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1.
Curr Opin Ophthalmol ; 31(3): 167-173, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32175941

RESUMO

PURPOSE OF REVIEW: The present article reviews the most common and most serious vision-threatening and life-threatening complications of vitreoretinal surgery. RECENT FINDINGS: Serious complications after vitreroretinal surgery are rare. Endophthalmitis for example has recently been estimated to occur in 0.08% of small gague vitrectomy. Other complications such as cataract are almost unavoidable, becoming visually significant in up to 80% of patients. The introduction of smaller gauge vitrectomy systems has reduced surgical times, conjunctival scarring and inflammation, and the rate of some complications such as retinal tears. Ocular venous air embolism is an exceedingly rare complication that is potentially life threating and therefore important for all vitreoretinal surgeons to be aware of. SUMMARY: Though vitreoretinal surgery is well tolerated and effective, it is inevitable that all surgeons will experience complications and are therefore best served by understanding the potential complications, strategies to reduce the likelihood of them occurring, and ways to address them when they do happen.


Assuntos
Complicações Pós-Operatórias , Vitrectomia/efeitos adversos , Cirurgia Vitreorretiniana/efeitos adversos , Catarata/etiologia , Cicatriz/etiologia , Endoftalmite/etiologia , Humanos , Inflamação/etiologia
2.
Medicine (Baltimore) ; 99(7): e18637, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049779

RESUMO

RATIONALE: To report a case of diode laser transscleral cyclophotocoagulation (DLTSC) for uveitis-glaucoma-hyphema syndrome (UGH). PATIENT CONCERNS: The patient developed UGH on the right eye (OD) after vitrectomy and intraocular lens (IOL) implantation. DIAGNOSES: Best corrected visual acuity (BCVA) was HM/50 cm, intraocular pressure (IOP) was 51.3 mm Hg on the OD. He was found to have 3+ anterior chamber cells. A B-scan ultrasound showed vitreous opacity. Ultrasound biomicroscopy (UBM) showed the chafing between the IOL and the posterior surface of the iris. Thus, he was diagnosed as UGH on the OD. INTERVENTIONS: The patient was worried about the complications for removal of the IOL, a DLTSC approach was performed. OUTCOMES: BCVA was 20/40 on the OD, IOP was 12 mm Hg on the OD. There were no anterior chamber inflammation and no vitreous opacity. UBM showed there was no contact between IOL and the posterior surface of the iris, the fundus of the eye was clearly visible. LESSONS: UGH syndrome is a severe complication of cataract extraction. IOL extraction has been the traditional approach to treatment. DLTSC can be an option when the IOL is slightly tilted.


Assuntos
Glaucoma/cirurgia , Hifema/cirurgia , Fotocoagulação a Laser/métodos , Uveíte/cirurgia , Extração de Catarata/efeitos adversos , Glaucoma/etiologia , Humanos , Hifema/etiologia , Lasers Semicondutores , Implante de Lente Intraocular/efeitos adversos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Uveíte/etiologia , Vitrectomia/efeitos adversos
3.
Eur J Ophthalmol ; 30(1): 81-87, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30426767

RESUMO

INTRODUCTION: To evaluate the adverse event rate following pars plana vitrectomy as a function of surgical start time and the presence of a vitreoretinal fellow. METHODS: Single-institution retrospective cohort study of patients undergoing pars plana vitrectomy from 1 January 2016 to 31 December 2016 at Stanford University School of Medicine (Palo Alto, CA, USA). Records were reviewed for surgical start time, the presence of vitreoretinal fellow, and postoperative adverse events defined as any finding deviating from the expected postoperative course requiring observation or intervention. RESULTS: A total of 310 pars plana vitrectomies were performed. There was no statistical difference in the rate of any adverse event when comparing cases starting after 16:01 (9/13, 69.2%) and after 12:01 (42/99, 42.4%) to a morning start time (69/198, 34.9%, adjusted p = 0.083). There was a statistically significant increase in the risk of postoperative vitreous hemorrhage with afternoon and evening cases as compared to morning cases (adjusted p = 0.021). In addition, there was no difference in any adverse event with a fellow present (93/244, 38.1%) compared to without (27/66, 40.9%, adjusted p = 0.163). There was a higher risk of postoperative hypotony when a fellow was involved (6.6% vs 0%, p = 0.028), though this difference disappeared after adjusting for confounders (adjusted p = 0.252). There was no difference in the length of surgery with and without a fellow (49 vs 54 min, respectively; p = 0.990). DISCUSSION: Afternoon start time and the presence of a fellow were not independent risk factors for postoperative adverse events.


Assuntos
Competência Clínica , Bolsas de Estudo , Duração da Cirurgia , Oftalmologia/educação , Complicações Pós-Operatórias , Doenças Retinianas/cirurgia , Vitrectomia/efeitos adversos , Idoso , Educação de Pós-Graduação em Medicina , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acuidade Visual/fisiologia
5.
Ophthalmic Surg Lasers Imaging Retina ; 50(10): 613-619, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31671193

RESUMO

BACKGROUND AND OBJECTIVE: Intravitreal triamcinolone acetonide (IVTA) used as a surgical adjuvant for pars plana vitrectomy (PPV) can stain cortical vitreous, control postoperative inflammation, and reduce retinal edema. Sterile endophthalmitis uncommonly complicates office-based IVTA injection. The authors report a new complication of IVTA depot injection at the end of PPV. PATIENTS AND METHODS: Retrospective records review of all patients treated at the Cincinnati Eye Institute with PPV between January 1, 2011, and December 31, 2017, who developed a triad of sterile endophthalmitis, atrophic retinal breaks under the depot IVTA in the inferior retina, and rhegmatogenous retinal detachment (RRD). Eyes with flap tears, solely superior breaks, or stretch holes from proliferative vitreoretinopathy causing RRD were excluded. RESULTS: Eight eyes of eight patients (four males and four females; mean age: 73.7 years) who received 4 mg or 8 mg IVTA depot at the end of PPV surgery presented at a mean of 23.5 days following PPV with RRD (one macula-involving, seven macula-sparing), requiring treatment with PPV in six eyes and laser retinopexy alone in two eyes. Seven eyes that underwent membrane peeling (MP) received IVT to prevent cystoid macular edema (CME) and one eye with prior MP was treated for CME. Mean vitreous inflammation was 2+ cell at 1 week postoperatively. Two patients had documented sterile endophthalmitis within the first week requiring vitreous cultures and antibiotics injections. Visual acuity (VA) for eyes requiring PPV for RD repair declined from 20/90 preoperatively to 20/212 at 6 months postoperatively. VA for eyes amenable to laser alone improved from 20/53 to 20/35. All eyes remained attached, with the exception of one patient who refused further treatment after developing recurrent detachment from PVR. CONCLUSIONS: Particle-induced sterile endophthalmitis from IVTA depot at the end of PPV surgery resulted in atrophic inferior retinal breaks and RRD as a newly described entity coined "erosive retinopathy." All retinal detachment surgeries required silicone oil tamponade. Poor visual outcome at 6 months was common for eyes requiring PPV for RD repair. The authors recommend avoiding IVTA depot injection at the end of PPV. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:613-619.].


Assuntos
Anti-Inflamatórios/efeitos adversos , Descolamento Retiniano/induzido quimicamente , Perfurações Retinianas/induzido quimicamente , Triancinolona Acetonida/administração & dosagem , Vitrectomia/métodos , Idoso , Idoso de 80 Anos ou mais , Anti-Inflamatórios/administração & dosagem , Feminino , Humanos , Injeções Intravítreas , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Óleos de Silicone/administração & dosagem , Vitrectomia/efeitos adversos
6.
Arch. Soc. Esp. Oftalmol ; 94(11): 529-535, nov. 2019. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-187408

RESUMO

Objetivo: Estudiar la eficacia y perfil de seguridad de la vitretomía diagnóstica en pacientes con uveítis no filiada. Métodos: Estudio observacional descriptivo retrospectivo de 29 pacientes (37 ojos) con panuveítis no filiada en los que se realizó vitrectomía diagnóstica. Las características clínicas y demográficas fueron recogidas. Se estudiaron los métodos de extracción de muestras y las técnicas de procesado aplicadas para el diagnóstico. Resultados: De los 29 pacientes analizados 18 (62%) eran hombres. La media de edad fue de 63,11 años (desviación estándar: 14,55). El síntoma inicial más frecuente fue la disminución de agudeza visual, la agudeza visual media fue de 20/40 excluyendo 8 ojos en los que resultó inferior a 20/200. Veintiún pacientes presentaban alteración unilateral. Se realizó extracción de muestra en seco a todos los pacientes. Además, fueron empleadas las siguientes técnicas de toma de muestras: 5 biopsias retinianas, 5 muestras diluidas, 1 aspirado de absceso subretiniano, 1 aspirado de humor acuoso. Con respecto al procesado de las muestras la técnica más utilizada fue la citología en 25 ojos, seguida de la reacción en cadena de la polimerasa en 11 ojos, el cultivo en 10 ojos. El diagnóstico etiológico fue encontrado en 94,5% de los casos, siendo el principal linfoma, seguido de toxoplasmosis. Conclusión: La vitrectomía diagnóstica es útil para la identificación de la inflamación oftalmológica. Pueden utilizarse diferentes técnicas de obtención de muestras y procesado de las mismas


Objective: To study the results and safety of diagnostic vitrectomy in patients with unknown etiology panuveitis. Methods: A retrospective descriptive observational study was carried out in which a total of 29 patients (37 eyes) were included, who underwent a vitreous biopsy due to acute intraocular inflammatory processes. In all, demographic and clinical data were collected. We studied the specific samples extraction methods and their diagnosic processing. Results: Of the 29 patients analyzed, 18 were men. Mean of age was 63.11 years old (standard deviation: 14.55). The most frequent initial symptom was visual acuity decrease, with mean initial visual acuity being 20/40, excluding 8 eyes that had vision lower than 20/200. 21 presented unilateral ocular involvement. Vitrectomy was performed in all of them obtaining a dry sample. Vitrectomy was performed in all of the patients obtaining a dry sample. Moreover, the following techniques were done: 5 retinal biopsies, obtaining 5 muestras diluidas, 1 subretinal abscess aspirate and 1 aqueous humor aspirate. The most frequent processing technique that was used was cytology in 25 eyes, followed by PCR (polymerase chain reaction) in 11 eyes and culture in 10 eyes. Diagnosis was achieved in 94.5% of patients. Main diagnosis found was lymphoma, followed by toxoplasmosis. Conclusions: Diagnostic vitrectomy is very important in ophthalmic inflammation identification. Different techniques for obtaining and processing can be used


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Pan-Uveíte/etiologia , Vitrectomia/métodos , Corticosteroides/administração & dosagem , Amiloidose/diagnóstico , Aspergilose/diagnóstico , Candida albicans/isolamento & purificação , Candidíase/diagnóstico , Granuloma de Corpo Estranho/diagnóstico , Leucemia Linfocítica Crônica de Células B/diagnóstico , Pan-Uveíte/tratamento farmacológico , Reação em Cadeia da Polimerase , Estudos Retrospectivos , Manejo de Espécimes/métodos , Toxoplasmose Ocular/diagnóstico , Acuidade Visual , Vitrectomia/efeitos adversos , Doença de Whipple/diagnóstico
7.
Curr Pharm Biotechnol ; 20(12): 1037-1043, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31393242

RESUMO

BACKGROUND & OBJECTIVE: Corneal endothelial cells (ECD) are characterized by limited regenerative potential, which is additionally impaired in patients with diabetes. This retrospective study included 27 patients aged 58.1±13.6, 16 female and 11 males, who underwent 23-gauge vitrectomy in combination with cataract surgery (phacovitrectomy) and further Ex-PRESS shunt implantation throughout 2013-2017 at St. Barbara Hospital in Sosnowiec, Poland. METHODS: In our study, we distinguished 4 periods: initial period; post phacovitrectomy and removal of oil tamponade; and 3 and 12 months post implantation of the Ex-PRESS shunt. Statistical analysis was performed at the level of statistical significance of p<0.05. It included an analysis of variance (ANOVA) and Tukey's post-hoc test in order to determine the differences in the density of ECD cells/mm2 between the periods of observation. The paired-samples t-Student test was also performed to determine whether the differences in visual acuity values before and after PPV and before and after Ex-PRESS shunt were statistically significant. RESULTS: The initial count of ECD cells was 2381.1±249, which decreased to 1872.8±350.7 cell/mm2 and finally to 1677.9±327 at the endpoint. Differences in the density of ECD cells/mm2 were observed to be statistically significant between the periods: after PPV vs. initial number of ECD (p = 0.000138); before 3 months after Ex-PRESS shunt vs. initial number of ECD (p = 0.000138); 12 months after Ex- PRESS shunt vs. initial number of ECD (p = 0000138). Analyzing the changes in visual acuity, we observed a deterioration both before and 3 months after Ex-PRESS shunt (p = 0.007944) and before and after PPV (p = 0.060334). In turn, correlation analysis indicated that there is a statistically significant, moderate, positive relationship. The relationship between visual acuity after Ex-PRESS shunt and ECD cells/mm2 density turned out to be statistically significant (r = +0.521381; p < 0.05). CONCLUSION: Regardless of the period of observation and the choice of ophthalmic treatment of diabetic complications, we observed a decrease in the number of ECD cells and a deterioration in visual acuity. It is, therefore, reasonable to provide the patient with complete information about the proposed procedures and to consider the risk-benefit balance.


Assuntos
Córnea/cirurgia , Diabetes Mellitus Tipo 2/patologia , Células Endoteliais/patologia , Implantes para Drenagem de Glaucoma , Glaucoma/cirurgia , Facoemulsificação , Vitrectomia , Adulto , Idoso , Contagem de Células , Córnea/irrigação sanguínea , Diabetes Mellitus Tipo 2/cirurgia , Feminino , Glaucoma/complicações , Implantes para Drenagem de Glaucoma/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Facoemulsificação/efeitos adversos , Estudos Retrospectivos , Acuidade Visual , Vitrectomia/efeitos adversos
8.
Ophthalmic Surg Lasers Imaging Retina ; 50(7): 414-422, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31344240

RESUMO

BACKGROUND AND OBJECTIVE: To investigate the displacement of foveal retinal layers in surgically closed macular holes (MHs) after removal of the internal limiting membrane (ILM). PATIENTS AND METHODS: Medical records of 26 consecutive patients who underwent vitrectomy and removal of the ILM for idiopathic MH were retrospectively reviewed. En face optical coherence tomography images were exported at the level of the choroid, ellipsoid zone (EZ), and inner plexiform layer (IPL) at baseline and at 1, 3, and 6 months. The foveal center of the EZ and IPL was marked in the choroid en face image. The choroidal images were overlapped to match the vasculature in each patient, and the postoperative displacement of the foveal center was compared to baseline. RESULTS: The center of the EZ and IPL was displaced significantly toward the disc during the first 3 months. The mean horizontal displacement at 1, 3, and 6 months was 52.7 µm, 112.5 µm, and 115.4 µm, respectively, for the EZ and 75.2 µm, 117.1 µm, and 136.5 µm, respectively, for the IPL. The location of the foveal center was significantly correlated between the EZ and the IPL (P ≤ .016). CONCLUSIONS: The fovea was displaced nasally and slightly inferiorly after removal of the ILM. The displacement of the photoreceptor and inner retinal layers was concurrent. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:414-422.].


Assuntos
Técnicas de Diagnóstico Oftalmológico , Fóvea Central/patologia , Perfurações Retinianas/cirurgia , Tomografia de Coerência Óptica/métodos , Vitrectomia/métodos , Idoso , Idoso de 80 Anos ou mais , Membrana Epirretiniana/cirurgia , Feminino , Fóvea Central/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Oftalmoscopia , Estudos Retrospectivos , Vitrectomia/efeitos adversos
9.
Indian J Ophthalmol ; 67(7): 1204-1206, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31238466

RESUMO

Aqueous misdirection (AM) is a dreaded complication, but fortunately quite rare. It usually occurs after intervention for angle closure glaucoma. When pharmacotherapy and/or laser interventions are unsuccessful, then the surgical management hitherto most commonly undertaken is pars plana posterior vitrectomy. We describe the management of recurrent AM via the anterior route, when it occurred following relapse as pars plana posterior vitrectomy failed to result in long-term normalization of anterior chamber and intraocular pressure. Anterior vitrector with anterior vitrectomy settings was used by a glaucoma specialist to carry out the procedure.


Assuntos
Segmento Anterior do Olho/cirurgia , Humor Aquoso , Glaucoma de Ângulo Fechado/cirurgia , Pressão Intraocular/fisiologia , Paracentese/métodos , Complicações Pós-Operatórias/cirurgia , Vitrectomia/efeitos adversos , Segmento Anterior do Olho/diagnóstico por imagem , Feminino , Glaucoma de Ângulo Fechado/fisiopatologia , Humanos , Iridectomia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Reoperação , Acuidade Visual
11.
Ophthalmic Surg Lasers Imaging Retina ; 50(6): 371-376, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31233154

RESUMO

BACKGROUND AND OBJECTIVE: This paper reports 3-year intraocular pressure (IOP) outcomes of the Prospective Retinal and Optic Nerve Vitrectomy Evaluation (PROVE) study. PATIENTS AND METHODS: The prospective, controlled, observational study included 80 eyes of 40 participants undergoing routine pars plana vitrectomy. Study patients underwent preoperative evaluation and multimodal testing of the study (surgical) and fellow (control) eye. This testing was repeated at 3 months postoperatively and then annually for 3 years. RESULTS: Thirty-two of 40 patients (80%) completed 3-year follow-up. At 3 years postoperatively, there was no difference in IOP measurements in surgical eyes overall from baseline (P = .36). Subgroup analysis of pseudophakic eyes at baseline showed a significant elevation in IOP from 14.3 mm Hg ± 2.9 mm Hg at baseline to 16.8 mm Hg ± 3.2 mm Hg at 3-year follow-up (P < .029). Fellow eyes did not experience a significant change from baseline. CONCLUSION: The authors' 3-year results show that IOP is consistently and significantly elevated in pseudophakic eyes compared to baseline following routine vitrectomy. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:371-376.].


Assuntos
Pressão Intraocular/fisiologia , Pseudofacia/fisiopatologia , Pseudofacia/cirurgia , Vitrectomia/efeitos adversos , Adulto , Idoso , Análise de Variância , Feminino , Glaucoma/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Vitrectomia/métodos
12.
Arq Bras Oftalmol ; 82(3): 214-219, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31116303

RESUMO

PURPOSE: To evaluate the effects of suturing 23-gauge pars plana vitrectomies on ocular discomfort and tear film dynamics. METHODS: This retrospective chart review involved data from 50 procedures in 50 patients who underwent 23-gauge pars plana vitrectomy from January to November 2016. We divided the eyes into two groups according to the presence or absence of sutures; 35 eyes underwent sutureless vitrectomies (Group 1), and 15 eyes underwent vitrectomy with at least one sclerotomy suture site (Group 2). In each group, we assessed objective variables including tear film break-up time, Schirmer test I, corneal surface grading with Oxford system, and a quantitative method evaluating subjective dry eye symptoms using ocular surface disease index questionnaires preoperatively 1 week, and 1 and 3 months after surgery. RESULTS: The tear film break-up time showed a significant difference at the 3-months follow-up (p=0.026). The Schirmer test I and corneal surface staining score showed no statistically significant differences between two groups at any time after the operations. The ocular surface disease index score was significantly lower in Group 1 than in Group 2 at 1 week (p=0.032), 1 month (p=0.026), and 3 months (p=0.041) after the operation. CONCLUSION: Sclerotomy suturing caused ocular discomfort and had a negative effect on tear film dynamics during the late postoperative period. Sclerotomies without suturing seem to reduce the ocular surface changes.


Assuntos
Esclerostomia/efeitos adversos , Técnicas de Sutura/efeitos adversos , Lágrimas/fisiologia , Vitrectomia/efeitos adversos , Vitrectomia/métodos , Idoso , Idoso de 80 Anos ou mais , Síndromes do Olho Seco/etiologia , Síndromes do Olho Seco/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Esclerostomia/métodos , Estatísticas não Paramétricas , Inquéritos e Questionários , Técnicas de Sutura/instrumentação , Fatores de Tempo , Resultado do Tratamento , Vitrectomia/instrumentação
13.
Acta Diabetol ; 56(10): 1141-1147, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31089929

RESUMO

AIM: Main failure of diabetic tractional retinal detachment (TRD) surgery is the development of proliferative vitreoretinopathy (PVR), causing higher re-detachment rates. We investigated whether the use of dexamethasone (DEX) implant at the end of pars plana vitrectomy (PPV) with silicone oil tamponade might have an impact on these outcomes. DESIGN: Comparative, nonrandomized, retrospective study. PARTICIPANTS: A total of 148 eyes from 148 patients that underwent PPV with silicone oil tamponade for diabetic TRD (with DEX implant, n = 52; without DEX implant, n = 96). METHODS: Consecutive patients' records were reviewed for time between TRD diagnosis and surgery; lens status before surgery and after 6, 12, and 24 months; retina attachment rate after primary PPV; change in postoperative PVR severity; rate of re-detachment at 6, 12, and 24 months; use of IOP lowering treatment after 6, 12, and 24 months; surgery details; intra- and postoperative complications. Correlations between outcome measures, postoperative PVR severity, and re-detachment rates were analyzed. MAIN OUTCOME MEASURES: Change in postoperative PVR severity and retinal re-detachment rates with and without the adjuvant use of DEX implant. RESULTS: Retinal re-detachment rates were significantly higher in the group of patients that did not receive DEX implant [11/96 (11.5%) vs. 0/52 (0%), p = 0.049; 11/84 (12.9%) vs. 4/52 (7.7%), p = 0.007; 14/71 (19.7%) vs. 5/52 (10%) p < 0.001 at 6, 12, and 24 months, respectively]. PVR severity correlated with retinal status at 12 and 24 months (p = 0.018 and p = 0.027, respectively). The difference in PVR severity between the two groups was statistically significant at 6, 12, and 24 months (p < 0.001). CONCLUSIONS: DEX implant at the end of PPV in patients with diabetic TRD improves PVR severity and decreases re-detachment rates. This should be considered as an option in the customized treatment of TRD.


Assuntos
Dexametasona/administração & dosagem , Retinopatia Diabética/tratamento farmacológico , Retinopatia Diabética/cirurgia , Descolamento Retiniano/tratamento farmacológico , Descolamento Retiniano/cirurgia , Vitrectomia/métodos , Adulto , Idoso , Terapia Combinada , Dexametasona/efeitos adversos , Retinopatia Diabética/complicações , Implantes de Medicamento/administração & dosagem , Implantes de Medicamento/efeitos adversos , Feminino , Humanos , Injeções Intravítreas , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Retina/efeitos dos fármacos , Retina/fisiopatologia , Estudos Retrospectivos , Óleos de Silicone/administração & dosagem , Óleos de Silicone/efeitos adversos , Acuidade Visual/efeitos dos fármacos , Vitrectomia/efeitos adversos , Vitreorretinopatia Proliferativa/tratamento farmacológico , Vitreorretinopatia Proliferativa/etiologia , Vitreorretinopatia Proliferativa/cirurgia
14.
Indian J Ophthalmol ; 67(6): 917-921, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31124515

RESUMO

Purpose: The purpose of this study is to describe the short-term incidence, clinical features, and management of glaucoma in children after successful surgery for stage 4 retinopathy of prematurity (ROP). Methods: The retrospective study included all eyes undergoing successful surgery for stage 4 ROP with good outcomes at a tertiary eye care center between June 2014 and June 2016. Cases developing postoperative glaucoma underwent examination under anesthesia for measurement of intraocular pressures (IOP), corneal diameters, Retcam-assisted fundus imaging, and gonioscopy. Outcomes of glaucoma management were evaluated. Results: Hundred eyes of 70 babies underwent successful surgery for stage 4 ROP (with postoperative attached retina, and minimal sequelae) with minimum follow-up of 15 months. Six eyes (6%) developed postoperative glaucoma. Of these, four eyes had undergone lens-sparing vitrectomy and two were managed with lensectomy and vitrectomy (LV). Median time duration for development of glaucoma after primary vitreous surgery was 17.5 weeks. Two cases could be managed with topical IOP-lowering agents alone, whereas four required filtering surgeries (trabeculotomy with trabeculectomy and 0.04% mitomycin C [MMC] application). Average IOP decreased from 25 ± 2.36 to 12.2 ± 2.05 mmHg at 12 months from glaucoma diagnosis. Conclusion: Glaucoma is a potential adverse event following successful vitreous surgery for stage 4 ROP. A combined trabeculotomy-trabeculectomy along with MMC gives favorable outcome.


Assuntos
Cirurgia Filtrante/métodos , Glaucoma/cirurgia , Pressão Intraocular/fisiologia , Retinopatia da Prematuridade/cirurgia , Acuidade Visual , Vitrectomia/efeitos adversos , Feminino , Seguimentos , Glaucoma/etiologia , Glaucoma/fisiopatologia , Humanos , Recém-Nascido , Masculino , Complicações Pós-Operatórias , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
15.
Indian J Ophthalmol ; 67(6): 965-966, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31124534

RESUMO

A case of stage 4B retinopathy of prematurity (ROP) after successful retinal reattachment surgery with maintained vision presented with hazy cornea with spontaneous Descemet's membrane detachment (DMD) 15 years after the surgery, requiring Descemet Stripping Endothelial Keratoplasty (DSEK) to restore vision. There are reports of late spontaneous DMD after phacoemulsification or previous corneal surgeries. This report is unique as there is no published literature of spontaneous DMD after limbal surgery for ROP when searched in PubMed. The immature Descemet's membrane (DM), surgical intervention and changes in immature DM with age would have contributed to spontaneous DMD and warrant a long-term follow-up of premature kids.


Assuntos
Doenças da Córnea/etiologia , Lâmina Limitante Posterior/patologia , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/métodos , Previsões , Facoemulsificação/efeitos adversos , Retinopatia da Prematuridade/cirurgia , Vitrectomia/efeitos adversos , Doenças da Córnea/diagnóstico , Doenças da Córnea/cirurgia , Seguimentos , Humanos , Recém-Nascido , Masculino , Complicações Pós-Operatórias , Reoperação , Retinopatia da Prematuridade/diagnóstico , Tomografia de Coerência Óptica , Acuidade Visual
16.
Ulus Travma Acil Cerrahi Derg ; 25(3): 298-302, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31135941

RESUMO

BACKGROUND: This study is a report of the outcomes of 23-gauge (G) transconjunctival vitrectomy (TV) performed to treat a posterior segment intraocular foreign body (IOFB). METHODS: The data of 14 eyes of 14 patients who underwent 23-G TV for the removal of a posterior segment IOFB were reviewed in this study. Surgery was initiated with a 23-G system in each case and the posterior segment IOFB was removed through the enlarged sclerotomy site. All of the patients were male. The mean age of the patients was 36.6+-11.0 years. RESULTS: The foreign body (FB) was located in the vitreous in 11 eyes and in the retina in 3 eyes. Before the 23-G TV, complicated cataract was detected in 6 eyes, vitreous hemorrhage was detected in 5 eyes, and retinal detachment was detected in 1 eye. The size of the FB ranged from 3 mm to 7 mm; 12 of the FBs were metallic and 2 were glass. Silicone oil was used as a tamponade agent in 5 eyes and gas tamponade (C3F8) was used in 4 eyes. The mean follow-up time was 8.15+-2.9 months. At the last examination, of the 14 eyes included in the study, the visual acuity (VA) was 0.1 or better in 10 eyes and less than 0.1 in 4 eyes because 2 eyes had peri-macular scar, 1 eye had massive sub-epiretinal membrane and 1 eye had retinal re-detachment. CONCLUSION: 23-G TV is seen as an effective and minimally invasive technique to remove posterior segment IOFBs.


Assuntos
Corpos Estranhos no Olho/cirurgia , Segmento Posterior do Olho , Vitrectomia , Adulto , Humanos , Pessoa de Meia-Idade , Segmento Posterior do Olho/lesões , Segmento Posterior do Olho/cirurgia , Estudos Retrospectivos , Vitrectomia/efeitos adversos , Vitrectomia/instrumentação , Vitrectomia/métodos , Vitrectomia/estatística & dados numéricos
17.
ScientificWorldJournal ; 2019: 5416806, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30956624

RESUMO

Purpose: Most studies about retinal detachment cover a limited follow-up period. The purpose of this research is to assess the long-term results after pars plana vitrectomy (PPV) and scleral buckle (SB) surgery in patients with rhegmatogenous retinal detachment (RRD). Methods: 155 patients with RRD are treated either with SB or PPV with a mean follow-up of more than 5 years. Retrospective analysis of patient data with RRD was performed between January 2006 and June 2008 at a tertiary eye clinic. Results: Overall primary success rate was 85.2% (PPV: 84.6%, SB: 89.5%; p=0.57). 90.5% of redetachments appeared within the first 124 days. No significant different success rate was found for vitrectomy with and without additional encircling band (p=0.09). No advantage of a supplemental encircling band in cases of preoperative inferior breaks was seen (p=0.81). Patients of SB group were treated more frequently in follow-up time because of epiretinal membrane (ERM) (SB: 15.5% versus PPV: 7.3%). No patient of the PPV group without intraoperative use of endolaser cerclage (14.7%) had any peeling surgery postoperatively. Conclusion: Redetachment rates of both methods are comparable in a clinical setting where PPV is considered a suitable method for pseudophakic patients and in complex cases and SB was performed in younger phakic patients with clearly identified retinal tears. PPV seems to show a more heterogenous pattern of complications. No advantage of a supplemental encircling band could be found in these case series of patients with primary RRD. No relevant long-term risk of redetachment was seen after SB.


Assuntos
Complicações Pós-Operatórias/epidemiologia , Descolamento Retiniano/cirurgia , Recurvamento da Esclera/efeitos adversos , Vitrectomia/efeitos adversos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Recidiva , Estudos Retrospectivos , Resultado do Tratamento
18.
Medicine (Baltimore) ; 98(8): e14603, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30813184

RESUMO

This retrospective study investigated the risk factors of exudative retinal detachment (ERD) occurring after vitrectomy performed to treat proliferative diabetic retinopathy (PDR).All patients were treated with vitrectomy for PDR. Patients with history(s) of the following were excluded: ocular surgery (except phacoemulsification combined with intraocular lens implantation or retinal laser photocoagulation); ocular trauma; systemic diseases; ocular diseases; uveitis; scleritis; tumor; congenital ocular disorders; or others.Included were 205 eyes of 169 patients, of whom 18 (8.78%) developed ERD with varying degrees of exudative choroidal detachment after 1 to 3 days. Binary logistic regression showed the following association with the development of ERD: lower serum albumin concentration (P = .001); without intravitreal anti-vascular endothelial growth factor (anti-VEGF) drug injection before vitrectomy (P = .044); and history of phacoemulsification combined with intraocular lens implantation (P = .046). No association was found with gender; age; systolic pressure; diastolic pressure; panretinal photocoagulation; intraocular pressure on the 1st postoperative day; intraocular pressure on the 2nd postoperative day; serum albumin concentration; or blood urea nitrogen.Risk factors for ERD after vitrectomy for PDR include low serum albumin concentration, without history of intravitreal anti-VEGF drug injection before surgery, and a history of phacoemulsification combined with intraocular lens implantation.


Assuntos
Retinopatia Diabética/cirurgia , Descolamento Retiniano/etiologia , Vitrectomia/efeitos adversos , Adulto , Idoso , Feminino , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco
19.
Graefes Arch Clin Exp Ophthalmol ; 257(5): 1029-1036, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30868235

RESUMO

PURPOSE: To determine the factors that may affect the accuracy of vitrectomy cell block technique in detecting atypical lymphoid cells in patients with vitreoretinal lymphoma (VRL). METHODS: We retrospectively reviewed 43 eyes in 39 patients who underwent vitrectomy for definitive histological diagnosis of VRL with vitrectomy cell block technique and/or smear preparation at Kyushu University Hospital from January 2001 to March 2016. The association of detection of atypical lymphoid cells using vitrectomy cell block technique with the following factors was assessed using logistic regression analysis: age at diagnosis, sex, presence or absence of concurrent cataract surgery with vitrectomy, clinical grading of vitreous haze, presence or absence of subretinal tumor infiltration, interval between initial symptoms and vitrectomy, and presence or absence of systemic corticosteroid therapy before vitrectomy. RESULTS: Atypical lymphoid cells were more significantly detected using vitrectomy cell block technique compared to that using smear preparation (p = 0.018). After adjusting for age and sex, concurrent cataract surgery (odds ratio [OR], 10.41; 95% confidence interval [CI], 1.42-76.41) and subretinal tumor infiltration (OR, 5.06; 95% CI, 1.06-24.32) were significantly associated with failure of histological analysis with vitrectomy cell blocks. In multivariable logistic regression analysis, similar results were obtained, although subretinal tumor infiltration was only marginally associated with the detective capability of the technique. CONCLUSION: Vitrectomy cell block technique significantly improved the definitive diagnosis of VRL. Concurrent cataract surgery with vitrectomy and subretinal tumor infiltration were risk factors for failure in vitrectomy cell blocks.


Assuntos
Linfoma Intraocular/cirurgia , Linfoma/cirurgia , Neoplasias da Retina/cirurgia , Vitrectomia/efeitos adversos , Corpo Vítreo/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Linfoma Intraocular/diagnóstico , Linfoma/diagnóstico , Masculino , Pessoa de Meia-Idade , Neoplasias da Retina/diagnóstico , Estudos Retrospectivos , Fatores de Risco , Falha de Tratamento , Corpo Vítreo/patologia
20.
Ophthalmologica ; 242(1): 16-21, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30889589

RESUMO

PURPOSE: The aim of this study was to investigate the efficacy and safety of intravitreal dexamethasone implant for the treatment of macular edema after pars plana vitrectomy (PPV) for epiretinal membrane (ERM) removal. METHODS: This prospective study included 27 patients who were diagnosed with macular edema after PPV for ERM removal and who were treated with either intravitreal dexamethasone implant (n = 15) or were observed without intervention (n = 12). Changes in best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were assessed 1, 6, and 12 months -after treatment. RESULTS: Patients treated with intravitreal dexamethasone implant showed significant improvement in BCVA and reduction in CRT at months 1, 6, and 12 after treatment, while patients in the control group showed improvement that did not reach statistical significance. The two groups differed significantly in terms of BCVA and CRT at all time points of the follow-up period, in favor of the dexamethasone implant group. Eighty percent of the patients treated with intravitreal dexamethasone needed only one implant until month 12, while no serious adverse events were noticed in any group. CONCLUSIONS: Intravitreal dexamethasone implant was found to be effective and safe for the treatment of macular edema after PPV for ERM removal.


Assuntos
Dexametasona/administração & dosagem , Membrana Epirretiniana/cirurgia , Glucocorticoides/administração & dosagem , Edema Macular/tratamento farmacológico , Vitrectomia/efeitos adversos , Idoso , Implantes de Medicamento , Feminino , Humanos , Injeções Intravítreas , Edema Macular/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tomografia de Coerência Óptica , Resultado do Tratamento , Acuidade Visual
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