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1.
The Results of Pars Plana Vitrectomy in the Treatment of Intraocular Retinoblastoma: A Retrospective Study and Literature Review.
Li, L, He, T, Su, Y, Wu, L, Chen, C
Technology in cancer research & treatment. 2021;:15330338211048634
Abstract
Purpose: To assess the efficacy and safety of pars plana vitrectomy (PPV) as a treatment for intraocular retinoblastoma (RB) patients. Methods: Twenty-eight RB patients who had PPV were recruited in this retrospective case study, using the digital wide-angle retinal imaging device to record and assess disease condition. Results: The mean value of follow-up time was 79.4 months from diagnosis and 73.1 months from PPV. Up to the end of the follow-up time after PPV, the 5-year survival rate was 96.4%. Ultimately, 35.7% patients underwent enucleation of the eyeball. Among patients with salvaged eyes, 50% had no light perception vision. During the postoperative follow-up time, 14.3% of patients required no further antitumor treatment, and the remaining patients still need to continue to receive systemic or local antitumor treatment, such as chemotherapy, arterial interventional therapy, laser treatment, cryotherapy, and so on. The complication after PPV include cataracts (46.4%), iris adhesion (7.1%), emulsification of the silicone oil (17.9%), band degeneration of the cornea (10.7%), glaucoma (3.6%), and retinal neovascularization (3.6%). Conclusion: According to our observations, we recommend that the utmost care should be taken when considering PPV for the treatment of activated RB. When weighing the risk of tumor recurrence and metastasis, PPV is not suitable for routine treatment. It is necessary to fully grasp the operative indications and strictly observe operation specifications, which includes close postoperative follow-up.
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2.
Early pars plana vitrectomy for proliferative diabetic retinopathy: update and review of current literature.
Berrocal, MH, Acaba-Berrocal, L
Current opinion in ophthalmology. 2021;(3):203-208
Abstract
PURPOSE OF REVIEW Diabetic retinopathy (DR) is one of the leading causes of preventable vision loss in the world and its prevalence continues to increase worldwide. One of the ultimate and visually impairing complications of DR is proliferative diabetic retinopathy (PDR) and subsequent tractional retinal detachment. Treatment modalities, surgical techniques, and a better understanding of the pathophysiology of DR and PDR continue to change the way we approach the disease. The goal of this review is to provide an update on recent treatment modalities and outcomes of proliferative diabetic retinopathy and its complications including tractional retinal detachment. RECENT FINDINGS Panretinal photocoagulation (PRP), anti-vascular endothelial growth factor (anti-VEGF), and pars plana vitrectomy are the mainstay of PDR treatment. However, PRP and anti-VEGF are associated with significant treatment burden and multiple subsequent treatments. Early vitrectomy is associated with vision preservation, less treatment burden, and less subsequent treatments than therapy with PRP and anti-VEGF. SUMMARY Concerning costs, high rates of noncompliance in the diabetic population and significant rates of subsequent treatments with initial PRP and anti-VEGF, early vitrectomy for diabetic retinopathy in patients at risk of PDR is a cost-effective long-term stabilizing treatment for diabetics with advanced disease.
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3.
WITH OR WITHOUT INTERNAL LIMITING MEMBRANE PEELING FOR IDIOPATHIC EPIRETINAL MEMBRANE: A Meta-Analysis of Randomized Controlled Trials.
Sun, Y, Zhou, R, Zhang, B
Retina (Philadelphia, Pa.). 2021;(8):1644-1651
Abstract
PURPOSE To clarify whether internal limiting membrane (ILM) peeling provides better outcomes for patients with idiopathic epiretinal membrane. METHODS Randomized controlled trials comparing epiretinal membrane removal with and without ILM peeling were searched in Embase, PubMed, Web of Science, Cochrane Library, and CNKI before April 15, 2020. The pooled mean difference (MD) for best-corrected visual acuity, central macular thickness, and odds ratio for recurrence were calculated. RESULTS Eight randomized controlled trials involving 422 eyes were included. No significant difference in best-corrected visual acuity (final follow-up: MD, 0.03 logarithm of the minimum angle of resolution [1.5 Early Treatment Diabetic Retinopathy Study letters]; 95% confidence interval [CI], -0.04 to 0.09 [-4.5 to 2 Early Treatment Diabetic Retinopathy Study letters]; P = 0.40) or recurrence rate (odds ratio, 0.21; 95% CI, 0.04-1.05; P = 0.06) between the groups was observed. However, patients with ILM peeling presented thicker central macular thickness at 3 months (MD, 16.36; 95% CI, 1.26-31.46; P = 0.03), 6 months (MD, 22.64; 95% CI, 10.29-34.98; P = 0.0003) and the final follow-up (MD, 25.87; 95% CI, 13.96-37.79; P < 0.0001). CONCLUSION The study showed that ILM peeling did not significantly improve the postoperative visual outcome or decrease recurrence, but result in thicker central macular thickness, indicating that it is inessential for idiopathic epiretinal membrane.
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4.
Role of Vital Dyes in Chromovitrectomy.
Bergamo, VC, Caiado, RR, Maia, A, Magalhães, O, Moraes, NSB, Rodrigues, EB, Farah, ME, Maia, M
Asia-Pacific journal of ophthalmology (Philadelphia, Pa.). 2020;(1):26-38
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Abstract
Chromovitrectomy, the intraocular application of dyes to assist visualization of preretinal tissues during vitreoretinal surgery, was introduced to avoid ocular complications related to internal limiting membrane peeling, inadequate removal of the vitreous, and incomplete removal of epiretinal membranes. Since 2000, chromovitrectomy has become a popular approach among vitreoretinal specialists. The first vital dye used in chromovitrectomy, indocyanine green, facilitated identification of the fine and transparent internal limiting membrane. Following indocyanine green, trypan blue was introduced to identify epiretinal membranes, and triamcinolone acetonide stained the vitreous well. Recently, additional natural dyes such as lutein and anthocyanin from the açaí fruit have been proposed for intraocular application during vitrectomy. The main goal of this review was to study the role of vital stains in chromovitrectomy and report the latest findings in the literature.
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5.
Endoresection utilizing pars plana vitrectomy for benign and malignant intraocular tumors.
Reichstein, D, Karan, K
Current opinion in ophthalmology. 2019;(3):151-158
Abstract
PURPOSE OF REVIEW Endoresection of intraocular tumors is a complicated procedure utilizing pars plana vitrectomy techniques. Though it has potential downsides and complications, there is potential for this technique in the treatment of malignant and benign intraocular tumors. RECENT FINDINGS Endoresection has been utilized in some form for the last three decades, but recent advances in vitreoretinal surgery have improved the technique. Endoresection is used most commonly to treat posterior uveal melanoma, but success in treating benign tumors, such as astrocytoma or retinal capillary hemangioblastoma has emboldened surgeons to expand its indications. It appears that removal of a malignant tumor, such as uveal melanoma may spare the eye some damaging effects of radiation retinopathy and radiation optic neuropathy. These benefits may occur even when the tumor is treated concurrently with plaque brachytherapy, proton beam irradiation, or stereotactic radiotherapy. The benefits of the technique are tempered, however, by the inherent difficulties associated with performing the surgery. These include potentially severe intraoperative bleeding, recurrent rhegmatogenous retinal detachment with proliferative vitreoretinopathy, air embolism, and recurrence of the tumor at the edge of the resection. Nonetheless, endoresection has recently been used for retinoblastoma in refractory cases in order to spare the globe. SUMMARY Endoresection is an advanced vitreoretinal surgical technique that has potential advantages in the treatment of malignant and benign intraocular tumors.
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Surgical Therapy for Macular Edema: What We Have Learned through the Decades.
Bae, JH, Al-Khersan, H, Yannuzzi, NA, Hasanreisoglu, M, Androudi, S, Albini, TA, Nguyen, QD
Ocular immunology and inflammation. 2019;(8):1242-1250
Abstract
Macular edema is a leading cause of functional visual loss in retinal vascular or ocular inflammatory diseases. Because persistent macular edema can lead to irreversible retinal damage, multi-approached treatment should be considered to achieve complete resolution of macular edema. With an enhanced understanding of its pathophysiology, numerous therapeutic options have been developed for the management of macular edema over the decades. Although medical therapies account for the mainstay of treatment, surgical approaches with vitrectomy can play an important role in the management of macular edema, depending on its mechanism of fluid accumulation. The index review focuses on the efficacy of surgical therapy for macular edema secondary to various ocular diseases including diabetic retinopathy, uveitis, and retinal vein occlusion, and consequently provides the evidences that may expand the knowledge and support the employment of surgical options.
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Preoperative intravitreal bevacizumab for proliferative diabetic retinopathy patients undergoing vitrectomy - First update.
Pérez-Argandoña, E, Verdaguer, J, Zacharías, S, González, R
Medwave. 2019;(1):e7512
Abstract
UPDATE This Living FRISBEE (Living FRIendly Summary of the Body of Evidence using Epistemonikos) is an update of the summary published in December 2014. INTRODUCTION Proliferative diabetic retinopathy can cause severe vision loss and even blindness if left untreated. Vitrectomy is often required in the treatment of more severe cases. Preoperative administration of bevacizumab, a humanized anti-vascular endothelial growth factor would improve intraoperative variables that facilitate surgery and improve postoperative course. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified five systematic reviews including 16 studies overall, of which 14 were randomized trials. We concluded the preoperative use of intravitreal bevacizumab reduces the rate of vitreous hemorrhage in the early postoperative period, and probably also in the late postoperative period, but its effect on visual acuity is not clear. Furthermore, it probably decreases the surgical time and may decrease the incidence of iatrogenic retinal breaks. Although we are uncertain whether preoperative bevacizumab decreases intraoperative bleeding, it may reduce the need for endodiathermy.
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Surgical management of diabetic tractional retinal detachments.
Iyer, SSR, Regan, KA, Burnham, JM, Chen, CJ
Survey of ophthalmology. 2019;(6):780-809
Abstract
Tractional retinal detachment is an end-stage form of diabetic retinopathy that occurs when contractile forces in the vitreous and neovascular tissue lead to the detachment of the neurosensory retina. We review the literature related to the management of this disease. Preoperative planning includes appropriate patient selection, diagnostic and prognostic imaging, and medical optimization with reduction of systemic risk factors. Use of antivascular endothelial growth factor for preoperative treatment has had significant benefits for tractional retinal detachment repair in improving surgical efficiency and outcomes. Advances in microsurgical instrumentation are discussed, with attention to small-gauge vitrectomy with improved flow dynamics, viewing strategies, and lighting allowing bimanual surgery. Special emphasis is placed on bimanual surgical technique, choice of tamponade, and the avoidance of iatrogenic damage. Complications and special considerations are further explored. Based on our compilation of relevant literature, we propose a surgical algorithm for the management of these complex patients.
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Postoperative Complications of Pars Plana Vitrectomy for Diabetic Retinal Disease.
Yau, GL, Silva, PS, Arrigg, PG, Sun, JK
Seminars in ophthalmology. 2018;(1):126-133
Abstract
Despite recent advances in the medical management of diabetic retinal disease, there remain established indications for vitreoretinal surgery in the treatment of severe proliferative diabetic retinopathy. These include non-clearing vitreous hemorrhage and tractional retinal detachment. Advances in surgical instrumentation, technique, and experience have led to improved visual outcomes, as well as a corresponding decrease in the incidence of postoperative complications. However, the presence of systemic and ocular factors in diabetic patients increases the risk of adverse events compared to non-diabetic individuals. This review will focus on the most important postoperative complications following pars plana vitrectomy, with specific considerations for the diabetic patient.
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10.
OCULAR HYPERTENSION AND GLAUCOMA FOLLOWING VITRECTOMY: A Systematic Review.
Miele, A, Govetto, A, Fumagalli, C, Donati, S, Biagini, I, Azzolini, C, Rizzo, S, Virgili, G
Retina (Philadelphia, Pa.). 2018;(5):883-890
Abstract
PURPOSE Pars plana vitrectomy has been reported to increase the risk of ocular hypertension and open-angle glaucoma. The authors conducted a systematic review of randomized and nonrandomized studies to compare the incidence of open-angle glaucoma and ocular hypertension in vitrectomized versus nonvitrectomized eyes. METHODS A literature search was performed using MEDLINE and EMBASE until August 2016. Data on ocular hypertension and open-angle glaucoma incidence and mean intraocular pressure after at least 1 year were pooled using random-effects metaanalysis models. Because only nonrandomized studies were retrieved, ROBINS-I tool was used to assess risk of bias in the review. RESULTS Seven included studies had a paired design to compare the outcomes of vitrectomized versus fellow eyes, with mean follow-up of least 12 months. Four studies (851 patients) provided data on open-angle glaucoma: incidence in vitrectomized versus non-vitrectomized eyes was 7.8% and 4.8%, respectively, yielding a metaanalytic odds ratio of 1.67 (95% CI: 1.08-2.57). Six studies (1,060 patients) reported on the occurrence of ocular hypertension, which was 5.8% in vitrectomized eyes versus 3.1% in fellow eyes (odds ratio: 2.03, 95% CI: 0.97-4.22), without significant differences in the mean postoperative intraocular pressure (mean difference 0.31 mmHg, 95% CI: -0.26 to 0.89). CONCLUSION Although the review found increased risk of open-angle glaucoma with pars plana vitrectomy, the studies were heterogenous or inconsistent regarding ocular hypertension and intraocular pressure increase. Larger studies should be conducted in homogenous cohorts of patients undergoing macular surgery, excluding complex conditions such as retinal detachment or diabetic retinopathy.