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1.
Ophthalmic Res ; 63(1): 18-24, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31430744

RESUMO

PURPOSE: To assess closure rate and visual outcome of a court of patients with macular hole (MH) who underwent surgical repair with intraoperative optical coherence tomography (iOCT)-confirmed MH closure and short-term postoperative face-down posturing (FDP). Secondary aim was to assess the correlation between iOCT and postoperative OCT at day 1. METHODS: Retrospective clinical study conducted in the Miulli Hospital Acquaviva delle Fonti (Italy), enrolling patients with idiopathic MH who underwent 25-G pars plana vitrectomy plus internal limiting membrane peeling. During surgery, closure of MH was confirmed by iOCT and short-term FDP (12-24 h, until day-1 visit) was prescribed. All patients had measurement of best-corrected visual acuity (BCVA) and spectral domain-OCT before the surgery and during follow-up (at 1 day, 1 month, 3 months). RESULTS: Twenty-nine eyes of 29 patients (14 males, 62.1%) were enrolled in the study. MH mean size was 451.7 ± 139.7 µm and baseline BCVA was 0.77 ± 0.26 logarithm of the minimum angle of resolution (LogMAR). MH was confirmed to be closed in 100% of patients intraoperatively (iOCT) and at OCT during early follow-up (1-3 days). Mean time of FDP was 18 ± 2.6 h. At 3 months, MH closure rate was 93%; 2 eyes -underwent secondary MH repair surgery. Final BCVA was 0.39 ± 0.22 LogMAR (p < 0.0001). CONCLUSION: iOCT-based confirmation of MH closure could be a safe and useful tool for prescribing short-term FDP after surgery, with high closure rate and no additional complication. The execution of an OCT in the immediate postoperative days could be potentially unnecessary.


Assuntos
Decúbito Ventral , Perfurações Retinianas/cirurgia , Cirurgia Assistida por Computador/métodos , Tomografia de Coerência Óptica/métodos , Vitrectomia/métodos , Idoso , Idoso de 80 Anos ou mais , Tamponamento Interno/métodos , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Perfurações Retinianas/diagnóstico por imagem , Estudos Retrospectivos , Acuidade Visual/fisiologia
2.
Ophthalmic Res ; 63(1): 25-33, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31013505

RESUMO

PURPOSE: To determine the long-term outcome of patients operated with pars plana vitrectomy (PPV) for primary rhegmatogenous retinal detachment (RRD) and to identify potential predictors for poor visual outcome. METHODS: Prospective, observational 30-month study of patients operated for primary RRD with PPV. Examinations were performed preoperatively and after months 2, 6, and 30. RESULTS: Eighty-four patients (84 eyes) were included and 73 (86.9%) participated at month 30. The macula was attached in 30 (35.7%) patients at primary operation. The majority of patients (n = 59, 80.8%) achieved a good final best corrected visual acuity (BCVA ≤0.3 logMAR, ≥0.5 Snellen) with a better outcome in patients with the macula attached than detached (0.02 vs. 0.17 logMAR, p = 0.007). Variables associated with poor visual outcome were baseline BCVA >0.3 logMAR (p = 0.03), female gender (p = 0.02), silicone oil (p = 0.03), and larger areas of retinal detachment (p = 0.01). In multivariable regression analysis, female gender (OR = 8.5 [95% CI 1.8-39.8]) was the strongest risk factor for poor visual outcome. CONCLUSION: The majority of patients operated for primary RRD achieved a reasonable long-term visual outcome. Notably, female gender was associated with poor visual outcome, indicating a need for closer follow-up.


Assuntos
Descolamento Retiniano/cirurgia , Vitrectomia/métodos , Idoso , Feminino , Humanos , Macula Lutea/patologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Análise de Regressão , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Acuidade Visual
3.
Eur J Ophthalmol ; 30(1): 88-93, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30474397

RESUMO

PURPOSE: To identify the causative microorganism of fungal endogenous endophthalmitis in our tertiary referral uveitis center and review the therapeutic role of pars plana vitrectomy in patients with fungal endogenous endophthalmitis. METHODS: Seven eyes of six cases were identified as fungal endogenous endophthalmitis through positive cultures of ocular fluids and clinical presentations. The final anatomical and functional results were evaluated. RESULTS: Four women (66.7%) and two men (33.3%) underwent vitrectomy. Control of infection was achieved early on in all cases. Candida (71.4%) and Aspergillus (28.6%) species were identified as causative fungi in patients with fungal endogenous endophthalmitis. Two patients were reoperated due to reinfection and retinal detachment, respectively. Visual acuity improved in six eyes (85.7%) and worsened in one eye (14.3%). At the final examination, the retina was flat in all cases. No eye developed phthisis bulbi. CONCLUSION: Candida species are the most common causative organisms of fungal endogenous endophthalmitis in this study. Pars plana vitrectomy in fungal endogenous endophthalmitis may enhance the treatment of infection by removing fungal elements in the vitreous and aid in diagnosis. Vitrectomy may also be an important tool in the management of vision-threatening post-infectious sequelae such as retinal detachment and reinfections.


Assuntos
Aspergilose/cirurgia , Candidíase/cirurgia , Endoftalmite/cirurgia , Infecções Oculares Fúngicas/cirurgia , Vitrectomia/métodos , Adulto , Idoso , Aspergilose/microbiologia , Aspergilose/fisiopatologia , Candidíase/microbiologia , Candidíase/fisiopatologia , Endoftalmite/microbiologia , Endoftalmite/fisiopatologia , Infecções Oculares Fúngicas/microbiologia , Infecções Oculares Fúngicas/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Descolamento Retiniano/cirurgia , Estudos Retrospectivos , Centros de Atenção Terciária , Acuidade Visual/fisiologia , Corpo Vítreo/microbiologia , Adulto Jovem
4.
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
5.
Ophthalmic Surg Lasers Imaging Retina ; 50(10): 649-652, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31671198

RESUMO

A patient with acquired optic disc pit (ODP) maculopathy underwent vitrectomy with anterior capsule transplantation to the ODP and gas tamponade. Structural changes were evaluated by enhanced depth imaging optical coherence (OCT) tomography. During vitrectomy, the eye was confirmed to have preexisting posterior vitreous detachment. Postoperative OCT showed complete closure of the optic pit resulting in rapid absorption of subretinal fluid. The authors' observations suggest that the anterior capsule is a useful material for achieving optic pit closure. To the authors' knowledge, this is the first report describing application of the anterior capsule to the treatment of ODP maculopathy. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:649-652.].


Assuntos
Cápsula do Cristalino/transplante , Disco Óptico/cirurgia , Doenças do Nervo Óptico/cirurgia , Doenças Retinianas/cirurgia , Vitrectomia/métodos , Idoso , Feminino , Humanos , Estudos Retrospectivos
6.
Rom J Ophthalmol ; 63(3): 264-267, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31687629

RESUMO

Objective. To report a rare presentation of solitary retinal capillary hemangioma manifesting with combined retinal detachment as initial presentation and its successful management. Methods. A 35-year-old healthy Indian male presented with combined retinal detachment associated with solitary retinal capillary hemangioma as initial presentation; a clinical entity still not reported in literature. Patient was managed with pars plana vitrectomy combined with retinectomy, endolaser, & silicon oil tamponade with good visual & anatomical recovery. Results. Patient had good clinical outcome with final best-corrected visual acuity (BCVA) of 6/ 24 and well attached retina at last follow-up. Conclusion. Solitary retinal capillary hemangiomas can rarely present with advanced vitreo-retinal complications like combined retinal detachment as initial manifestation that can be effectively managed with skilled & appropriate surgical intervention.


Assuntos
Angiofluoresceinografia/métodos , Hemangioma Capilar/diagnóstico , Descolamento Retiniano/etiologia , Neoplasias da Retina/diagnóstico , Recurvamento da Esclera/métodos , Acuidade Visual , Vitrectomia/métodos , Adulto , Seguimentos , Fundo de Olho , Hemangioma Capilar/complicações , Hemangioma Capilar/cirurgia , Humanos , Masculino , Retina/patologia , Retina/cirurgia , Descolamento Retiniano/diagnóstico , Descolamento Retiniano/cirurgia , Neoplasias da Retina/complicações , Neoplasias da Retina/cirurgia
7.
Rom J Ophthalmol ; 63(3): 268-272, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31687630

RESUMO

Purpose. To report a case of malignant glaucoma in a pseudophakic female patient, with no history of glaucoma, resolved through pars plana anterior vitrectomy. Case presentation. An 80-year-old female patient presented in our Emergency Department after a five-day history of pain in her left eye (LE). In the last day, the patient noticed marked visual loss and ocular pain. Visual acuity was light perception and Goldman tonometry was 80 mmHg in her LE. The biomicroscopy revealed absent peripheral and central anterior chamber (AC) and posterior chamber (PC) pseudophakia. Posterior segment ecography showed no vitreous or choroidal abnormalities. A peripheral laser YAG iridotomy was made and the patient was treated with intravenous 20% mannitol, topical timolol, topical brimonidine, and topical cycloplegics. 12 hours later, despite a patent iridotomy in the LE eye, intraocular pressure (IOP) was 55 mmHg, absent AC with severe corneal edema. The diagnosis of pseudophakic malignant glaucoma was made and laser YAG capsulotomy was performed with no resolution of symptoms and signs. 24 hours later, we performed pars plana anterior vitrectomy. Postoperatively, the AC depth increased and the IOP decreased to 20mmHg. After a week, the patient was discharged with hand movement perception visual acuity in her LE, 20 mmHg IOP, reduced corneal edema, normal depth AC. After a month, the corneal edema resolved, the visual acuity was 2/50, IOP was 20mmHg, and the AC had a normal depth. Conclusion. Malignant glaucoma is a sight threatening condition, reported in pseudophakic eyes. Although, literature describes cases solved by cycloplegics and laser YAG capsulotomy, our patient needed pars plana anterior vitrectomy for the resolution of symptoms and signs.


Assuntos
Glaucoma/cirurgia , Pressão Intraocular/fisiologia , Terapia a Laser/métodos , Pseudofacia/cirurgia , Acuidade Visual , Vitrectomia/métodos , Idoso de 80 Anos ou mais , Feminino , Glaucoma/complicações , Glaucoma/diagnóstico , Humanos , Pseudofacia/complicações , Pseudofacia/diagnóstico , Lâmpada de Fenda
8.
Ophthalmic Surg Lasers Imaging Retina ; 50(11): e278-e287, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31755979

RESUMO

BACKGROUND AND OBJECTIVE: To analyze the anatomic success rate of pars plana vitrectomy (PPV), retinectomy, and silicone oil (SO) tamponade without scleral buckle (SB) for repair of recurrent rhegmatogenous retinal detachment (RRD) associated with proliferative vitreoretinopathy (PVR). PATIENTS AND METHODS: Retrospective, consecutive, single-surgeon case series of 28 eyes of 28 patients with PVR-associated RRD repaired with PPV, retinectomy, and SO tamponade without SB. RESULTS: The single-procedure anatomic success rate was 85.2% at 3 months and 82.1% at 12 months. Final reattachment rate was 100.0%. There were no preoperative factors that predicted single procedure anatomic success. Mean logarithm of the minimal angle of resolution visual acuity (VA) was improved at 3 months (1.61 to 1.51, P = .732) and at 12 months (1.61 to 1.41; P = .271). VA outcome was related to preoperative macula and lens status. CONCLUSION: The single-procedure anatomic success rate of PPV, retinectomy, and SO tamponade without SB for PVR-related recurrent RRD is comparable to prior reports of similar surgery incorporating SB. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:e278-e287.].


Assuntos
Procedimentos Cirúrgicos Oftalmológicos/métodos , Descolamento Retiniano/cirurgia , Vitreorretinopatia Proliferativa/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Tamponamento Interno/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Recurvamento da Esclera/métodos , Óleos de Silicone/administração & dosagem , Acuidade Visual , Vitrectomia/métodos , Vitreorretinopatia Proliferativa/cirurgia , Adulto Jovem
9.
Ophthalmic Surg Lasers Imaging Retina ; 50(11): e288-e293, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31755980

RESUMO

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


Assuntos
Vitrectomia/métodos , Descolamento do Vítreo/terapia , Conduta Expectante , Adulto , Idoso , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acuidade Visual
10.
Turk J Ophthalmol ; 49(5): 270-276, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31650801

RESUMO

Objectives: To evaluate the clinical results of combined pars plana vitrectomy (PPV) with Landers wide-field temporary keratoprosthesis and penetrating keratoplasty (PK). Materials and Methods: From January 2016, traumatic eyes with coexisting corneal and vitreoretinal diseases that underwent combined keratoprosthesis/PPV/PK surgery were retrospectively evaluated. Demographic characteristics, visual acuity (VA), intraocular pressure (IOP) and clinical findings of the cornea, lens, and retina were recorded during the follow-up. Cases with clear corneal graft, attached retina, normotonic IOP, and improved or stable VA were considered successful. Results: Eight eyes were enrolled in the study. The mean follow-up time was 21.1±8.20 months. Surgery was performed a mean of 23 (10-40) days after trauma. Preoperative VA ranged from no light perception to counting fingers from 50 cm. Postoperatively, corneal graft was clear in 5 patients (62.5%) and retina was attached in 6 eyes (75%). Chronic hypotonia developed in 3 patients (37.5%). VA was unchanged in 3 patients and improved in 5 patients. A total of 5 cases (50%) were considered successful. Shorter interval between trauma and surgery was associated with higher likelihood of success (p=0.043). No significant difference was observed between the groups in terms of type or location of trauma (p=1; p=0.143). Conclusion: Although the functional results are not very satisfactory, the combined procedure provides a final opportunity for preserving remaining vision and anatomic reconstruction in eyes that will otherwise result in phthisis due to severe anterior and posterior segment pathologies.


Assuntos
Ferimentos Oculares Penetrantes/cirurgia , Próteses e Implantes , Implantação de Prótese/métodos , Acuidade Visual , Vitrectomia/métodos , Adolescente , Adulto , Ferimentos Oculares Penetrantes/diagnóstico , Ferimentos Oculares Penetrantes/fisiopatologia , Feminino , Seguimentos , Humanos , Pressão Intraocular/fisiologia , Ceratoplastia Penetrante/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
11.
Turk J Ophthalmol ; 49(5): 294-296, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31650813

RESUMO

Endogenous endophthalmitis is a serious sight-threatening ocular emergency that usually occurs in patients with serious underlying risk factors. In this report, we describe a case of endogenous Candida endophthalmitis following trans-urethral lithotripsy in an immunocompetent woman. In our case, the retinal lesion regressed completely and vision was restored. We discuss diagnostic procedures and management strategies in this article.


Assuntos
Antifúngicos/uso terapêutico , Candida albicans/isolamento & purificação , Candidíase/terapia , Endoftalmite/terapia , Infecções Oculares Fúngicas/terapia , Litotripsia/efeitos adversos , Vitrectomia/métodos , Adulto , Candida albicans/genética , Candidíase/etiologia , Candidíase/microbiologia , DNA Fúngico/análise , Endoftalmite/etiologia , Endoftalmite/microbiologia , Infecções Oculares Fúngicas/etiologia , Infecções Oculares Fúngicas/microbiologia , Feminino , Humanos , Tomografia por Emissão de Pósitrons , Cálculos Ureterais/terapia , Acuidade Visual
12.
Ophthalmologica ; 242(4): 214-221, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31509827

RESUMO

PURPOSE: To identify the predictors for anatomical and functional outcome after re-vitrectomy with application of autologous platelet concentrate (APC) in eyes with persistent idiopathic macular hole (MH). METHODS: Retrospective study of 103 eyes with persistent MHs after vitrectomy with peeling of internal limiting membrane (ILM) and expansive gas. All patients underwent re-vitrectomy with APC and endotamponade. The anatomical MH closure rate and postoperative best-corrected visual acuity (BCVA) were evaluated. Further, predictive factors influencing the success of the surgery were analyzed. RESULTS: Median BCVA (logMAR) before the surgery was 1.00 (interquartile range [IQR] 0.80-1.30) and the median of minimum diameter between hole edges was 508 µm (IQR 387-631). The final closure rate after re-vitrectomy with APC was 60.2% (62 of 103 eyes). The following predictors were identified to significantly influence the closure rate: tractional hole index (THI), axial length, time between first and second surgery, and the experience of the surgeon (p < 0.05). CONCLUSIONS: Re-vitrectomy with APC led to the closure of 60.2% of the persistent MHs. The closure rate negatively correlates with increasing axial length, time between the first and second surgery, and the decreased THI. Further, experienced surgeons (with a history of >100 pars plana vitrectomies with ILM peeling) had significantly higher closure rates.


Assuntos
Plaquetas , Transfusão de Sangue Autóloga/métodos , Tamponamento Interno/métodos , Macula Lutea/patologia , Perfurações Retinianas/terapia , Acuidade Visual , Vitrectomia/métodos , Idoso , Feminino , Seguimentos , Humanos , Masculino , Prognóstico , Reoperação , Perfurações Retinianas/diagnóstico , Estudos Retrospectivos , Tomografia de Coerência Óptica , Resultado do Tratamento
13.
J Pediatr Ophthalmol Strabismus ; 56(5): 327-332, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31545867

RESUMO

PURPOSE: To compare short-term visual outcomes (best corrected visual acuity [BCVA]), visual axis opacification, anterior (ACCC) and posterior (PCCC) continuous curvilinear capsulorhexis size, shape, and extension, and their decentration between manual capsulorhexis and 25-gauge vitrectorhexis in pediatric cataract surgery with intraocular lens (IOL) implantation. METHODS: Thirty eyes of children aged 3 to 8 years with developmental cataract were randomly selected for ACCC and PCCC by manual capsulorhexis forceps and 25-gauge vitrectomy cutter followed by IOL implantation and limited anterior vitrectomy. The size of the ACCC and PCCC was measured intraoperatively with calibrated capsulorhexis forceps. Patients were followed up for 3 months postoperatively and were evaluated for BCVA and visual axis opacification. Slit-lamp photographs of operated eyes were taken in retroillumination. The size in millimeters and decentration of the ACCC and PCCC from the center of the IOL were measured with the help of the Python imaging library. RESULTS: There was no statistically significant difference between BCVA (P > .05), visual axis opacification (P > .05), size of the ACCC (P > .05) and its decentration (P > .05), extension of the rhexis (P > .05), and size of the PCCC (P > .05) and its decentration (P > .05) between the two methods. CONCLUSIONS: In both groups, BCVA, visual axis opacification, and ACCC and PCCC size, shape, and decentration from the center of the IOL were comparable, making 25-gauge vitrectorhexis a good alternative to manual capsulorhexis. [J Pediatr Ophthalmol Strabismus. 2019;56(5):327-332.].


Assuntos
Capsulorrexe/métodos , Catarata/complicações , Anormalidades do Olho/cirurgia , Lentes Intraoculares , Acuidade Visual , Vitrectomia/métodos , Corpo Vítreo/anormalidades , Criança , Pré-Escolar , Anormalidades do Olho/complicações , Anormalidades do Olho/diagnóstico , Feminino , Seguimentos , Humanos , Masculino , Projetos Piloto , Estudos Prospectivos , Corpo Vítreo/cirurgia
14.
JNMA J Nepal Med Assoc ; 57(217): 181-183, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31477959

RESUMO

INTRODUCTION: Large macular holes cause significant reduction in central visual acuity. The aim of the study is to find out short term anatomical and visual outcomes of inverted internal limiting membrane flaps technique for large macular holes (base diameter>1000µm) surgery in patients at a tertiary care hospital. METHODS: A descriptive cross-sectional study was conducted in a tertiary care hospital from January 2018 to December 2018 after ethical clearance from the institutional review committee. The study was done in 12 patients with idiopathic macular holes (base diameter>1000µm), they were repaired with 25 gauge pars plana vitrectomy with brilliant blue assisted large inverted internal limiting membrane flap technique. Statistical analyses were performed using SPSS 19.0 Results: All twelve eyes had complete anatomical closure. Mean best corrected visual acuity preoperatively was 1.48 logMAR±0.246. The mean macular hole base diameter was 1217.0±196.77µm. The mean age of patients was 68.75±4.97 years. Postoperatively, mean best corrected visual acuity was 0.978 logMAR±0.12. There were no postoperative complications. All the patients perceived decreased size of central scotoma. CONCLUSIONS: Inverted internal limiting membrane flaps for large macular holes is suitable method for closure of the very large hole, restoration of functional vision and decreased size of central scotoma.


Assuntos
Membrana Epirretiniana/cirurgia , Perfurações Retinianas/cirurgia , Retalhos Cirúrgicos , Vitrectomia/métodos , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nepal , Prevalência , Perfurações Retinianas/patologia , Centros de Atenção Terciária , Acuidade Visual
15.
Ophthalmologica ; 242(4): 234-238, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31480058

RESUMO

BACKGROUND: Surgical intervention for dense vitreous hemorrhage (DVH) with unclear etiology is often delayed in favor of conservative follow-up despite possible disease progression and the availability of safe minimally invasive vitrectomy. OBJECTIVES: The aim of this study is to investigate the efficacy of early surgical intervention for DVH with unknown etiology. METHODS: Eighty-eight cases (88 eyes) of DVH with unknown origin were retrospectively reviewed. Inclusion criteria were as follows: (1) measured visual acuity (VA) of 20/200 or worse and (2) fundus invisibility requiring B-scan ultrasonography. Eyes with a history of diabetic retinopathy, recent trauma, or likely retinal detachment (RD) as revealed by B-scan ultrasonography were excluded. Outcome measures were a cause of vitreous hemorrhage and final VA following early (≤2 weeks after symptom onset) or delayed vitrectomy. RESULTS: The most frequently occurring causes of DVH were central or branch retinal vein occlusion (30 eyes, 34%) and retinal tear or RD (29 eyes, 33%). logMAR VA significantly improved after treatment (p < 0.001). Final VA was significantly higher for eyes treated within 2 weeks compared with eyes treated later than 2 weeks after symptom onset (p = 0.020). CONCLUSIONS: Surgical intervention within 2 weeks after symptom onset may prevent a lower visual outcome.


Assuntos
Terapia a Laser/métodos , Acuidade Visual , Vitrectomia/métodos , Corpo Vítreo/diagnóstico por imagem , Hemorragia Vítrea/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia , Hemorragia Vítrea/diagnóstico , Adulto Jovem
16.
Nepal J Ophthalmol ; 11(21): 29-32, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31523064

RESUMO

INTRODUCTION: Large macular holes are not uncommon among Nepalese women population causing severe visual problem. OBJECTIVE: To evaluate the technique of inverted internal limiting membrane (ILM) flaps for the repairment of large macular holes. METHODS: All 10 macular holes (diameter > 400 µm) were treated with pars planavitrectomy with inverted ILM flap technique. The procedure for macular hole surgerywas pars plana vitrectomy, posterior vitreous removal, internal limiting membrane(ILM) peeling with brilliant blue assisted, inverting ILM flap into macular hole, filling of the vitreous cavity with a gas bubble(C3 F8) and post-operative face-down positioning for 1 week. SD OCT images were taken preoperative and postoperative 1 month and 3 months follow up to assess the anatomical outcome of surgery and best corrected visual acuity (BCVA) was used to evaluate the functional outcome during each visit. The BCVA was recorded using the Snellen chart and was converted to the logarithm of the minimum angle of resolution (LogMAR) equivalents. RESULTS: All 10 eyes had complete anatomical closure. The mean age of patients was 64.3 ± 7.53 years. The mean macular hole base diameter was 1039.4 µm (663-1526µm). Mean BVCA pre-operatively was 1.29 log MAR ±SD 0.25. Post-operatively, mean BCVA was 0.925 log MAR ±SD 0.143 (p= 0.002). There were no intra operative or post-operative complications. All the patients were followed up for a period of 3months. CONCLUSIONS: Inverted ILM flaps is effective for closure of the large macular hole and restoration of functional vision.


Assuntos
Membrana Basal/cirurgia , Recuperação de Função Fisiológica , Perfurações Retinianas/cirurgia , Retalhos Cirúrgicos , Acuidade Visual , Vitrectomia/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Perfurações Retinianas/diagnóstico , Estudos Retrospectivos , Fatores de Tempo , Tomografia de Coerência Óptica , Resultado do Tratamento
17.
Ophthalmologica ; 242(4): 222-233, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31533121

RESUMO

PURPOSE: To report the surgical results and technique of perfluorocarbon-assisted neurosensory retinal flap transplantation into macular hole for concomitant macular hole and complicated retinal detachment. METHOD: This is a retrospective, consecutive case series of 7 cases with concomitant macular hole and complicated retinal detachment with proliferative vitreoretinopathy. All eyes had previous vitrectomy and internal limiting membrane peeling, or very large (>1,000 µm) macular holes. Perfluorocarbon liquid-assisted free neurosensory retinal flap transplantation into the macular hole, and subretinal fluid drainage through iatrogenic retinectomy/retinotomy were performed, followed by air-fluid exchange with gas or silicone oil tamponade. RESULTS: All eyes had retina reattached. Macular hole was closed in all eyes, with the graft visualized by optical coherence tomography. The best corrected visual acuity in logarithm of minimal angle of resolution improved from 2.80 ± 0.45 preoperatively to 1.40 ± 0.51 postoperatively (p < 0.01). CONCLUSIONS: Neurosensory retinal flap may be a good option in closing macular holes in eyes with concomitant macular hole and complicated retinal detachment. Because of its specific properties, the flap is easy to handle during the operation. Retinectomy or retinotomy serves to release traction, drain subretinal fluid, and provide retinal flap tissue.


Assuntos
Tamponamento Interno/métodos , Fluorcarbonetos/farmacologia , Retalhos de Tecido Biológico , Retina/transplante , Descolamento Retiniano/cirurgia , Perfurações Retinianas/cirurgia , Vitrectomia/métodos , Idoso , Feminino , Seguimentos , Humanos , Macula Lutea/patologia , Masculino , Pessoa de Meia-Idade , Descolamento Retiniano/complicações , Descolamento Retiniano/diagnóstico , Perfurações Retinianas/complicações , Perfurações Retinianas/diagnóstico , Estudos Retrospectivos , Tomografia de Coerência Óptica , Resultado do Tratamento , Vitreorretinopatia Proliferativa/complicações , Vitreorretinopatia Proliferativa/diagnóstico , Vitreorretinopatia Proliferativa/cirurgia
18.
BMC Ophthalmol ; 19(1): 175, 2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31395046

RESUMO

BACKGROUND: To assess the relationship between different indications for trans pars plana vitrectomies (PPV's) and the intraocular pressure (IOP), and the effect of multiple PPV's on the IOP. We also examined whether there were differences in the number of IOP-lowering medications or surgeries before and after PPV. METHODS: A retrospective study including all patients that underwent at least one PPV in the period from 2001 till 2014 at our clinic. Medical records of all patients were reviewed and clinically relevant data were entered in a database. Generalized estimating equations models for repeated measurements were used to examine the effect of the number of PPV's on the IOP and on the risk of undergoing glaucoma surgery, for each of the indications for PPV. RESULTS: Of 1072 PPV's 447 eyes fulfilled the inclusion criteria. The IOP increased with 3.0 mmHg after a PPV with indication retinal detachment (p < 0.001), but remained stable after PPV for epiretinal membrane (p = 0.555), macular hole (p = 0.695), and vitreous hemorrhage (p = 0.787). At the end of the follow-up period the number of IOP-lowering medications was significantly higher compared to baseline, except in the macular hole group (p = 0.103). Also, the number of eyes that underwent glaucoma surgery was significantly higher compared to the fellow (not-operated) eyes (p < 0.001). There was a significant association between the number of PPV's and the final IOP for the indication retinal detachment (p = 0.009), and between the number of PPV's and glaucoma surgery (odds ratio [95% confidence interval]: 2.60 [1.62-4.15]). CONCLUSIONS: The IOP rises significantly after PPV with indication retinal detachment. This association was not found for other indications for PPV. Also, the risk of IOP-lowering surgeries was higher after PPV, but not different between the PPV indications. The IOP should be monitored carefully after PPV, since there may be a higher risk of secondary glaucoma.


Assuntos
Previsões , Pressão Intraocular/fisiologia , Complicações Pós-Operatórias/epidemiologia , Doenças Retinianas/cirurgia , Vitrectomia/métodos , Idoso , Feminino , Seguimentos , Humanos , Masculino , Países Baixos/epidemiologia , Reoperação/tendências , Doenças Retinianas/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Tonometria Ocular , Acuidade Visual
19.
Graefes Arch Clin Exp Ophthalmol ; 257(11): 2367-2373, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31418105

RESUMO

PURPOSE: The purpose of the present paper is to describe a surgical technique aimed at creating multiple layers of Internal Limiting Membrane (ILM) using Perfluorocarbon Liquid (PFCL) in order to favour the closure of large, chronic and myopic Macular Holes (MH). METHODS: Thirty patients belonging to 3 subgroups: large (> 500 µm), chronic (> 12 months) and myopic (> - 9 diopters), MHs, underwent surgery and completed 6 months follow-up. The ILM was engaged and peeled 360° around the MH, hinged to the rim and folded over the hole. A PFCL bubble spanning the vascular arcades was then injected and the ILM is grasped repeatedly to fold the distal edge towards the MH centre, creating multiple ILM layers over the MH. RESULTS: MH closed in 26/30 cases (86.6%) with no significant difference among subgroups. Vision improved 2.57 ± 1.56 Snellen lines from LogMAR 1.50 ± 1.19 to 1.19 ± 1.32 (p < 0.01). Ellipsoid Zone (EZ) interruption width reduced from 1129 ± 439 µm to 258 ± 507 µm (p < 0.001) and correlated to pattern of MH closure, post-BCVA and line improvement (p < 0.001 in all cases). DISCUSSION: The use PFCL allows multiple ILM layers and resulted in a high closure rate. Pattern of MH closure differs from those previously described leaving a plug of ILM tissue that interrupts retinal architecture often only in the inner layers. PFCL gravity and hydrophobicity displace aqueous while the intensely polar opposite faces of the ILM attract each other. The folded ILM plugs MH and bridges the gap and may help glial cell proliferation and migration.


Assuntos
Membrana Basal/transplante , Tamponamento Interno/métodos , Fluorcarbonetos/farmacologia , Miopia/complicações , Refração Ocular/fisiologia , Perfurações Retinianas/cirurgia , Retalhos Cirúrgicos , Idoso , Doença Crônica , Feminino , Seguimentos , Humanos , Macula Lutea/patologia , Masculino , Pessoa de Meia-Idade , Miopia/diagnóstico , Miopia/fisiopatologia , Perfurações Retinianas/diagnóstico , Perfurações Retinianas/etiologia , Estudos Retrospectivos , Tomografia de Coerência Óptica , Resultado do Tratamento , Acuidade Visual , Vitrectomia/métodos
20.
BMC Ophthalmol ; 19(1): 183, 2019 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-31412813

RESUMO

BACKGROUND: To evaluate the efficacy of epiretinal membrane removal in patients with good best-corrected visual acuity (BCVA) for improving visual function and quality of life (QOL). METHODS: This prospective case study compared 37 subjects with preoperative BCVA ≦ 0.046 logMAR (Good group) to 35 patients with 0.10-0.52 logMAR (Moderate group) at 3 and 6 months. Linear mixed-effect models were used for statistical analysis. The primary outcome was the horizontal metamorphopsia score (MH) at 6 months postoperatively (post-6 M), while secondary outcomes were postoperative BCVA, vertical metamorphopsia score (MV), aniseikonia, stereopsis and central foveal thickness. In the Good group, QOL was assessed using the National Eye Institute Visual Functioning Questionnaire-25 (NEI VFQ-25) at 6 and 12 months. RESULTS: MH was significantly improved at post-3 M and post-6 M in the both groups but there were no significant differences between the two groups. MV showed no improvement at the final observation in either group. LogMAR BCVA was significantly improved at post-6 M in the Good group, which had significantly better vision than the Moderate group. Preoperative vertical and horizontal aniseikonia scores remained unchanged in the Good group at post-6 M but worsened in the Moderate group. The NEI VFQ-25 score improved in the Good group, reflecting improved general health, general vision, and mental health. CONCLUSIONS: Early epiretinal surgery for patients with BCVA ≦ 0.046 logMAR was effective for improvement of HM, BCVA, and QOL and prevented worsening of aniseikonia. TRIAL REGISTRATION: UMIN000021220 . Registered 10 September 2015. UMIN Clinical Trials Registry.


Assuntos
Percepção de Profundidade/fisiologia , Membrana Epirretiniana/cirurgia , Qualidade de Vida , Acuidade Visual/fisiologia , Vitrectomia/métodos , Idoso , Membrana Epirretiniana/diagnóstico , Membrana Epirretiniana/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Prospectivos , Retina/diagnóstico por imagem , Tomografia de Coerência Óptica
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