Extending the Limbus-to-Cannula Distance to 6.0 mm During Pars Plana Vitrectomy in Highly Myopic Eyes.

PURPOSE: To evaluate the utility of extending the limbus-to-cannula distance to 6.0 mm during pars plana vitrectomy for highly myopic eyes. METHODS: Four eyes with axial lengths exceeding 31.0 mm, that underwent 25-gauge pars plana vitrectomy were retrospectively evaluated. Assuming that cannulas were inserted 3.5 mm and 6.0 mm from the corneal limbus, the distance from the cannula to the fovea (CF distance) was preoperatively evaluated using anterior segmental optical coherence tomography. Surgical complications were also investigated. RESULTS: The CF distance was shortened by 1.22 ± 0.05 mm and 1.22 ± 0.09 mm on the temporal and nasal sides, respectively, by inserting the cannula at 3.5 mm to 6.0 mm from the corneal limbus. As per the preoperatively measured CF distance, one of the cannulas was inserted 6.0 mm from the corneal limbus in three eyes. Their cannulas were confirmed to be inserted at the pars plana, and no surgical complications associated with this technique were observed. CONCLUSION: Extending the limbus-to-cannula distance to 6.0 mm during pars plana vitrectomy could be one of the options to reach the posterior pole in highly myopic eyes. A preoperatively measured CF distance can be a clinical criterion in determining the cannula position.

Retrospective comparison of 25-gauge vitrectomy for repair of proliferative vitreoretinopathy with or without anterior proliferation.

PURPOSE: The purpose of the study was to compare the outcomes of 25-gauge vitrectomy for the repair of rhegmatogenous retinal detachment (RRD) complicated by proliferative vitreoretinopathy (PVR) with and without anterior PVR (A-PVR). METHODS: We reviewed the medical records of 26 eyes of 26 patients who underwent 25-gauge vitrectomy for grade C PVR with A-PVR and 16 eyes of 16 patients who underwent the same procedure for grade C PVR without A-PVR. RESULTS: The number of previous surgeries for RRD was significantly higher in A-PVR cases than in those without A-PVR (P = 0.021). Scleral buckling and retinotomy/retinectomy were performed significantly more frequently in A-PVR eyes than in those without A-PVR (P = 0.017 and <0.001, respectively). The A-PVR eyes required longer surgical times than those without A-PVR (P =0.001). Final anatomical success was achieved in 24 of 26 (92.3 %) eyes with A-PVR and 16 of 16 (100 %) eyes without A-PVR (P =0.517). Best-corrected visual acuity before and six months after vitrectomy was 1.41 ± 0.96 and 0.86 ± 0.78 logarithm of minimal angle of resolution (logMAR) units, respectively, in eyes with A-PVR and 1.17 ± 0.87 and 0.63 ± 0.72 logMAR units, respectively, in eyes without A-PVR (P =0.355 and 0.276, respectively). CONCLUSIONS: These results indicate that 25-gauge vitrectomy can be used for both types of PVR, although eyes with A-PVR may require scleral buckling and retinotomy/retinectomy more often and may require longer surgical times.

[Retrospective comparison of 25-gauge vitrectomy with 20-gauge vitrectomy in the repair of retinal detachment complicated with proliferative vitreoretinopathy].

PURPOSE: To compare the surgical outcomes of 25-gauge vitrectomy with that of 20-gauge vitrectomy for the repair of retinal detachment complicated with proliferative vitreoretinopathy (PVR). METHODS: Forty-one eyes of 40 patients (17 women, 23 men), who underwent vitrectomy for grade C PVR and had at least 6 months of follow-up period, were investigated retrospectively. The mean age of the patients was 44.6 years (range; 13-78 years). Twenty eyes underwent vitrectomy with a 25-gauge system (25 G Group, including 5 cases with hybrid surgery, i.e., vitrectomy conducted mostly with a 25-gauge and partially with 20-gauge instruments) and 21 eyes had vitrectomy with a 20-gauge system(20 G Group). The intraoperative technique used for vitreous surgery, the number of vitrectomy procedures, the length of the surgery, the surgical success rate, the best-corrected visual acuity (BCVA) and intraocular pressure (IOP) both before and after the vitrectomy were compared between the two groups. RESULTS: There was no significant difference in preoperative background between the two groups. The number patients with inner limiting membrane peeling was significantly higher in the 25 G Group than in the 20 G Group (p = 0.020). There were no significant differences in the number of vitrectomies, surgical time and the rate of retinal reattachment between the two groups (25 G Group; 95.0%, 20 G Group; 85.7%). The BCVAs 6 months after the surgery were significantly better than preoperative BCVAs in both 25 G (p < 0.001) and 20 G Group (p = 0.003). In the 25 G Group, the BCVA was significantly improved 1, 3, and 6 month(s) after the surgery compared to before surgery (p < 0.05), while, in the 20 G Group, the BCVA was significantly improved 3 and 6 months after the surgery (p < 0.05). In addition, the BCVA 6 months after the surgery was significantly (p = 0.010) better in the 25 G Group than in the 20 G Group. There was no significant difference in either the pre- or the postoperative IOP between the two groups, while the rate of the cases with hypotony of less than 5 mmHg was significantly higher (p = 0.048) in the 20 G Group than in the 25 G Group. CONCLUSIONS: These results suggest that, although vitrectomy only with 25-gauge system proved insufficient, 25-gauge vitrectomy may achieve the surgical outcomes for the repair of retinal detachment complicated with PVR equal to or higher than 20-gauge vitrectomy.

[Long-term prognosis of 5 cases with stage 3A Coats disease after vitrectomy].

PURPOSE: The effectiveness of laser photocoagulation and/or cryopexy to the abnormal retinal vessels for the treatment of eyes with Coats disease is reported. However, in Coats cases with serous detachment laser photocoagulation and/or cryopexy is sometimes not enough to coagulate and consecutively scar the abnormal vessels, leading to persistent subretinal fluid and multiple courses of treatment. Therefore, we investigated the long-term prognosis of Stage 3A Coats cases with macular detachment which underwent vitrectomy. METHODS: Five eyes of 5 cases (all men) with Stage 3A Coats disease, which underwent primary vitrectomy between 1999 and 2009, were investigated retrospectively. The average age at vitrectomy was 13.8 years (range; 6-21 years) and the average preoperative visual acuity in decimal equivalent was 0.1 (range; 0.04-0.5). The average follow-up period after vitrectomy was 83 months (range; 13-137 months). In the vitrectomy, posterior vitreous detachment either occurred or was confirmed. An intentional retinal hole was made and the subretinal fluid was drained through the hole. The abnormal vessels were coagulated by endo-diathermy and/or laser photocoagulation. The vitreous fluid was replaced with long-lasting gas or air. The visual acuity and the findings from the ocular fundus both before and after the vitrectomy were investigated. RESULTS: The average best-corrected visual acuities in decimal equivalent before, 3 and 12 months after the vitrectomy, and at the final visit were 0.1, 0.2, 0.2, 0.4, respectively. There was a statistically significant (p = 0.007) difference between the 4 time points, and the visual acuities at 12 months after vitrectomy and the final visit were significantly (p < 0.05) better than before the vitrectomy. The macular part of the retina in all 5 cases was attached once the gas in the vitreous cavity had disappeared. The foveal exudation which was observed before the vitrectomy in all 5 cases was completely absorbed after the vitrectomy. The average period from the vitrectomy to the complete absorption of the exudation was 20 months. Subfoveal fibrosis was observed in 4 of the 5 eyes and chorioretinal atrophy occurred in 3. CONCLUSIONS: Vitrectomy for eyes with Stage 3A Coats disease may be effective for visual prognosis compared to conventional therapy, i.e., laser photocoagulation and cryopexy, by enabling retinal attachment in the early postoperative period and by causing the foveal exudation to disappear.

[Comparison of vitrectomy outcomes for eyes with proliferative vitreoretinopathy with and without prior vitrectomy].

PURPOSE: To compare the surgical outcomes of vitrectomy for eyes with proliferative vitreoretinopathy (PVR) with and without prior vitrectomy. METHODS: Eighty-two eyes of 81 patients (35 women and 46 men), who underwent vitrectomy for grade C PVR and had at least 6 months of follow-up, were studied retrospectively. The mean age of the cases was 50.8 years (range; 8-84 years). Twenty-eight eyes had undergone prior vitrectomy (vitrectomized group) and 54 eyes had no prior vitrectomy (primary vitrectomy group). The intraoperative technique of vitreous surgery, number of vitrectomy procedures, surgical success rate, visual acuity and intraocular pressure before and 6 months after the vitrectomy of the two groups were compared. RESULTS: The rate of the anterior (type 4 and 5) PVR cases was significantly higher in the vitrectomized group than in the primary vitrectomy group (p = 0.028), whereas the rate of the only subretinal cases (type 3) PVR was significantly higher in the primary vitrectomy group (p<0.001). There were no significant differences in the preoperative visual acuity and intraocular pressure between the two groups. The rate of the cases who underwent retinotomy/retinectomy was significantly higher (p< 0.001)in the vitrectomized group than in the primary vitrectomy group. The surgical success rate and postoperative visual acuity were significantly better in the primary vitrectomy group than in the vitrectomized group (p = 0.040, <0.001, respectively). The postoperative intraocular pressure was significantly lower (p = 0.017) in the vitrectomized group than in the primary vitrectomy group, and the rate of the cases with hypotony of less than 5mmHg was significantly higher (p<0.001) in the vitrectomized group than in the primary vitrectomy group. CONCLUSIONS: Compared to the PVR eyes that had had no prior vitrectomy, the PVR eyes that underwent prior vitrectomy had a significantly higher rate of complications of anterior PVR and a significantly higher rate of retinotomy/retinectomy, leading to a significantly poorer surgical outcomes.

Accuracy of the Barrett Universal II formula integrated into a commercially available optical biometer when using a preloaded single-piece intraocular lens.

PURPOSE: To compare the commonly used formulas for intraocular lens (IOL) selection using IOLMaster®700 (Carl Zeiss Meditec) and to evaluate the Barrett Universal II (BU-II) formula accuracy when using the Vivinex™ iSert® XY1 IOL (Hoya Corporation Medical Division). METHODS: A retrospective chart review was performed that included patients who underwent uneventful cataract surgery with in-the-bag insertion of Vivinex™ iSert® XY1 IOL. Prediction errors at 3 months postoperative of IOLMaster® 700 with Haigis, Holladay 1, SRK/T, and BU-II formulas were compared. As a subgroup analysis, we focused on the axial length (AL) and IOL power. AL subgroup analysis was based on the following AL subgroups: short (<22.5 mm), medium (22.5-25.5 mm), and long (>25.5 mm). IOL power subgroup analysis was based on the following IOL power subgroups: low (≤18.0 diopters [D]), medium (18.5-24.0 D), and high (≥24.5 D). RESULTS: This study included 590 eyes of 590 patients. Overall, the four IOL calculation formulas appeared to be similarly accurate. In the long AL subgroup, the BU-II formula had a significantly lower absolute error (AE) than the Holladay 1 formula. In the low-power subgroup, the BU-II formula had a significantly lower AE than the Holladay 1 and SRK/T formulas. On the other hand, in the high-power subgroup, the BU-Ⅱ formula was significantly less accurate than the SRK/T formula and also appeared to be worse than the Holladay 1 formula (P = 0.052). CONCLUSION: The BU-II formula might be less accurate when using a Vivinex™ iSert® XY1 IOL of 24.5 D or greater.

Severe intraocular inflammation after intravitreal injection of bevacizumab.

PURPOSE: To report 5 cases of severe intraocular inflammation that developed after an intravitreal injection of the same lot of bevacizumab. DESIGN: Retrospective case series. PARTICIPANTS: Patients treated with an intravitreal injection of bevacizumab (lot B3003B01). METHODS: The clinical charts of 35 eyes of 35 consecutive patients who were treated with intravitreal injection of lot B3003B01 bevacizumab from December 18, 2008, through January 20, 2009, were reviewed. MAIN OUTCOME MEASURES: Incidence of intraocular inflammation, results of bacterial cultures, best-corrected visual acuity (BCVA), and endothelial cell density. RESULTS: Five (14.3%) of the 35 cases had severe intraocular inflammation, and the inflammation had some characteristics of toxic anterior segment syndrome (TASS). Five of the 5 cases had a predominantly anterior chamber reaction, and 4 of the 5 cases were accompanied by hypopyon. Undiluted samples collected from both the aqueous and vitreous of the 5 cases were culture negative. The BCVA was 0.66+/-0.29 (mean+/-standard deviations) logarithm of the minimum angle resolution (logMAR) units, and the endothelial cell density was 2683.6+/-97.3/mm(2) before the intravitreal bevacizumab. At the final visit, the BCVA was 0.44+/-0.36 logMAR units, and the cell density was 2679.0+/-217.5/mm(2). These differences were not significant (P = 0.171 and 0.964). CONCLUSIONS: These observations indicate that an intravitreal injection of bevacizumab can induce sterile endophthalmitis that has characteristics of TASS.

[Efficacy of intravitreal bevacizumab for age-related macular degeneration].

PURPOSE: To investigate the efficacy of intravitreal bevacizumab (IVB) for neovascular age-related macular degeneration (AMD). METHODS: We conducted a retrospective study of 29 eyes of 29 patients with AMD (19 eyes) and polypoidal choroidal vasculopathy (PCV; 10 eyes), who were followed up at least 1 year after the initial IVB (1.0 mg/0.04 ml). The eyes were classified according to the lesion type and size. Best-corrected visual acuity (BCVA) and central retinal thickness were examined before and 3 months, 6 months and 12 months after the IVB. RESULTS: The mean application times of IVB were 2.1 in 1 year. When classifying the eyes according to the lesion type, BCVA improved in 5 (26.3%) eyes with AMD and 1 (10.0%) eye with PCV by over 0.2 logarithmic minimum angle of resolution (logMAR) units. The BCVA decreased significantly 1 year after the IVB in eyes with PCV (p = 0.032). When classifying the eyes according to the lesion size, BCVA improved by over 0.2 logMAR units in the 4 (50.0%) eyes with a size of less than 1 disc diameter, 1 (10.0%) eye with the size of 1 to 3 disc diameters, and 1 (9.1%) eye with the size of over 4 disc diameters. The BCVA decreased significantly 1 year after the IVB in the eyes with the size of 1 to 3 disc diameters and with the size of over 4 disc diameters (p = 0.028, 0.013, respectively). The central retinal thickness did not change significantly at any time point compared to that before the IVB. CONCLUSIONS: These results suggest that IVB may be efficacious in preserving visual acuity in AMD eyes and in eyes with the size of less than 1 disc diameter.

Foveal Crack Sign: An OCT Sign Preceding Macular Hole After Vitrectomy for Rhegmatogenous Retinal Detachment.

PURPOSE: To describe an optical coherence tomography (OCT) sign preceding macular hole (MH) formation after pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD). DESIGN: Retrospective observational case series. METHODS: Patients who underwent PPV for RRD at Osaka Rosai Hospital between January 2014 and December 2017 were examined. First, the medical records of the patients who had secondary MH after RRD repair were examined, and their sequential changes of the OCT images until MH formation were evaluated. Second, the OCT findings and the medical records of all patients who underwent PPV for RRD were evaluated based on the findings of the cases of secondary MH. RESULTS: Ten eyes of 10 patients who had secondary MH after PPV for RRD were enrolled. Before MH formation, all eyes had parafoveal epiretinal membrane (ERM) and a characteristic OCT sign that was termed a foveal crack sign (FCS), a hyperreflective vertical line in the foveola with a deformation of the fovea. FCS was found 255 ± 217 days after PPV for RRD, and MH developed 232 ± 171 days after FCS appearance. Furthermore, among 518 eyes that underwent PPV for RRD, FCS with parafoveal ERM was found in 3 eyes without succeeding MH after RRD repair. FCS of these 3 eyes were found 363 ± 4 days after PPV for RRD. CONCLUSIONS: In all cases of secondary MH formation after PPV for RRD, FCS with parafoveal ERM was found before MH formation. This sign may predict secondary MH formation caused by ERM traction.

Impact of vitrectomy and air tamponade on aspheric intraocular lens tilt and decentration and ocular higher-order aberrations: phacovitrectomy versus cataract surgery.

PURPOSE: To evaluate the impact of vitrectomy and air tamponade on aspheric intraocular lens (IOL) tilt and decentration and postoperative internal higher-order aberrations (HOAs) in combined cataract surgery and vitrectomy (phacovitrectomy). STUDY DESIGN: Prospective comparative observational study. METHODS: Forty-five eyes that underwent phacovitrectomy using aspheric IOLs and 18 eyes that only underwent cataract surgery also using aspheric IOLs were prospectively evaluated. The subjects were divided into three groups: phacovitrectomy without fluid-air exchange (F/Ax) or with F/Ax and cataract surgery alone (Groups A, B, and C, respectively) Surgery-induced changes in lens tilt and decentration and internal HOAs were compared between each pair of groups. Subgroup analysis was conducted for cases with largely tilted (> 7°) or decentered (> 0.40 mm) IOLs 1 month postoperatively. RESULTS: Surgery-induced changes in lens tilt in Group B were significantly more pronounced than those in Group C at 1 week, 1 month, and 3 months postoperatively (P = 0.007, 0.009, and 0.043, respectively), while there was no significant difference in surgery-induced changes in lens decentration among the groups. IOLs in Group B were tilted and decentered toward the inferonasal direction. In contrast, there was no significant difference in internal HOAs among the groups at any postoperative visit. Only Group B included cases with largely decentered IOLs, and the internal total HOAs in these cases were significantly larger than those in the others (P = 0.015). CONCLUSION: Although largely decentered IOLs were occasionally found in Group B, aspheric IOLs could be effectively used in phacovitrectomy.

Risk Factors, Onset, and Progression of Epiretinal Membrane after 25-Gauge Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment.

PURPOSE: To investigate the risk factors, onset timing, and progression of epiretinal membrane (ERM) after pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD). DESIGN: Retrospective, comparative case series. PARTICIPANTS: The study included 322 eyes of 322 patients who underwent primary PPV for RRD from January 2014 through December 2016. METHODS: Patients underwent OCT before and 1, 3, 6, and 12 months after surgery. Patients showing hyperreflective lines above the inner retinal surface and deformation of the foveal pit were defined as ERM cases. Those with loss of the foveal pit were defined as advanced ERM cases. A multivariate logistic regression model was used to evaluate the risk factors of postoperative ERM. The onset timing of ERM and progression to advanced ERM after PPV for RRD were also investigated based on the OCT findings. MAIN OUTCOME MEASURES: Risk factors, onset timing, and progression of ERM after PPV for RRD. RESULTS: In the multivariate analysis, the incidence of postoperative ERM was significantly higher in eyes with preoperative vitreous hemorrhage (VH; P = 0.011) and without internal limiting membrane (ILM) peeling (P < 0.001). Among the patients who underwent ILM peeling, none demonstrated postoperative ERM. Postoperative ERM was observed in 39 of the 322 eyes (12.1%) within 1 year after surgery; in 30 of these eyes (76.9%), ERM occurred within 3 months after surgery. Advanced ERM was observed in 12 eyes (12/39 eyes [30.8%]). Among these, 9 eyes (9/12 eyes [75%]) showed progression within 3 months after surgery. CONCLUSIONS: Preoperative VH can increase the occurrence of postoperative ERM. In most patients with ERM, the occurrence and progression were detected relatively early after surgery; therefore, in high-risk patients, careful follow-up is encouraged until 3 months after surgery.

[Efficacy of treatments on vision-related quality of life in patients with diabetic retinopathy].

PURPOSE: To evaluate changes in the vision-related quality of life in patients with diabetic retinopathy with the 25-item National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25). Patients were categorized into three groups : without treatment, receiving pan-retinal photocoagulation, and those who had vitrectomy. SUBJECTS AND METHODS: Altogether 327 patients (131 without treatment, [observation group]; 60 receiving pan-retinal photocoagulation, [photocoagulation group]; and 136 patients who had vitrectomy, [vitrectomy group]). The VFQ-25 was recorded at the time of entry and 1 year later. The VFQ-25 score was compared between the time of entry and 1 year later for each group and among the three groups at both the time of entry and 1 year later. RESULTS: VFQ-25 scores (mean +/- standard deviations) at the time of entry and 1 year later were 91.3 +/- 7.8 and 92.2 +/- 7.8 in the observation group, 80.7 +/- 15.7 and 77.6 +/-19.1 in the photocoagulation group, and 67.4 +/-17.3 and 75.4 +/- 17.5 in the vitrectomy group. VFQ-25 scores in the observation group and in the photocoagulation group did not change statistically between the time of entry and 1 year later (p = 0.113, 0.169, respectively), while the score of the vitrectomy group increased statistically (p < 0.001). In addition, although VFQ-25 scores were statistically significant among the three groups at the time of entry (p < 0.05), the scores 1 year later were not statistically different between the photocoagulation group and vitrectomy group. CONCLUSIONS: These results suggest that vitrectomy for diabetic retinopathy may be effective in increasing the quality of life of patients with diabetic retinopathy.

[Evaluation of the efficacy of intravitreal gas injection for submacular hemorrhages].

PURPOSE: To evaluate the efficacy of intravitreal gas injection for submacular hemorrhages(SMH). PATIENTS AND METHODS: The records of 29 patients with SMH, who were treated by pneumatic displacement with expansile gas, were reviewed retrospectively. RESULT: In observable cases, SMH had started moving within five days after the procedure. After 6 months visual acuity had been improved 2 or more lines in 23 eyes(79%). The causes of SMH were age-related macular degeneration (17 eyes) and microaneurysm (12 eyes). The larger the size of SMH, had the greater the risk of developing vitreous hemorrhage. Twelve eyes of the 29 eyes required vitrectomy owing to vitreous hemorrhage, insufficient removal of SMH, etc. but this pneumatic procedure often eliminated the need for vitrectomy. The visual acuity of the patients with additional vitrectomy was improved with only pneumatic displacement. None of the patients had serious complications with this pneumatic procedure and the vitrectomy. CONCLUSION: The first choice for SMH is intravitreal gas injection which saves foveal function, and improves the prognosis for better vision.

[Efficacy of vitreous surgery for uveal effusion syndrome].

PURPOSE: To evaluate the efficacy of pars plana vitrectomy for uveal effusion syndrome retrospectively. SUBJECTS AND METHODS: Six patients (six eyes) with uveal effusion syndrome(UE) underwent vitrectomy followed by internal drainage of subretinal fluid, fluid-gas exchange, and pan-retinal photocoagulation. Three of these cases with nanophthalmos underwent silicone oil injection. RESULTS: The retina became reattached in all cases. The silicone oil was not removed in two of the three cases with nanophthalmic eyes. Two cases of the three cases with nanophthalmic eyes needed to perform full thickness sclerostomy additionally, and in one case subchoroidal hemorrhage occurred. The visual acuity finally improved in five out of the six eyes. CONCLUSIONS: In cases of uveal effusion without nanophthalmic, vitrectomy hastens quick reattachment of the retina and may result in better visual outcome. But in cases of nanophthalmic eyes, it would be better to perform sclerostomy first.

[Influence of vitrectomy for diabetic retinopathy on health-related quality of life].

PURPOSE: To evaluate the vision-related quality of life (QOL) in patients undergoing vitrectomy for diabetic retinopathy with the Japanese version of the 25-item National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25). SUBJECTS AND METHODS: Subjects were 87 patients undergoing vitrectomy for diabetic retinopathy of vitreous hemorrhage, macular edema, or fibrovascular membrane, only for the subject eye, or for subjects undergoing vitrectomy for the fellow eye within 6 months or later. The VFQ-25 date was recorded one month before and 6 months after the vitrectomy. The VFQ-25 data were compared before and after the vitrectomy. The subjects were classified by the pathological condition: 41 eyes with vitreous hemorrhage, 28 eyes with macular edema, and 18 eyes with fibrovascular membrane. RESULTS: The average VFQ-25 scores of all the patients increased in almost all of the 12 subscales. Vitrectomy for vitreous hemorrhage was most effective in improving the VFQ-25 score, in improving 10 of the 12 subscales in the VFQ-25, and in increasing VFQ-25 scores to almost the same level as in phacoemulsification and foldable intraocular lens implantation for cataract patients in both eyes. CONCLUSION: NEI VFQ-25 quantitatively clarified that vitrectomy for diabetic retinopathy is effective in increasing the QOL of diabetic retinopathy patients.

Influence of Surgical Procedures and Instruments on the Incidence of Suprachoroidal Hemorrhage during 25-gauge Pars Plana Vitrectomy.

PURPOSE: To evaluate the influence of surgical procedures and instruments that are associated with intraocular pressure (IOP) fluctuations on the incidence of suprachoroidal hemorrhage (SCH) during 25-gauge pars plana vitrectomy (25G-PPV), and to investigate the clinical features of SCH during 25G-PPV. DESIGN: Retrospective, comparative case series. PARTICIPANTS: A total of 3034 cases that underwent initial 25G-PPV at a single surgical center. METHODS: Univariate analysis was performed to evaluate the relationships between the incidence of SCH during 25G-PPV and the surgical procedures and instruments that were associated with IOP fluctuations. The participants were divided into 4 groups that underwent the following procedures: neither fluid-air exchange nor vitreous shaving under scleral depression (group 1, n = 1144); fluid-air exchange alone (group 2, n = 463); vitreous shaving under scleral depression alone (group 3, n = 639); and both procedures (group 4, n = 788). The incidence of SCH in each group was compared. The clinical features and surgical outcomes of SCH during 25G-PPV were also investigated. MAIN OUTCOME MEASURES: The incidence of SCH during 25G-PPV and the clinical features and surgical outcomes of SCH during 25G-PPV. RESULTS: The incidence of SCH was significantly higher in cases that underwent fluid-air exchange (P = 0.0047) or vitreous shaving under scleral depression (P = 0.0157). There were no significant relationships between the incidence of SCH and the use of surgical instruments. The incidence of SCH in group 4 (8/788, 1.02%) was significantly higher than that in groups 1 (1/1144, 0.09%), 2 (0/463, 0%), and 3 (0/639, 0%) (P = 0.01). Almost all SCH cases were localized, and there were no cases of SCH involving the posterior pole. Of all the SCH cases, only one case required reoperation for retinal redetachment. No cases required secondary surgical management for SCH. CONCLUSIONS: There remains a slight risk of SCH during 25G-PPV in cases that require both fluid-air exchange and vitreous shaving under scleral depression. Even if SCH occurs during 25G-PPV, the surgical outcomes after SCH may not be substantially worse.

Effect of indocyanine green staining in peeling of internal limiting membrane for retinal detachment resulting from macular hole in myopic eyes.

PURPOSE: To investigate the effect of using indocyanine green (ICG) to stain the internal limiting membrane (ILM) during vitrectomy in eyes with retinal detachment resulting from macular hole (MHRD). DESIGN: Nonrandomized comparative trial. PARTICIPANTS: Thirty-two cases of MHRD. INTERVENTION: The medical records of the cases were reviewed retrospectively. During the initial vitrectomy, the ILM was peeled in 22 eyes with ICG (group A) and in 10 eyes without ICG (group B). MAIN OUTCOME MEASURES: Anatomic reattachment, visual acuity, and optical coherence tomography-determined macular hole closure were measured. RESULTS: The initial reattachment rate in group A (86%) was significantly higher than in group B (40%; P = 0.013, Fisher exact test). The postoperative visual acuity at 6 months and the visual improvements at 6 and 12 months in eyes with an initial reattachment were not significantly different between the 2 groups (P = 0.123, Mann-Whitney rank-sum test; P = 0.17, t test; P = 0.237, t test). The postoperative visual acuity at 12 months with an initial reattachment in group A was significantly better than in group B (P = 0.039, t test). The macular hole closure rate with an initial reattachment was 6 of 17 eyes (35%) in group A and 0 of 4 eyes (0%) in group B, and this difference was not significant (P = 0.281, Fisher exact test). CONCLUSIONS: These results show that ICG staining improves the initial reattachment rate and is associated with better postoperative visual acuity at 12 months. Therefore, ICG staining should be used during vitrectomy for MHRD because the complete removal of the ILM with ICG ensures the removal of the tangential traction by an epiretinal membrane and the inverse traction by the retina that cannot follow the posterior enlargement of a staphyloma.

Retrospective comparisons of vitrectomy with and without air tamponade to repair lamellar macular hole.

BACKGROUND AND OBJECTIVE: To investigate the surgical outcomes of vitrectomy with to that without air tamponade in eyes with a lamellar macular hole. PATIENTS AND METHODS: The medical records of 23 eyes that underwent 25-gauge vitrectomy with air tamponade and 18 eyes that underwent 25-gauge vitrectomy alone were reviewed. RESULTS: The pre- and postoperative best corrected visual acuities (BCVAs) in logarithm of the minimum angle resolution units were 0.26 ± 0.27 and 0.12 ± 0.15 in eyes with tamponade and 0.35 ± 0.30 and 0.14 ± 0.23 in eyes without tamponade. There were no significant differences in BCVAs between the two groups both pre- and postoperatively. Postoperative BCVA was significantly improved in eyes with tamponade (P = .023) and without tamponade (P < .001). None of the cases developed a full-thickness macular hole postoperatively. CONCLUSION: These results suggest that air tamponade may not be required during vitrectomy to achieve good BCVA and anatomic closure in eyes with a lamellar macular hole.