Pars plana vitrectomy combined with irido-zonulo-hyaloidectomy for aqueous misdirection

Introduction: To review the indications and necessary steps for successful irido-zonulo-hyaloidectomy in persistent aqueous misdirection. Study design/materials and methods: A 60-year-old woman was referred for persistent aqueous misdirection despite aggressive medical management. Her intraocular pressure would elevate with discontinuation of cycloplegics and her lens shifted anteriorly. She underwent standard 25g pars plana vitrectomy with irido-zonulo-hyaloidectomy. Results: The aqueous misdirection resolved with successful creation of the irido-zonulo-hyaloidectomy with noticeable deepening of the anterior chamber immediately. Vision improved to 20/30 and intraocular pressure was controlled without cycloplegics or ocular hypotensives. Conclusion: In persistent cases of aqueous misdirection unresponsive to medical management, irido-zonulo-hyaloidectomy is a useful adjunct to pars plana vitrectomy in ensuring resolution of the misdirection.

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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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Treatment outcomes and efficacy of pars plana vitrectomy-hyaloidotomy-zonulectomy-iridotomy in malignant glaucoma

European Journal of Ophthalmology ◽

10.1177/1120672119877139 ◽

2019 ◽

pp. 112067211987713

Author(s):

Srishti Raj ◽

Faisal Thattaruthody ◽

Gunjan Joshi ◽

Natasha Gautam Seth ◽

Sushmita Kaushik ◽

...

Keyword(s):

Intraocular Pressure ◽

Treatment Outcomes ◽

Medical Management ◽

Pars Plana Vitrectomy ◽

Second Line ◽

Case Series Study ◽

Malignant Glaucoma ◽

Significant Difference ◽

Pars Plana

Aim: To study the treatment outcomes and efficacy of pars plana vitrectomy-hyaloidotomy-zonulectomy-iridotomy in malignant glaucoma. Method: A retrospective case series study of patients treated for malignant glaucoma between 2005 and 2017. The treatment included medical management as first-line in the form of cycloplegic with anti-glaucoma medications (AGM) or pars plana vitrectomy-hyaloidotomy-zonulectomy-iridotomy as second-line therapy. The resolution was defined as ‘deepening of central anterior chamber’ with intraocular pressure of ⩽ 21 mm Hg (minimum on two consecutive visits 1 week apart) with or without topical anti-glaucoma medications in the absence (complete success) or presence (qualified success) of systemic medications. Results: Twenty-three eyes of 22 patients were included. At the time of diagnosis of malignant glaucoma preceding surgeries were cataract surgery (13 eyes) and trabeculectomy (4 eyes). One eye each had phacotrabeculectomy, Yag capsulotomy and optical keratoplasty. Eighteen eyes were pseudophakic and two eyes were phakic. At presentation, mean intraocular pressure was 26.25 ± 14.78 mmHg which was decreased to 15.90 ± 8.12 mmHg (p < 0.0001) at final follow-up (median follow-up was 15.50 months). Fifteen (75%) eyes had complete success, 3 (15%) eyes had qualified success and 2 (10%) eyes had treatment failure. Of 15 eyes that had achieved complete success, 3 eyes had undergone medical management and 12 eyes undergone second-line procedure. There was no significant difference in visual acuity or number of anti-glaucoma medication at presentation and final follow-up (p > 0.05). Conclusions: Though malignant glaucoma is highly refractory to treatment, appropriate management in the form of medical or vitrectomy-hyaloidotomy-zonulectomy-iridotomy could achieve 90% success in this series.

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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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Intraocular pressure changes following 20G pars-plana vitrectomy

Acta Ophthalmologica ◽

10.1111/j.1755-3768.2011.02251.x ◽

2011 ◽

Vol 90 (8) ◽

pp. 744-749 ◽

Cited By ~ 20

Author(s):

Carsten Framme ◽

Susanne Klotz ◽

Ute E.K. Wolf-Schnurrbusch ◽

Peter Wiedemann ◽

Sebastian Wolf

Keyword(s):

Intraocular Pressure ◽

Pars Plana Vitrectomy ◽

Pars Plana ◽

Pressure Changes

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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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