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1.
J Ayub Med Coll Abbottabad ; 32(4): 450-453, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33225642

RESUMO

BACKGROUND: The objective of this study was to determine and compare the structural and functional outcome in eyes who underwent Pars Plana Vitrectomy (PPV) with Epiretinal Membrane (ERM) peeling alone verses combined Epiretinal membrane with Internal Limiting Membrane (ILM) peeling for Idiopathic Epiretinal Membrane along with the rate of recurrence. METHODS: It was an interventional randomized study, conducted at Al-Ibrahaim Eye Hospital, Malir, Karachi, for two-year period from 1st August 2016 to 1st August 2018. A total of forty-four eyes of 44 patients were divided into two groups equally. Group A contains 22 eyes of 22 patients who underwent PPV with ERM peeling alone. Group B also contains 22 eyes of 22 patients who underwent PPV with ERM and ILM peeling. The follow up period was 1 year. The patients having best corrected visual acuity (BCVA) less than 6/18 or symptom of metamorphopsia were included in our study. The best corrected visual acuity (BCVA) and central macular thickness (CMT) were recorded at 3, 6 and 12-month follow up. RESULTS: In group A, the mean preoperative BCVA was 0.148 Log MAR (6/36 Snellen chart). The mean postoperative BCVA at 3, 6, and 12 months was 0.32 (6/18), 0.49 (6/12 P), and 0.50 (6/12), respectively. In group B, the mean preoperative best corrected visual acuity was 0.161 Log MAR (6/36 P Snellen chart). The mean postoperative BCVA at 3, 6, and 12 months was 0.36 (6/18 P), 0.51 (6/12), and 0.51 (6/12) respectively. The mean preoperative Central Macular Thickness (CMT) was 398.9 µm in group A and 384.7 µm in group B. The mean CMT in group A was 271.4, 236.7, and 229.8 µm at 3, 6, and 12 months, respectively. In group B, the mean CMT was 272.1, 233.8, and 220.4 µm at 3, 6, and 12 months, respectively. No significant difference was found in the visual outcome and central macular thickness between the two groups. CONCLUSIONS: Pars plana vitrectomy along with ERM peeling alone or combined with ILM peeling is a safe procedure. Both methods were effective functionally and structurally in the treatment of idiopathic ERM, however, no significant difference and no recurrence of ERM was observed in either group.


Assuntos
Membrana Epirretiniana/cirurgia , Vitrectomia/efeitos adversos , Vitrectomia/métodos , Humanos , Paquistão , Retina/cirurgia , Acuidade Visual
2.
PLoS One ; 15(11): e0242567, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33201931

RESUMO

This study evaluated changes in intraocular pressure (IOP) with face-down positioning (FDP) following surgical treatment of idiopathic macular hole. We retrospectively reviewed the records of 130 patients diagnosed with idiopathic macular hole who underwent pars plana vitrectomy (PPV) with intravitreal gas injection after fluid-gas exchange. We analyzed IOP changes in both eyes following FDP over the course of 7 days. The mean IOP of the operated eyes was 14.98±2.95 mmHg preoperatively and 16.82±3.12 and 15.57±6.10 mmHg on postoperative days 2 and 7, respectively. In contralateral eyes, the mean IOP changed from 14.78±3.15 mmHg preoperatively to 16.27±1.87 and 14.40±4.14 mmHg on postoperative days 2 and 7, respectively. On postoperative day 2, the IOP increased in both eyes compared to the preoperative values, but the increase was significant only in operated eyes (p = 0.039). In contralateral eyes, the IOP on postoperative day 7 was significantly decreased compared with that on postoperative day 2 (p = 0.021) and in eyes with an axial length ≥ 23.0 mm, compared with the preoperative values (p = 0.042). The IOP of the operated eyes on postoperative day 7 was higher than that of the contralateral eyes (p = 0.039). Based on a short-term follow-up, FDP after PPV with intravitreal gas tamponade for the treatment of idiopathic macular hole may cause IOP elevation not only in the operated, but also in the contralateral eyes; the IOP increase in contralateral eyes was not as significant as that in operated eyes and was not maintained over 7 days after surgery; the IOP change seems to be affected by axial length and lens status.


Assuntos
Pressão Intraocular/fisiologia , Perfurações Retinianas/cirurgia , Vitrectomia/métodos , Idoso , Membrana Epirretiniana/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Decúbito Ventral/fisiologia , Retina/cirurgia , Estudos Retrospectivos , Tonometria Ocular/métodos , Acuidade Visual , Corpo Vítreo/cirurgia
3.
Sci Rep ; 10(1): 17583, 2020 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-33067537

RESUMO

This study aimed to assess optical coherence tomography (OCT) parameters associated with vitreomacular traction (VMT) resolution after ocriplasmin intravitreal injection and also associated with the development of vitreomacular complications. Study designed was a retrospective case series. Structural OCT images were acquired at baseline and over the follow-up after treatment. We developed a mathematical model to provide quantitative parameters associated with VMT resolution. Moreover, we adopted the same model to assess the quantitative parameters associated with development of further vitreomacular complications or with the worsening of the coexisting condition. Main outcome measures were BCVA, central macular thickness (CMT), VMT reflectivity, VMT size, VMT resolution, epiretinal membrane (ERM), macular holes. 73 eyes of 73 VMT patients (mean age 73 ± 9 years) were recruited. The mean follow-up duration was 2.6 ± 1.1 years. Mean baseline BCVA was 0.38 ± 0.18 LogMAR, improving to 0.26 ± 0.20 at the end of the follow-up (p < 0.01). Baseline CMT was 431 ± 118 µm, improving to 393 ± 122 µm at the end of the follow-up (p < 0.01). 38/73 eyes (52%) showed only VMT, whereas 35/73 eyes (48%) also showed coexisting alterations at baseline. VMT resolved in 40/73 eyes (55% of cases). Our model disclosed VMT reflectivity as the most involved parameter in VMT resolution. VMT size showed less influence on the success of ocriplasmin treatment. ERM was negatively associated with VMT resolution. Moreover, VMT reflectivity values and ERM represented the most important parameters for the onset of vitreomacular complications.


Assuntos
Vitrectomia/métodos , Descolamento do Vítreo/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Feminino , Fibrinolisina/farmacologia , Humanos , Injeções Intravítreas/métodos , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Fragmentos de Peptídeos/farmacologia , Retina/patologia , Retina/cirurgia , Perfurações Retinianas/cirurgia , Estudos Retrospectivos , Tomografia de Coerência Óptica/métodos , Resultado do Tratamento , Transtornos da Visão , Acuidade Visual , Corpo Vítreo/metabolismo
4.
Sci Rep ; 10(1): 18507, 2020 10 28.
Artigo em Inglês | MEDLINE | ID: mdl-33116246

RESUMO

We sought to describe the surgical techniques required in the ab-interno method to implant subretinal prostheses in mini-pigs and suggest tips to facilitate optimal outcomes. During vitrectomy, the use of valved trocar cannulas was essential to stabilize the detached retina and implanted chip. As a first step in retinal detachment, a 23-gauge cannula with very small amount of viscoelastic material was used to establish the retinal hole and promote retinal detachment. Then, balanced salt solution was applied to increase the retinal detachment and diathermy was used to make opening for subretinal prosthesis. For easy positioning of the subretinal prosthesis, a curved laser probe was adopted when handling the subretinal prosthesis under the retina. After surgery, the sclerotomy sites were tightly sutured to prevent silicone oil leakage. Without special equipment, such as a 41-gauge tip, retinal detachment could be induced easily, while the prosthesis was also successfully inserted and manipulated under the retina without an iatrogenic retinal tear. Two weeks after the operation, the oil fully occupied the intraocular volume without leakage. The subretinal prosthesis remained stable without complication. Understanding the principle of the ab-interno method and considering several tips for improving surgical access may help to enhance surgical success rates of subretinal prostheses implantation.


Assuntos
Implantação de Prótese/métodos , Próteses Visuais/efeitos adversos , Vitrectomia/métodos , Animais , Próteses e Implantes , Retina/cirurgia , Descolamento Retiniano/cirurgia , Perfurações Retinianas/cirurgia , Suínos , Porco Miniatura , Acuidade Visual
5.
Sci Rep ; 10(1): 18268, 2020 10 26.
Artigo em Inglês | MEDLINE | ID: mdl-33106589

RESUMO

To objectively analyze the gas tamponade area in patients with different concentrations of perfluoropropane (C3F8) after pars plana vitrectomy (PPV), retrospective analysis was performed in patients diagnosed with retinal detachment or macular hole and underwent PPV with C3F8 tamponade of two concentrations (14% and 20%). The ultra-widefield fundus (UWF) images at one and 10 days and four weeks postoperatively were corrected using stereographic projection to adjust peripheral distortion. The gas-fluid interface curvatures were delineated using UWF stereographic projection images, and the gas-fluid area ratio and estimated gas area were calculated at each concentration. Among 65 eyes, 30 were in the 14% group and 35 were in the 20% group. The gas-fluid area ratio was 0.71 in the 14% group and 0.83 in the 20% group at 10 days (p = 0.046) and 0.27 and 0.45, respectively, at four weeks postoperatively (p < 0.001). The estimated gas area was 52.56 and 60.82 mm2 at 10 days (p = 0.025) and 19.83 and 33.86 mm2 at four weeks (p < 0.001). The gas tamponade areas were objectively shown to be greater under the 20% concentration than the 14% concentration of C3F8 at 10 days and 4 weeks postoperatively using UWF stereographic projection images.


Assuntos
Fluorcarbonetos/administração & dosagem , Descolamento Retiniano/cirurgia , Perfurações Retinianas/cirurgia , Vitrectomia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fundo de Olho , Humanos , Masculino , Pessoa de Meia-Idade , Descolamento Retiniano/diagnóstico por imagem , Perfurações Retinianas/diagnóstico por imagem , Estudos Retrospectivos , Resultado do Tratamento , Acuidade Visual , Adulto Jovem
6.
PLoS One ; 15(10): e0241005, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33095828

RESUMO

PURPOSE: To evaluate the long-term effect of 20 and 23 gauge pars plana vitrectomy (PPV) on intraocular pressure (IOP). METHODS: Study type: Monocentric retrospective cohort study. 249 eyes of 249 patients undergoing PPV due to epiretinal membrane (EM), idiopathic macular hole (IMH) or vitreoretinal traction (VT) were included. The fellow eye served as control. Exclusion criteria were factors known to influence the IOP, such as cataract surgery during follow-up, extended use of steroids, cryotherapy and silicone oil endotamponade. The relative change of IOP (operated vs. fellow eye) at 6-12 months after surgery was defined as primary endpoint. Secondary endpoints were the relative change of IOP at 3-6 and 12-24 months. Possible influencing cofactors were analysed using ANCOVA. RESULTS: The primary endpoint did not show a significant IOP reduction of the operated eye relative to the fellow eye (P = 0.089, n = 84). However, the IOP of the operated eye alone was significantly reduced at 6-12 and 12-24 months after surgery (-0.75 ± 2.80 and -1.22 ± 3.29 mmHg, P = 0.008 and 0.007, respectively). The IOP of the fellow eye was also significantly reduced at the 12-24 months period (-0.75 ± 2.73 mmHg, P = 0.008). In the subgroup analysis, sclerotomy size was a significant influencing cofactor, leading to lower IOP after 20G compared to 23G vitrectomy (P = 0.04). CONCLUSION: Pars plana vitrectomy did not induce a significant long-term IOP reduction relative to the contralateral eye. However, we observed a IOP lowering potential in 20G vitrectomy.


Assuntos
Pressão Intraocular , Vitrectomia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Membrana Epirretiniana/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Perfurações Retinianas/cirurgia , Estudos Retrospectivos , Fatores de Tempo
7.
Croat Med J ; 61(4): 366-370, 2020 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-32881435

RESUMO

Spontaneous posterior capsule rupture with lens-nucleus dislocation is a very rare entity, as is the development and spontaneous closure of a full thickness macular hole (FTMH) after vitrectomy. The occurrence of these two entities in one eye has not been previously described. A 79-year-old woman was referred because of the right eye intermittent pain and progressive visual loss. Best corrected visual acuity (BCVA) with correction for aphakia was 20/20. Intraocular pressure was normal with therapy. The cornea, anterior chamber, and vitreous were clear. Gonioscopy was normal. The capsular bag was clear, with rolled-up anterior and posterior lens capsule, and the nucleus dislocated in the vitreous. As surgery waiting time was prolonged due to administrative problems, the patient's intraocular pressure (IOP) increased and cystoid macular edema (CME) with lamellar macular hole developed. The patient underwent pars plana vitrectomy with endophacofragmentation and epiretinal membrane peeling. Postoperative optical coherence tomography was normal, BCVA was 20/40, and IOP was normal with topical therapy. One month after surgery, the eye was without signs of inflammation and IOP started rising in spite of maximum therapy. CME reoccurred and progressed to a FTMH, which started closing spontaneously in one month. One year after surgery, IOP normalized and FTMH closed completely. A dislocated crystalline lens in a quiet eye with normal BCVA, which rapidly developed into intractable glaucoma and FTMH, is an unusual finding. The deterioration was followed by spontaneous IOP normalization and macular hole closure. Such unexpected disease course, suggesting a possible autoimmune reaction, has not yet been described.


Assuntos
Catarata/complicações , Núcleo do Cristalino/patologia , Subluxação do Cristalino/etiologia , Ruptura da Cápsula Posterior do Olho/etiologia , Perfurações Retinianas/etiologia , Idoso , Feminino , Humanos , Pressão Intraocular , Subluxação do Cristalino/diagnóstico , Subluxação do Cristalino/cirurgia , Edema Macular/diagnóstico , Edema Macular/etiologia , Ruptura da Cápsula Posterior do Olho/diagnóstico , Ruptura da Cápsula Posterior do Olho/cirurgia , Perfurações Retinianas/fisiopatologia , Estudos Retrospectivos , Tomografia de Coerência Óptica , Acuidade Visual , Vitrectomia/métodos
8.
PLoS One ; 15(9): e0239138, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32970724

RESUMO

There are multiple surgical approaches to the repair of rhegmatogenous retinal detachment (RRD). Here, we evaluated the outcomes of small-gauge pars plana vitrectomy (PPV), alone or in combination with scleral buckle (SB-PPV), for RRD repair using a standardized technique by 3 vitreoretinal surgeons: "extensive" removal of the vitreous with scleral depression and dynamic examination of the peripheral retina. One hundred eighty seven eyes of 180 consecutive patients treated for primary RRD by three vitreoretinal surgeons at a tertiary academic medical center from September 2015 to March 2018 were analyzed. Most RRDs occurred in males (134 [71.3%] eyes), affected the left eye (102 [54.3%]), and were phakic (119 [63.3%]). PPV alone was performed in 159 eyes (84.6%), with a combined SB-PPV used in the remaining 29 eyes (15.4%); focal endolaser was used in all (100%) cases. The single surgery anatomic success rate was 186 eyes (99.5%) at 3 months, and 187 (100%) at last follow up. Overall best-corrected visual acuity (BCVA) had significantly improved at 3 months ([Snellen 20/47] P<0.00005) and last follow up ([Snellen 20/31] P<0.00005), as compared to day of presentation ([Snellen 20/234]). Our findings suggest that "extensive" removal of the vitreous and dynamic peripheral examination with scleral depression may lead to high single surgery success in primary uncomplicated RRD repair.


Assuntos
Oftalmopatias Hereditárias/cirurgia , Fotocoagulação a Laser/métodos , Descolamento Retiniano/cirurgia , Recurvamento da Esclera/métodos , Vitrectomia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada/métodos , Oftalmopatias Hereditárias/diagnóstico , Feminino , Seguimentos , Humanos , Fotocoagulação a Laser/instrumentação , Masculino , Pessoa de Meia-Idade , Retina/diagnóstico por imagem , Retina/cirurgia , Descolamento Retiniano/diagnóstico , Estudos Retrospectivos , Esclera/diagnóstico por imagem , Esclera/cirurgia , Recurvamento da Esclera/instrumentação , Fatores Sexuais , Tomografia de Coerência Óptica , Resultado do Tratamento , Acuidade Visual , Vitrectomia/instrumentação
9.
Niger J Clin Pract ; 23(9): 1248-1253, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32913164

RESUMO

Aims: To report a comparison of clinical features, visual and anatomic outcomes between patients with retinal detachments from giant retinal tears (GRTs) and those from other types of holes and tears undergoing retina reattachment surgery in the same institution within the same time period in sub-Saharan Africa. Materials and Methods: A retrospective noncomparative case series of patients undergoing primary retina detachment (RD) repair for rhegmatogenous retina detachment (RRD) at Eye Foundation Hospital Retina Institute between January 2014 and December 2018 was done. Results: A total of 275 eyes of 275 patients met the inclusion criteria. Ages ranged from 7 to 87 years. And 81 (29.4%) eyes had giant tears were categorized as group A and 194 (70.6%) eyes had other types of tears were categorized as group B. At presentation Visual acuity in 66 eyes (79.6%) in the group A was worse than 3/60, compared to 117 eyes (60.3%) in group B. Primary anatomic success was achieved in 73 eyes (92.4%) in-group A and 157 eyes (86.7%) in group B. Final anatomic success was achieved in 75 eyes (94.9%) in group A and 164 eyes (93.2%) in group B. Good visual outcomes were achieved in 48 eyes (59.3%) in group A and 126 eyes (65.6%) in group B. Conclusion: Good anatomic and visual outcomes can be achieved after surgery for RRD secondary to giant tears in a sub-Saharan Africa setting in this era of small gauge vitrectomy and perflourocarbon use, these outcomes are comparable to those from surgery for RRD secondary to other types of holes and tears.


Assuntos
Descolamento Retiniano/cirurgia , Perfurações Retinianas/cirurgia , Vitrectomia/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Corioide , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Descolamento Retiniano/complicações , Descolamento Retiniano/epidemiologia , Perfurações Retinianas/complicações , Perfurações Retinianas/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento , Acuidade Visual , Vitrectomia/efeitos adversos , Adulto Jovem
10.
Rev. cuba. oftalmol ; 33(3): e903, graf
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1139100

RESUMO

RESUMEN El agujero macular es un desorden de la interface vitreorretinal definido como un defecto de espesor completo desde la membrana limitante interna hasta los segmentos externos de los fotorreceptores, que normalmente involucra a la fóvea. Con el desarrollo de la tomografía de coherencia óptica se han mejorado el diagnóstico, el tratamiento y el seguimiento de las enfermedades de la interface vitreorretinal, entre ellas el agujero macular. La vitrectomía pars plana es la técnica quirúrgica de elección para el agujero macular. Se presenta una paciente de 75 años, pseudofáquica, con mejor agudeza visual corregida en el ojo derecho de 0,1 Snellen. Se diagnostica agujero macular grande (810 µm) según su mínima apertura, con 8 meses de evolución. Se realizó vitrectomía pars plana, el levantamiento de la hialodes posterior, el flap invertido de membrana limitante interna, el uso de hexafluoruro de azufre en mezcla 20 por ciento y el posicionamiento de la paciente 24-72 horas. Se logró el cierre anatómico del agujero macular y la recuperación visual de 0,6 Snellen a los seis meses del tratamiento quirúrgico(AU)


ABSTRACT Macular hole is a disorder of the vitreous-retina interface defined as a full-thickness defect from the internal limiting membrane to the external segments of photoreceptors which typically involves the fovea. The development of optical coherence tomography has improved the diagnosis, treatment and follow-up of vitreous-retina interface diseases, among them macular hole. Pars plana vitrectomy is the surgical technique of choice for macular hole. A case is presented of a female 75-year-old pseudophakic patient with best corrected right eye visual acuity of 0.1 on the Snellen chart. Large macular hole is diagnosed (810 µm) according to its minimum opening, of 8 month's evolution. The following procedures were performed: pars plana vitrectomy, posterior hyalode lifting, inverted internal limiting membrane flap, use of sulfur hexafluoride in a 20% mixture, and positioning of the patient for 24-72 hours. Anatomical closure of the macular hole and a visual recovery of 0.6 Snellen were achieved six months after surgery(AU)


Assuntos
Humanos , Feminino , Idoso , Perfurações Retinianas/diagnóstico , Hexafluoreto de Enxofre/uso terapêutico , Vitrectomia/métodos , Tomografia de Coerência Óptica/métodos
11.
Rev. cuba. oftalmol ; 33(3): e839,
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1139095

RESUMO

RESUMEN Se hace una revisión bibliográfica acerca del tratamiento que se utiliza en el edema macular clínicamente significativo. Esta es la primera causa de mala visión en los pacientes con diabetes mellitus. Entre las líneas de tratamiento tenemos los antiangiogénicos con sus variantes, los esteroides y la cirugía por medio de la vitrectomía pars plana con pelado de la membrana limitante interna. No existe hasta el momento el tratamiento ideal. La tomografía de coherencia óptica ayuda a predecir la visión final(AU)


ABSTRACT Treatment of clinically significant diabetic macular edema is the topic of our review. This condition is the first cause of vision loss in diabetic patients. Treatment options include anti-VEFG drugs, steroids and surgery (vitrectomy with internal limiting membrane peeling). There is no an ideal treatment at present. Optic coherence tomography is a useful tool to predict final vision in these patients(AU)


Assuntos
Humanos , Vitrectomia/métodos , Edema Macular/diagnóstico , Tomografia de Coerência Óptica/métodos , Literatura de Revisão como Assunto , Diabetes Mellitus/epidemiologia
13.
Middle East Afr J Ophthalmol ; 27(2): 100-104, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32874042

RESUMO

PURPOSE: The aim of this study is to evaluate the short anatomical and visual outcomes of scleral buckling surgery in relation to the pattern of presentation of rhegmatogenous retinal detachment (RRD) in the presence of different situations and risk factors. METHODS: A total of 206 eyes of 203 patients who underwent scleral buckling surgery for RRD were evaluated in this retrospective study. Information retrieved included patient demographics, duration of symptoms, and presenting vision, lens status, site of a retinal break, extent of retinal detachment, the involvement of the fellow eye, macular involvement, presence of lattice degeneration, and associated refractive errors. Postoperative retinal reattachment, postoperative visual acuity, the need for further surgical intervention, intraoperative, and postoperative complications were also evaluated. Proportions and percentages were used to analyze data. RESULTS: Primary anatomical reattachment was seen in 172 eyes (83.5%) after the complete resolution of the tamponade used. The mean best-corrected visual acuity improved from 2.81 logarithms of the minimum angle of resolution (LogMar) preoperatively to 1.21 LogMar postoperatively, the most important factors that appeared statistically significantly affecting the anatomic and visual outcome were the duration of macular detachment (P = 0.036), the status of the lens; phakic eyes gave better visual outcome than aphakic and pseudophakic eyes (P < 0.05). CONCLUSION: Scleral buckling procedure showed high structural and visual success rates, improvement of visual acuity was found to correlate well with the shorter duration of macular detachment and pseudophakic eyes. We believe that scleral buckling, when done appropriately in the appropriate cases, gives the maximum visual outcome with the least cost and need for consecutive procedures.


Assuntos
Retina/anatomia & histologia , Descolamento Retiniano/cirurgia , Recurvamento da Esclera/métodos , Acuidade Visual/fisiologia , Adulto , Idoso , Tamponamento Interno , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Descolamento Retiniano/fisiopatologia , Estudos Retrospectivos , Resultado do Tratamento , Vitrectomia/métodos
14.
Medicine (Baltimore) ; 99(31): e21441, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756157

RESUMO

INTRODUCTION: We report a case of type III uveal effusion syndrome (UES) suspected to be related to pachychoroid spectrum disease. PATIENT CONCERNS: A 42-year-old man became aware of visual field constriction and deterioration of visual acuity in his right eye. DIAGNOSIS: Upon examination, a bullous non-rhegmatogenous retinal detachment was observed in the inferior 2 quadrants of the right eye fundus, and the subretinal fluid moved with postural changes. The axial length in that eye was 22.36 mm, thus indicating no nanophthalmia. Preoperative indocyanine green angiography revealed dilated choroidal vessels in the posterior pole of the right eye and mild leakage in the late phase. Optical coherence tomography examination revealed choroidal thickening in both eyes. INTERVENTIONS: For treatment, we first performed sclerotomy, and the intraoperative findings showed no thickening of the sclera. Following surgery, reattachment of the retina was not achieved. OUTCOMES: Thus, we next performed vitrectomy, which led to successful reattachment of the retina. LESSONS: In this case, we theorize that pachychoroid spectrum disease might have been involved in the pathogenesis of type III UES.


Assuntos
Doenças da Coroide/patologia , Corioide/irrigação sanguínea , Síndrome da Efusão da Úvea/etiologia , Transtornos da Visão/etiologia , Adulto , Angiografia/métodos , Corioide/diagnóstico por imagem , Doenças da Coroide/cirurgia , Corantes/administração & dosagem , Angiofluoresceinografia/métodos , Fundo de Olho , Humanos , Verde de Indocianina/administração & dosagem , Masculino , Microftalmia/etiologia , Descolamento Retiniano , Esclera/cirurgia , Tomografia de Coerência Óptica/métodos , Resultado do Tratamento , Síndrome da Efusão da Úvea/classificação , Síndrome da Efusão da Úvea/diagnóstico , Síndrome da Efusão da Úvea/cirurgia , Transtornos da Visão/diagnóstico , Vitrectomia/métodos
15.
Medicine (Baltimore) ; 99(30): e21173, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791691

RESUMO

We investigated the clinical efficacy and safety of 25-gauge (G) vitrectomy combined with intrascleral intraocular lens (IOL) implantation. A 25G vitrectomy combined with intrascleral IOL implantation was performed on 39 patients diagnosed with lens dislocation, IOL dislocation, or aphakia. Changes in visual acuity, intraocular pressure (IOP), number of corneal endothelial cells, location of IOL, anatomic success of IOL, recurrence rate of IOL dislocation, and complications were analyzed. One week postoperatively, the IOL was in the centered position in all patients (100%), and 1 month postoperatively, it was centered in 36 patients (92.3%). IOL haptics were exposed under the conjunctiva in one patient (2.6%). Reimplantation of IOL for IOL dislocation was required in two patients (5.1%). Three to six months postoperatively, the IOLs were in the optimum position in 36 patients (92.3%). There were significant differences between the average logarithm of minimal angle of resolution (logMAR) visual acuity at 1 week, 1 month, 3 months, and 6 months postoperatively and that before surgery (P < .05). The average IOP at 1 week, 1 month, 3 months, and 6 months postoperatively was significantly lower than the preoperative IOP (P < .05). A 25G vitrectomy combined with intrascleral IOL implantation is effective and safe for the treatment of eyes without capsular support.


Assuntos
Afacia/cirurgia , Implante de Lente Intraocular , Subluxação do Cristalino/cirurgia , Vitrectomia/métodos , Adulto , Idoso , Afacia/fisiopatologia , Feminino , Humanos , Pressão Intraocular , Implante de Lente Intraocular/efeitos adversos , Subluxação do Cristalino/fisiopatologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Reoperação , Esclera , Fatores de Tempo , Resultado do Tratamento , Acuidade Visual , Vitrectomia/efeitos adversos
16.
Sci Rep ; 10(1): 13331, 2020 08 07.
Artigo em Inglês | MEDLINE | ID: mdl-32770021

RESUMO

We investigated the microvascular changes in eyes with lamellar macular holes (LMHs) using optical coherence tomography angiography (OCTA), compare them between two subtypes of LMH. Tractional and degenerative LMH were differentiated based on the morphological characteristics of OCT. In OCTA images, foveal and parafoveal vessel density (VD) in the superficial and deep capillary plexus (SCP, DCP) and foveal avascular zone (FAZ) area were measured. Eyes that underwent vitrectomy for LMH were included in subgroup analysis. We analysed 63 LMH (42 tractional and 21 degenerative) eyes and 63 control eyes. Compared with degenerative LMH, tractional LMH had better BCVA (p = 0.010), smaller FAZ area (p = 0.001), and higher foveal VD in the SCP (p = 0.130) and DCP (p = 0.002). In degenerative LMH, better BCVA was associated with greater foveal VD in the SCP (p = 0.040) and DCP (p = 0.005), and parafoveal VD in the SCP (p = 0.006). In subgroup analysis, only the tractional LMH group showed significant increases in foveal and parafoveal VDs in the SCP after vitrectomy (p = 0.001 and p = 0.026, respectively). Significant differences in microvascular changes were noted between tractional and degenerative LMH, suggesting that two subtypes are distinct pathogenetic entities.


Assuntos
Angiofluoresceinografia/métodos , Macula Lutea/patologia , Tomografia de Coerência Óptica/métodos , Tração/métodos , Idoso , Idoso de 80 Anos ou mais , Capilares/patologia , Feminino , Fóvea Central/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Perfurações Retinianas/patologia , Vasos Retinianos/patologia , Estudos Retrospectivos , Acuidade Visual/fisiologia , Vitrectomia/métodos
17.
J Fr Ophtalmol ; 43(10): 1062-1068, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32811657

RESUMO

PURPOSE: To evaluate the predisposing factors, management and visual prognosis of intraocular Lens (IOL) dislocation into the posterior segment. METHODS: The cases of posterior IOL dislocation from January 2012 to May 2017 at 2 centers were reviewed. Only eyes with dislocations requiring IOL explantation or repositioning were included. Predisposing factors, interval between cataract surgery and IOL dislocation, circumstances of onset, management, and postoperative complications are reported. RESULTS: 72 eyes of 72 patients were included. The mean age was 67.6 years. 47 patients (68%) were men. The mean time interval from cataract surgery to IOL dislocation was significantly shorter in the out-of-the bag group than the in-the-bag IOL dislocation group (3.8 months vs 132 months, P=0.002). Predisposing factors for out-of-the-bag IOL dislocation were mainly capsular rupture and/or zonular dehiscence (83%) after complicated cataract surgery. The predisposing factors for in-the-bag IOL dislocation were high myopia (40%), pseudoexfoliation syndrome (40%), previous vitrectomy (38%), or Marfan syndrome (3%) with uneventful cataract surgery. The type of luxated implant was mainly a 3-piece foldable IOL (50%), followed by foldable one-piece IOL (28%) and a rigid one-piece IOL (17%). Most cases of posterior chamber IOL dislocation occurred spontaneously (80%) without a trigger event. Management consisted of a posterior approach in 24 cases (33%) or an anterior approach in 48 cases (67%), associated with IOL repositioning in 20 eyes (28%), and IOL replacement in 34 eyes (47%). Finally, 18 eyes (25%) were left aphakic. Postoperative complications occurred in 7 cases (9.7%). CONCLUSIONS: Predisposing factors and time from cataract surgery to IOL dislocation were different for out-of-the bag versus in-the-bag IOL dislocation. Management of IOL dislocation varied considerably, depending on surgeon preference and experience. Surgery for IOL dislocation significantly improved best corrected visual acuity and was associated with a low complication rate.


Assuntos
Migração do Implante de Lente Intraocular , Remoção de Dispositivo , Falha de Prótese/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Migração do Implante de Lente Intraocular/diagnóstico , Migração do Implante de Lente Intraocular/epidemiologia , Migração do Implante de Lente Intraocular/etiologia , Migração do Implante de Lente Intraocular/cirurgia , Remoção de Dispositivo/métodos , Remoção de Dispositivo/estatística & dados numéricos , Síndrome de Exfoliação/complicações , Síndrome de Exfoliação/diagnóstico , Síndrome de Exfoliação/epidemiologia , Síndrome de Exfoliação/cirurgia , Feminino , Humanos , Cápsula do Cristalino/patologia , Cápsula do Cristalino/cirurgia , Implante de Lente Intraocular/efeitos adversos , Implante de Lente Intraocular/estatística & dados numéricos , Subluxação do Cristalino/diagnóstico , Subluxação do Cristalino/epidemiologia , Subluxação do Cristalino/etiologia , Subluxação do Cristalino/cirurgia , Lentes Intraoculares/efeitos adversos , Masculino , Pessoa de Meia-Idade , Miopia/complicações , Miopia/diagnóstico , Miopia/epidemiologia , Miopia/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Prognóstico , Reoperação/métodos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Vitrectomia/efeitos adversos , Vitrectomia/métodos , Vitrectomia/estatística & dados numéricos
18.
PLoS One ; 15(7): e0236867, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32735583

RESUMO

PURPOSE: To compare the anatomical and functional outcomes of severe diabetic macular edema (DME) with massive hard exudates managed by pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling or nonsurgical treatment. METHODS: We retrospectively reviewed 40 eyes with DME and massive hard exudates treated with either PPV with ILM peeling (vitrectomy group, 21 eyes) or nonsurgical treatment with anti-vascular endothelium growth factor (VEGF) and/or steroids (nonsurgical group, 19 eyes). Changes in best-corrected visual acuity (BCVA) and central retinal thickness (CRT) and resolution of macular hard exudates were compared between the two groups. RESULTS: After treatment, CRT decreased steadily in the vitrectomy group but fluctuated in the nonsurgical group. Compared with eyes in the nonsurgical group, eyes in the vitrectomy group had better visual improvement (P < 0.05 at 6 and 12 months and the final visit) and greater decrease in CRT (P < 0.05 at 3 and 6 months and the final visit) after adjustment for baseline BCVA. Hard exudates resolved more rapidly in the vitrectomy group than in the nonsurgical group, with 94.1% versus 47.4% eyes showing significant absorption after 6 months of the treatment (P = 0.003). In the vitrectomy group, 62% eyes did not require any further injections for treating DME after the operation. CONCLUSIONS: PPV with ILM peeling resulted in rapid resolution of hard exudates with significant anatomical and functional improvement in DME with massive hard exudates.


Assuntos
Retinopatia Diabética , Membrana Epirretiniana/cirurgia , Edema Macular , Vitrectomia/métodos , Idoso , Retinopatia Diabética/fisiopatologia , Retinopatia Diabética/cirurgia , Retinopatia Diabética/terapia , Feminino , Humanos , Edema Macular/fisiopatologia , Edema Macular/cirurgia , Edema Macular/terapia , Masculino , Pessoa de Meia-Idade , Retina/fisiopatologia , Doenças Retinianas/cirurgia , Doenças Retinianas/terapia , Estudos Retrospectivos , Resultado do Tratamento
19.
Medicine (Baltimore) ; 99(26): e20895, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590799

RESUMO

INTRODUCTION: In cases of persistent pupillary membrane (PPM), the eye is usually slightly microphthalmic and emmetropia or hyperopia is often present, yet severe myopia is reportedly rare. Here we presented a case of PPM complicated by vitreomacular traction syndrome and posterior staphyloma due to severe myopia. PATIENT CONCERNS: This study involved a 63-year-old female patient who had been diagnosed with bilateral PPM at a local eye clinic and who was subsequently referred to our department for a more detailed examination due to a recent decrease of visual acuity. DIAGNOSES: Slit-lamp microscopy examination revealed bilateral PPM. The ocular fundus revealed peripapillary conus and myopic change in both eyes. Optical coherence tomography examination revealed no particular abnormalities in the right eye, yet did show findings indicative of vitreomacular traction syndrome in the left eye. INTERVENTIONS: In both eyes, we performed surgical removal of the PPM, phacoemulsification aspiration, and intraocular lens implantation, yet in the patient's left eye, vitrectomy was also performed. OUTCOMES: After surgery, the patient's visual acuity improved in both eyes. CONCLUSION: The findings in this case show that when required, vitrectomy should be considered based upon the preoperative Optical coherence tomography findings for PPM.


Assuntos
Anormalidades do Olho/cirurgia , Vitrectomia/métodos , Anormalidades do Olho/complicações , Feminino , Humanos , Japão , Pessoa de Meia-Idade , Miopia/etiologia , Miopia/fisiopatologia , Microscopia com Lâmpada de Fenda/métodos , Tomografia de Coerência Óptica/métodos
20.
Middle East Afr J Ophthalmol ; 27(1): 34-39, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32549722

RESUMO

PURPOSE: The purpose of this study was to analyze the diagnostic and therapeutic approach of five cases with optic disc pit (ODP) maculopathy. MATERIALS AND METHODS: This was a retrospective study of five patients diagnosed with ODP maculopathy. Four of these cases had unilateral involvement, whereas one case had bilateral findings. The medical notes of these individuals were reviewed in order to record the presenting symptoms, clinical signs, visual acuity (VA), imaging, management, and the final visual outcome on their last follow-up appointment. RESULTS: The first patient (53-year-old female) underwent a left pars plana vitrectomy (PPV) combined with inner retinal fenestration, endolaser, and perfluoropropane (C3F8) gas tamponade and her VA improved from 6/24 to 6/9 Snellen. A focal retinal laser treatment was carried out on our second patient leading to decrease of the subretinal fluid but had a poor visual outcome due to the underlying secondary glaucoma from iris melanoma treatment in the past. The third patient was an asymptomatic 7-year-old girl in which the maculopathy resolved spontaneously without any surgical intervention with a final VA of 6/5. The fourth and fifth patients were asymptomatic with good vision in both eyes and were, therefore, only monitored with follow-ups. CONCLUSION: ODP maculopathy remains a challenging clinical entity for a vitreoretinal surgeon. The current management for ODP maculopathy involves surgical procedures with PPV being a common treatment of choice. Spontaneous resolution of ODP maculopathy has also been reported. Our study highlights the contrasting management that can be adopted in the treatment of ODP maculopathy, and there is not one definite treatment for this condition.


Assuntos
Anormalidades do Olho/etiologia , Disco Óptico/anormalidades , Doenças Retinianas/etiologia , Adulto , Idoso , Criança , Tamponamento Interno , Anormalidades do Olho/diagnóstico , Anormalidades do Olho/cirurgia , Feminino , Fluorcarbonetos/administração & dosagem , Humanos , Fotocoagulação a Laser , Masculino , Pessoa de Meia-Idade , Doenças Retinianas/diagnóstico , Doenças Retinianas/cirurgia , Estudos Retrospectivos , Líquido Sub-Retiniano , Tomografia de Coerência Óptica/métodos , Acuidade Visual/fisiologia , Vitrectomia/métodos
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