23-Gauge transconjunctival sutureless vitrectomy for retained lens fragments after complicated cataract surgery.

PURPOSE: The purpose of this study was to evaluate the effectiveness and safety of 23-gauge (23-G) transconjunctival sutureless vitrectomy in patients with retained lens fragments after complicated cataract surgery. METHODS: In this retrospective consecutive case series, 17 eyes of 17 patients with retained lens fragments after complicated cataract surgery and managed by using 23-G transconjunctival sutureless vitrectomy were evaluated between January 2007 and March 2009 at our institution. RESULTS: Mean follow-up time was 8.5 ± 3.00 months. Nine patients (53%) were pseudophakic, and 8 (47%) were aphakic. A foldable acrylic intraocular lens was implanted in eight eyes with aphakia. In 2 eyes (11.8%), one of 23-G sclerotomy port was enlarged and intravitreal phacoemulsification was performed with 20-gauge phacofragmatome to remove hard nucleus. Visual acuity improved in 100% of eyes and was 20/40 or better in 70.6% of eyes. Postoperative complications were transient elevation of intraocular pressure (29.4%), decentralization of the intraocular lens (5.9%), fibrin reaction (5.9%), mild vitreous hemorrhage (5.9%), and macular retinal pigment epithelial changes (5.9%). CONCLUSION: Twenty-three-gauge transconjunctival sutureless vitrectomy was observed to be effective and safe in patients with retained lens fragments after complicated cataract surgery. In cases with hard nucleus, 23-G vitrectomy probe may not be adequate to remove the lens fragments.

Macular thickness changes after phacoemulsification in previously vitrectomized eyes for diabetic macular edema.

PURPOSE: To report visual results and anatomical outcome after uncomplicated phacoemulsification in eyes that previously underwent pars plana vitrectomy for diabetic macular edema. METHODS: This retrospective noncomparative study included 22 eyes of 19 diabetic patients who underwent uncomplicated cataract surgery with phacoemulsification and intraocular lens implantation after pars plana vitrectomy with internal limiting membrane removal for diabetic macular edema. Main outcome measures included visual acuity and foveal thickness (FT) changes as assessed by optical coherence tomography. Wilcoxon test was used for statistical analysis. RESULTS: Mean follow-up time was 11.9 ± 8.75 months. Mean FT increased by 20.5 ± 67.6 µm (8.4%), with a mean preoperative FT of 237 ± 69 µm compared with a mean postoperative FT of 257.6 ± 89.8 µm (P = 0.236). Foveal thickness increased by at least 20% in 6 eyes (27.3%), remained within 20% in 14 eyes (63.6%), and decreased by 20% in 2 eyes (9.1%). Visual acuity improved by ≥2 lines in 16 eyes (72.7%) and remained stable in 6 eyes (27.3%). Visual acuity was 20/40 or better in 11 eyes (50%). CONCLUSION: Moderate but insignificant increase in FT was observed after phacoemulsification in eyes that previously underwent pars plana vitrectomy for diabetic macular edema. Prospective studies with a large number of patients are warranted for a more reliable conclusion.

Quantitative assessment of photoreceptor layer in eyes with resolved edema after pars plana vitrectomy with internal limiting membrane removal for diabetic macular edema.

BACKGROUND/AIMS: To evaluate the correlation between visual acuity (VA) and photoreceptor integrity in eyes with resolved diabetic macular edema (DME) after pars plana vitrectomy (PPV). METHODS: Eleven eyes with resolved macular edema following PPV with internal limiting membrane removal for DME were included in this retrospective study. The integrity of the external limiting membrane (ELM) and inner and outer segments (IS/OS) of the photoreceptor junction was evaluated by spectral domain optical coherence tomography. The main outcome measures were percentage of disrupted ELM and IS/OS lines, and correlation between VA and photoreceptor integrity. RESULTS: The mean time after PPV was 78 ± 17 months. The mean lengths of the disrupted ELM and IS/OS lines were 223 ± 167 µm (63%) and 189 ± 175 µm (54%) in the foveola, and 900 ± 522 µm (60%) and 835 ± 582 µm (55%) in the fovea, respectively. Intact ELM and IS/OS lines were positively correlated with VA in both the fovea (p = 0.09 and p = 0.02, respectively) and foveola (p = 0.004 and p = 0.03, respectively). Linear regression analysis showed a statistically significant association of intact ELM and IS/OS lines with VA in the fovea. Disrupted ELM and IS/OS lines had a strong correlation with each other in both the fovea (r = -0.71, p = 0.013) and foveola (r = 0.81, p = 0.02). CONCLUSIONS: The integrity of the ELM and IS/OS lines was positively correlated with VA in eyes with resolved DME after PPV.

Corneal topographic changes after transconjunctival 23-gauge sutureless vitrectomy.

To evaluate the topographic changes of cornea after pars plana vitrectomy (PPV) with the 23-gauge- (23-G) transconjunctival sutureless vitrectomy (TSV) system within the first postoperative month. In this prospective study, corneal topographic changes were evaluated in 24 eyes of 24 patients who underwent PPV with the 23-G TSV system. All eyes underwent computer-assisted videokeratography using NAVIS (Nidek Advanced Vision Information System) software preoperatively and at the first day, first week, and first month postoperatively. The topographic parameters that were analyzed statistically were the average corneal power (ACP), corneal surface cylinder (CSC), surface asymmetry index (SAI), and surface regularity index (SRI). Mean induced astigmatism was estimated by vector analysis software. The Wilcoxon test was used for statistical analysis. Mean ACP was 43.12±1.16 diopters (D) preoperatively and 42.88±1.44 D at first day (P=0.301), 43.04±1.14 D at first week (P=0.796), and 43.32±1.17 D at first month postoperatively (P=0.187). Mean CSC was 0.61±0.32 D preoperatively and 0.71±0.48 D at first day (P=0.918), 0.60±0.25 D at first week (P=0.826), and 0.70±0.33 D at first month postoperatively (P=0.414). Mean SAI was 0.12±0.05 preoperatively and 0.21±0.16 at first day (P=0.070), 0.15±0.06 at first week (P=0.176), and 0.16±0.09 at first month postoperatively (P=0.198). Mean SRI was 0.41±0.37 preoperatively and 1.05±0.41 at first day (P=0.001), 0.54±0.42 at first week (P=0.211), and 0.41±0.5 at first month postoperatively (P=0.861). Mean surgically induced astigmatism was 0.67±0.7 D at first day, 0.36±0.2 D at first week, and 0.33±0.17 D at first month postoperatively. Corneal surface and astigmatic changes were observed to be insignificant in the early postoperative period after PPV with the 23-G TSV system.

Bevacizumab (Avastin) for diabetic macular edema in previously vitrectomized eyes.

PURPOSE: To report the visual acuity (VA) and foveal thickness (FT) changes after intravitreal bevacizumab for diabetic macular edema (DME) in previously vitrectomized eyes. DESIGN: Retrospective, noncomparative, interventional case series. METHODS: Medical records of 11 eyes of 10 patients who underwent intravitreal bevacizumab injection for persistent DME were reviewed. This retrospective study included eyes that had persistent DME despite prior pars plana vitrectomy with internal limiting membrane removal at our institution with optical coherence tomography (OCT) assessment of DME. All eyes received three intravitreal injections of bevacizumab 1.25 mg/0.05 ml monthly. RESULTS: Mean FT was 408 +/- 77 microm at baseline, 453 +/- 97 microm at three months, and 454 +/- 101 microm at six months (P = .172). Mean Early Treatment Diabetic Retinopathy Study (ETDRS) letter scores were 59 +/- 15 (20/80) at baseline, 59 +/- 16 (20/80) at three months, 57 +/- 15 (20/80) at six months (P = .398). CONCLUSION: No change in VA and FT was observed in the short-term after intravitreal bevacizumab for DME in previously vitrectomized eyes.

Primary 25-gauge transconjunctival sutureless vitrectomy in pseudophakic retinal detachment.

AIMS: There are few reports on 25-gauge transconjunctival sutureless vitrectomy (TSV) in cases of pseudophakic retinal detachment. We conducted this study to report the anatomic and functional outcomes of 25-gauge TSV in the treatment of primary pseudophakic retinal detachment (RD). DESIGN: Prospective, interventional case series. MATERIALS AND METHODS: Fifteen eyes of 15 patients with RD after cataract surgery with phacoemulsification were evaluated. Primary pseudophakic RDs with macular detachment and proliferative vitreoretinopathy Stage B or less were included in the study. Pars plana vitrectomy with the 25-gauge TSV system, perfluorocarbon liquid injection followed by air exchange, endolaser photocoagulation and sulfur hexafluoride gas (20%) injection were applied to all eyes. RESULTS: Mean follow-up time was 9.2 months (range, six to 12 months). Retinal reattachment with a single operation was achieved in 93% of eyes and with additional surgery, the retina was reattached in 100% of eyes. Preoperative visual acuity was less than 20/200 in all eyes (range, hand motions to 20/400). Postoperative visual acuity was 20/40 or better in eight eyes (53%) and between 20/50 and 20/200 in seven eyes (47%). No severe hypotony was encountered and no sutures were required to close the scleral and conjunctival openings. Postoperative complications were macular pucker in one eye (7%) and cystoid macular edema in another eye (7%). CONCLUSIONS: Primary 25-gauge TSV system appears to be an effective and safe procedure in the treatment of uncomplicated pseudophakic RD.

Modified grid laser photocoagulation versus pars plana vitrectomy with internal limiting membrane removal in diabetic macular edema.

PURPOSE: To compare the effectiveness of pars plana vitrectomy (PPV) and removal of the internal limiting membrane (ILM) with modified grid laser photocoagulation in diabetic macular edema. DESIGN: Randomized, comparative, interventional study. METHODS: In this prospective study, 24 eyes of 12 patients with bilateral diabetic macular edema were evaluated. PPV with removal of the ILM was performed at random in one eye of 12 patients (ILM group), and a single session of modified grid laser photocoagulation was performed in the fellow eyes (grid group). Main outcome measures were the foveal thickness measured with optical coherence tomography, preoperative, and postoperative visual acuities. Mann-Whitney U and Wilcoxon tests were used in statistical analysis. RESULTS: All patients were followed up for 6 months. In the ILM group, mean foveal thickness was 439.2 +/- 106.5 microm preoperatively and 219.8 +/- 63.2 mum postoperatively (P = .002). In the grid group, mean foveal thickness was 407 +/- 100.2 microm preoperatively and 378.5 +/- 141.6 microm postoperatively (P = .433). A mean decrease in foveal thickness was found to be 219.4 +/- 127.6 microm in the ILM group and 28.5 +/- 90.5 microm in the grid group (P = .001). In the ILM group, best-corrected logMAR visual acuity was 0.75 +/- 0.41 preoperatively and 0.53 +/- 0.41 postoperatively (P = .006). In the grid group, best-corrected logMAR visual acuity was 0.59 +/- 0.27 preoperatively and 0.49 +/- 0.27 postoperatively (P = .058). Visual acuity improved by 2 or more lines in six eyes (50%) in the ILM group and in three eyes (25%) in the grid group. Visual acuity remained stable in six eyes (50%) in the ILM group and in nine eyes (75%) in the grid group. CONCLUSIONS: PPV with ILM removal appears to be more effective than a single session of modified grid laser photocoagulation in the treatment of diabetic macular edema. Further studies with a large number of patients are required for a more reliable conclusion.

Corneal topographic changes after transconjunctival (25-gauge) sutureless vitrectomy.

PURPOSE: To evaluate the topographic changes in the cornea after pars plana vitrectomy (PPV) with 25-gauge transconjunctival sutureless vitrectomy (TSV) system. DESIGN: Prospective, interventional case series. METHODS: In this prospective study, we evaluated the topographic changes of the cornea in 32 eyes of 32 patients who underwent PPV with the 25-gauge TSV system. The topographic parameters that were analyzed statistically were the average corneal power, corneal surface cylinder, surface asymmetry index, and surface regularity index. Mean induced astigmatism was estimated by vector analysis software. Wilcoxon test was used for statistical analysis. RESULTS: There was no significant change in average corneal power, corneal surface cylinder, surface asymmetry index, and surface regularity index parameters at first day, first week, and first month after the operation. Mean induced astigmatism was 0.38 diopters at 15 degrees. CONCLUSIONS: Corneal surface and astigmatic changes were observed to be insignificant in the early postoperative period after PPV with the 25-gauge TSV system.

Primary 23-gauge vitreoretinal surgery for rhegmatogenous retinal detachment.

AIM: To report the effectiveness and safety of primary 23-Gauge (G) vitreoretinal surgery for rhegmatogenous retinal detachment (RRD). METHODS: In this retrospective study, 49 eyes of 49 consecutive patients who underwent primary 23-G transconjunctival sutureless vitrectomy (TSV) for RRD between January 2007 and July 2009 at our institution were evaluated. RESULTS: Mean follow-up time was 8.9±7.7 months (1-28 months). Retinal reattachment was achieved with a single operation in 47(95.9%) of 49 eyes. In two eyes (4.1%), retinal redetachment due to new breaks was successfully treated with reoperation using the 23-G TSV system. Mean logMAR visual acuity was 2.01±0.47 preoperatively and 1.3±0.5 postoperatively (P<0.001, Paired t-test). Mean preoperative intraocular pressure (IOP) was 14.1±2.8mmHg. Mean postoperative IOP was 12.3±3.6mmHg at 1 day, 13.1±2.1mmHg at 1 week, 14.3±2.2mmHg at 1 month. Iatrogenic peripheral retinal break was observed in 1 eye (2.0%) intraoperatively. No sutures were required to close the scleral or conjunctival openings, and no eyes required convertion of surgery to 20-G vitrectomy. CONCLUSION: Primary 23-G TSV system was observed to be effective and safe in the treatment of RRD.

Outcomes of 23-gauge pars plana vitrectomy and internal limiting membrane peeling with brilliant blue in macular hole.

PURPOSE: The evaluation of anatomic and visual outcomes in macular hole cases treated with internal limiting membrane (ILM) peeling, brilliant blue (BB), and 23-gauge pars plana vitrectomy (PPV). MATERIALS AND METHODS: Fifty eyes of 48 patients who presented between July 2007 and December 2009 with the diagnosis of stage 2, 3, or 4 macular holes according to Gass Classification who had undergone PPV and ILM peeling were included in this study. Pre- and postoperative macular examinations were assessed with spectral-domain optical coherence tomography. 23 G sutureless PPV and ILM peeling with BB was performed on all patients. RESULTS: The mean age of patients was 63.34 ± 9.6 years. Stage 2 macular hole was determined in 17 eyes (34%), stage 3 in 24 eyes (48%), and stage 4 in 9 eyes (18%). The mean follow-up time was 13.6 ± 1.09 months. Anatomic closure was detected in 46/50 eyes (92%), whereas, in four cases, macular hole persisted and a second operation was not required due to subretinal fluid drainage. At follow-up after 2 months, persistant macular hole was detected in one case and it was closed with reoperation. At 12 months, an increase in visual acuity in 41 eyes was observed, while it remained at the same level in six eyes. In three eyes visual acuity decreased. There was a postoperative statistically significant increase in visual acuity in stage 2 and 3 cases (P < 0.05), however, no increase in visual acuity in stage 4 cases was observed. CONCLUSION: PPV and ILM peeling in stage 2, 3, and 4 macular hole cases provide successful anatomic outcomes, however, in delayed cases, due to photoreceptor loss, it has no effect on functional recovery. BB, used for clarity of ILM, may be beneficial due to its low retinal toxicity.

Long-term outcomes of pars plana vitrectomy with internal limiting membrane removal in diabetic macular edema.

PURPOSE: To report the long-term visual results and anatomical outcome as assessed by optical coherence tomography (OCT) after pars plana vitrectomy (PPV) with removal of the internal limiting membrane (ILM) in diabetic macular edema (DME). METHODS: Medical records of 27 eyes of 27 patients who underwent PPV with ILM removal for DME attributable to diffuse leakage were reviewed. This retrospective study included eyes that underwent PPV with ILM removal at our institution with preoperative and postoperative OCT assessment of DME. None of the eyes had OCT evidence of anteroposterior vitreomacular traction. Main outcome measures were foveal thickness and visual acuity changes. RESULTS: Foveal thickness decreased by at least 20% in 22 eyes (81.4%) and increased by at least 20% in 3 eyes (11.1%) with PPV and ILM removal (mean follow-up +/- SD, 27.6 +/- 7.2 months; range, 12-38 months). Mean foveal thickness decrease +/- SD was 178 +/- 164 microm (43.6%), with a mean preoperative foveal thickness +/- SD of 408 +/- 121 microm compared with a mean postoperative foveal thickness +/- SD of 230 +/- 74 microm (P < 0.001). Recurrence of DME was observed at postoperative month 24 in 2 eyes and postoperative month 30 in 1 eye. Visual acuity improved by > or =2 lines in 10 eyes (37%) and decreased by > or =2 lines in 3 eyes (11.1%). Mean best-corrected logMAR (logarithm of the minimum angle of resolution) visual acuity +/- SD was 0.75 +/- 0.35 preoperatively and 0.63 +/- 0.33 postoperatively (P = 0.033). CONCLUSION: PPV with ILM removal appears to be effective in reducing DME and improving visual acuity, and its effectiveness is maintained in the long term. Recurrence of DME may be observed in the late postoperative period.

Steamroller versus basic technique in pneumatic retinopexy for primary rhegmatogenous retinal detachment.

PURPOSE: To compare the effectiveness and safety of the "basic" technique with those of the "steamroller" technique in pneumatic retinopexy (PR) for primary rhegmatogenous retinal detachment. METHODS: In this prospective study, 40 eyes of 40 patients with primary rhegmatogenous retinal detachment were treated with PR by argon laser photocoagulation. PR with the steamroller technique (steamroller group) was performed randomly on 21 eyes of 21 patients, and 19 eyes of 19 patients were treated with PR with the basic technique (basic group). Main outcome measures were visual acuity, anatomical outcome, rate of proliferative vitreoretinopathy (PVR) development, and postoperative complications. RESULTS: Mean follow-up +/- SD was 14.7 +/- 9.9 months (range, 6-48 months). Single-operation success rate for all patients was 70% (28/40 eyes). Single-operation success rate was 74% (14/19 eyes) for the basic group and 67% (14/21 eyes) for the steamroller group (P = 0.629). PVR grade C-1 developed in one eye (5%) in each group. Overall success rate, after reoperations, was 100% for each group. Preoperative logMAR (logarithm of the minimum angle of resolution) visual acuity +/- SD was 2.01 +/- 0.43 in the basic group and 1.89 +/- 0.45 in the steamroller group (P = 0.434). Postoperative logMAR visual acuity +/- SD was 0.64 +/- 0.42 in the basic group and 0.46 +/- 0.35 in the steamroller group (P = 0.152). There was no statistically significant difference between basic and steamroller groups in terms of postoperative complications (P > 0.05). CONCLUSION: Basic and steamroller techniques appear to be equally effective and safe in PR for primary rhegmatogenous retinal detachment. The risk for PVR development seems to be similar with either technique. Further studies with a large number of patients are required for a more reliable conclusion.