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COMPARISON OF THE INTERNAL LIMITING MEMBRANE INSERTION TECHNIQUE AND THE INVERTED INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE WITH VITRECTOMY TO TREAT MACULAR HOLE-ASSOCIATED RETINAL DETACHMENT.
Zhu, K, Lei, B, Wong, W, Zhang, J, Guo, Y, Chen, H, Song, F, Chang, Q, Xu, G, Zhang, Y
Retina (Philadelphia, Pa.). 2021;(1):37-44
Abstract
PURPOSE To compare the anatomical and functional outcomes of macular hole (MH)-associated retinal detachment after vitrectomy with the internal limiting membrane (ILM) insertion technique or the inverted ILM flap technique. METHODS In this retrospective observational study, we reviewed the medical records of 49 eyes with MH-associated retinal detachment that underwent vitrectomy with the ILM insertion (26 eyes) or ILM flap (23 eyes) technique. RESULTS The MH closure rate at 12 months was greater in the ILM flap group versus the ILM insertion group (95% vs. 73%, respectively, P = 0.059). The postoperative best-corrected visual acuity (BCVA) at 12 months was significantly better in the ILM flap group (P = 0.014). All eyes (100%) showed an improvement in the BCVA of ≥0.3 logarithm of the minimum angle of resolution (15 Early Treatment Diabetic Retinopathy Study letters) in the ILM flap group versus 20 eyes (77%) in the ILM insertion group (P = 0.026). The preoperative BCVA and the ILM flap technique were significantly correlated with the postoperative BCVA (P = 0.028 and 0.027, respectively) and BCVA improvement (≥0.3 logarithm of the minimum angle of resolution [15 Early Treatment Diabetic Retinopathy Study letters]; P = 0.003 and 0.026, respectively). CONCLUSION The inverted ILM flap technique was more effective in improving the postoperative BCVA in patients with MH-associated retinal detachment when compared with the ILM insertion technique. The preoperative BCVA and the ILM flap technique were independent prognostic factors for visual outcomes in patients with MH-associated retinal detachment.
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The Pneumatic Retinopexy versus Vitrectomy for the Management of Primary Rhegmatogenous Retinal Detachment Outcomes Randomized Trial (PIVOT).
Hillier, RJ, Felfeli, T, Berger, AR, Wong, DT, Altomare, F, Dai, D, Giavedoni, LR, Kertes, PJ, Kohly, RP, Muni, RH
Ophthalmology. 2019;(4):531-539
Abstract
PURPOSE The optimal surgery to repair rhegmatogenous retinal detachment (RRD) is unknown. The purpose of this trial was to compare outcomes of pneumatic retinopexy (PnR) versus pars plana vitrectomy (PPV) for the management of primary RRD. DESIGN Prospective, randomized controlled trial. PARTICIPANTS Patients with RRD demonstrating a single retinal break or a group of breaks in detached retina within 1 clock hour above the 8- and 4-o'clock meridians, with any number, location and size of retinal breaks or lattice degeneration in attached retina. METHODS Patients were randomized to undergo either PnR or PPV. Macula-on and macula-off patients were assigned to intervention group by stratified randomization and were treated within 24 and 72 hours, respectively. MAIN OUTCOME MEASURES The primary outcome was 1-year Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity (VA). Important secondary outcomes were subjective visual function (25-item National Eye Institute Visual Function Questionnaire), metamorphopsia score (M-CHARTS), and primary anatomic success. RESULTS One hundred seventy-six patients were recruited between August 2012 and May 2016. ETDRS VA after PnR exceeded that after PPV by 4.9 letters at 12 months (79.9±10.4 letters vs. 75.0±15.2 letters; P = 0.024). Mean ETDRS VA also was superior for the PnR group compared with the PPV group at 3 months (78.4±12.3 letters vs. 68.5±17.8 letters) and 6 months (79.2±11.1 letters vs. 68.6±17.2 letters). Composite 25-item National Eye Institute Visual Function Questionnaire scores were superior for PnR at 3 and 6 months. Vertical metamorphopsia scores were superior for the PnR group compared with the PPV group at 12 months (0.14±0.29 vs. 0.28±0.42; P = 0.026). Primary anatomic success at 12 months was achieved by 80.8% of patients undergoing PnR versus 93.2% undergoing PPV (P = 0.045), with 98.7% and 98.6%, respectively, achieving secondary anatomic success. Sixty-five percent of phakic patients in the PPV arm underwent cataract surgery in the study eye before 12 months versus 16% in the PnR group (P < 0.001). CONCLUSIONS Pneumatic retinopexy should be considered the first line treatment for RRD in patients fulfilling Pneumatic Retinopexy versus Vitrectomy for the Management of Primary Rhegmatogenous Retinal Detachment Outcomes Randomized Trial (PIVOT) recruitment criteria. Pneumatic retinopexy offers superior VA, less vertical metamorphopsia, and reduced morbidity when compared with PPV.
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Intravitreal ranibizumab injection at the end of vitrectomy for diabetic vitreous hemorrhage (Observational Study).
Liang, X, Zhang, Y, Wang, JX, Wang, LF, Huang, WR, Tang, X
Medicine. 2019;(20):e15735
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Abstract
To evaluate the outcomes and complications of intravitreal injections of ranibizumab in patients during pars plana vitrectomy for treatment of diabetic vitreous hemorrhage. This retrospective, observational, comparative study included 103 patients (103 eyes) who underwent pars plana vitrectomy for treatment of diabetic vitreous hemorrhage. Sixty-six patients received an intravitreal injection of 0.05 mg (0.05 cc) of ranibizumab at the end of surgery. Main outcome measures were the occurrence of recurrent early vitreous hemorrhage, reoperation, intraocular pressure, best corrected visual acuity. Mean follow-up time was 6 months. The rate of rebleeding in the intravitreal ranibizumab (IVR) group was 6.1% (4 eyes), which is significantly lower than the control group (24.3%, 9 eyes, P < .01). The incidence of postoperative diabetic vitreous hemorrhage (PDVH) was significantly lower in the IVR group than the control group, OR=0.26, 95% CI= (0.06, 0.95). Visual acuity 6 months after operation was better in IVR group (P<.01) There was no difference in mean intraocular pressure between the 2 groups (P=.56). The present clinical study suggests that intravitreal injection of ranibizumab is effective in the prevention of postoperative diabetic vitreous hemorrhage in eyes undergoing pars plana vitrectomy for the treatment of diabetic vitreous hemorrhage.
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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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Severe proliferative diabetic retinopathy treated with vitrectomy or panretinal photocoagulation: a monocenter randomized controlled clinical trial.
Avitabile, T, Bonfiglio, V, Castiglione, F, Castaing, M, Contarino, F, Mistretta, A
Canadian journal of ophthalmology. Journal canadien d'ophtalmologie. 2011;(4):345-51
Abstract
OBJECTIVE Visual and anatomic results of pars plana vitrectomy were compared with panretinal photocoagulation in cases of severe proliferative diabetic retinopathy. DESIGN Monocenter randomized controlled clinical trial; randomization and allocation to trial group were carried out by a central computer system. PARTICIPANTS We studied 180 eyes of 180 patients with severe proliferative diabetic retinopathy, half with tractional retinal detachment not involving the macula (n = 90). Some were treated by pars plana vitrectomy (n = 90) and some by panretinal photocoagulation (n = 90). METHODS Eyes were randomly divided into 2 groups. Group 1 was treated with pars plana vitrectomy, membrane and internal limited membrane peeling, panretinal photocoagulation, and focal or grid macular laser. Group 2 was treated with panretinal photocoagulation and focal or grid macular laser. Follow-up was at least 12 months. RESULTS Mean preoperative visual acuities and ophthalmic fundus characteristics were compared across groups. A year postoperation, visual acuity (the primary endpoint) in group 1 improved in 30 eyes (33%); was unchanged in 22 eyes (25%); and decreased in 38 eyes (42%). In group 2, visual acuity improved in 32 eyes (35%); was unchanged in 42 eyes (47%); and decreased in 16 eyes (18%). The percentage of improvement in the 2 groups was not statistically significant (p = 0.75), whereas the stabilized (p = 0.002) and worsened eyes (p = 0.0003) in group 1 and group 2 were significantly different. CONCLUSION In cases of severe proliferative diabetic retinopathy, even with tractional retinal detachment not involving macula, it is best to defer vitrectomy unless definite progression that threatens the vascular center is documented.
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Entry site treatment to prevent late recurrent postoperative vitreous cavity haemorrhage after vitrectomy for proliferative diabetic retinopathy.
Steel, DH, Connor, A, Habib, MS, Owen, R
The British journal of ophthalmology. 2010;(9):1219-25
Abstract
AIMS: To assess the effectiveness of treatment to the inner sclerostomy sites at the time of vitrectomy for proliferative diabetic retinopathy (PDR) in reducing the incidence of late recurrent postoperative vitreous cavity haemorrhage (POVCH). METHOD Retrospective study of a consecutive series of 82 eyes undergoing vitrectomy for PDR by a single surgeon treated with either cryotherapy or argon laser directly to the inner sclerostomy site at the completion of surgery (treatment group). These were compared with a previous consecutive series of 82 eyes operated on by the same surgeon who did not have inner sclerostomy site treatment (control group). The occurrence of any POVCH was recorded within the first 6 months of surgery. RESULTS The composition of the two groups was similar in terms of age, indication for surgery and a variety of other preoperative factors. There were 64 patients in the control group and 65 in the treatment group. There was a significant reduction in the incidence of late recurrent POVCH in the treatment group. Late recurrent POVCH occurred in 12 (15%) eyes in the control group compared with five (6%) in the treatment group (p=0.03). The number of eyes requiring revision surgery within the first 6 months for late recurrent POVCH was four (5%) in the control group and two (2.5%) in the treatment group (p=0.31). CONCLUSION This study suggests that inner sclerostomy site treatment is effective in reducing the occurrence of recurrent late POVCH in patients undergoing vitrectomy for PDR. A randomised controlled study is needed to clarify this.
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[Comparison of pars plana vitrectomy with ILM peeling and intravitreal triamcinolone in diffuse diabetic macular oedema].
Khurieva-Sattler, E, Krause, M, Löw, U, Gatzioufas, Z, Toropygin, S, Seitz, B, Ruprecht, K, Hille, K
Klinische Monatsblatter fur Augenheilkunde. 2010;(6):496-500
Abstract
BACKGROUND Visual outcome and anatomic results in patients with diffuse diabetic macular oedema (DDME) were evaluated after vitrectomy with internal limiting membrane (ILM) peeling versus intravitreal triamcinolone acetonide (TA). MATERIALS AND METHODS A prospective, non-randomised pilot study included 41 eyes (35 patients) with clinically significant DDME. In 24 eyes (group A) we performed pars plana vitrectomy with ILM peeling. Seventeen eyes (group B) received an injection of 10 mg TA. Best corrected visual acuity and central macular thickness (measured with OCT) were determined preoperatively as well as 1 and 4 months postoperatively. RESULTS In group A, OCT showed a macular thickness of 403 +/- 142 microm preoperatively. Best corrected visual acuity was 0.24 +/- 0.18. One month after surgery, macular thickness decreased to 311 +/- 62 microm (p = 0.06 ns) and visual acuity was 0.17 +/- 0.14 (ns). Four months after surgery, macular thickness remained significantly lower compared with preoperative values, at 307 +/- 161 microm (p = 0.012). There was a tendency towards a higher visual acuity of 0.30 +/- 0.26 (p = 0.32 ns). Before TA injection, macular thickness in group B was 551 +/- 180 microm and visual acuity was 0.19 +/- 0.14. One month after TA, macular thickness decreased to 242 +/- 82 (p = 0.001) microm while visual acuity increased to 0.31 +/- 0.21 (p = 0.005). At 4 months follow-up, group B showed recurrence of macular oedema. Compared with the preoperative findings macular thickness was significantly lower (368 +/- 159 microm; p = 0,001). Best corrected visual acuity after 4 months was 0.27 +/- 0.17 and did not differ significantly from the preoperative visual acuity (p = 0.033 ns). CONCLUSIONS Intravitreal TA as a single treatment reduces the extent of DDME within a short time after surgery. These promising results may not be stable during long-term follow-up, necessitating in many cases a re-injection of TA. Macular oedema reduction after vitrectomy with ILM peeling, however, remains stable for more than 4 months and, therefore, offers more permanent results. However, none of these treatments facilitated a significant visual acuity restoration 4 months postoperatively.
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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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Comparative evaluation of vitrectomy and dye-enhanced ILM peel with grid laser in diffuse diabetic macular edema.
Kumar, A, Sinha, S, Azad, R, Sharma, YR, Vohra, R
Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie. 2007;(3):360-8
Abstract
BACKGROUND The purpose of this study is to compare the effectiveness of pars plana vitrectomy (PPV) and dye-enhanced peeling of the internal limiting membrane (ILM) with modified grid laser photocoagulation in patients with diffuse diabetic macular edema and to determine if any correlation exists between improvement in visual acuity (functional improvement) and reduction in foveal thickness and macular volume (anatomical improvement). DESIGN This is a randomized, prospective, comparative, interventional study. METHOD In this study 24 eyes of 24 patients with metabolically stable diabetes and with diffuse diabetic macular edema were evaluated. The patients were randomized to either pars plana vitrectomy with removal of ILM which was done in 12 eyes (ILM group) and modified grid laser photocoagulation carried out in the remaining 12 eyes (laser group). Main outcome measures were (1) the postoperative visual acuity in the form of ETDRS log MAR values, (2) foveal thickness and (3) macular volume as measured by optical coherence tomography. The correlation between improvement in visual acuity and the reduction of foveal thickness and macular volume in both the groups were also evaluated. The results were all subjected to statistical analysis. RESULTS The ETDRS log MAR visual acuity difference between the two groups at the end of 6 months was not clinically significant (P = 0.525). However, foveal thickness and macular volume decreased significantly more in the ILM group compared to the laser group (P = 0.001, P < 0.001, Mann Whitney U test). There was no correlation between the improvement in visual acuity and the reduction of foveal thickness (r = -0.158, P = 0.6) (ILM group), r = -0.155, P = 0.7) (laser group) in both groups. CONCLUSIONS PPV with ILM peeling was shown to be beneficial by inducing a statistically significant reduction of macular thickness and macular volume. Visual acuity also demonstrated a trend towards improvement in both the ILM peel group and the grid laser group; however, the comparative VA outcome analysis between the two groups was not significantly different. Besides, there was also no correlation between the reductions of foveal thickness and macular volume with the improvement in visual acuity in either of the groups.
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Autologous serum for the treatment of corneal epithelial abrasions in diabetic patients undergoing vitrectomy.
Schulze, SD, Sekundo, W, Kroll, P
American journal of ophthalmology. 2006;(2):207-11
Abstract
PURPOSE To compare the effect of autologous serum versus hyaluronic acid for the treatment of epithelial corneal lesions in patients such as diabetics with reduced wound healing. DESIGN Prospective, randomized, masked clinical trial. METHODS Diabetic patients undergoing pars plana vitrectomy mostly combined with cataract extraction and intraocular lens (IOL) implantation who received corneal abrasion for better intraoperative visualization were included in this study. A standardized 8-mm diameter corneal abrasion was performed. Patients were randomized into one group treated with hourly application of autologous serum and another treated with hyaluronic acid drops (Vislube). Besides the time necessary for closure of the corneal epithelium other parameters such as patients' age, gender, duration of surgery, history of diabetes, and current HbA1C were evaluated. RESULTS A total of 23 patients were enrolled (15 men, eight women); the autologous serum group consisted of 13 patients, the hyaluronic acid (Vislube) group consisted of 10 patients. Patients' mean age was 64.8 years; mean duration of diabetes was 19.4 years. On average, the operation lasted 145 minutes. Mean epithelialization time was 7.1 days in the hyaluronic acid group. In the autologous serum group, epithelium healed after a mean of 4.3 days. Mann-Whitney U test for statistical analysis showed a significant difference of epithelial closure time between both groups (P < .05); therefore, the study was stopped after treatment of 23 patients. CONCLUSIONS It appears that autologous serum leads to a much faster closure of corneal epithelial wounds after abrasion compared with artificial tears.