO infusion was performed with a 24-gauge intravenous catheter connected with the SO syringe. Patients in Removal Group underwent machine-independent SO removal using a short section of infusion tube connected with a 10-mL syringe. Main outcomes were best-corrected visual acuity, intraocular pressure, surgical time and intra- and postoperative complications. RESULTS: There were thirty-five eyes (35 patients) and forty eyes (40 patients) included in Infusion and Removal Groups, respectively. Mean surgical time of complete SO infusion and removal was 5.5 ± 0.9 and 9.6 ± 2.1 min, respectively. In both groups, no patient experienced postoperative vision deterioration or hypotony. No obvious intra- and postoperative complications were observed. CONCLUSIONS: We recommend the use of the 24-gauge catheter method for 27-gauge silicone oil infusion when commercial infusion cannula is unavailable. The machine-independent method using easily available plastic infusion tube and syringe would be an ideal option when 27-gauge surgery is anticipated.

The Preliminary Experiences with Three-Dimensional Heads-Up Display Viewing System for Vitreoretinal Surgery under Various Status.

Statement: The current article has not been published elsewhere and has not been submitted simultaneously for publication elsewhere. PURPOSE: To investigate the preliminary use of three-dimensional (3D) heads-up display (HUD) viewing system for vitreoretinal surgery under various status. MATERIALS AND METHODS: Nonrandomized case-control study. Consecutive cases to have vitreoretinal surgery under various status were prospectively recruited. Twenty-five-gauge vitrectomy platform and 3D viewing system were used. Main outcomes included: luminous emittance (lux) of endoillumination pipe, surgical duration, the surgeon and residents' preference and ergonomics. Consecutive patients to have vitreoretinal surgery with the conventional viewing system were recruited as control group following the same inclusion and exclusion criteria and underwent surgeries by the same surgeon with the same microscope and vitrectomy platform. RESULTS: Thirty-one patients (31 eyes; Group Study) and twenty-eight patients (28 eyes; Group Control) were included; without significantly statistical difference in terms of age, gender, main diagnosis, surgical duration, and difficulty rating between both groups (all P > 0.05). Lower endoillumination intensity was needed in Group Study than that in Group Control (10% vs. 35%; 598.7 ± 5.4 vs. 1913.0 ± 12.9 lux, P < 0.001). The surgeon and residents expressed overwhelming preference with the 3D system in both groups. Improved ergonomic was rated in Group Study (4.4 ± 0.8 vs. 3.2 ± 1.0, P < 0.001). Some intraoperative difficulties and discomforts appeared to the surgeon and assistants when using the 3D viewing system. CONCLUSION: Vitreoretinal surgery under various status can be well finished with the HUD platform by novice at the system. Main benefits included lower endoillumination intensity, enhanced users' preference, and improved ergonomics. Some further refinements of the system are expected.

Comparative Study of 27-Gauge Versus 25-Gauge Vitrectomy With Air Tamponade in the Treatment of Myopic Foveoschisis.

BACKGROUND AND OBJECTIVE: To compare the surgical outcome of 27-gauge pars plana vitrectomy (PPV) with 25-gauge PPV and evaluate the efficacy of air tamponade for the treatment of myopic foveoschisis (MF). PATIENTS AND METHODS: Sixty eyes of 60 consecutive patients were recruited to undergo vitrectomy, internal limiting membrane (ILM) peeling, and air tamponade for treatment of MF. These eyes were divided into two groups: the 27-gauge group (n = 29) and the 25-gauge group (n = 31). RESULTS: There were no significant differences in the mean operating time (P = .32), the mean time for vitrectomy (P = .20), and the suturing rate(P = .46) between the 27-gauge group and the 25-gauge group. At the final follow-up, anatomical resolution rate did not differ between the two groups (P = .65). CONCLUSION: The 27-gauge vitrectomy system is as efficient and feasible as the 25-gauge system for the treatment of MF. Air tamponade can provide good postoperative anatomic resolution of MF. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e135-e142.].

Surgical outcomes of 27-gauge pars plana vitrectomy with short-term postoperative tamponade of perfluorocarbon liquid for repair of giant retinal tears.

PURPOSE: To investigate the use of 27-gauge pars plana vitrectomy (PPV) with short-term tamponade of perfluorocarbon liquid (PFCL) for repair of giant retinal tears (GRT). METHODS: Retrospective case series study. Consecutive patients with GRT were treated with 27-gauge PPV and short-term tamponade of PFCL for 7-10 days. PFCL was completely removed with a secondary surgery. RESULTS: Twenty-three eyes of 23 patients were included. All the patients achieved primary anatomic success. Preoperative logarithm of the minimum angle of resolution (logMAR) BCVA was 1.59 ± 0.58 (Snellen 20/778). Five (21.7%), nine (39.1%), eleven (47.8%) and fifteen (65.2%) eyes experienced vision improvement at the Month-1, Month-3, Month-6 and final follow-ups, respectively. The final logMAR BCVA was 0.84 ± 0.51 (Snellen 20/138), being statistically better than the preoperative one (P < 0.001). Surgical complications included foreign body response (n = 7), transient elevated intraocular pressure (n = 5), cataract formation/deterioration (n = 11) and posterior capsule opacity (n = 16). CONCLUSIONS: 27-Gauge PPV with short-term tamponade of PFCL is safe and effective for the repair of GRT. Side effects of the surgery mainly included foreign body response, transient elevated intraocular pressure, cataract formation/deterioration and posterior capsule opacity.

Combined 23-G Pars Plana Vitrectomy and Lensectomy in the Management of Glaucoma Associated with Nanophthalmos.

PURPOSE: To investigate the surgical results of 23-G pars plana vitrectomy (PPV) combined with lensectomy (PPL) in nanophthalmic patients with angle closure glaucoma. METHODS: This prospective nonrandomized study included consecutive patients with nanophthalmic glaucoma recruited for 23-G PPV combined with PPL. Best-corrected visual acuity (BCVA), intraocular pressure (IOP), the number of antiglaucoma medications, and surgery-associated complications were recorded. Surgical success rates were evaluated at each follow-up. Prognostic factors for success were also assessed using logistic regression analysis. RESULTS: This study enrolled 21 eyes of 21 patients. The mean follow-up was 18.6 ± 7.0 months. At the final follow-up visit, the mean IOP was significantly reduced (from 47.4 ± 5.7 to 18.6 ± 3.6 mm Hg). The mean number of antiglaucoma medications dropped from 5 to 0. BCVA improved in 3 (14.3%) eyes. The complete success rate (IOP >6 and <21 mm Hg without antiglaucoma medication) was 71.4, 66.7, and 71.4% at the 6-month, 12-month, and final follow-up visit, respectively. CONCLUSIONS: Nanophthalmic glaucoma can be effectively managed with the combined surgery of 23-G PPV and PPL. IOP control was achieved with elimination of pupillary block and deepening of the anterior chamber. This surgical procedure proved to be safe in eyes with a potential risk of vision-threatening complications.

Pars plana vitrectomy with partial tamponade of filtered air in Rhegmatogenous retinal detachment caused by superior retinal breaks.

BACKGROUND: To investigate the anatomic and functional outcomes of pars plana vitrectomy (PPV) with partial tamponade of filtered air for rhegmatogenous retinal detachment (RRD) caused by superior retinal breaks. METHODS: Retrospective, comparative, consecutive case series study. Patients with RRD caused by superior retinal breaks undergone PPV with partial tamponade (Group A) and whole tamponade (Group B) of filtered air were included. The main outcomes were primary and final success rates, best corrected visual acuity (BCVA), and rate of postoperative cataract surgery. RESULTS: Forty-one patients (41 eyes) were included in Group A and 36 patients (36 eyes) were included in Group B. There were no significant differences in primary or final success rates between Groups A and B (P = 0.618 and P = 1.000, respectively). The patients in Group A experienced quicker postoperative vision improvement (from the Week 1 follow-up) than the patients in Group B (from the Month 3 follow-up). The postoperative cataract surgery rate of Group A (7/31) was lower than that of Group B (13/26) (P = 0.031). CONCLUSIONS: PPV with partial tamponade of air is effective in achieving a high anatomic success rate, quicker postoperative vision improvement, and lower rate of postoperative cataract surgery in RRD caused by superior retinal breaks.