Removal of dislocated intraocular lenses using pars plana vitrectomy with placement of an open-loop, flexible anterior chamber lens,

The surgical technique is described for simultaneous removal of posteriorly dislocated crystalline lenses and implantation of anterior chamber (AC) or scleral fixation posterior chamber (PC) intraocular lenses (IOL) using pars plana vitrectomy. Twenty-two patients underwent this complex operation. Observation time ranged from 2 to 10 months (mean 5 months). Best-corrected post-operative visual acuity was 1.0 in half the patients in the AC group (n=12), and in 80% of the PC group (n=10). It was less than 0.5 in 25% of cases in the AC group whereas all PC patients had visual acuity 0.5 or better. In nine cases with pre-operative ocular hypertension, post-operative intraocular pressure became normal, although topical glaucoma therapy was necessary in three patients in the AC group and in one from the PC group. No severe complications were found. Removal of posteriorly dislocated crystalline lens using pars plana vitrectomy and limbal incision is a safe procedure. Simultaneous AC or transscleral PC lens implantation is a good alternative to contact lenses. Visual rehabilitation was good in both groups of patients, although post-operative visual acuity was better after PC transscleral fixation than after AC surgery.

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Changes in anterior segment optical coherence tomography following pars plana vitrectomy without tamponade

International Journal of Retina and Vitreous ◽

10.1186/s40942-021-00285-w ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Alireza Khodabande ◽

Massood Mohammadi ◽

Hamid Riazi-Esfahani ◽

Shahab Karami ◽

Massood Mirghorbani ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Anterior Chamber ◽

Pars Plana Vitrectomy ◽

Anterior Segment ◽

Anterior Chamber Depth ◽

Optical Coherence ◽

Mean Values ◽

Iop Measurement ◽

Pars Plana ◽

The Mean

Abstract Background To evaluate changes in anterior segment morphology on anterior segment optical coherence tomography (AS-OCT) following pars plana vitrectomy (PPV) without tamponade. Methods Patients who underwent PPV without tamponade for epiretinal membrane were evaluated. Eligible patients underwent intraocular pressure (IOP) measurement and AS-OCT preoperatively as well as 1 month and 6 months post-operatively. Anterior chamber width (ACW), anterior chamber depth (ACD), trabecular iris angle (TIA), angle opening distance at 500 and 750 µm (AOD), and trabecular iris space area at 500 and 750 µm (TISA) at four quadrants were recorded and analyzed. Additionally, the mean values of TIA (MTIA), AOD (MAOD), and TISA (MTISA) for each eye (mean of four quadrants) were analyzed. Results 23 patients completed the study. The mean age of participants was 56.4 ± 3.6 years of age and 13/23 (56%) were female. Mean IOP of patients was 18.1 ± 1.1, 18.3 ± 1.1, and 18.1 ± 1.2 preoperatively,1 month post-operatively, and 6 months post-operatively, respectively. (p = 0.83). No difference was detected post-operatively in measurements of ACW, ACD, MTIA, MAOD500, MAOD750, MTISA500, and MTISA750. Conclusion Pars plana vitrectomy without tamponade was not associated with changes in anterior chamber morphology.

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Unusual presentation of a choroidal melanoma

BMJ Case Reports ◽

10.1136/bcr-2020-240983 ◽

2021 ◽

Vol 14 (5) ◽

pp. e240983

Author(s):

Sunila Jain ◽

Kar Yen Phoong

Keyword(s):

Intraocular Pressure ◽

Anterior Chamber ◽

Pars Plana Vitrectomy ◽

Visual Loss ◽

Spindle Cell ◽

Choroidal Melanoma ◽

Artificial Eye ◽

History Of ◽

Pars Plana ◽

Eye Clinic

A 49-year-old gentleman presented with a 1-day history of painful deterioration of vision in his right eye. He was lifting heavy weights just before this visual loss. On examination, his vision was perception of light in that eye, with a medically uncontrollable high intraocular pressure and hyphaema almost completely filling his anterior chamber. An ultrasound performed suggested a working diagnosis of a Valsalva related ‘eight ball’ bleed. After an anterior chamber washout, he had another episode of bleeding three days later. A pars plana vitrectomy was performed and the sample obtained was sent off to the laboratory, revealing a choroidal melanoma. Following enucleation, the histology confirmed a large necrotic spindle cell melanoma, with a haemorrhagic background. Fortunately, no liver metastasis was found. Since his diagnosis 3 years ago, he continues to be followed up in an artificial eye clinic and has regular liver scans under the care of his oncologist.

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Pars Plana Vitrectomy and the Risk of Ocular Hypertension and Glaucoma: Where Are We?

Journal of Clinical Medicine ◽

10.3390/jcm9123994 ◽

2020 ◽

Vol 9 (12) ◽

pp. 3994

Author(s):

Tommaso Rossi ◽

Guido Ripandelli

Keyword(s):

Anterior Chamber ◽

Ocular Hypertension ◽

Oxygen Tension ◽

Pars Plana Vitrectomy ◽

Open Angle Glaucoma ◽

Crystalline Lens ◽

Cataract Extraction ◽

Oxygen Scavenger ◽

Clinical Series ◽

Pars Plana

Purpose is to review the pathogenic mechanism for ocular hypertension and glaucoma development after pars plana vitrectomy. Both acute and chronic causes are considered, and special attention is paid to the theories and clinical evidence on the risk of developing Open Angle Glaucoma (OAG) after Pars Plana Vitrectomy (PPV). Most existing scientific literature on the issue agree on the role of ascorbate as an oxygen scavenger within the vitreous chamber. Oxygen tension in the vitreous and anterior chamber is maximum inn proximity of the retinal surface and endothelium, respectively and steeply decreases toward the lens, on both sides, and trabecular meshwork. Vitreous removal and, to a lesser extent, liquefaction, greatly reduces oxygen tension gradient in vitreous chamber while cataract extraction has similar effects on anterior chamber oxygen gradients. Oxygen derivatives originated from the cornea and retina are actively reduced by the vitreous gel and/or the crystalline lens. Vitreous removal and cataract extraction reduce drastically this function. Most reported clinical series confirm this hypothesis although protocol difference and follow-up length greatly impact the reliability of results.

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