Influence of intraocular tamponade on unintentional retinal displacement after vitrectomy for rhegmatogenous retinal detachment.

PURPOSE: To investigate the relationship between type of intraocular tamponade and unintentional retinal displacement after vitrectomy for rhegmatogenous retinal detachment. METHODS: Twenty-three eyes of 23 consecutive patients affected by rhegmatogenous retinal detachment underwent 3-port pars plana vitrectomy with gas (C3F8) or silicone oil (polydimethylsiloxane) tamponade. Ophthalmologic examination and fundus autofluorescence were performed before surgery (baseline) and at the 7-day, 1-month, and 3-month postoperative visits. Macula sparing rhegmatogenous retinal detachment underwent fixation test (with microperimetry) at baseline and at the 7-day and 1-month follow-up examinations. RESULTS: Fundus autofluorescence revealed postoperative retinal displacement in 12 of the 23 eyes (52.2%). Occurrence of retinal displacement was higher in eyes with gas tamponade (10 of 14 eyes; 71.4%) compared with eyes with silicone oil (2 of 9 eyes; 22.2%) (P = 0.036). Retina shifted downward in all eyes with C3F8 and upward in all eyes with polydimethylsiloxane. Baseline and follow-up macular fixation was tested in 10 macula-on cases. In all cases, a shift of mean fixation point was present at the 7-day postoperative examination, with a partial return toward the baseline mean fixation point at the 1-month follow-up examination. CONCLUSION: In eyes with rhegmatogenous retinal detachment treated with vitrectomy and gas or silicone oil tamponade, retinal displacement may occur despite successful reattachment. Type of intraocular tamponade seems to influence the occurrence of retinal dislocation and its direction.

Previous colonic resection is a risk factor for surgical relapse in Crohn's disease.

BACKGROUND: Despite the improvement of medical therapies, nearly half of patients with Crohn's disease require surgery within 10 years after diagnosis. However, intestinal resection is not curative and recurrence may occur. AIMS: To evaluate post-surgical outcomes for patients with Crohn's disease in a large monocentric cohort, and to identify variables associated with clinical and surgical relapse. METHODS: Patients with Crohn's disease who had surgery for ileal and colonic Crohn's disease between 2004 and 2016 and on at least one-year follow-up following surgery were included. RESULTS: One hundred ninety-three patients were included in the study. Crohn's disease recurrence concerned 53% of patients after a median 56-month (6-158) follow-up and 29% of patients required a second surgical intervention. At logistic regression analysis, active smoking and young age at diagnosis were identified as independent risk factor for post-surgical relapse (p = 0.01), while colonic or ileocolonic resection was recognized as a risk factor for surgical Crohn's disease relapse (p = 0.003). CONCLUSIONS: Post-surgery recurrence is frequent for patients with Crohn's disease. Active smoking and young age at diagnosis are risk factors for Crohn's disease recurrence. As compared with patients undergoing small-bowel surgery, patients with colonic resection are proner to relapse requiring a second surgical intervention.

Anterior chamber migration of dexamethasone intravitreal implant (Ozurdex®) through basal iridectomy (Ando) in a pseudophakic patient.

PURPOSE: Intravitreal implantation of dexamethasone implant (Ozurdex®) is being widely used for the treatment of macular edema (ME) after branch or central retinal vein occlusion, diabetic ME, and persistent ME associated with uveitis or Irvine-Gass syndrome. We describe a complication: migration of the dexamethasone implant into the anterior chamber through basal iridectomy (Ando) in a pseudophakic patient with development of corneal edema and secondary high intraocular pressure. METHODS: This is a case report of migration of Ozurdex® through basal iridectomy in a pseudophakic patient with iris claw lens. CONCLUSIONS: Pseudophakic patients, with a history of vitrectomy, even those with a basal iridectomy (Ando), are at high risk for migration of the Ozurdex® into the anterior chamber and development of corneal edema.

Intrasurgical plasmin enzyme in diabetic macular edema.

PURPOSE: To evaluate in a prospective study the efficacy of intrasurgical autologous plasmin enzyme (APE) in producing posterior vitreous detachment. DESIGN: Consecutive, interventional case series. METHODS: A group of 12 eyes of 11 patients with diabetic macular edema secondary to posterior vitreous cortex contraction was considered. A quantity of 0.1- to 0.2-ml containing 0.8 to 1.2 IU of APE prepared by our Coagulation Service was injected into the vitreous body 25 minutes before surgery. The efficacy of the APE was subjectively evaluated. A control group of 10 eyes with the same clinical characteristics underwent the same surgery without APE injection. Complete eye examinations, including optical coherence tomography, were performed on all patients before surgery and during the 1-year follow-up period. RESULTS: During surgery in the APE-treated group, the posterior vitreous cortex was judged adherent in three cases, partially detached in six cases, and totally detached in three cases. In two cases a complete collapse of the vitreous body was observed. During surgery in the non-APE-treated group, the posterior vitreous cortex was judged still adherent in nine of 10 eyes and partially detached in 1 eye. Comparing the postoperative results between the APE-treated group and the non-APE-treated group, we found no significant differences in final postoperative retinal thickness (P = .2552), whereas we found a significant difference in final visual acuity (P = .0121). CONCLUSIONS: Autologous plasmin enzyme was useful in inducing a pharmacologic posterior vitreous detachment and in facilitating surgery. It did not seem to interfere with the final retinal thickness, and it ameliorates the final visual acuity.