Outcomes of transconjunctival sutureless 27-gauge vitrectomy with silicone oil infusion.

PURPOSE: To demonstrate the safety and efficacy of 27-gauge pars plana vitrectomy (PPV) in selected patients with vitreoretinal diseases requiring silicone oil (SO) tamponade. METHODS: Retrospective review of a consecutive interventional case series at a single center. RESULTS: Twenty-one eyes of 19 patients were included in the study. The indications for PPV and SO tamponade were as follows: fibrovascular tractional retinal detachment (12 eyes), rhegmatogenous retinal detachment with proliferative vitreoretinopathy (three eyes), primary rhegmatogenous retinal detachment (two eyes), macular hole (two eyes), vitreous hemorrhage (one eye), and endophthalmitis (one eye). All eyes underwent transconjunctival sutureless 27-gauge PPV with either 1000-cS (16 eyes) or 5000-cS (five eyes) SO tamponade. No intraoperative complications occurred. Mean preoperative best-corrected visual acuity (BCVA) was 20/300 (range, light perception to 20/40; median, counting fingers). Mean postoperative BCVA was 20/160 (range, no light perception to 20/25; median 20/300; p = 0.022). Follow-up was 6.4 ± 8.8 months (range, 1-38 months; median, 4 months). No complications relating to 27-gauge placement of SO were observed. CONCLUSIONS: Results show that 27-gauge PPV with SO injection appears safe, is efficient, and may be considered for the surgical management of vitreoretinal diseases requiring SO tamponade.

LONG-TERM FOLLOW-UP OF INTRAOCULAR PRESSURE AFTER VITRECTOMY IN EYES WITHOUT PREEXISTING GLAUCOMA.

PURPOSE: To identify whether vitrectomy is associated with an increased risk of elevated intraocular pressure (IOP) and to report the incidence of open-angle glaucoma after vitrectomy. METHODS: In this retrospective case series of 234 consecutive patients without a history of glaucoma or diabetes undergoing primary unilateral vitrectomy for an idiopathic epiretinal membrane or macular hole with a minimum of 2 years follow-up, mean IOP in operative and fellow eyes were compared at baseline and multiple postoperative times. Eyes were also assessed for the development of open-angle glaucoma. RESULTS: The mean baseline IOP was 14.91 mmHg, and the mean final IOP was 14.6 (P = 0.278) in the operative eyes. Linear regression analysis of IOP in operative eyes from baseline to the final visit found an increase of 0.000047 mmHg per year compared with -0.00027 mmHg per year in the fellow eyes with no significant difference in the slope of the 2 regression lines (P = 0.27). Six vitrectomy eyes were diagnosed with new-onset open-angle glaucoma during a mean follow-up of 4.4 years; however, only one was not also diagnosed with glaucoma or ocular hypertension in the fellow unoperated eye. CONCLUSION: Vitrectomy does not seem to be correlated with increased risk of IOP elevation or glaucoma development in comparison with fellow control eyes.

COMBINED PHACOEMULSIFICATION SURGERY WITH MULTIFOCAL INTRAOCULAR LENS IMPLANTATION AND PARS PLANA VITRECTOMY FOR SYMPTOMATIC VITREOUS OPACITIES.

PURPOSE: To report surgical outcomes of combined vitrectomy for vitreous floaters and phacoemulsification surgery with multifocal intraocular lens implantation. METHODS: Retrospective, interventional, noncomparative case series of five eyes from five patients who underwent same-day combined phacoemulsification surgeries with apodized, diffractive multifocal intraocular lens implantation for cataract and pars plana vitrectomy for symptomatic vitreous opacities, that is, floaters. Primary outcomes were distance and near visual acuities, and resolution of symptoms. Secondary outcomes included intraocular pressure, refractive outcomes, and surgical complications. RESULTS: Mean logarithm of the minimum angle of resolution glare distance visual acuity improved from 0.36 (best-corrected Snellen 20/47) preoperatively to an uncorrected distance visual acuity of 0.05 (Snellen 20/23) at 6 months postoperatively (P = 0.042). All but one patient achieved multifocality with a near visual acuity of J2 or better. All patients noted subjective improvement in symptoms from floaters postoperatively. Mean intraocular pressure remained stable during follow-up. Two eyes ultimately required YAG capsulotomies for symptomatic posterior capsular opacification, one of which additionally received LASEK for refractive correction. CONCLUSION: Multifocality and improvement in symptoms from symptomatic vitreous opacities were observed in this pilot series of carefully selected patients who underwent combined phacovitrectomy with multifocal intraocular lens implantation. A high rate of retinal tears was found in these patients. Appropriate caution should be taken in preoperative assessment and patient selection for the combined procedure.