1,720,967 research outputs found
Early vitrectomy for vitreous haemorrhage associated with retinal tears
No full textPurpose: To evaluate outcome of early surgery in vitreous hemorrhage, presumably associated with retinal tears. Design: Retrospective, noncomparative interventional case series. Methods: We included 40 consecutive cases in 39 patients treated with early vitrectomy for vitreous hemorrhage. Main outcome measures were incidence of tears identified preoperatively and intraoperatively, visual acuity, and complications. Results: Vitrectomy took place after a mean delay of 2.7 days after presentation. A total of 69 tears were found in 40 eyes; 53.7% of tears were identified preoperatively by funduscopy or ultrasound (U/S) and the remaining 46.3% of tears were only identified during vitrectomy. Visual acuity improved significantly from 1/60 to 0.8. The sensitivity of U/S tear detection was 55.9%. A history of predisposing factors was not related to the risk of presence of unsupported tears. In 2 cases a retinal detachment developed between the U/S evaluation and vitrectomy. Postoperative complications were cataract (30%), macular pucker (2.5%), and retinal detachment (5.0%). Conclusions: Our findings illustrate the potential dangers of a conservative approach to vitreous hemorrhage and show that early vitrectomy has good outcome with acceptable complication rates. Prospective studies on optimal treatment of vitreous hemorrhage associated with tears are neede
Air versus gas tamponade in retinal detachment surgery
No full textObjective: To compare the outcome of air tamponade with gas tamponade in primary vitrectomy for the treatment of rhegmatogenous retinal detachment (RRD). Methods: We examined the records of 524 cases of 523 patients that underwent primary vitrectomy for RRD with air or sulphur hexafluoride 20% gas tamponade and a follow-up of at least 3 months, excluding cases with inferior retinal breaks. Results: 318 cases were treated with gas and 128 cases with air. Overall, vitrectomy led to an attached retina after a single operation in 85.1% of cases. Eyes treated with air had an 81.0% chance of primary success and those treated with gas had an 86.9% success rate (p=0.083, NS, χ2 test). Involvement of lower retinal quadrants in the retinal detachment was revealed as a significant confounding factor. After correction for this confounder using a multivariate logistic regression model, air versus gas tamponade became a statistically significant determinant for success rate (OR 1.97; p=0.012). In a sub-analysis, eyes with a retinal detachment that involved the inferior quadrants had significantly lower primary success rates when using air tamponade (69.6%), compared to gas tamponade (84.7%; p=0.009, χ2 test). Conclusions: Gas tamponade is superior to air tamponade in retinal detachment cases with involvement of the lower quadrants. These results suggest that air tamponade should only be used in retinal detachments that are restricted to the superior quadrants. Further prospective study is needed to confirm these findings, and to address functional outcome
Safety of vitrectomy for floaters
No full textPurpose: To assess the risks of vitrectomy for the removal of primary and secondary vitreous opacities. • Design: Retrospective, nonrandomized, interventional case series. • Methods: We reviewed the results of 116 consecutive cases of vitrectomy for vitreous floaters. Eighty-six cases were primary and 30 cases were secondary floaters. Main outcome measures were the incidence of iatrogenic retinal breaks and postoperative rhegmatogenous retinal detachments. • Results: We found iatrogenic retinal breaks in 16.4% of operations. There was no statistically significant difference in risk between cases of primary and secondary floaters. Intraoperative posterior vitreous detachment induction was found to increase significantly the risk of breaks. Retinal detachment occurred in 3 cases (2.5%), all after operations for primary floaters. One case of complicated retinal detachment ended with a low visual acuity of hand movements. Cataract occurred in 50% of phakic cases. Transient postoperative hypotony was found after 5.2% of our operations, and transient postoperative high intraocular pressure was encountered in 7.8%. An intraoperative choroidal hemorrhage occurred in 1 case, which resolved spontaneously. The mean visual acuity improved from 0.20 to 0.13 logarithm of the minimal angle of resolution units. • Conclusions: The risk profile of vitrectomy for floaters is comparable with that of vitrectomy for other elective indications. Retinal breaks are a common finding during surgery and treatment of these breaks is crucial for the prevention of postoperative retinal detachment. Patients considering surgery for floaters should be informed specifically about the risks involved
Retinal breaks in vitrectomy for retained lens fragments
No full textPURPOSE: To describe the incidence and outcome of retinal breaks in vitrectomy for retained lens fragments. METHODS: This is a retrospective noncomparative interventional case series. Medical records of consecutive cases of vitrectomy for retained lens fragments over a period of 4 years were reviewed. Main outcome measures were incidence of breaks, visual acuity outcome, and occurrence of postoperative complications. RESULTS: We included 89 consecutive cases in 89 patients. The median interval between cataract surgery and vitrectomy was 2 days (range, 0-106 days). Visual acuity at last follow-up was ≥0.5 in 70% of cases. During surgery, retinal breaks were found in 29% of cases. Induction of a posterior vitreous detachment, the use of a fragmatome, or delay between cataract surgery and vitrectomy did not influence retinal break incidence. Postoperative retinal detachment occurred in only 2% of cases. Other complications were intraoperative choroidal hemorrhage in 1 case, postoperative macular pucker in 2, postoperative macular edema in 1, and glaucoma in 2 cases. CONCLUSION: We identified a high number of retinal breaks during vitrectomy for retained lens fragments. Prophylactic treatment of breaks and other areas of retinal traction seem to reduce the risk of postoperative retinal detachmen
Subretinal versus intravitreal injection of recombinant tissue plasminogen activator in post-traumatic submacular haemorrhages
No full textIn our report, we compare two similar cases of commotio retinae with subretinal haemorrhages of recent onset. To quantify the amount of blood, we considered several data:
(1) Foveal thickness of the haemor- rhage, calculated by the native software of the OCT (macular cube 6 9 6 mm, 512 9 128, 3D OCT 2000, Topcon); (2) Area of the haemorrhage, drawn on the colour fundus photography using ImageJ, a Java-based image-pro- cessing program (version 1.48, National Institute of Health, USA); and
(3) Volume of the haemorrhag
Pars plana vitrectomy for the repair of primary inferior rhegmatogenous retinal detachment associated to inferior breaks. A comparison 25-gauge versus 20-gauge system
No full textBackground: To compare anatomical, functional outcomes and complications of high-speed 25-gauge (G) pars plana vitrectomy (PPV) versus 20-G PPV for the management of primary inferior rhegmatogenous retinal detachment (RRD) associated to inferior breaks/holes. Methods: Eighty-five eyes from 85 patients with a minimum follow-up of 3 months were retrospectively evaluated. Forty-one patients underwent 25-G and 44 patients underwent 20-G PPV. All patients underwent PPV with fluid-air exchange, sulfur hexafluoride (SF6) 20 % gas tamponade and laser or cryo retinopexy. Results: The mean follow-up interval was 6.51(±2.32) and 6.63 (±2.58) months in the 25-G and 20-G groups respectively. Single-operation success rate was 92.7 % for the 25-G group and 81.8 % for the 20-G group (P = 0.24). Post-operative hypotony was observed in no case. Redetachment occurred in 3 eyes operated on with 25-G and in 8 eyes operated on with 20-G system. All retinas were attached at final follow-up. Logarithm of the minimum angle of resolution visual acuity significantly improved from 0.69 ± 0.76 to 0.33 ± 0.37 in the 25-G and from 0.47 ± 0.59 to 0.21 ± 0.28 in the 20-G group (P = 0.0007 and P < 0.0001 respectively). Conclusions: High-speed PPV and SF6 gas tamponade using either 25-G or 20-G PPV system, yields similar single operation anatomical success rates for the repair of uncomplicated, primary inferior RRDs associated to inferior breaks
Outcome of orbital decompression for disfiguring proptosis in patients with Graves’ orbitopathy using various surgical procedures.
No full textEvolution of outer retinal folds occurring after vitrectomy for retinal detachment repair
No full textPurpose.: To assess the evolution of outer retinal folds (ORFs) occurring after repair of rhegmatogenous retinal detachment (RRD) using spectral domain-optical coherence tomography (sd-OCT) and fundus autofluorescence (FAF), and to discuss their pathogenesis.
Methods.: Twenty patients were operated on with 25-gauge pars plana vitrectomy and 20% sulfur hexafluoride gas injection for primary macula-off RRD repair and were followed prospectively. Sd-OCT and FAF images were recorded at 1, 3 and 6 months postoperatively.
Results.: ORFs appeared on sd-OCT as hyperreflective lesions consisting of folded inner segment/outer segment of photoreceptors band and external limiting membrane band. Corresponding lines of increased or decreased autofluorescence were observed on FAF. Over the follow-up, the thick hypoautofluorescent lines progressively evolved to thick hyperautofluorescent lines and to thin hyperautofluorescent lines and eventually disappeared. Concomitantly, OCT scans revealed that the corresponding hyperreflective lesions decreased in number, height, and size. In six cases FAF assessment at month 6 was precluded by cataract development.
Conclusions.: ORFs tend to resolve spontaneously within a few months from operation leaving no or subtle abnormalities at the level of the outer retinal layers. OCT is superior to FAF to follow the evolution of ORFs in phakic eyes. The following factors might be involved in ORFs pathogenesis: structural changes occurring in the detached retina, residual pockets of subretinal fluid after retinal reattachment, intravitreal gas, unintentional retinal translocation, and intraoperative or perioperative hypotony
Iatrogenic retinal breaks in ultra-high-speed 25 gauge vitrectomy: a prospective study of elective cases
No full textBackground/Aims To evaluate the incidence of intraoperative retinal breaks in the ultrahigh-speed (UHS) 25-gauge vitrectomy system in elective vitreous-retina surgery cases. Methods A prospective series of 1676 eyes of 1306 consecutive patients. All eyes underwent an UHS 25-gauge transconjunctival sutureless pars plana vitrectomy for elective cases such as idiopathic epiretinal membrane (586 cases), floaters (153), macular hole (385), vitreous macular traction syndrome (119), dropped nucleus or intraocular lens (84) and vitreous bleeding (82). Patients were followed up for a minimum of 6 months. Results There were 1409 eyes involved in this study. Iatrogenic retinal breaks were found in 25 eyes (1.8%) during surgery. The majority were detected in cases where posterior vitreous detachment was induced during surgery (21 eyes; 2.8% of the patients), and in only four eyes (0.6%) with an already detached vitreous. In nine cases, rhegmatogenous retinal detachment developed during the follow-up. Patients who showed intraoperative retinal breaks were not in this group. Other complications during the follow-up included two cases of vitreous haemorrhage (0.1%), two cases of dislocated intraocular lens (0.1%), and 23 eyes with hypotony without any further complications. Conclusions UHS 25-gauge transconjunctival sutureless vitrectomy is a safe procedure for treatment of elective vitreous-retina cases. The risk of developing iatrogenic breaks seems to be correlated with adhesion of the posterior vitreous hyaloid. Other complications, such as rhegmatogenous retinal detachment or hypotony, were similar to previous reports. No correlation was found between iatrogenic retina breaks and other complications
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