A Population-Based Analysis of Long-Term Costs and Adverse Events after Pneumatic Retinopexy and Pars Plana Vitrectomy.

PURPOSE: To comprehensively examine the cost effectiveness, reattachment rate, and complications of pneumatic retinopexy (PnR) compared with pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) within a universal health care system. DESIGN: Population-based, multicenter, consecutive, retrospective longitudinal cohort analysis. SUBJECTS: We identified consecutive adults aged ≥ 50 years requiring surgery for primary RRD over a 20-year interval between April 1, 2002, and March 31, 2022. Initial surgery was considered the index date for analyses. INTERVENTION: Pneumatic retinopexy was compared with PPV in all analyses. MAIN OUTCOME MEASURES: The primary analysis investigated the mean annualized health care costs comparing PnR to PPV over the 2 years after initial surgery. Secondary analyses examined the primary reattachment rate and complications. RESULTS: In total, 25 665 eligible patients were identified, with 8794 undergoing PnR and 16 871 undergoing PPV. The mean patient age was 65 years and 39% were women. The mean annualized cost after PnR was $8924 and $11 937 after PPV (mean difference, $3013; 95% confidence interval, $2533-$3493; P < 0.001). The primary reattachment rate at 90 days after PnR was 83% and after PPV was 93% (P < 0.001). The risk of cataract or glaucoma surgery was lower after PnR, and the frequency of ophthalmology clinic visits, intravitreal injections, and anxiety was higher after PnR. Hospitalizations and long-term disability were less frequent after PnR. CONCLUSIONS: Pneumatic retinopexy, when compared with PPV, was associated with lower long-term health care costs. Pneumatic retinopexy appeared to be effective, safe, and inexpensive, thus offering a viable option for improving access to RRD repair in appropriately selected cases. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Comparison of Methods of Endotamponade Used During 23-Gauge Pars Plana Vitrectomy and the Risk of Raised Intraocular Pressure During 24-Month Follow-Up: A Retrospective Study of 196 Patients.

BACKGROUND Pars plana vitrectomy (PPV) is used to treat retinal conditions, including retinal detachment, and involves removal of the vitreous gel from the eye. Complications following PPV include raised intraocular pressure (IOP). This retrospective study aimed to compare methods of endotamponade used during 23-gauge PPV and the risk of raised IOP during 24-month follow-up at a single center. MATERIAL AND METHODS The study included 196 patients (age, 15-86 years; mean, 63.5 years) (196 eyeballs). There were 93 patients (47.45%) with a preoperative history of type 2 diabetes mellitus and 14 patients (7.14%) with a history of myopia. IOP was measured with Goldmann applanation tonometry at one-, three-, six-, 12-, and 24-month follow-up. The outcome was compared following endotamponade with silicone oil, sulfur hexafluoride (SF6), and balanced salt solution (BSS). RESULTS Mean IOP at one-month follow-up was 17.2 mmHg (±3.61 mmHg; range, 9-45 mmHg), and at 24-month follow-up was 17.3 mmHg (±3.23 mmHg; range, 7-30 mmHg). IOP following PPV was significantly associated with the indication for PPV (P=0.023), and the type of endotamponade used (P=0.049). In patients with silicone oil endotamponade, the risk of IOP at 24 months was increased by 2.3 times compared with SF6 or BSS endotamponade. Patients with SF6 endotamponade had a risk of IOP that was 3.3 times lower than for silicone oil tamponade or BSS tamponade. CONCLUSIONS Silicone oil endotamponade in PPV was associated with an increased risk of IOP at 24-month follow-up.

Pars plana vitrectomy to repair retinal detachment following brachytherapy for uveal melanoma.

AIMS: Retinal detachment can develop following brachytherapy for uveal melanoma. This complication may result in substantial visual loss and poses a significant therapeutic dilemma due to the required surgical intervention for correction of the detachment. We report the incidence of retinal detachment in eyes treated with brachytherapy for posterior uveal melanoma and the outcome of pars plana vitrectomy in those eyes. METHODS: Patients who developed tractional or combined tractional-rhegmatogenous retinal detachment following brachytherapy for posterior uveal melanoma in a single referral centre were retrospectively evaluated. Clinical findings, demographics, and ophthalmic imaging findings were recorded, as well as the manner of treatment and its success. RESULTS: Seven of the 473 posterior uveal melanoma patients (1.48%), who were treated between 2000 and 2011 with brachytherapy, developed tractional or combined tractional-rhegmatogenous retinal detachment. Retinal detachment developed at a mean of 50.1 months (range 3.5-120 months) following brachytherapy. All patients underwent pars plana vitrectomy. Retinas remained attached in each of the cases. In five of seven patients there was substantial improvement in visual acuity following repair of the retinal detachment. No tumour growth or dissemination were observed during the mean follow-up of 18.4 months after vitrectomy (range 10-36 months). CONCLUSIONS: Tractional and tractional-rhegmatogenous retinal detachment are rare complications of treated uveal melanoma. Pars plana vitrectomy appears to be an effective and safe procedure in such cases.

[Clinical course of pars planitis in patients treated with selective photocoagulation]. / Pacientes con pars planitis tratados con fotocoagulación selectiva: curso clínico.

INTRODUCTION: Pars planitis is an intermediate uveitis with bilateral and asymmetric presentation. The etiology is unknown and pathogenesis is unclear. Treatment follows the algorithm of Foster, which includes selective photocoagulation. The mechanism of action of photocoagulation is still unknown. MATERIAL AND METHODS: An observational, longitudinal, ambispective cohort study was performed with the objective of evaluating the course of inflammation in patients with pars planitis treated with a selective argon laser. RESULTS: The study included 29 patients (10 female and 19 male) diagnosed with pars planitis and were treated with selective laser. The mean age of onset was 11.77 years. Eighteen (62.1%) patients were not immunosuppressed at the time of receiving the selective laser, and 11 (37.9%) were taking immunosuppressants. Indications for selective laser were; following the algorithm, 19 (65.55%), vitreous hemorrhage 7 (24.1%), vitrectomy 2 (6.98%), and neovascularization 1 (3.4%). The mean time for inflammation reduction was 5.9 months, and 17 patients (58.6%) had no relapse. Visual acuity showed improvement post-laser (OD P=.025 and OI P=.022). There was also an improvement in vitreous cells. CONCLUSION: Selective laser was effective in 58.6%% of patients.

Posterior assisted levitation (PAL) by using Akahoshi/Wahab irrigating pars plana levitator.

OBJECTIVE: To assess the outcome of irrigating Akahoshi/Wahab pars plana levitator for posterior assisted levitation in dropped nucleus during phacoemulsification. STUDY DESIGN: A case series. PLACE AND DURATION OF STUDY: Ophthalmology Unit-III, Dow University of Health Sciences at Sindh Government Lyari General Hospital and Al-Noor Eye Hospital, Karachi, from January 2008 to December 2009. METHODOLOGY: Cases of dropped nucleus during phacoemulsification were recruited. Predisposing factors and stage of phacoemulsification at which dropped nucleus were recognized. Levitator was inserted through pars plana after vitrectomy around nucleus and levitation was carried out. Follow-up was done till 6 months. RESULTS: Thirty two patients including 18 males (56.3%) and 14 females (43.8%) underwent pars plana levitation. Predisposing factors were pupillary miosis in 9 cases, Brunescent cataract in 7 cases, pseudoexfoliation in another 7 cases, hypermature cataract in 5 cases and extended capsulorrhexis in 4 cases. Posterior capsular rent occurred in 22 (68.8%) cases while zonular dehiscence / rupture were found in 10 cases (31.3%). Nuclei were dropped during quadrant aspiration in 10 cases (31.3%) and during chopping in 8 cases (25%). Another 5 cases (15.6%) occurred during each hydrodissection and chopping while 4 cases (12.5%) were found during sculpting of nuclei. Final best corrected visual acuity was 6/12 and better in 22 cases (68.8%) while in 10 cases (31.3%) it was 6/18 to 6/36. No complication related to pars plana levitator was observed. CONCLUSION: Posterior assisted levitation of dropped nucleus during phacoemulsification by irrigating Akahoshi/Wahab pars plana levitator is a fast and safe surgical technique.

Utility of large spot binocular indirect laser delivery for peripheral photocoagulation therapy in children.

The purpose of this article is to demonstrate the utility of the large spot size (LSS) setting using a binocular laser indirect delivery system for peripheral ablation in children. One patient with bilateral retinopathy of prematurity received photocoagulation with standard spot size burns placed adjacently to LSS burns. Using a pixel analysis program called Image J on the Retcam picture, the areas of each retinal spot size were determined in units of pixels, giving a standard spot range of 805 to 1294 pixels and LSS range of 1699 to 2311 pixels. Additionally, fluence was calculated using theoretical retinal areas produced by each spot size: the standard spot setting was 462 mJ/mm2 and the LSS setting was 104 mJ/mm2. For eyes with retinopathy of prematurity, our study shows that LSS laser indirect delivery halves the number of spots required for treatment and reduces fluence by almost one-quarter, producing more uniform spots.

Laser photocoagulation in intermediate uveitis associated with retinoschisis.

PURPOSE: To describe cases of pars planitis associated with retinoschisis, in which laser photocoagulation was carried out. METHODS: Retrospective review. RESULTS: Three pars planitis cases were associated with retinoschisis and underwent laser photocoagulation. All cases were idiopathic. Retinoschisis was located in the inferior retinal quadrants in all cases and all of them were in bullous formation. None of the cases developed retinal detachment. CONCLUSION: As well as posterior vitreous detachment, or peripheral retinal tears, retinoschisis may accompany pars planitis. Laser photocoagulation of the pars plana is effective in these cases both as a treatment and to prevent sight-threatening complications like retinal detachment.

Pars plana vitrectomy for vitreo-retinal complications of birdshot chorioretinopathy.

PURPOSE: To evaluate the anatomical and functional outcomes of pars plana vitrectomy (PPV) in the treatment of vitreoretinal complications of birdshot chorioretinopathy (BCR). METHODS: The clinical records of 9 consecutive patients (16 eyes) with vitreo retinal complications in BCR refractory to medical therapy who underwent pars plana vitrectomy were reviewed. RESULTS: Indications for PPV were macular edema in 9 eyes (56.2%), and persistent vitreous opacities in 7 (43.8%). At a mean postoperative follow-up of 44.1 months, best-corrected visual acuity improved ≥2 Snellen lines in 9 eyes (56.2%), remained stable in 6 (37.5%) and worsened in 1 eye (11.1%). Systemic medication was significatively reduced after surgery (p = .020) and macular thickness on optical coherence tomography exams decreased significatively in eyes with macular edema (p= .0039). CONCLUSIONS: In this small series of eyes with limited follow-up PPV seems to be a safe and effective for treatment of vitreoretinal complications in patients with BCR.

Evaluation of limbal and pars plana silicone oil removal in aphakic eyes.

PURPOSE: To compare limbal and pars plana silicone oil removal (SOR) in aphakic eyes and to evaluate the acute effect of silicone oil flow to the corneal endothelium. METHODS: Sixteen aphakic patients with silicone oil endotamponade requiring SOR were recruited for this prospective study and randomly scheduled for limbal or pars plana SOR. The central corneal thickness (CCT), visual acuity (VA) and intraocular pressure were measured preoperatively, on the first postoperative day and 4 months after surgery. Endothelial cell density (ECD) was measured preoperatively and at the end of follow-up. The in vitro study was performed on ten enucleated porcine eyes. Corneoscleral discs were prepared and fixed on artificial anterior chamber followed by 2.5-mm limbal incision and 5-ml silicone oil injection in six cases and 5 ml balanced salt solution (BSS) in four cases. RESULTS: The ECD decreased by 239.2 ± 86.7 (13.9%) and 86.7 ± 22.4 cells/mm(2) (5%) after limbal (n = 8) and pars plana SOR (n = 8), respectively (p < 0.001 for both). The difference between the groups was significant (p < 0.001). A significant increase in CCT and corresponding decrease in VA was noted on the first postoperative day using both procedures. At the end of follow-up, the CCT and VA were comparable to initial values. Postoperative hypotony (≤6 mmHg) was observed more frequently after limbal SOR. In the experiment, lamellar abrasions of corneal endothelium were observed after silicone oil injection, whereas no changes were observed after BSS injection. CONCLUSION: Limbal SOR causes more considerable damage to the corneal endothelium than the pars plana approach because of mechanical abrasion.

Pars plana surgical capsulotomy for posterior capsular opacification (PCO).

OBJECTIVE: To evaluate the safety and efficacy of pars plana surgical posterior capsulotomy in pseudophakic adults. METHODS: This prospective interventional case series was conducted at Sindh Govt Lyari General Hospital Karachi and Al- Noor Eye Hospital Karachi from June 2006 to May 2008. Complete ophthalmic examination of anterior and posterior segment was performed including assessment of type of posterior capsular opacification, measurement of intraocular pressure. Visual acuity, measurement of intraocular pressure and any unwanted complications were analyzed. RESULTS: Seventy six (43.18%) patients were operated on both eyes. Mean age was 62.01 +/- 13.02 years. There were 104 (59.1%) females and 72 (40.9%) males. Visual acuity at presentation was found to be 6/9 to 6/18 in 130 (59.1%)eyes, 6/18 to 6/60 in 81(36.8%) and below 6/60 in 9 (4.1%) eyes. A significant reduction in intraocular pressure (13.8, +/- 1.4, P = 0.000) was noted on second post operative day. Intraoperative complication included subconjuctival haemorrhage in 22 (10%) eyes, pin head haematoma at the entry site in 7 (3.2%) eyes, pea head haematoma at the entry site in 8 (3.6%) eyes, minor grade of vitreous haemorrhage in 9 (4.1%) cases. Insufficient capsular opening was noted in 8 (3.6%) eyes. Clinically evident macular oedema in 4 (1.8%) eyes. We found no case of endophthalmitis or retinal detachment. CONCLUSION: Surgical posterior capsulotomy is a safe and effective procedure in experienced hands and could be adopted in place of YAG laser.

[Vitrectomy surgery for the treatment of the vitreo-retinal complications of the pars planitis]. / Cirugía de vitrectomía para el tratamiento de las complicaciones vítreo-retinianas asociadas a pars planitis.

OBJECTIVE: To evaluate the effect of pars plana vitrectomy in the management of patients with pars planitis. METHODS: A retrospective analysis of the clinical course, post-operative complications and recurrent uveal inflammation following pars plana vitrectomy in patients with pars planitis. RESULTS: The study included 22 eyes of 19 patients. The mean follow-up was 55.7 (± 39.6) months (range 7 - 144 months). The surgical indications were, persistent vitreous opacities in 10 eyes, vitreous haemorrhage in 9 eyes, and epiretinal membrane in 3 eyes. There was an improvement in the clinical course of the uveitis in 19 of the 22 eyes (86.4%), allowing the suspension of the systemic treatment in 16 patients. An improvement of the visual acuity was observed in 20 eyes (90.9%). The most common post-operative complications were, lens opacities in 9 eyes (40.9%), and glaucoma in 4 eyes (18.2%). CONCLUSIONS: The results of this study suggest that pars plana vitrectomy has a beneficial effect on the course and visual function of patients with vitreo-retinal complications associated with pars planitis.

La vitrectomía como terapia antinflamatoria de la uveítis intermedia en niños / Pars plana vitrectomy as anti-inflammatory therapy for intermediate uveitis in children

ObjetivoLas uveítis intermedias constituyen entre el 2 y el 26% de las uveítis en niños. El curso natural es variable existiendo desde casos leves autolimitados hasta formas crónicas más severas que cursan con múltiples recurrencias y complicaciones. El objetivo de este estudio es valorar la utilidad de la vitrectomía para controlar la inflamación en niños con uveítis intermedias recurrentes.MétodosEstudio retrospectivo con seguimiento de al menos seis meses. Se incluyeron todos los niños menores de dieciséis años intervenidos mediante vitrectomía por uveítis intermedia tras haber sufrido al menos dos brotes de inflamación intermedia sin tratamiento profiláctico inmunosupresor sistémico previo a la cirugía. Se recogieron los cambios en la agudeza visual (AV), las recaídas y las complicaciones derivadas de la cirugía.ResultadosSe seleccionaron siete ojos de cinco niños con uveítis intermedia que requirieron vitrectomía. Tras un seguimiento medio de 34 meses, la AV había mejorado en todos los ojos respecto a la situación prequirúrgica. Cuatro ojos desarrollaron cataratas subcapsulares posteriores leves. Las recurrencias posquirúrgicas fueron de localización anterior y controladas con tratamiento tópico, salvo un brote de uveítis intermedia tratada con una inyección de triamcinolona periocular. Solo un niño se encuentra actualmente bajo terapia inmunosupresora sistémica, debido a la presencia de brotes de uveítis intermedia en el ojo no operado y dado que sus padres rechazaron la cirugía.ConclusiónLa vitrectomía con crioterapia inferior es una opción terapéutica a considerar para el control de la actividad inflamatoria de las uveítis intermedias en niños a medio plazo para evitar los efectos secundarios asociados a los inmunosupresores sistémicos(AU)

PurposeIntermediate uveitis represents between 2 and 26% of uveitis in children. The spectrum of the disease is highly variable, ranging between mild cases that resolve spontaneously and chronic, severe forms that develop multiple episodes and complications. The purpose of this study is to evaluate the efficacy of vitrectomy to control inflammation in children with recurrent intermediate uveitis.MethodsRetrospective evaluation of patients with at least six months of follow-up. All patients under 16 who had undergone vitrectomy for intermediate uveitis were included. Vitrectomy was performed after at least two episodes of intermediate uveitis in children that had had no previous prophylactic systemic immunosuppressant treatment. Data recorded were visual acuity (VA), recurrences and surgical complications.ResultsSeven eyes of five children with intermediate uveitis who underwent vitrectomy were included. After a mean follow-up of 34 months, VA improved in all eyes after surgery. Four eyes developed mild subcapsular posterior cataracts. Post-surgical recurrences were anterior and responded to topical treatment, except for an episode of intermediate uveitis that required a periocular injection of triamcinolone. Only one patient is being treated with systemic immunosuppressants, due to the presence of repeated episodes of uveitis in the non-vitrectomised eye and since his parents were unwilling to have him undergo new surgery.ConclusionsVitrectomy with inferior cryotheraphy controls inflammation in intermediate uveitis in children with good mid-term results avoiding the secondary side-effects of systemic immunosuppressants(AU)

[Pars plana vitrectomy as anti-inflammatory therapy for intermediate uveitis in children]. / La vitrectomía como terapia antinflamatoria de la uveítis intermedia en niños.

PURPOSE: Intermediate uveitis represents between 2 and 26% of uveitis in children. The spectrum of the disease is highly variable, ranging between mild cases that resolve spontaneously and chronic, severe forms that develop multiple episodes and complications. The purpose of this study is to evaluate the efficacy of vitrectomy to control inflammation in children with recurrent intermediate uveitis. METHODS: Retrospective evaluation of patients with at least six months of follow-up. All patients under 16 who had undergone vitrectomy for intermediate uveitis were included. Vitrectomy was performed after at least two episodes of intermediate uveitis in children that had had no previous prophylactic systemic immunosuppressant treatment. Data recorded were visual acuity (VA), recurrences and surgical complications. RESULTS: Seven eyes of five children with intermediate uveitis who underwent vitrectomy were included. After a mean follow-up of 34 months, VA improved in all eyes after surgery. Four eyes developed mild subcapsular posterior cataracts. Post-surgical recurrences were anterior and responded to topical treatment, except for an episode of intermediate uveitis that required a periocular injection of triamcinolone. Only one patient is being treated with systemic immunosuppressants, due to the presence of repeated episodes of uveitis in the non-vitrectomised eye and since his parents were unwilling to have him undergo new surgery. CONCLUSIONS: Vitrectomy with inferior cryotheraphy controls inflammation in intermediate uveitis in children with good mid-term results avoiding the secondary side-effects of systemic immunosuppressants.

23-Gauge versus 20-gauge system for pars plana vitrectomy: a prospective randomised clinical trial.

AIM: To compare the sutureless 23-gauge system with a standard 20-gauge system in pars plana vitrectomy. METHODS: 60 patients in two randomised groups were included in this prospective clinical trial. Pars plana vitrectomy with either 23- or 20-gauge instruments was performed. The main outcome measures were postoperative conjunctival injection and pain. Secondary outcome parameters were time of surgery, intraocular pressure, visual acuity and complications. RESULTS: Conjunctival injection (p = 0.0003) and postoperative pain (p = 0.01) were significantly reduced following 23-gauge vitrectomy compared with the 20-gauge procedure. Opening (p = 0.006) and closure times (p<0.00001) were significantly shorter, and vitrectomy time (p = 0.001) significantly longer in the 23-gauge system compared with 20-gauge vitrectomy. However, retinal manipulation and overall surgery times did not differ significantly between both groups. The same applies for eye pressure, distance and reading acuity. Regarding complications, two choroidal haemorrhages and one flat serous choroidal detachment occurred in the 23-gauge group. CONCLUSION: The 23-gauge system for pars plana vitrectomy offers significantly higher patient comfort during the early postoperative period. Time of surgery is almost equal--a shorter time for wound closure is neutralised by a longer vitrectomy time in the 23-gauge group.

Pars plana vitrectomy and internal limiting membrane peeling for macular oedema secondary to retinal vein occlusion: a pilot study.

INTRODUCTION: Macular oedema is the main cause of visual impairment following retinal vein occlusion. The purpose of this study was to evaluate the anatomical and functional outcome of pars plana vitrectomy and internal limited membrane (ILM) peeling for macular oedema secondary to retinal vein occlusion. CLINICAL PICTURE: This pilot study is a prospective nonrandomised series of 11 eyes of 11 patients with macular oedema secondary to retinal vein occlusion. The best-corrected visual acuity (BCVA), foveal thickness on optical coherence tomography, fundus fluorescein angiography (FFA) and multifocal electroretinography were evaluated. TREATMENT AND OUTCOME: All 11 patients underwent pars plana vitrectomy with ILM peeling. The mean postoperative follow-up was 13.5 months (range, 1.5 to 24). The mean thickness at the foveal centre decreased from 794 +/- 276 microm preoperatively to 373 +/- 150 microm, 302 +/- 119 microm, 249 +/- 203 microm and 185 +/- 66 microm at 1 week, 1 month, 3 months and the final visit postoperatively, respectively (all P <0.001, paired t- test, compared to preoperative thickness). Postoperative FFA demonstrated markedly reduced leakage in the macular region. At the final visit, BCVA improved 2 lines or more in 72.7% (8/11) of patients and was unchanged in 27.3% (3/11) patients. Complications included cataract in 7 patients and vitreous haemorrhage, recurrence of macular oedema and visual field defect in 1 case each. CONCLUSION: Pars plana vitrectomy and ILM peeling rapidly reduced the macular oedema caused by retinal vein occlusion, with improvement in BCVA.

Comparing fibrin glue to sutures for conjunctival closure in pars plana vitrectomy.

PURPOSE: To evaluate whether fibrin glue causes less postoperative pain, discomfort and work inaptitude in conjunctival closure following 20 gauge pars plana vitrectomy than sutures. DESIGN: Retrospective study. METHODS: A questionnaire was sent in 2006 to 506 patients who underwent 20 gauge pars plana vitrectomy in 2004 at the University Hospital, Leuven, Belgium. Patients were asked about their postoperative pain and discomfort of the eye and the duration of their work inaptitude. RESULTS: Our results showed a shorter duration of the eye being reddish (p-value 0.0471), discomfort of the eye (p-value 0.0376) and using an ointment (p-value 0.0105) in the glue group. The glue group used less ointment (p-value 0.0038) and independent workers had a shorter work inaptitude after receiving glue (p-value 0.0292). If patient had vitrectomy without cerclage, they had less pain on the first postoperative day when having received glue (p-value 0.0340). CONCLUSIONS: Fibrin glue causes less postoperative pain, discomfort and work inaptitude for closure of conjunctival wounds in 20 gauge pars plana vitrectomy than sutures. Fibrin glue appears in our hands to be a better alternative to sutures for closure of conjunctival wounds in 20 gauge pars plana vitrectomy.