Cryotherapy versus Laser Does Not Influence Anatomic Success after Vitrectomy for Primary Rhegmatogenous Retinal Detachment Repair: Registry Analysis of 2413 Patients.

PURPOSE: To determine whether a difference exists between cryotherapy and endolaser photocoagulation retinopexy in terms of the rates of anatomic success after primary rhegmatogenous retinal detachment (RRD) repair with pars plana vitrectomy (PPV). DESIGN: Registry-based, nonrandomized, observational cohort study. SUBJECTS: Eyes with primary RRD in a binational retinal surgery registry that underwent repair with PPV and had a minimum of 3 months of follow-up. METHODS: Cases were recorded prospectively by participating surgeons, and the outcomes were recorded at 3 months. A generalized mixed model approach was used to compare the effect of retinopexy type on the outcomes. Variables known to be associated with retinal surgical success were considered as covariates for the final model. The eyes were divided into 2 groups: Cryo group (receiving cryotherapy as the only form of retinopexy) and Laser group (receiving endolaser as the only form of retinopexy). MAIN OUTCOME MEASURES: The primary endpoint was the proportion of patients with stable retinal reattachment without the need for further retinal detachment surgery, assessed 3 months after the surgery. Failure was defined as either retinal redetachment or foveal attachment with long-term silicone oil tamponade at the endpoint. The secondary outcome measured was visual acuity at 3 months compared with baseline measurements. RESULTS: A total of 2413 patients were included, and the overall single-procedure success rate was 85%. There was no statistically significant difference in surgical success between the adjusted proportion of successful reattachment for the Cryo group (87%) and that of successful reattachment for the Laser group (82%) (P = 0.84; odds ratio, 1.04; 95% confidence interval, 0.74-1.46). There was no difference in the mean change in the visual outcomes at 3 months between the groups (adjusted mean change of -0.48 logarithm of the minimum angle of resolution [logMAR] for the Cryo group vs. -0.50 logMAR for the Laser group, P = 0.82). CONCLUSIONS: The choice of cryotherapy versus endolaser retinopexy was observed to influence neither the anatomic success of PPV for RRD nor the visual acuity outcomes at 3 months after the surgery.

SUCCESSFUL CLOSURE OF FULL-THICKNESS MACULAR HOLES SECONDARY TO MACULAR VITELLIFORM LESIONS.

PURPOSE: To describe the first reported cases of full-thickness macular holes secondary to vitelliform lesions that were successfully closed with vitrectomy surgery and gas tamponade. METHODS: Two female patients developed visual loss secondary to bilateral vitelliform lesions and associated full-thickness macular holes. The patients underwent 25-gauge pars plana vitrectomy, internal limiting membrane peeling, and 26% sulfur hexafluoride gas, followed by 3 days of face-down positioning. RESULTS: In both patients, the macular holes remain closed 3 and 25 months postoperatively. CONCLUSION: Vitrectomy surgery with gas tamponade may successfully close full-thickness macular holes secondary to macular vitelliform lesions.

Two cases of very late-onset capsular bag distension syndrome.

PURPOSE: We present two cases of late-onset capsular bag distension syndrome (CBDS). OBSERVATIONS: Two female patients were referred with decreased visual acuity and blurred vision. They had both undergone uncomplicated phacoemulsification and intraocular lens implantation into the capsular bag, seven and 13 years prior.Slit-lamp biomicroscopy and anterior segment optical coherence tomography demonstrated milky fluid between the intraocular lens and posterior capsules, consistent with late-onset capsular bag distension syndrome. A 25-gauge pars plana vitrectomy surgery was performed on each patient.This turbid retrolental fluid was successfully aspirated with posterior capsulotomy using 25-gauge pars plana vitrectomy surgery. CONCLUSIONS AND IMPORTANCE: Late-onset capsular bag distension syndrome may occur up to 13 years following cataract surgery; the longest reported duration of onset. Anterior segment optical coherence tomography is useful in aiding diagnosis. Management with vitrectomy surgery has the advantages of complete clearance of the turbid fluid and microbial and pathological testing.