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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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Abstract
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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Triamcinolone during pars plana vitrectomy for open globe trauma: a pilot randomised controlled clinical trial.
Banerjee, PJ, Xing, W, Bunce, C, Woodcock, M, Chandra, A, Scott, RA, Charteris, DG
The British journal of ophthalmology. 2016;(7):949-955
Abstract
PURPOSE To investigate the feasibility of conducting a randomised controlled trial in patients undergoing pars plana vitrectomy surgery following open globe trauma (OGT). Additionally, to investigate the treatment effect and toxicity of intensive anti-inflammatory agents. METHODS A 2-year, pilot, single-centre prospective, participant and surgeon-masked randomised controlled trial (RCT). Forty patients requiring vitrectomy surgery following OGT were randomised to either standard (control) or study treatment (adjuncts) in a 1:1 allocation ratio. Perioperatively, the adjunct group received intravitreal and subtenons triamcinolone acetonide, oral flurbiprofen and guttae prednisolone acetate 1%. The control group received standard care. Primary outcome was anatomical success at 6 months. Secondary outcomes included final visual acuity, occurrence of proliferative vitreoretinopathy, intraocular pressure rise, number of operations and recruitment rate. RESULTS 40 patients were recruited within 21 months. Primary outcome assessment showed similar results in anatomical success with 50% (10/20) in the adjunct group compared with 47% (9/19) in the standard group (OR 1.11, 95% CI 0.316 to 3.904). Visual outcomes were better in the adjunct group with a final median visual acuity of 31 Early Treatment Diabetic Retinopathy Study (ETDRS) letters compared with 25 ETDRS letters in the standard group. A higher proportion of patients gained 10, 20 and 30 ETDRS letters in the adjunct group (80%, 65% and 50%, respectively) compared with the standard group (52.6%, 52.6% and 42.1%). Fewer adjunct patients (15%, n=3) had poor visual outcomes (Zero ETDRS letters) compared with 42.1%, (n=8). CONCLUSIONS An RCT in this population is deliverable and estimated recruitment rates are realistic. Results and patient discussions determined that the definitive study should have vision as a primary outcome. This pilot study is supportive of there being a positive treatment effect of intensive anti-inflammatory agents in OGT. TRIAL REGISTRATION NUMBER European Clinical Trials Database 2007-005138-35; Results.
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Comparison of microinsicion vitrectomy and conventional 20-gauge vitrectomy for severe proliferative diabetic retinopathy.
Yokota, R, Inoue, M, Itoh, Y, Rii, T, Hirota, K, Hirakata, A
Japanese journal of ophthalmology. 2015;(5):288-94
Abstract
PURPOSE To compare the outcomes of 23-gauge (G) and 25G vitrectomy to 20G vitrectomy on eyes with severe proliferative diabetic retinopathy (PDR). METHODS The medical records of 424 eyes of 347 patients with severe PDR were reviewed. There were 80 eyes that had 23G, 174 eyes that had 25G, and 170 eyes that had 20G vitrectomy. The incidences of postoperative vitreous hemorrhage, intraoperative retinal breaks, retinal detachment, and neovascular glaucoma were compared. RESULTS The incidence of intraoperative retinal breaks was significantly lower in the 23G group (21 %) than in the 20G group (35 %, P = 0.03) but not in the 25G group (26 %, P = 0.057). The incidence of postoperative retinal detachment was not significantly different among the three groups (P = 0.73). The incidence of postoperative vitreous hemorrhage that developed ≥1 month after vitrectomy was not different whether the eyes had panretinal photocoagulation or not (P = 0.15). The incidence of postoperative neovascular glaucoma was significantly lower in the 25G group (3 %) than in the 20G group (11 %, P = 0.01) but not significant compared with that in the 23G group (8 %, P = 0.72). CONCLUSION The lower incidence of intraoperative retinal breaks and postoperative neovascular glaucoma after microincision vitrectomy indicates that microincision vitrectomy should be considered for eyes with severe PDR.
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[Pars plana vitrectomy, phacoemulsification and intraocular lens implantation for the management of cataract and proliferative diabetic retinopathy: comparison of a combined versus two-step surgical approach].
Rivas-Aguiño, P, García-Amaris, RA, Berrocal, MH, Sánchez, JG, Rivas, A, Arévalo, JF
Archivos de la Sociedad Espanola de Oftalmologia. 2009;(1):31-8
Abstract
PURPOSE To report the intra-and postoperative complications and visual acuity outcomes in pars plana vitrectomy (PPV), phacoemulsification and intraocular lens (IOL) implantation in patients with cataract and proliferative diabetic retinopathy (PDR). A comparison of the combined versus two-step surgical approach is given. METHOD Retrospective uncontrolled interventional clinical trial. Forty-eight eyes of 48 consecutive patients with PDR were included. Twenty-eight (58.3%) eyes with combined surgery and 20 (41.7%) eyes with sequential surgery were analyzed. RESULTS Postoperative follow-up time was between 6 and 63 months (mean: 18 months). 1) Combined surgery: Preoperative best-corrected visual acuity (BCVA) ranged from 20/200 to hand motions, and postoperative BCVA ranged from 20/30 to hand motions. BCVA improved in 17 eyes (60.7%), while in 7 (25%) eyes there was no change (> or =2 ETDRS lines) in VA, and in 4 (14.3%) eyes BCVA decreased. Postoperative complications included vitreous hemorrhage (VH) in 10 (35.7%) eyes, and fibrinous exudation in 9 (32.1%) eyes. 2) Two-step surgery: Preoperative BCVA ranged from 10/200 to light perception, and from 20/40 to light perception in the postoperative period. Best-corrected visual acuity improved in 15 (75%) eyes, remained the same in 4 (20%) eyes, and decreased in 1 (5%) eye. Postoperative complications included fibrinous exudation in 6 (30%) eyes, and VH in 3 (15%) eyes. CONCLUSION Combined PPV, phacoemulsification and IOL implantation as well as the two-step procedure are safe and effective for the management of cataract in PDR. Sequential surgery could be advantageous to BCVA outcomes by minimizing postoperative VH, which is significantly more frequent after combined surgery.
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[Value of different measurements of the preoperative visual acuity and perception of Purkinje's vessel shadows for prediction of the postoperative visual acuity after vitrectomy in diabetic vitreous hemorrhage].
Schulze, S, Köhler, K, Schüller, C
Klinische Monatsblatter fur Augenheilkunde. 2006;(4):321-5
Abstract
BACKGROUND In cases of strong vitreous hemorrhage due to diabetic vitreo-retinopathy there is an uncertainty for the prediction of postoperative visual acuity after vitrectomy. This study compares the value of different preoperative measurements for the prognosis of postoperative visual acuity. METHOD AND PATIENTS We evaluated retrospectively the reports of all patients who have been operated by vitrectomy due to diabetic vitreous hemorrhage at our hospital in 2004 (first vitreoretinal surgery). The following measurements were evaluated: preoperative distance and reading VA, last known VA before hemorrhage, laser interference VA, Purkinje's vessel shadow and postoperative distance VA. RESULTS 42 patients had entire documentation of all evaluated parameters. The preoperative distance VA was 20/1000 (light perception to 20/60), only 3 patients had a reading VA. Laser interference VA was better than red light perception in 13 patients (7 without red light perception). Purkinje's vessel shadows were positive in 22 patients, negative in 17 patients, but 3 patients did not understand the procedure. Prehemorrhage VA was known in 19 patients. Laser interference VA and last known VA prior to hemorrhage (in mean 20 months old) had the best correlation to postoperative VA (p > 0.05). Purkinje's vessel shadow predicts -- if positive -- a postoperative VA of 20/300 or better. CONCLUSIONS Postoperative VA after vitrectomy due to diabetic vitreous hemorrhage is best predicted by prehemorrhage VA or laser interference VA, especially if no prehemorrhage VA is known. Positive Purkinje's vessel shadow predicts a postoperative VA of 20/300 or better.
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[Radial optic neurotomy: efficacy monitoring using venous ophthalmodynamometry].
Rauber, M, Müller, S, Mester, U
Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft. 2006;(10):861-5
Abstract
BACKGROUND Retinal central venous outflow pressure (VOP) can be measured with a new ophthalmodynamometer (Meditron, Völklingen, Germany). Radial optic neurotomy (RON) is a new surgical approach for central retinal vein occlusion (CRVO) which is still controversially discussed. Particularly the early formation of retinochoroidal collaterals is intended to achieve normalization of the preoperatively increased pressure in the central retinal vein. We investigated the VOP after RON. PATIENTS AND METHODS In total, 21 eyes of 21 patients (9 male, 12 female) suffering from CRVO were treated by RON. Pars plana vitrectomy with nasal radial optic neurotomy and peeling of the internal limiting membrane were performed. The mean follow-up time was 10.8 months (6-24 months). Central venous outflow pressure was measured using ophthalmodynamometry. RESULTS The most frequent concomitant ophthalmic disease was glaucoma (52%), and the predominantly associated systemic disease was hypertension (81%). After RON in 16 eyes (76%) visual acuity improved by at least 2 lines; in 3 eyes (14%) visual acuity was unchanged (+/-1 line) and in 2 patients (10%) visual acuity decreased by 2 or more lines. Eyes with visual improvement and formation of chorioretinal anastomosis postoperatively showed a significantly lower venous outflow pressure assessed with ophthalmodynamometry.
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Effect of tranexamic acid on early postvitrectomy diabetic haemorrhage; a randomised clinical trial.
Ramezani, AR, Ahmadieh, H, Ghaseminejad, AK, Yazdani, S, Golestan, B
The British journal of ophthalmology. 2005;(8):1041-4
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Abstract
AIMS: To evaluate the effect of tranexamic acid on early postvitrectomy haemorrhage in diabetic patients. METHODS In a clinical trial, 62 diabetic patients scheduled for vitrectomy were randomly assigned to two groups. The treatment group (32 eyes) received two doses of tranexamic acid (10 mg/kg) shortly before and after the operation intravenously, continued orally for 4 days (20 mg/kg/8 hours). The control group (30 eyes) received no medication. Both media clarity and visual acuity were compared during 4 weeks. RESULTS Four weeks after surgery visual acuity was low (< or =1 metre counting fingers) in 21.4%, moderate (>1 metre counting fingers but<20/200) in 14.3%, and good (> or =20/200) in 64.3% of the treated group. Corresponding figures in the control group were 26.1%, 26.1%, and 47.8%, respectively. These differences were of no statistical significance. The ratio of mild to severe vitreous haemorrhage during the first 4 days and after 4 weeks was 79% to 21% and 82% to 18% in the treatment group and 76.7% to 23.3% and 78.3% to 21.7% in the control group respectively, which showed no statistically significant difference. CONCLUSION Tranexamic acid, with the method of administration in this study, had no effect on reducing early postvitrectomy haemorrhage in diabetic patients.
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[Autologous serum versus hyaluronic acid eye drops for the treatment of corneal erosions after vitrectomy in diabetic patients. A prospective randomized study].
Schulze, S, Sekundo, W, Kroll, P
Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft. 2005;(9):863-8
Abstract
PURPOSE The purpose of this study was to evaluate whether treatment with autologous serum exhibits better epitheliotropic properties than hyaluronic acid in patients with reduced wound healing (diabetics). PATIENTS AND METHOD This prospective randomized study included all diabetic patients undergoing pars plana vitrectomy with abrasion of the corneal epithelium. In addition to the usual topical therapy one group was treated with hourly application of autologous serum, the other group with hyaluronic acid drops. We evaluated the time needed for closure of the corneal epithelium as well as other parameters such as patient's age, sex, duration of surgery, history of diabetes, and the current HbA1C. RESULTS There were 23 patients enrolled in the study. The epithelium healed a mean of 2 days earlier in the autologous serum group. Based on the statistically significant difference in favor of autologous serum, the study was terminated after treatment of 23 patients. CONCLUSIONS Autologous serum eye drops lead to earlier closure of the corneal epithelium after intraoperative abrasion in diabetic patients when compared with artificial tears.
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Vitrectomy with peeling of the inner limiting membrane for treating diabetic macular edema.
Kolacny, D, Parys-Vanginderdeuren, R, Van Lommel, A, Stalmans, P
Bulletin de la Societe belge d'ophtalmologie. 2005;(296):15-23
Abstract
PURPOSE to evaluate the results of pars plana vitrectomy with peeling of the inner limiting membrane (ILM stained with infracyanine green (IfCG) in 26 patients with diabetic macular edema, and to identify which factors are associated with a better postoperative visual outcome. PATIENTS AND METHODS 26 patients with diabetic macular edema were included in the study. A pars plana vitrectomy with ILM peeling stained with IfCG was performed, in some cases combined with cataract surgery. In 22 patients the ILM was retained, examined with electron microscopy and compared with normal ILM's. Visual acuity and fundus examination were recorded several months after surgery. To determine which factors lead to the best postoperative results, patients were divided into different groups and compared. RESULTS during surgery, a taut posterior hyaloid was found in 26 patients, which was successfully detached in all cases. ILM peeling within the vessel arcade succeeded in all patients. Postoperative examination showed improved visual acuity and decreased macular edema in 19 patients, unaltered visual acuity in 3 patients and decreased visual acuity in 4 patients. Comparison between different groups of patients revealed that young patients with recent vision loss and without previous macular laser treatment, had better postoperative results. Electron microscopical examination showed a more condensed ILM in diabetic patients, consisting of a layer of fine curled fibers. CONCLUSION pars plana vitrectomy with peeling of the ILM stained with IfCG leads to good postoperative results in young diabetic patients with recent vision loss due to macular edema and without previous macular laser treatment.
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Modified grid laser photocoagulation versus pars plana vitrectomy with internal limiting membrane removal in diabetic macular edema.
Yanyali, A, Nohutcu, AF, Horozoglu, F, Celik, E
American journal of ophthalmology. 2005;(5):795-801
Abstract
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.