Comparison of Observation Versus Vitrectomy for Patients With Hemorrhagic Posterior Vitreous Detachment.

BACKGROUND AND OBJECTIVE: Patients with hemorrhagic posterior vitreous detachments (HPVDs) have a high rate of retinal tears and often develop retinal detachments (RDs). This study aims to compare outcomes of 25-gauge pars plana vitrectomy (PPV) for HPVD versus an observational group. PATIENTS AND METHODS: Retrospective cohort study of 109 consecutive eyes of 105 patients diagnosed with HPVD; 66 eyes underwent PPV and 43 eyes were observed. RESULTS: Twenty-four eyes (36.4%) in the surgical group were found to have tears intraoperatively not seen preoperatively. The median time to vitreous hemorrhage (VH) resolution was significantly shorter for the PPV group, 14 days (interquartile range [IQR]: 7 days to 35 days), compared to those who were observed, 58.5 days (IQR: 30 days to 91 days) (P < .0001). RDs occurred more frequently among observational patients (11.63%) compared to 1.52% of surgical patients (P = .0344). CONCLUSION: Twenty-five-gauge PPV for HPVD resulted in less RDs, diagnosis of occult retinal breaks intraoperatively, and shorter time to VH resolution. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:e288-e293.].

Vitrectomy and Vitrector Port Needle Biopsy of Choroidal Melanoma for Gene Expression Profile Testing Immediately before Brachytherapy.

PURPOSE: Transvitreal and transscleral needle biopsy can result in complications including vitreous hemorrhage and retinal detachment. This study evaluated a technique using 25-gauge vitrectomy as an adjunct to needle biopsy immediately before brachytherapy to minimize these complications and preserve good visual acuity. DESIGN: Retrospective, observational case series. PARTICIPANTS: Fifty-seven consecutive eyes of 57 patients with treatment-naïve medium choroidal melanomas without extraocular extension from July 2012 through September 2015. METHODS: Fifty-seven consecutive eyes of 57 patients with a clinically diagnosed choroidal melanoma underwent complete 25-gauge posterior vitrectomy followed by transvitrector port fine-needle aspiration biopsy of the tumor immediately before implantation of a radioactive iodine 125 plaque as treatment for the tumor. Cytopathologic analysis was not performed on the tumor aspirates in this study. MAIN OUTCOME MEASURES: Best-corrected postoperative visual acuity, postoperative complications of the reported technique, implantation tumor development, local tumor recurrence, presence of metastatic disease after surgery, and sufficiency of the tumor aspirates obtained by the reported technique for successful gene expression profile testing and prognostic classification. RESULTS: Mean preoperative and postoperative visual acuities were similar (20/60 vs. 20/80, respectively). Mean tumor thickness was 5.0 mm (range, 2.5-10 mm) and mean tumor basal diameter was 13.1 mm (range, 7-22 mm). Only 1 of 57 eyes (1.8%) showed a transient vitreous hemorrhage, biopsy yield was 100% for genetic analysis, and no patients showed recurrence or implantation tumor at the vitrector site. CONCLUSIONS: Combined 25-gauge posterior vitrectomy and 25-gauge trans-vitrector port needle aspiration biopsy immediately before brachytherapy is excellent for obtaining tumor aspirate for gene expression profiling while controlling for hemostasis, resulting in few complications.

Outcomes of Choroidal Melanoma 25-Gauge Vitrectomy Needle Biopsy and Iodine 125 Brachytherapy Performed by Directly Supervised Fellows versus Attending Faculty.

PURPOSE: To evaluate the outcomes of choroidal melanoma 25-gauge vitrectomy needle biopsy and iodine 125 (125I) brachytherapy performed by supervised fellows compared with experienced faculty. DESIGN: Retrospective, observational case series. PARTICIPANTS: Sixty-three consecutive eyes of 63 patients with treatment-naïve medium choroidal melanomas without extraocular extension. METHODS: Sixty-three consecutive eyes of 63 patients undergoing simultaneous 125I brachytherapy and 25-gauge vitrectomy melanoma biopsy for choroidal melanoma. One attending surgeon performed 31 surgeries and 2 fellows performed 32 surgeries. All cases treated by fellows were under direct supervision of the attending physician. MAIN OUTCOME MEASURES: Percentage of adequate biopsy sample, tumor regression, and postoperative complications. RESULTS: There were no baseline differences between the groups. The biopsy yield for gene expression profile and the melanoma regression rate were equal in both groups (63/63 [100%]; P = 1.0). Complications occurred in 1 of 31 faculty surgery patients (transient vitreous hemorrhage) and in 0 of 32 fellow surgery patients (P = 1.0). CONCLUSIONS: With proper supervision, fellows can achieve equally high biopsy yield and melanoma regression rate with few complications compared with experienced faculty.

BILATERAL ISOLATED CHOROIDAL MELANOCYTOSIS.

PURPOSE: To report a very rare case of bilateral isolated choroidal melanocystosis. METHODS: Clinical case report and literature review. RESULTS: A 24-year-old asymptomatic African American woman presented with bilateral diffuse choroidal pigmentation. The diagnosis of bilateral isolated choroidal melanocytosis was made, and optical coherence tomography was remarkable for increased choroidal thickness with a normal inner and outer retina. CONCLUSION: Although extremely rare, bilateral isolated choroidal melanocytosis may occur in young patients, as well as in those who are African American. Longer follow-up of this case and those in the literature will elucidate whether these choroidal lesions enlarge or have a risk of developing uveal melanoma.

VITREORETINAL SURGICAL OUTCOMES PERFORMED BY SUPERVISED RETINAL FELLOWS VERSUS ATTENDING FACULTY SURGEONS.

PURPOSE: To evaluate common vitreoretinal surgeries performed by retinal fellows under direct faculty supervision, compared with experienced faculty members. METHODS: Retrospective study analyzing 592 consecutive eyes undergoing retinal surgery from 2009 to 2011 at Retina Consultants of Alabama/University of Alabama at Birmingham, Department of Ophthalmology. Vitreoretinal surgeries included macular hole, macular pucker, retinal detachment, diabetic vitreous hemorrhage, and diabetic tractional retinal detachment. Three fellows performed 390 cases (divided into first or second year fellows), while 4 faculty members performed 202 cases. All 390 fellow-performed cases were under direct supervision. Chi-square analysis was used to compare outcomes. RESULTS: There were no baseline differences between the groups. The mean postoperative visual improvement was statistically significant and equal in all groups, as well as between each physician (P ≤ 0.0001). Complications occurred in 29/592 cases (4.8%), whereas reoperations occurred in 21/592 cases (3.5%) and were equally distributed across groups. There were no differences in complications and reoperations when comparing first-year with second-year fellows. CONCLUSION: With proper supervision, vitreoretinal fellows can achieve an equally high visual improvement with low complication and reoperation rates compared with experienced faculty. The year of fellowship does not significantly influence outcomes or complications. Quality outcomes after vitreoretinal surgery can be obtained throughout fellowship training.