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Comparison of macular buckling and vitrectomy for the treatment of macular schisis and associated macular detachment in high myopia: a randomized clinical trial.
Liu, B, Chen, S, Li, Y, Lian, P, Zhao, X, Yu, X, Li, T, Jin, C, Liang, X, Huang, SS, et al
Acta ophthalmologica. 2020;(3):e266-e272
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Abstract
OBJECTIVE To compare the efficacy and safety of macular buckling and vitrectomy for myopic traction maculopathy showing macular schisis (MS) and associated macular detachment (MD) but without full-thickness macular hole (FTMH). DESIGN Prospective, randomized, parallel, open-label study. METHODS Patients were randomly assigned to either buckling or vitrectomy group. Macular buckling and intravitreal C3F8 gas injection were performed in the buckling group. Small gauge vitrectomy, internal limiting membrane peeling (ILMP) and C3F8 gas tamponade were performed in the vitrectomy group. The patients were followed for 12 months. MAIN OUTCOME MEASURES Best-corrected visual acuity (BCVA) at 12 months. RESULTS A total of 85 patients were randomized, 80 eyes were included (41 receiving buckling, 39 received vitrectomy), and 78 patients completed the study. There were less eyes determined as surgical failure and required a second surgery in the buckling group than vitrectomy the group (2.4% versus 18.4%, p = 0.021). After surgery, macular buckling achieved more improvement in BCVA (+21.7 versus +4.5 Early Treatment Diabetic Retinopathy Study (ETDRS) letters, p = 0.002). FTMH development was observed in only 1 (2.4%) eye, after removing of the implant due to recurrent conjunctival erosion, in the buckling group and 10 (26.3%) eyes (seven with-, three without MD) in the vitrectomy group (p < 0.001). More eyes developed cataracts in the vitrectomy group than did in the buckling group (28.9% versus 7.5%, p = 0.014). Macular buckling-associated strabismus (esotropia), binocular diplopia and implant exposure were observed in limited cases. CONCLUSIONS AND RELEVANCE Macular buckling is superior to vitrectomy with ILM peeling plus gas injection for surgical treatment of MS and associated MD in high myopia.
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The effect of adjunctive intravitreal conbercept at the end of diabetic vitrectomy for the prevention of post-vitrectomy hemorrhage in patients with severe proliferative diabetic retinopathy: a prospective, randomized pilot study.
Jiang, T, Gu, J, Zhang, P, Chen, W, Chang, Q
BMC ophthalmology. 2020;(1):43
Abstract
BACKGROUND To investigate the effect of intravitreal conbercept (IVC) injections on the incidence of postoperative vitreous hemorrhage (VH) in eyes undergoing surgery for severe proliferative diabetic retinopathy. METHODS This was a pilot prospective, comparative, and randomized study. Thirty patients, who underwent vitrectomy for severe proliferative diabetic retinopathy, were assigned randomly to either group 1 (intravitreal conbercept [IVC] injection at the end of pars plana vitrectomy) or group 2 (no IVC injection). Postoperative follow-up was performed on the first day, first week, first month, third month, sixth month and first year after surgery. The primary outcome was the incidence of postoperative VH. Secondary outcomes were the initial time of vitreous clearing (ITVC), best-corrected visual acuity (BCVA) and central retinal thickness (CRT) after surgery. RESULTS A total of 30 eyes, from 30 patients, were included. Fifteen eyes were enrolled in the IVC group and fifteen in the control group. The incidence of early and late postoperative VH was not significantly different between the control and IVC groups. ITVC was shorter in the IVC group than that in the control group, but this was not significant (7.38 ± 10.66 vs 13.23 ± 17.35, P = 0.31). Final BCVA, 1 year after surgery, showed significant improvement compared to baseline in both groups. However, analysis of the BCVA at any postoperative visit after surgery showed no significant differences between the two groups. There were two cases of recurrent VH identified at 3 and 6 months after surgery in each group, requiring a second round of surgery. Foveal thickness was significantly different between the two groups at the 3-month, 6-month and 1-year follow-up visits. CONCLUSIONS In this pilot study, the effect of IVC injection in reducing the incidence of postoperative VH after diabetic vitrectomy at the end of vitrectomy was not shown. TRIAL REGISTRATION The study was registered with the Chinese Clinical Trial Registry. (Reference Number: ChiCTR1800015751).
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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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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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Perioperative anti-vascular endothelial growth factor agents treatment in patients undergoing vitrectomy for complicated proliferative diabetic retinopathy: a network meta-analysis.
Wang, DY, Zhao, XY, Zhang, WF, Meng, LH, Chen, YX
Scientific reports. 2020;(1):18880
Abstract
Currently, controversies regarding the optimal time-point of anti-vascular endothelial growth factor (VEGF) pretreatment before pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR) still exist. To clarify this, we conducted a network meta-analysis, 26 randomized controlled trials including 1806 PDR patients were included. Compared with the sham group, performing anti-VEGF injection at preoperative (Pre-Op) 6 to 14 days could significantly improve post-operative best-corrected visual acuity (BCVA) and decrease the incidence of recurrent vitreous hemorrhage (VH). Meanwhile, it could significantly reduce the duration of surgery. Performing anti-VEGF injection at Pre-Op more than 14 days, 6 to 14 days or 1 to 5 days could significantly reduce the incidence of intra-operative bleeding, while no significant benefit existed at the end of PPV (P > 0.05). No significant difference existed between all those strategies and sham group in reducing the rate of silicone oil tamponade. Based on currently available evidence, performing the anti-VEGF pretreatment at pre-operative 6 to 14 days showed best efficacy in improving post-operative BCVA, reducing the duration of surgery and incidence of recurrent VH, it also achieves satisfactory effect in reducing the incidence of intra-operative bleeding.
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Effect of Face-Down Positioning vs Support-the-Break Positioning After Macula-Involving Retinal Detachment Repair: The PostRD Randomized Clinical Trial.
Casswell, EJ, Yorston, D, Lee, E, Heeren, TFC, Harris, N, Zvobgo, TM, Tarafdar, S, Xing, W, Bourmpaki, E, Bunce, C, et al
JAMA ophthalmology. 2020;(6):634-642
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IMPORTANCE A lack of consensus exists with regard to the optimal positioning regimen for patients after macula-involving retinal detachment (RD) repair. OBJECTIVE To evaluate the effect of face-down positioning vs support-the-break positioning on retinal displacement and distortion after macula-involving RD repair. DESIGN, SETTING, AND PARTICIPANTS A prospective 6-month single-masked randomized clinical trial was conducted at a multicenter tertiary referral setting from May 16, 2016, to May 1, 2018. Inclusion criteria were fovea-involving rhegmatogenous RD; central visual loss within 14 days; patients undergoing primary vitrectomy and gas surgery, under local anesthetic; patients able to give written informed consent; and 18 years old and older. Analysis was conducted following a modified intention-to-treat principle, with patients experiencing a redetachment or failure to attach the macula being excluded from analysis. INTERVENTIONS Participants were randomized 1:1 to receive face-down positioning or support-the-break positioning for a 24-hour period postoperatively. Positioning compliance was not monitored. MAIN OUTCOMES AND MEASURES The proportion of patients with retinal displacement on autofluorescence imaging at 6 months postoperatively. Secondary outcomes included proportion of patients with displacement at 2 months; amplitude of displacement at 2 and 6 months; corrected Early Treatment Diabetic Retinopathy Study visual acuity; objective Distortion Scores; and quality of life questionnaire scores at 6 months. RESULTS Of the 262 randomized patients, 239 were analyzed (171 male [71.5%]; mean [SD] age, 60.8 [9.8] years). At 6 months, retinal displacement was detected in 42 of 100 (42%) in the face-down positioning group vs 58 of 103 (56%) in the support-the-break positioning group (odds ratio, 1.77; 95%CI, 1.01-3.11; P = .04). The degree of displacement was lower in the face-down group. Groups were similar in corrected visual acuity (face-down, 74 letters vs support-the-break, 75 letters), objective D Chart Distortion Scores (range: 0, no distortion to 41.6, severe distortion; with face-down at 4.5 vs support-the-break at 4.2), and quality of life scores (face-down 89.3 vs support-the-break 89.0) at 2 and 6 months. Retinal redetachment rate was similar in both groups (face-down group, 12.2% and support-the-break group, 13.7%). Retinal folds were less common in the face-down positioning group vs the support-the-break positioning group (5.3% vs 13.5%, respectively; odds ratio, 2.8; 95% CI, 1.2-7.4; P = .03). Binocular diplopia was more common in the support-the-break group compared with the face-down positioning group (7.6% vs 1.5%, respectively; odds ratio, 5.3; 95% CI, 1.3-24.6; P = .03). Amplitude of displacement was associated with worse visual acuity (r = -0.5; P < .001) and distortion (r = 0.28; P = .008). CONCLUSIONS AND RELEVANCE In this study, findings suggest that face-down positioning was associated with a reduction in the rate and amplitude of postoperative retinal displacement after macula-involving RD repair and with a reduction in binocular diplopia. No association was found with visual acuity or postoperative distortion. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02748538.
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Intravitreal conbercept improves outcome in patients undergoing vitrectomy for proliferative diabetic retinopathy: A systematic review and meta-analysis.
Pranata, R, Vania, A
Journal of evidence-based medicine. 2020;(2):116-124
Abstract
OBJECTIVES To evaluate the latest evidence concerning the efficacy of conbercept on vitrectomy for proliferative diabetic retinopathy (PDR) and its efficacy compared to control and other antivascular endothelial growth factor. METHODS We performed a systematic literature search on topics that assess the role of conbercept in patients undergoing vitrectomy for PDR from inception to November 2019, using PubMed, EuropePMC, Cochrane Central Database, ProQuest, ScienceDirect, and Clinicaltrials.gov. Two researchers independently searched literature, extracted data, and evaluated the risk of bias. RevMan 5.3 and StataMP 16 software were used to perform data analysis. RESULTS There were 699 cases (eyes) from eight studies. Baseline best-corrected visual acuity (BCVA) was better in the control group compared to conbercept group (mean difference [MD] = 0.13, I2 = 0%). A greater BCVA improvement was observed in the conbercept group after 1-month (MD = -0.27, I2 = 1%), 3-month (MD = -0.28, I2 = 0%), and 6-month (MD = -0.20, I2 = 78%) follow-up. The need for endodiathermy (odds ratio [OR] = 0.20, I2 = 0%) and silicone oil tamponade use (OR = 0.59, I2 = 72%) and intraoperative bleeding (OR = 0.11, I2 = 33%) was lower in conbercept group. Postoperative early (OR = 0.22, I2 = 0%) and late (OR = 0.47, I2 = 0%) vitreous hemorrhage was lower in conbercept group. There was no significant difference in BCVA improvement and intraoperative outcome between conbercept and ranibizumab. CONCLUSIONS Intravitreal conbercept was associated with a more significant BCVA improvement, better intraoperative outcome, and less postoperative vitreous hemorrhage compared to no conbercept.
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Intravitreal Conbercept Injection as an Adjuvant in Vitrectomy with Silicone Oil Infusion for Severe Proliferative Diabetic Retinopathy.
Gao, S, Lin, Z, Chen, Y, Xu, J, Zhang, Q, Chen, J, Shen, X
Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics. 2020;(5):304-310
Abstract
Purpose: To assess the clinical effects of preoperative, intraoperative, or preoperative combined with intraoperative intravitreal conbercept (IVC) injection in vitrectomy with silicone oil tamponade for severe proliferative diabetic retinopathy (PDR). Methods: Ninety-eight eyes of 98 severe PDR patients undergoing vitrectomy with silicone oil tamponade were randomly assigned to 3 groups: Group 1 (34 eyes) received IVC injections 3 to 5 days before surgery; Group 2 (35 eyes) received IVC injections at the end of surgery; and Group 3 (29 eyes) received IVC injections 3 to 5 days before and at the end of operation. Follow-up examinations were performed for 6 months. Results: The incidence and severity of intraoperative bleeding were not significantly different (P = 0.233). However, the duration of surgery was significantly shorter in Group 1 and Group 3 compared with Group 2 (P < 0.001). The incidences of early and late recurrent vitreous hemorrhage (VH) were 32.35%, 28.57%, and 13.80%, respectively. At 6-month follow-up, mean best-corrected visual acuity had significantly increased to 1.25 ± 0.45 logMAR in Group 1, 1.29 ± 0.46 logMAR in Group 2, 1.16 ± 0.44 logMAR in Group 3 (all P < 0.001). The incidence of postoperative VH, neovascular glaucoma, and retinal detachment in Group 3 was slightly lower, however, no significant differences were observed (all P > 0.05). In young patients, similar results were observed and Group 3 had better visual improvements (P = 0.037). Conclusions: Preoperative IVC injection could be a safe and effective adjunct in pars plana vitrectomy with silicone oil tamponade for severe PDR. Preoperative combined with intraoperative IVC are promising, especially in young patients.
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Visual Outcomes of Pars Plana Vitrectomy Alone or with Intravitreal Bevacizumab in Patients of Diabetic Vitreous Haemorrhage.
Haseeb, U, Aziz-Ur-Rehman, , Haseeb, M
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP. 2019;(8):728-731
Abstract
OBJECTIVE To evaluate the visual outcomes of pars plana vitrectomy (PPV) alone or with intravitreal bevacizumab in patients of diabetic vitreous haemorrhage. STUDY DESIGN A quasi-experimental study. PLACE AND DURATION OF STUDY Al-Ibrahim Eye Hospital, Malir, Karachi, from March to November 2018. METHODOLOGY Patients between 40-70 years of age, irrespective of gender with non-resolving dense diabetic vitreous haemorrhage were divided into two groups. Group A received injection bevacizumab 7 days before PPV surgery. Group B received no preoperative injection. Log Mar chart was used for documenting postoperative vision. All patients completed their 6 months follow-up. SPSS was used to analyse the data. RESULTS Best corrected visual acuity (BCVA) was documented as improved, same, or worse. In Group A, 21 (70%) patients had improved VA; whereas, in Group B, 17 (56.6%) patients showed improved visual acuity postoperatively. Patients were examined at four weeks, three months, and six months, respectively for recurrent vitreous haemorrhage. In Group A, 25 (83.3%) patients had no vitreous haemorrhage up to six months, whereas, in Group B, 13 (43.3%) patients had no vitreous haemorrhage up to six months with p-value of 0.021. CONCLUSION Anti VEGF injection bevacizumab before PPV in patients with non-resolving diabetic vitreous haemorrhage is good to get better results in terms of BCVA, as well as reduce the incidence of recurrent vitreous haemorrhage.
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Glue-assisted retinopexy for rhegmatogenous retinal detachments (GuARD): A novel surgical technique for closing retinal breaks.
Tyagi, M, Basu, S
Indian journal of ophthalmology. 2019;(5):677-680
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PURPOSE This study describes a novel surgical technique of fibrin glue-assisted retinopexy for rhegmatogenous retinal detachment (GuARD) without oil or gas tamponade after pars plana vitrectomy (PPV). METHODS This pilot clinical trial included five eyes of five patients with rhegmatogenous retinal detachments (RD). A complete PPV was done in all cases followed by fluid-air exchange, laser photocoagulation around the break/s, and application of 0.1-0.2 mL of fibrin glue. No air, long-acting gas or silicone oil was used subsequently. No specific postoperative positioning was prescribed. The primary outcome measure was efficacy of the procedure defined as successful anatomical retinal reattachment. Secondary outcome measures were postoperative improvement in best corrected visual acuity (BCVA) and complications. RESULTS The median age of patients was 55 (range: 36-61 years) years and median duration of symptoms was 15 (range: 7-60) days. All eyes were pseudophakic, four eyes had inferior and one eye had total RD. Successful retinal reattachment was achieved in all (100%) cases and was maintained at the end of 3-8 months of follow-up. The median BCVA improved from 20/100 preoperatively to 20/80 at 1-week and 20/50 at 1-month postoperatively. None of the eyes had any postoperative complications such as elevated intraocular pressures or unexpected inflammation. CONCLUSION The findings of this study suggest that GuARD is a promising technique for treatment of rhegmatogenous RD that may allow early visual recovery while avoiding the problems of gas or oil tamponade and obviating the need of postoperative positioning.
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Treatment of macular hemorrhage in retinal arterial microaneurysm: anatomic site-oriented therapy.
Kitagawa, Y, Kawamorita, A, Shimada, H, Nakashizuka, H
Japanese journal of ophthalmology. 2019;(2):186-196
Abstract
PURPOSE To investigate the usefulness of anatomic site-oriented therapy for macular hemorrhage secondary to retinal arterial macroaneurysm (RAM). STUDY DESIGN Retrospective observational study, clinical case series METHODS Twenty-seven consecutive patients (27 eyes) with macular hemorrhage secondary to RAM were classified according to the retinal layer(s) with hemorrhage identified by optical coherence tomography into 4 types and treated differentially. Vitrectomy was conducted for subinternal limiting membrane hemorrhage (SILMH), intravitreal gas injection for subretinal hemorrhage (SRH) or intraretinal hemorrhage (IRH), and vitrectomy and intravitreal air/gas exchange for multilevel hemorrhage (at least 2 among SILMH/SRH/IRH). RESULTS Complete displacement or resolution of the macular hemorrhage was achieved in all 27 eyes: 7 with SILMH, 7 with SRH, 3 with IRH, and 10 with multilevel hemorrhage. Compared with the baseline score, the 3-month postoperative Early Treatment Diabetic Retinopathy Study score (mean ± SD) improved significantly in SILMH (+42.9 ± 6.9 letters; P < .0001, paired t test), multilevel hemorrhage (+23.9 ± 14.4 letters; P = .0005), and SRH (+17.7 ± 18.4 letters; P = .0440), but not in IRH (+6.7 ± 9.0 letters; P = .3228). Compared with the baseline thickness, the 3-month postoperative central retinal thickness decreased significantly in multilevel hemorrhage (-930.3 ± 290.8 µm; P < .0001), SILMH (-628.4 ± 177.0 µm; P < .0001), IRH (-508.3 ± 72.1 µm; P = .0066), and SRH (-476.9 ± 300.0 µm; P = .0056). The central ellipsoid zone was detectable in 7/7 eyes with SILMH but in none of the eyes in the other 3 groups (P < .0001). No retinal detachment or macular hole occurred in any eyes. CONCLUSION For macular hemorrhage secondary to RAM, anatomic site-oriented therapy using different treatments targeting the hemorrhagic retinal layers is useful. The optimal treatments for individual hemorrhagic retinal layers require further studies.