Outcome of vitrectomy for advanced proliferative vitreoretinopathy complicating primary rhegmatogenous retinal detachment among Nigerians.

AIM: To present the anatomical and visual outcome and compare different techniques in the surgical treatment of proliferative vitreoretinopathy (PVR) in Nigerians. METHOD: Comparative retrospective review of PVR grade C and D eyes that had vitreoretinal surgery with silicone oil between April 2005 and December 2012. Data was extracted from consecutive case notes after exclusion of eyes with PVR associated with proliferative diabetic retinopathy (PDR), proliferative sickle cell retinopathy (PSCR) and eyes with nonuse of silicone oil. A comparison of the outcome of vitrectomy alone (Vit.), versus combined with a scleral buckle (Vit.+SB), versus with retinectomy (Vit.+RT), versus with all three procedures (Vit.+SB+RT) was done. Statistical analysis was done using the Statistical Package for Social Sciences version 16 software. Pearson Chi-square test and Fisher's exact T-test were used to determine the effect of relationships. RESULTS: 138 eyes of 138 patients had grades C (100 eyes) and grade D (38 eyes) PVR. Surgery involved vitrectomy and membrane peel in 53% of eyes, additional scleral buckle in 22%, and retinectomy was performed in 17%. Retinal reattachment rate was 86% for PVR C eyes and 87% in PVR D eyes. There was no statistically significant difference in anatomical outcome between vitrectomy alone and the combination surgeries. In the vitrectomy only category, the postoperative vision was noted to improve (> preoperative), in 48% of PVR C and in 31% of PVR D. 33% of PVR C and 44% of PVR D eyes had a worse vision (< preoperative). Visual outcome was similarly poor in the combination surgeries with improved vision noted in 12%, 44%, and 33% of the Vit.+SB, Vit. +RT, and Vit.+SB+RT PVR C eyes, respectively. In PVR D eyes, improved vision was seen in 57% and 12% of Vit.+SB and Vit.+RT eyes, respectively. CONCLUSION: Surgery results in anatomical reattachment and there is nonsuperiority of any technique. Visual outcome is poor as previously reported. Recent trials of pharmacological adjuncts may show promise for improved visual outcomes.

Changes Of Intraocular Pressure In Vitrectomised Eyes After Removal Of Silicone Oil.

BACKGROUND: Patients with Rhegmatogenous retinal detachment develop raised intraocular pressure (IOP) when they undergo pars plana vitrectomy with silicone oil. The present study was done to document changes in IOP with silicone oil and after its removal. METHODS: The interventional study was conducted at Eye department of Lady Reading Hospital Peshawar, from August 2012 to July 2014 on 30 patients with Rhegmatogenous retinal detachment in whom pars plana vitrectomy with silicone oil injection was indicated. IOP readings were obtained on 1st postoperative day, at one month and at 6 months; the silicone oil was removed after the third reading and the IOP readings obtained after 2 weeks. RESULTS: Of the 30 patients selected for the study, there were 25 (83.3%) males and 5 (16.7%) females with ages ranging from 12-80 years (mean age 41.83±21.43 years). The mean of three pre silicone oil removal IOP readings was 27.35±9.20 mmHgwhich was reduced to a mean of 16.10±6.14mmHg following the removal of silicone oil at 6 months (p<0.001). Postoperative raised IOP values were highly predictive of persistently elevated IOP readings in patients after six months. CONCLUSIONS: Vitrectomised eyes with silicone oil raised intraocular pressure which was reduced after silicone oil removal.

Epidemiologic characteristics of retinal detachment surgery at a specialized unit in Denmark.

PURPOSE: To examine the incidence of retinal detachments and to evaluate patient profiles and surgical characteristics. METHODS: Retrospective review of patients operated for primary retinal detachment (RD) and redetachment between 2010 and 2012 at the Department of Ophthalmology, Odense University Hospital, Denmark. We included all RD such as rhegmatogenous retinal detachment (RRD), tractional retinal detachment (TRD) and exudative retinal detachment (ERD). RESULTS: In total, 779 RD surgeries were performed: 83.7% (n = 652) primary operations and 16.3% (n = 127) reoperation. For primary operation, pars plana vitrectomy (PPV), scleral buckling and combined operations were performed in 95.1% (n = 620), 4.6% (n = 30) and 0.3% (n = 2) respectively. Over time there was less use of silicone oil and greater use of gas tamponade (p = <0.001), less simultaneous cataract operations (p = <0.001), less use of cryotherapy (p = 0.045) and more use of peeling procedures (p = <0.001) in primary operations. The annual incidence of surgery for primary RD was 22.0 [95% confidence interval (CI) 20.4-23.8] per 100 000 inhabitants aged >15 years. Retinal detachment (RD) was more common in males than females (1.8:1), and mean age at presentation was 61.8 years (standard deviations ± 12.3). The annual incidence for RRD and TRD operation was 20.72 (95% CI 19.11-22.43) and 1.25 (95% CI 0.9-1.7) per 100 000 inhabitants >15 years. CONCLUSION: This study presents the first overall incidence for RD in Denmark. The highest incidence of RRD was among males aged 60 to 79 years, whereas TRD was among females at same age. Pars plana vitrectomy (PPV) was the preferred surgical technique, and during 2012 all RD patients were treated with PPV, independent of lens status and age.

[Efficacy of vitreorretinal surgery to improve best corrected visual acuity in diabetics with retinopathy]. / Eficacia de la cirugía vitreorretiniana para mejorar la capacidad visual en diabéticos con retinopatía.

BACKGROUND: complications of proliferative diabetic retinopathy require surgical treatment. In 2007 Flaxel reported visual improvement after vitreoretinal surgery in 37% of Latino diabetics; in our country it is estimated that a higher proportion of patients improves, but this has not been documented. AIM: to identify the efficacy of vitreoretinal surgery for improving best corrected visual acuity, in diabetic patients treated at a hospital in Mexico City. METHODS: an observational, longitudinal, retrospective, descriptive study was conducted in diabetics who underwent vitreoretinal surgery (2007-2010) with one year follow-up. Visual acuity was measured before surgery and one year after, and it was registered when the retinopexy orphacoemulsification was performed, or silicone tamponade wasused. The proportions and 95% confidence intervals (CI) of patients whose visual acuity improved, did not change or worsened, were compared with those reported by Flaxel in Latino patients (χ(2), relative risk [RR]). RESULTS: 63 patients, mean age 58.5 ± 11.6 years, 26 with retinal detachment (41.3%), phacoemulsification was performed in 50 (79.4%), and silicone was used in 27 (42.9%). BCVA worsened in 12 patients (19%), did not change in 5 (8%) and improved in 46 (73%, 95% CI 62-84); the latter proportion exceeded that reported by Flaxel (p = 0.0005, RR 1.97, 95% CI 1.25-3.1). DISCUSSION: although the difference was not clinically significant, the efficacy of vitreoretinal surgery to improve visual acuity in the sample was consistently higher than that reported by Flaxel in Latinos, and did not vary from other studies. These results do not support an association between an ethnic group and a lower surgical efficacy.