Perfluorocarbon-perfused vitrectomy: a new method for vitrectomy--a safety and feasibility study.

PURPOSE: To evaluate the safety and feasibility of perfluorocarbon-perfused vitrectomy (PCPV) as a technique during vitrectomy for proliferative diabetic retinopathy (PDR) and rhegmatogenous retinal detachment (RRD). METHODS: In an experimental, prospective, noncomparative and interventional study, 28 eyes of 28 patients were submitted to vitrectomy with the PCPV technique, 18 eyes with PDR and 10 with RRD. In this technique we replaced the traditional balanced saline solution (BSS) in the infusion line (conventional vitrectomy) by perfluorocarbon liquids (PCL). Some patients with PDR were treated with oxygenated PCL. Clinical evaluation, electroretinography (ERG), and endothelial cell count (ECC) were used to assess the safety of this procedure. An arbitrary grading system (grades 0-5) was used to classify the surgery and maneuvers to assess feasibility. RESULTS: No eyes had a significant decrease in ECC, and the patients in whom we could obtain ERG postoperatively showed no significant differences from preoperative ERG. In the PDR group (using oxygenated and nonoxygenated PCL), 77.8% were graded 5/5; in the RRD group 90% were 5/5. PCPV allowed better visualization of vitreous and intraocular structures, rapid retinal reattachment, less blood in the vitreous cavity, subretinal fluid resolution, blood confinement, retinal stabilization, and easier dissection of epiretinal membranes. In all cases at least one surgical step was eliminated. CONCLUSIONS: PCPV in humans is a safe and feasible technique. Probably in selected cases the use of PCL offers several advantages over BSS, because of their properties (gravitational forces, immiscibility with bodily fluids, and ability to transport oxygen). Prospective and comparative studies are necessary to establish formal indications and possible contraindications.

[Phacoemulsification cataract surgery in vitrectomized eyes]. / Facoemulsificación en ojos post-vitrectomía pars plana.

OBJECTIVE: This study focuses on determining the intra- and post-operative complications stemming from technical difficulties, anatomical aspects, intraoperatory management and visual outcome of post-vitrectomized patients that undergo phacoemulsification. METHOD: In this prospective, longitudinal, observational and descriptive study phacoemulsification was performed in 25 post-vitrectomized eyes that required cataract surgery. Pre-surgical variables: sex, age, affected eye, visual accuity, underlying vitreoretinal disease, anterior segment morphological findings such as: cataract density and pupil alterations. Intrasurgical variables: characteristic of anterior chamber and pupil, phacoemulsification technique and time and the presence of complications. Post-surgical variables were also registered: visual capacity and the presence of complications. Minimum six-month follow-up period. RESULTS: The average interval between pars plana vitrectomy and phacoemulsification was 18.5 months. Silicone oil was the most frequent tamponade used in our serie (44%). Biomicroscopical findings were miosis 28% and posterior synechies 24%. The average interval of phaco time was 2.26 minutes. The intraoperative findings were fluctuations in the anterior chamber depth (24%) and anterior capsular tears (12%). The postoperative complications most frequently seen were posterior capsular plaque (28%) and corneal edema (16%). CONCLUSIONS: Phacoemulsification is a safe and effective technique in eyes after pars plana vitrectomy that require cataract surgery. The surgeon must be aware of the morphological and anatomical findings of these eyes. Visual rehabilitation will generally be determined by the presence of an underlying vitreo-retinal pathology.

Facoemulsificación en ojos post-vitrectomía pars plana / Phacoemulsification cataract surgery in vitrectomized eyes

Objetivo: Determinar las complicaciones intra y postoperatorias en ojos de pacientes post-vitrectomizados que ameritan cirugía de catarata con técnica de facoemulsificación. Método: Estudio prospectivo, longitudinal observacional y descriptivo en 25 ojos de 25 pacientes, previa vitrectomía pars plana que requerían cirugía de catarata. Variables prequirúrguicas: edad, sexo, ojo afectado, capacidad visual, patología vitreorretiniana, características morfológicas del segmento anterior tales como grado de opacidad del cristalino, características de la cámara anterior y de la pupila. Variables intraoperatorias: técnica, tiempo de facoemulsificación y complicaciones intraoperatorias. Variables post-operatorias: Complicaciones y capacidad visual. Seguimiento no menor de 6 meses. Resultados: El tiempo promedio entre la vitrectomía pars plana y la facoemulsificación fue de 18,5 meses. La silicona fue el material de tamponamiento utilizado con mayor frecuencia 44%. Hallazgos biomicroscópicos: miosis 28% y sinequias posteriores 24%. El tiempo promedio de facoemulsificación: 2,26 minutos. Complicaciones intraoperatorias: cámara anterior inestable 24% y el desgarro de la capsulorrexis anterior 12%. La complicación post-operatoria más frecuente fue la placa subcapsular posterior 28% y el edema corneal 16%. Conclusiones: La facoemulsificación en ojos con vitrectomía pars plana previa que ameriten cirugía de catarata, es una técnica bastante segura y efectiva. El cirujano debe familiarizarse con los hallazgos y modificaciones anatómicas que sufren estos ojos. La rehabilitación visual por lo general va a estar limitada por la patología vitreo-retiniana de base(AU)

Objective: This study focuses on determining the intra- and post-operative complications stemming from technical difficulties, anatomical aspects, intraoperatory management and visual outcome of post-vitrectomized patients that undergo phacoemulsification. Method: In this prospective, longitudinal, observational and descriptive study phacoemulsification was performed in 25 post-vitrectomized eyes that required cataract surgery. Pre-surgical variables: sex, age, affected eye, visual accuity, underlying vitreoretinal disease, anterior segment morphological findings such as: cataract density and pupil alterations. Intrasurgical variables: characteristic of anterior chamber and pupil, phacoemulsification technique and time and the presence of complications. Post-surgical variables were also registered: visual capacity and the presence of complications. Minimum six-month follow-up period. Results: The average interval between pars plana vitrectomy and phacoemulsification was 18.5 months. Silicone oil was the most frequent tamponade used in our serie (44%). Biomicroscopical findings were miosis 28% and posterior synechies 24%. The average interval of phaco time was 2.26 minutes. The intraoperative findings were fluctuations in the anterior chamber depth (24%) and anterior capsular tears (12%). The postoperative complications most frequently seen were posterior capsular plaque (28%) and corneal edema (16%). Conclusions: Phacoemulsification is a safe and effective technique in eyes after pars plana vitrectomy that require cataract surgery. The surgeon must be aware of the morphological and anatomical findings of these eyes. Visual rehabilitation will generally be determined by the presence of an underlying vitreo-retinal pathology(AU)

[Bilateral macular cysts secondary to electric current strike. A case report]. / Quistes maculares bilaterales inducidos por descarga eléctrica. Presentación de un caso.

OBJECTIVE: To report the clinical and tomographic findings in a case of maculopathy secondary to high-tension electric current strike. CASE REPORT: A 27-year-old male refers a reduction in his visual acuity after electric strike. Visual acuity was 0.05 in both eyes. Circular reddish macular lesions measuring 400 micro m in RE and 200 micro m in LE were evident. Optical coherence tomography (OCT) showed intraretinal foveal cysts. At the third month follow-up visit, visual acuity had improved to 0.4 in RE and 0.5 in LE. Clinical and tomographic evaluation showed a reduction of the foveal cysts. DISCUSSION: Electricity affects retinal pigment epithelium and retina by thermal denaturation. OCT provides a conclusive diagnosis.

Quistes maculares bilaterales inducidos por descarga eléctrica. Presentación de un caso / Bilateral macular cysts secondary to electric current strike. A case report

Objetivo: Reportar hallazgos clínicos y tomográficos de maculopatía por descarga eléctrica. Caso Clinico: Paciente varón, 27 años con disminución visual tras descarga eléctrica. Agudezas visuales de 0,05 en ambos ojos. Lesiones maculares circulares, rojizas, de 400 µm en OD y 200 µm en OI. Tomografía óptica coherente demostró lesiones foveales quísticas intraretinianas. A los 3 meses la agudeza visual mejoró a 0,4 en OD y 0,5 en OI con reducción de los quistes foveales clínica y tomográficamente. Discusión: La electricidad afecta el epitelio pigmentario y retina externa por desnaturalización térmica. La tomografía es concluyente para el diagnóstico (AU)

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[Choroidal melanoma treated with 810 nm diode laser and indocyanine green. A case report]. / Reporte de caso. Melanoma de coroides fotocoagulado con láser de diodo 810 nm coadyuvado con verde de indocianina.

CASE REPORT: A 35 year-old female with a pigmented choroidal tumor in the inferotemporal quadrant, of 3.31 x 7.64 x 5.46 mm. The patient received an intravenous injection of 25 mg of indocyanine green previous to photocoagulation of the lesion with an 810 nm diode laser. After one year follow-up the tumor showed involution demonstrated by clinical and ultrasonographic evaluation. DISCUSSION: Indocyanine green allows maximal absortion of light energy delivered by diode laser, enhancing its action by making the deepest tissues vulnerable to photocoagulation and reducing time of exposure and number of sessions.

Reporte de caso. Melanoma de coroides fotocoagulado con láser de diodo 810 nm coadyuvado con verde de indocianina / Choroidal melanoma treated with 810 nm diode laser and indocyanine green. A case report

Caso clínico: Paciente femenino de 35 años de edad con presencia de tumoración coroidea pigmentada en cuadrante inferotemporal, de 3,31x7,64 x 5,46 mm. La lesión se fotocoaguló con láser de diodo de 810 nm previa inyección intravenosa de 25 mg de verde de indocianina.Tras un año de seguimiento el tumor mostró involución demostrada por clínica y ultrasonido.Discusión: El verde de indocianina permite máxima absorción de la energía luminosa suministrada por el láser de diodo, potenciando su acción al hacer a los tejidos más profundos vulnerables a la fotocoagulación, reduciendo el tiempo de exposición y número de sesiones (AU)

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