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1.
Surv Ophthalmol ; 68(1): 113-125, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36116526

RESUMO

Little is known about the comparative benefit of different positioning regimens in rhegmatogenous retinal detachment (RRD) repair. We compared outcomes of different postoperative posturing regimens following pars plana vitrectomy (PPV). MEDLINE, EMBASE, and Cochrane CENTRAL were searched from 2000 to February 2022 for original studies that compared at least 2 postoperative posturing regimens in adults who underwent PPV for RRD. Seven comparative studies and 703 eyes were included. There were no differences in final visual acuity between posturing regimens. Single-procedure reattachment rates were higher with alternative positioning compared to prone positioning in patients with inferior breaks. Prone and alternative positioning were associated with similar risks of complications. In contrast, prone posturing had a higher risk of neck pain and intraocular pressure elevation than support-the-break, which had a greater risk of retinal displacement, retinal folds, and binocular diplopia. Immediate prone positioning was superior to delayed prone for the risk of retinal displacement. The present review shows that prone positioning was associated with a lower reattachment rate than alternative positioning. There were trade-offs in complications between prone and support-the-break positioning. Retinal displacement could be mitigated when prone positioning is maintained immediately after surgery.


Assuntos
Descolamento Retiniano , Perfurações Retinianas , Adulto , Humanos , Descolamento Retiniano/cirurgia , Descolamento Retiniano/etiologia , Perfurações Retinianas/cirurgia , Vitrectomia/efeitos adversos , Vitrectomia/métodos , Acuidade Visual , Período Pós-Operatório , Estudos Retrospectivos , Resultado do Tratamento , Complicações Pós-Operatórias/cirurgia
3.
BMC Ophthalmol ; 22(1): 420, 2022 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-36333675

RESUMO

BACKGROUND: Phacoemulsification has been the mainstay method for extracapsular cataract extraction surgery in the anterior segment; for cases of posterior drop of lens fragments into the vitreous, a posterior segment phacoemulsification instrument (fragmatome; Alcon, Inc., Fort Worth, TX) can be employed to remove the dislocated lens materials. Studies have reported on thermal injury to the cornea during phacmoemulsification of the anterior segment. However, few studies have investigated thermal burn in the simultaneous sclera and eyelid induced by the fragmatome. Currently, there is no reports and lack of optimal strategy for the management of nucleus drop in a vitreous cavity filled with silicon oil. CASE PRESENTATION: We present the case of a 53-year-old male patient with a thermal burn wound on the upper eyelid and sclera following phacoemulsification for a dropped lens in a silicone oil-filled vitreous. We further designed an experiment to verify our hypothesis that thermal injury could be induced by the high temperature of the metal tip during phacoemulsification in silicone oil. In our experiment, during 420 s of continuous ultrasonic wave, the temperature of the fragmatome tip in the balanced salt solution (BSS) increased from 22.0 to 24.0 ºC, while the temperature of the fragmatome tip in the silicone oil group increased from 22.0 to 43.0 ºC. CONCLUSIONS: The temperature of the fragmatome tip increased significantly in silicone oil compared to BSS in the experiment. Thus, physicians should be aware of possible thermal complications when using fragmatome in eyes filled with silicone oil.


Assuntos
Extração de Catarata , Subluxação do Cristalino , Facoemulsificação , Doenças da Esclera , Masculino , Humanos , Pessoa de Meia-Idade , Facoemulsificação/efeitos adversos , Facoemulsificação/métodos , Óleos de Silicone/efeitos adversos , Subluxação do Cristalino/cirurgia , Doenças da Esclera/cirurgia , Pálpebras/cirurgia , Vitrectomia
5.
J Vis Exp ; (189)2022 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-36440839

RESUMO

Degenerative disorders of the retina (including age-related macular degeneration), which originate primarily at or within the retinal pigmented epithelial (RPE) layer, lead to a progressive disorganization of the retinal anatomy and the deterioration of visual function. The substitution of damaged RPE cells (RPEs) with in vitro cultured RPE cells using a subretinal cell carrier has shown potential for re-establishing the anatomical structure of the outer retinal layers and is, therefore, being further studied. Here, we present the principles of a surgical technique that allows for the effective subretinal transplantation of a cell carrier with cultivated RPEs into minipigs. The surgeries were performed under general anesthesia and included a standard lens-sparing three-port pars plana vitrectomy (PPV), subretinal application of a balanced salt solution (BSS), a 2.7 mm retinotomy, implantation of a nanofibrous cell carrier into the subretinal space through an additional 3.0 mm sclerotomy, fluid-air exchange (FAX), silicone oil tamponade, and closure of all the sclerotomies. This surgical approach was used in 29 surgeries (18 animals) over the past 8 years with a success rate of 93.1%. Anatomic verification of the surgical placement was carried out using in vivo fundus imaging (fundus photography and optical coherence tomography). The recommended surgical steps for the subretinal implantation of RPEs on a carrier in minipig eyes can be used in future preclinical studies using large-eye animal models.


Assuntos
Epitélio Pigmentado da Retina , Vitrectomia , Humanos , Animais , Suínos , Porco Miniatura , Cuidados Pós-Operatórios , Vitrectomia/métodos , Epitélio Pigmentado da Retina/cirurgia , Retina/cirurgia
6.
Retina ; 42(12): 2284-2293, 2022 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-36394885

RESUMO

PURPOSE: To identify postoperative macula deviation after epiretinal membrane surgery and to investigate its clinical effects. METHODS: Patients who underwent idiopathic epiretinal membrane removal and followed up for >12 months were enrolled. Macular deviation was evaluated using disk margin-to-fovea distance, foveal angle, and horizontal and vertical asymmetry of retinal thickness and volume. Horizontal or vertical asymmetry was defined as percentile asymmetry between nasal and temporal quadrants or between superior and inferior quadrants, respectively. The association between macular deviation parameters and best-corrected visual acuity and metamorphopsia were evaluated. Baseline and postoperative parameters were compared depending on epiretinal membrane severity. RESULTS: Data from 102 eyes with a mean follow-up of 21.14 months were analyzed. Disk margin-to-fovea distance and foveal angle decreased with time and horizontal asymmetry of thickness and volume increased with time, showing nasal crowding and nasal tilting. Postoperative changes of disk margin-to-fovea distance and horizontal asymmetry were associated with best-corrected visual acuity. Severe epiretinal membrane eyes showed greater postoperative nasal deviation than mild epiretinal membrane eyes. CONCLUSION: Postoperative nasal crowding and tilting was quantitatively identified. The causative layers for nasal deviation might be the inner retinal layers, as the foveal angle decreased with time. Postoperative disk margin-to-fovea distance shortening and nasal-deviated horizontal asymmetry were correlated with best-corrected visual acuity improvement.


Assuntos
Membrana Epirretiniana , Macula Lutea , Humanos , Membrana Epirretiniana/cirurgia , Vitrectomia , Acuidade Visual , Tomografia de Coerência Óptica
7.
Retina ; 42(12): 2307-2314, 2022 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-36394886

RESUMO

PURPOSE: To identify risk factors for recurrent retinal detachment after uncomplicated pars plana vitrectomy in patients with primary rhegmatogenous retinal detachment (RRD). METHODS: This single-center retrospective study included patients with primary RRD who underwent 23-gauge and 25-gauge pars plana vitrectomy at Hiroshima University Hospital between January 2016 and May 2021. All patients had ≥3 months of follow-up. Patients were excluded if they had preoperative proliferative vitreoretinopathy worse than Grade C1; giant retinal tears; tractional, exudative, or traumatic retinal detachment; or the use of perfluorocarbon liquid. Factors that influenced RRD treatment outcome and postoperative complications were evaluated. RESULTS: We analyzed 519 eyes of 509 patients who underwent pars plana vitrectomy for primary RRD. The primary and final success rates were 93.8% and 99.8%, respectively. Drainage retinotomy was a risk factor for surgical failure in both multivariate analysis (odds ratio 2.36, 95% confidence interval 1.08-5.15, P = 0.0314) and a propensity score-matching analysis (odds ratio 3.20, 95% confidence interval 1.14-9.04, P = 0.0277). Postoperative epiretinal membrane was associated with drainage retinotomy in multivariate analysis (odds ratio 1.93, 95% confidence interval 1.04-3.57, P = 0.0358). CONCLUSION: The avoidance of drainage retinotomy during small-gauge pars plana vitrectomy in patients with RRD may lead to better surgical success and less frequent epiretinal membrane formation.


Assuntos
Membrana Epirretiniana , Descolamento Retiniano , Humanos , Vitrectomia/efeitos adversos , Descolamento Retiniano/etiologia , Descolamento Retiniano/cirurgia , Membrana Epirretiniana/cirurgia , Estudos Retrospectivos , Acuidade Visual , Drenagem , Fatores de Risco
8.
Cochrane Database Syst Rev ; 11: CD013760, 2022 11 18.
Artigo em Inglês | MEDLINE | ID: mdl-36398614

RESUMO

BACKGROUND: Endophthalmitis is a sight-threatening emergency that requires prompt diagnosis and treatment. The condition is characterised by purulent inflammation of the intraocular fluids caused by an infective agent. In exogenous endophthalmitis, the infective agent is foreign and typically introduced into the eye through intraocular surgery or open globe trauma. OBJECTIVES: To assess the potential role of combined pars plana vitrectomy and intravitreal antibiotics in the acute management of exogenous endophthalmitis, versus the standard of care, defined as vitreous tap and intravitreal antibiotics. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL; which contains the Cochrane Eyes and Vision Trials Register; 2022, Issue 5); Ovid MEDLINE; Ovid Embase; the International Standard Randomised Controlled Trial Number registry; ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform. There were no restrictions to language or year of publication. The date of the search was 5 May 2022. SELECTION CRITERIA: We included randomised controlled trials (RCTs) that compared pars plana vitrectomy and intravitreal injection of antibiotics versus intravitreal injection of antibiotics alone, for the immediate management of exogenous endophthalmitis. DATA COLLECTION AND ANALYSIS: We used standard methods expected by Cochrane. Two review authors independently screened search results and extracted data. We considered the following outcomes: visual acuity improvement and change in visual acuity at three and six months; additional surgical procedures, including vitrectomy and cataract surgery, at any time during follow-up; quality of life and adverse effects. We assessed the certainty of the evidence using the GRADE approach.  MAIN RESULTS: We identified a single RCT that met our inclusion criteria. The included RCT enrolled a total of 420 participants with clinical evidence of endophthalmitis, within six weeks of cataract surgery or secondary intraocular lens implantation. Participants were randomly assigned according to a 2 x 2 factorial design to either treatment with vitrectomy (VIT) or vitreous tap biopsy (TAP) and to treatment with or without systemic antibiotics. Twenty-four participants did not have a final follow-up: 12 died, five withdrew consent to be followed up, and seven were not willing to return for the visit.  The study did not report visual acuity according to the review's predefined outcomes. At three months, 41% of all participants achieved 20/40 or better visual acuity and 69% had 20/100 or better acuity. The study authors reported that there was no statistically significant difference in visual acuity between treatment groups (very low-certainty evidence). There was low-certainty evidence of a similar requirement for additional surgical procedures (risk ratio RR 0.90, 95% confidence interval 0.66 to 1.21). Adverse effects included: VIT group: dislocated intraocular lens (n = 2), macular infarction (n = 1). TAP group: expulsive haemorrhage (n = 1). Quality of life and mean change in visual acuity were not reported.  AUTHORS' CONCLUSIONS: We identified a single RCT (published 27 years ago) for the role of early vitrectomy in exogenous endophthalmitis, which suggests that there may be no difference between groups (VIT vs TAP) for visual acuity at three or nine months' follow-up.   We are of the opinion that there is a clear need for more randomised studies comparing the role of primary vitrectomy in exogenous endophthalmitis. Moreover, since the original RCT study, there have been incremental changes in the surgical techniques with which vitrectomy is performed. Such advances are likely to influence the outcome of early vitrectomy in exogenous endophthalmitis.


Assuntos
Extração de Catarata , Catarata , Endoftalmite , Humanos , Vitrectomia/efeitos adversos , Vitrectomia/métodos , Endoftalmite/tratamento farmacológico , Endoftalmite/etiologia , Endoftalmite/cirurgia , Extração de Catarata/efeitos adversos , Antibacterianos/uso terapêutico , Catarata/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto
9.
BMC Ophthalmol ; 22(1): 439, 2022 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-36384489

RESUMO

BACKGROUND: Recurrent retinal detachment (Re-RD) usually affects the prognosis of surgery for rhegmatogenous retinal detachment (RRD). Previous clinical studies of Re-RD were not specific. This study aimed to analyze the clinical characteristics of Re-RD in post-vitrectomy eyes with RRD and surgical outcomes after revitrectomy without combining it with retinectomy or scleral buckling. METHODS: This is a retrospective case series analyzed the ocular characteristics of 20 recurrent and contralateral eyes, evaluated the significance of the associations between variables before reoperation and the final best-corrected visual acuity (BCVA), and calculated the outcome of revitrectomy. RESULTS: Patients with phakic eyes, those undergoing only one surgery, and those with more than one break had better final BCVA. The final BCVA was negatively correlated with the axial length and positively correlated with the preoperative BCVA. Among the 12 eyes with no break detected before surgery, 11 (92%) were found to have a small crevice-like break beside the pigment scar of a large number of original laser spots. The single-operation complete retinal reattachment rate was 75%, the complete retinal reattachment rate was 80%, and the final incomplete retinal reattachment rate was 90%. The BCVA improved from 1.2 ± 0.6LogMAR (0.06 ± 0.25) before surgery to 0.8 ± 0.7LogMAR (0.15 ± 0.2) at the last follow-up. The BCVA of 16 patients with complete retinal reattachment improved from 1.0 ± 0.5LogMAR (0.1 ± 0.3) to 0.6 ± 0.4LogMAR (0.25 ± 0.4). In the contralateral eyes, 15% already had vision-damaging disease, and the incidence of eyesight-threating lesions was 5.9% during follow-up. CONCLUSIONS: Revitrectomy without retinectomy or scleral buckling can effectively treat Re-RD in post-vitrectomy eyes. In Re-RD patients with no definite retinal break detected preoperatively, the retinal hole usually shows small crevice-like changes alongside a large number of original laser pigment scars.


Assuntos
Descolamento Retiniano , Humanos , Descolamento Retiniano/diagnóstico , Descolamento Retiniano/cirurgia , Descolamento Retiniano/etiologia , Vitrectomia/efeitos adversos , Estudos Retrospectivos , Acuidade Visual , Recurvamento da Esclera/efeitos adversos , Transtornos da Visão/etiologia
10.
Zhonghua Yan Ke Za Zhi ; 58(11): 946-947, 2022 Nov 11.
Artigo em Chinês | MEDLINE | ID: mdl-36348538

RESUMO

The patient was a 48-year-old male with a previous history of diabetes mellitus and hypertension. The patient had persistent bleeding after vitrectomy of the left eye, and the patient was examined for abnormal coagulation factor Ⅷ combined with Ⅻ. This case suggests that we need effective control of blood glucose and blood pressure in patients undergoing vitrectomy in clinical work, and adequate examination of coagulation function. Patients with coagulation factor deficiency should be treated with plasma transfusion to supplement coagulation factors before performing the necessary surgical treatment to prevent severe bleeding.


Assuntos
Diabetes Mellitus , Retinopatia Diabética , Masculino , Humanos , Pessoa de Meia-Idade , Retinopatia Diabética/terapia , Fator VIII/uso terapêutico , Transfusão de Componentes Sanguíneos , Plasma , Vitrectomia , Fotocoagulação a Laser , Diabetes Mellitus/cirurgia
11.
Rom J Ophthalmol ; 66(3): 265-270, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36349176

RESUMO

Objective: This study aimed to determine the intravitreal concentration of VEGF in eyes with PDR and to evaluate the effects of previous PRP on its level. Methods: It was a cross-sectional study performed at the Clinical Centre University. It included 90 eyes surgically treated with PPV, divided into three groups, group A - patients with PDR with previous PRP, group B - patients with PDR without previous PRP, and group C - PPV performed due to the indication unrelated to diabetes. A vitreous sample was obtained during PPV, and the VEGF concentration was determined using an Enzyme-linked immunosorbent assay test (ELISA). Shapiro-Wilk, nonparametric tests Kruskal-Wallis, Mann-Whithney U test, ANOVA and Spearman's correlation test were used. Results: The highest vitreous VEGF concentration was in group B - 972.96 (743.33-1149.13) and was higher than in group A - 69.22 (37.33-225.15) and in group C - 19.93 (1.15-32.17) (p<0.001). There was a positive correlation between VEGF vitreous concentration and glucose level in group A patients (Rho=0.410; p=0.027). Conclusion: As a treatment before PPV surgery, PRP showed to be effective in the reduction of VEGF levels, which also highlighted a decrease in complications during and postoperatively. Abbreviations: DRS = Diabetic Retinopathy Study, PDR = proliferative diabetic retinopathy, VEGF = vascular endothelial growth factor, PRP = pan-retinal photocoagulation, PPV = pars plana vitrectomy, HbA1c = glycosylated hemoglobin, ETDRS = Early treatment diabetic retinopathy study, ESR = erythrocyte sedimentation rate, BCVA = best corrected visual acuity, OCT = optical coherent tomography, ILM = internal limiting membrane, PHACO = phacoemulsification, IOL = intraocular lens, ELISA = Enzyme-linked immunosorbent assay test, AUC = area under the curve, DME = diabetic macular oedema, TDR = tractional retinal detachment, VMT = vitreomacular traction.


Assuntos
Diabetes Mellitus , Retinopatia Diabética , Humanos , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/cirurgia , Fator A de Crescimento do Endotélio Vascular , Estudos Transversais , Fotocoagulação a Laser , Vitrectomia , Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Lasers
12.
Rom J Ophthalmol ; 66(3): 271-276, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36349167

RESUMO

Objective: The aim of this study was to determine the efficacy of hAM plug in the treatment of idiopathic macular hole and to see its post-operative visual improvement and anatomical apposition. Material and methods: 10 eyes of 10 patients who had idiopathic MH underwent a pars plana vitrectomy (PPV) with the hAM plug implanted in MH. The patients were followed up on 2nd day, 1st week, 3rd week, 6th week and 3rd month. Results: Final anatomical closure of MH was achieved in all the cases. BCVA improved from 0.91±0.11 logMAR to 0.28±0.06 logMAR after 3 months. No adverse event was documented in the specified period. Conclusion: hAM plug is an efficient method to treat and manage idiopathic MH with encouraging results both in terms of anatomical closure and visual acuity gain. Abbreviations: MH = Macular Hole, IOP = Intra Ocular Pressure, ILM = Internal Limiting Membrane, BCVA = Best Corrected Visual Acuity, OCT = Optical Coherence Tomography, LogMAR = Logarithm of Minimum Angle of Resolution, hAM = Human Amniotic Membrane, RPE = Retinal Pigment Epithelium.


Assuntos
Perfurações Retinianas , Humanos , Perfurações Retinianas/diagnóstico , Perfurações Retinianas/cirurgia , Âmnio , Estudos Retrospectivos , Vitrectomia/métodos , Acuidade Visual , Tomografia de Coerência Óptica/métodos , Membrana Basal/cirurgia
13.
Optom Vis Sci ; 99(11): 830-832, 2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-36413632

RESUMO

SIGNIFICANCE: In the recent past, there are increasing publications on microsporidia affecting the cornea in Asian population. However, microsporidia-causing endophthalmitis has been rarely reported. This report intends to draw the attention of eye care professionals to consider microsporidia as a differential diagnosis in cases of keratitis or endophthalmitis after ocular trauma. PURPOSE: The purpose of this study was to report a case of microsporidial endophthalmitis after corneal tear in an otherwise healthy patient. CASE REPORT: A 62-year-old healthy gentleman sustained injury to the left eye cornea with the tip of a soiled and wet screw driver. Two days after the corneal tear suturing, he complained of pain. On examination, circumcorneal congestion with hypopyon of 2 mm in height was present. Vitreous tap and intravitreal antibiotics were injected. Vitreous tap showed microsporidia. Pars plana vitrectomy was performed. His vision improved to 6/12. CONCLUSIONS: Microsporidia are an emerging cause of stromal keratitis. In the recent past, there has been an increase in microsporidial keratitis in both immunocompetent and immunocompromised individuals. History of trauma especially in rainy season and exposure to soil are reported risk factors. This is a case report on microsporidia-causing endophthalmitis after corneal tear repair. Ophthalmologists and optometrists should be aware of the possibility of microsporidia as a potential pathogen causing stromal keratitis or endophthalmitis in a setting of ocular trauma. Early treatment can result in good visual recovery.


Assuntos
Endoftalmite , Ferimentos Oculares Penetrantes , Ceratite , Masculino , Humanos , Pessoa de Meia-Idade , Endoftalmite/diagnóstico , Endoftalmite/etiologia , Endoftalmite/terapia , Ferimentos Oculares Penetrantes/complicações , Ferimentos Oculares Penetrantes/diagnóstico , Corpo Vítreo , Vitrectomia
14.
Sci Rep ; 12(1): 20320, 2022 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-36433997

RESUMO

Patients with rhegmatogenous retinal detachment (RRD) require face-down positioning (FDP) for 3-6 months or longer after pars plana vitrectomy (PPV) combined with silicone oil (SO) tamponade. This paper aimed to identify the factors that influenced FDP compliance. This study adopted semi-structured interviews with patients who require FDP after SO tamponade. Constructivist grounded theory was utilized in this study. The qualitative data was analyzed and coded via NVivo 11.0 through open coding, axial coding and selective coding. Twenty-four RRD patients were involved. The interviews yielded five main themes that defined home FDP compliance were identified: posture discomfort, doctor-patient communication, psychological factors, occupational character, and family factors. A theoretical model of the influencing factors of postural compliance of FDP was constructed based on the interview analysis. A variety of factors can affect FDP conformity. We can increase compliance of RRD patients by enhancing comfort, encouraging doctor-patient communication, providing comprehensive care, promoting community-based intervention, and strengthening family education.


Assuntos
Descolamento Retiniano , Humanos , Descolamento Retiniano/cirurgia , Teoria Fundamentada , Acuidade Visual , Vitrectomia , Cooperação do Paciente
15.
J Coll Physicians Surg Pak ; 32(11): 1454-1458, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36377014

RESUMO

OBJECTIVE: To determine the outcomes of using perfluorocarbon liquid (PFCL) as postoperative tamponade in complex inferior retinal detachments. STUDY DESIGN: Quasi-experimental study. PLACE AND DURATION OF STUDY: Layton Rahmatullah Benevolent Trust (LRBT) Eye Hospital, Karachi, Pakistan, from January 2020 to December 2021. METHODOLOGY: This study was carried out on forty eyes of forty patients from the surgical retina clinic with rhegmatogenous inferior retinal detachment involving macula having proliferative vitreoretinopathy grade C (PVR grade-C). All eyes underwent 25G pars plana vitrectomy with PFCL as postoperative tamponade for 15 to 21 days. All patients were advised to maintain supine position postoperatively. PFCL-Silicon oil exchange was done after 15-21 days. The outcomes were measured as complete retinal reattachment between the neurosensory retina (NSR) and retinal pigment epithelium (RPE), changes in postoperative visual acuity and complications. Patients were followed up for a minimum duration of 6 months. Data were analysed using SPSS version 23. RESULTS: In 39 out of 40 eyes (97.5%) retina was completely attached. Postoperative visual acuity was improved in 24 eyes (60%), while in 16 eyes (40%) it remained stable. Worsening of visual acuity was not noted in any case. During follow-ups, uveitis was detected in 2 eyes (5%), cataract in 4 eyes (10%), optic atrophy in 2 eyes (5%) and endophthalmitis and subsequently redetachment in 1 eye (2.5%). CONCLUSION: In complex inferior retinal detachments, PFCL is safe and effective postoperative tamponade provided it is used for a short-term period, especially in those patients who are noncompliant with postoperative face-down position. KEY WORDS: Perfluorocarbon liquid (PFCL), Postoperative tamponade, Complex inferior retinal detachments.


Assuntos
Fluorcarbonetos , Descolamento Retiniano , Perfurações Retinianas , Vitreorretinopatia Proliferativa , Humanos , Descolamento Retiniano/cirurgia , Descolamento Retiniano/etiologia , Vitrectomia , Vitreorretinopatia Proliferativa/complicações , Vitreorretinopatia Proliferativa/cirurgia , Acuidade Visual , Complicações Pós-Operatórias/cirurgia , Perfurações Retinianas/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
16.
BMC Ophthalmol ; 22(1): 432, 2022 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-36376819

RESUMO

BACKGROUND: The developmental pathways and subsequent evolutional processes of idiopathic lamellar macular hole (LMH) were studied with spectrum domain optical coherence tomography (SD-OCT). METHODS: Twenty-seven eyes of 26 patients of idiopathic LMH with pre-LMH SD-OCT available were retrospectively reviewed. Relevant OCT parameters and best-corrected visual acuity (BCVA) were collected and analyzed. RESULTS: Four types of developmental pathways of idiopathic LMH were noted. Type 1 (5 cases), involved disruption of a foveal cyst from vitreomacular traction. Type 2 (10 cases), demonstrated rupture of parafoveal cysts or schisis mainly from epiretinal membrane (ERM). In type 3 pathway (5 cases), a central intraretinal cyst formed under tight ERM with subsequent cyst roof dehiscence. Type 4 (7 cases), showed gradual loss of foveal tissue without cystic lesions from ERM traction. There was no statistically significant change in BCVA during LMH formations or subsequent evolutional processes in any types of the developmental pathways. Three cases developed epiretinal proliferation (EP) during evolution, which showed tendency of decrease in BCVA. Among the three cases, one later developed the degenerative configuration. CONCLUSIONS: In summary, four types of tractional developmental pathways of idiopathic LMH were identified. BCVA was relatively stable during LMH formation and follow-up. Deterioration of visual acuity were found in cases that developed EP during evolution. Transformation into degenerative configuration might be possible after LMH formation.


Assuntos
Cistos , Membrana Epirretiniana , Perfurações Retinianas , Humanos , Perfurações Retinianas/cirurgia , Projetos Piloto , Estudos Retrospectivos , Seguimentos , Membrana Epirretiniana/diagnóstico , Tomografia de Coerência Óptica/métodos , Vitrectomia/métodos
17.
Ophthalmic Surg Lasers Imaging Retina ; 53(11): 619-625, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36378614

RESUMO

BACKGROUND AND OBJECTIVE: Determine clinical characteristics and long-term outcomes of fellow eyes for patients with prior repair of rhegmatogenous retinal detachments due to a giant retinal tear (GRT). STUDY DESIGN: Retrospective case series of patients who underwent vitreoretinal surgery between January 2005 and August 2017 for GRT at the Bascom Palmer Eye Institute with a minimum of one year of follow-up information. Patients with a traumatic or post-vitrectomy GRT were excluded. MAIN OUTCOME MEASURES: Visual acuity and rate of retinal events in fellow eyes. RESULTS: The study group included 51 patients; 40 others were excluded due to having less than one year of follow-up (n = 27), a history of inciting trauma (n = 11), or a GRT occurring post-vitrectomy (n = 2). The mean age was 49.9 years (range 14 to 81) and mean follow-up duration was 6.9 years (range 1 to 16). During the follow-up interval, prophylactic laser retinopexy was performed in 5 fellow eyes for retinal breaks (9.8%) and in one fellow eye with a progressing retinoschisis cavity (2.0%). One patient had a previous history of a retinal break in the fellow eye. Vitreoretinal surgery was performed in 6 (11.8%) fellow eyes for rhegmatogenous retinal detachments, of which one was caused by a GRT. Three patients (5.9%) already had a retinal detachment repair in the fellow eye prior to presentation and one patient presented with bilateral giant retinal tear associated retinal detachments (GRT-RDs) at the initial visit. Overall, there was a retinal event in 33.3% of fellow eyes. Myopia was the most commonly documented associated factor (31%), followed by lattice degeneration (22%), and known or suspected inherited vitreoretinopathy (4%). CONCLUSIONS: Retinal tears and/or detachments were encountered relatively frequently in the fellow eye of patients with a history of GRT-RD during follow-up, but the rate of GRTs in the fellow eye (4%) was below what has been generally reported in the literature. Regular dilated fundus exams are warranted for patients with a history of GRT. [Ophthalmic Surg Lasers Imaging Retina 2022;53:619-625.].


Assuntos
Descolamento Retiniano , Perfurações Retinianas , Humanos , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Perfurações Retinianas/diagnóstico , Perfurações Retinianas/etiologia , Perfurações Retinianas/cirurgia , Descolamento Retiniano/diagnóstico , Descolamento Retiniano/etiologia , Descolamento Retiniano/cirurgia , Estudos Retrospectivos , Vitrectomia/métodos , Acuidade Visual
18.
Ophthalmic Surg Lasers Imaging Retina ; 53(11): 644-646, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36378617

RESUMO

Perfluorocarbon liquid (PFCL) is an important adjunct in pars plana vitrectomy (PPV) for complex retinal detachment (RD). Complete removal of PFCL is critical to prevent retinal inflammation and cellular toxicity, but removal is not risk-free. We report a case of a new postoperative onset paracentral visual field defect after PPV with PFCL use for treatment of a macula-on RD. We present pre- and postoperative imaging that suggests a likely perioperative iatrogenic cause. [Ophthalmic Surg Lasers Imaging Retina 2022;53:644-646.].


Assuntos
Fluorcarbonetos , Descolamento Retiniano , Humanos , Vitrectomia/efeitos adversos , Vitrectomia/métodos , Descolamento Retiniano/diagnóstico , Descolamento Retiniano/cirurgia , Descolamento Retiniano/etiologia , Campos Visuais , Acuidade Visual , Fluorcarbonetos/efeitos adversos , Transtornos da Visão/cirurgia , Doença Iatrogênica , Estudos Retrospectivos
19.
Turk J Ophthalmol ; 52(5): 360-365, 2022 10 28.
Artigo em Inglês | MEDLINE | ID: mdl-36317828

RESUMO

This study aimed to evaluate the prognosis of a retinal autograft that was used to treat a macular hole that occurred after repeated vitreoretinal surgeries. A patient underwent repeated vitreoretinal surgery due to retinal detachment in the right eye, and the internal limiting membrane was also removed during the surgeries. After silicone oil removal, the patient developed recurrent retinal detachment and macular hole, and for this reason a retinal autograft was applied to the macular hole and silicone tamponade was administered. The silicone oil was removed at postoperative 7 months, and the macular hole was observed to be closed on fundus examination at 18 months. The final visual acuity was 5/100. On optical coherence tomography (OCT), the hole in the detached retina was measured as 600 µm in diameter preoperatively, 1020 µm on the first postoperative day, gradually narrowed to 765 µm, and graft integration occurred. During follow-up, the accumulation of hyperreflective spots persisted on the inner surface of the graft tissue and in all vertically extending sections. In en face sections, it appeared as a hyperreflective arc between the graft and host retina with a shadowing artefact. In OCT angiography evaluation, a punctate multiple blood flow signal in the vertical axis of the graft was detected in the early phase at 3 months. This finding persisted at 1 month after silicone removal, and the flow signal disappeared with resorption of the cystic edema. These flow signals were in the same location as the areas of hyperreflective spots on structural OCT. In conclusion, structural OCT and OCT angiography are effective methods for the follow-up of retinal autograft integration into host tissue.


Assuntos
Descolamento Retiniano , Perfurações Retinianas , Humanos , Perfurações Retinianas/cirurgia , Óleos de Silicone , Descolamento Retiniano/diagnóstico , Descolamento Retiniano/cirurgia , Vitrectomia/métodos , Autoenxertos , Retina
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