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

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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Outcome and Complications of Combined Phacoemulsification and 23-Gauge Pars Plana Vitrectomy

Journal of Ophthalmology ◽

10.1155/2019/7918237 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Selcuk Sizmaz ◽

Ebru Esen ◽

Puren Isik ◽

Burcu Cam ◽

Nihal Demircan

Keyword(s):

Intraocular Pressure ◽

Retinal Detachment ◽

Pars Plana Vitrectomy ◽

Intraoperative Complications ◽

Vitreous Hemorrhage ◽

Patient Demographics ◽

Posterior Synechia ◽

Pars Plana ◽

23 Gauge

Background. With the advances in surgical tools, simultaneous removal of cataract associated with vitreoretinal disorders is gaining popularity. This combined surgery offers several advantages besides limitations. The aim of this study is to assess the outcome and complications of phacoemulsification combined with pars plana vitrectomy (PPV). Patients and Methods. In this retrospective review, medical charts of patients undergoing phacovitrectomy for coexisting cataract and various vitreoretinal disorders were analyzed. Patient demographics, retinal diagnosis, visual acuities (VA) in logMAR, intraocular pressure (IOP), intraoperative and postoperative complications were assessed. Clear corneal phacoemulsification and 23-gauge transconjunctival PPV were administered in all cases. Results. Eighty-four eyes of 64 (76.2%) males and 20 (23.8%) females were enrolled. The average age of patients was 59.5 ± 13.8 (18–81). The average period of follow-up was 7.2 ± 7.5 months (1–36). The vitreoretinal diagnoses were as follows: 28 (33.3%) rhegmatogenous retinal detachment, 23 (27.4%) vitreous hemorrhage, 12 (14.3%) intraocular foreign body, 12 (14.3%) epiretinal membrane, 4 (4.8%) macular hole, 4 (4.8%) tractional retinal detachment, and 1 (1.2%) vitreomacular traction. The most common intraoperative complications were miosis and rupture of the posterior capsule (92.9% and 8.3%, respectively). In 8 (9.5%) cases, there was fibrin in the anterior chamber. Posterior synechia developed in 7 (8.3%) of cases. No severe increase in intraocular pressure was evident. Conclusion. Phacoemulsification combined with PPV is a safe and efficient way of management in cases where cataract coexists with vitreoretinal pathologies.

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Risk of Endophthalmitis in Boston Type 1 Keratoprosthesis Combined with Vitrectomy and Silicone Oil Insertion

Journal of Ophthalmology ◽

10.1155/2019/9648614 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8

Author(s):

Mohamed Abou Shousha ◽

Taher Eleiwa ◽

Allister Gibbons ◽

Christopher Smith ◽

Sean Edelstein ◽

...

Keyword(s):

Retinal Detachment ◽

Pars Plana Vitrectomy ◽

Silicone Oil ◽

Group Versus ◽

Visual Rehabilitation ◽

Significant Difference ◽

Pars Plana ◽

Boston Type 1 Keratoprosthesis

Purpose. To identify the incidence of endophthalmitis and visual outcomes in eyes with Boston type 1 keratoprosthesis combined with pars plana vitrectomy and silicone oil insertion (KPro + PPV + SOI) as compared to eyes receiving Boston type 1 keratoprosthesis (KPro) alone. Patients and Methods. Retrospective chart review of 29 eyes of 27 patients with KPro having at least 12-month follow-up. Thirteen of these eyes had hypotony and/or retinal detachment in addition to corneal pathology and thus received KPro + PPV + SOI. Polymyxin-trimethoprim with a quinolone was used as chronic topical antibiotic prophylaxis in both groups after the first postoperative month. Outcome measures recorded at the 1-, 3-, 6-, 12-, and 24-month follow-up visits included best-corrected visual acuity (BCVA) and rates of postoperative complications. Results. All the patients had completed 24-month follow-up except one case in the KPro group who lost to follow-up after 12-month visit. In the KPro + PPV + SOI group, no eyes had developed endophthalmitis by the 24-month follow-up visit versus 5 eyes of 5 patients in the uncombined KPro group (P=0.048). The 2-year cumulative endophthalmitis incidence was 31.2% in the KPro group versus zero in the KPro + PPV + SOI group (P=0.030). Four of these 5 eyes had vitreous taps with positive cultures; 2 were positive with Staphylococcus aureus, 1 with coagulase-negative staphylococci, and 1 with Streptococcus pneumoniae. Other complications included KPro extrusion (1 in each group), retinal detachment (2 in the KPro and 1 in the KPro + PPV + SOI group), newly developed glaucoma (2 in each group), and retroprosthetic membrane (9 in the KPro and 5 in the KPro + PPV + SOI group). The KPro group had better average preoperative BCVA compared to those of the KPro + PPV + SOI group (−2.29 ± 0.72 LogMAR, versus −2.95 ± 0.30 LogMAR; P=0.004). No statistically significant difference in BCVA was noted in subsequent follow-up visits. Conclusion. The addition of PPV and SOI to the KPro implantation in the eyes with corneal pathology, as well as hypotony and/or retinal detachment, is a safe and effective procedure for visual rehabilitation. Pars plana vitrectomy and silicone oil insertion may have a protective effect against the development of postoperative endophthalmitis in eyes receiving KPro.

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Comparison of 25- and 27-Gauge Pars Plana Vitrectomy in Repairing Primary Rhegmatogenous Retinal Detachment

Journal of Ophthalmology ◽

10.1155/2018/7643174 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5 ◽

Cited By ~ 8

Author(s):

Keiko Otsuka ◽

Hisanori Imai ◽

Ayaka Fujii ◽

Akiko Miki ◽

Mizuki Tagami ◽

...

Keyword(s):

Retinal Detachment ◽

Pars Plana Vitrectomy ◽

Rhegmatogenous Retinal Detachment ◽

Success Rates ◽

Significant Difference ◽

Pars Plana ◽

Anatomical Success ◽

Better Than ◽

Baseline Demographic

Aim. To compare the anatomic and visual outcomes of 25-gauge (25G), and 27-gauge (27G) transconjunctival sutureless pars plana vitrectomy (TSV) for the management of primary rhegmatogeneous retinal detachment (RRD).Design. A retrospective nonrandomized clinical trial.Methods. A retrospective comparative analysis of 62 consecutive eyes from 62 patients with 6 months of follow-up was performed.Results. Thirty-two patients underwent 25G TSV, and 30 patients underwent 27G TSV for the treatment of primary RRD. There was no significant difference in baseline demographic and preoperative ocular characteristics between the two groups. The initial and final anatomical success rates were 93.8% and 100% in 25G TSV and 96.7% and 100% in 27G TSV, respectively (p=1andp=1, resp.). Preoperative best-corrected visual acuity (BCVA) (logMAR) was 0.44 ± 0.69 and 0.38 ± 0.61 for 25G and 27G TSV, respectively (p=0.73). The final follow-up BCVA was 0.07 ± 0.25 and −0.02 ± 0.17 for 25G and 27G TSV, respectively (p=0.16). The final BCVA was significantly better than the preoperative BCVA in both groups (p=0.02andp=0.002, resp.). Preoperative intraocular pressure (IOP) (mmHg) was 13.0 ± 3.5 in 25G TSV and 14.3 ± 2.8 in 27G TSV (p=0.11). IOP did not statistically significantly change in both groups during the follow-up period (p=0.63andp=0.21, resp.).Conclusion. The 27G TSV system is safe and useful for RRD treatment as 25G TSV.

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POSTOPERATIVE COMPLICATIONS AND INTRAOCULAR PRESSURE IN 943 CONSECUTIVE CASES OF 23-GAUGE TRANSCONJUNCTIVAL PARS PLANA VITRECTOMY WITH 1-YEAR FOLLOW-UP

Retina ◽

10.1097/iae.0b013e3181b21082 ◽

2010 ◽

Vol 30 (1) ◽

pp. 107-111 ◽

Cited By ~ 46

Author(s):

BARBARA PAROLINI ◽

GUIDO PRIGIONE ◽

FEDERICA ROMANELLI ◽

MATTEO G. CEREDA ◽

MAURO SARTORE ◽

...

Keyword(s):

Intraocular Pressure ◽

Postoperative Complications ◽

Pars Plana Vitrectomy ◽

Pars Plana ◽

23 Gauge

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Comparison of Methods of Endotamponade Used During 23-Gauge Pars Plana Vitrectomy and the Risk of Raised Intraocular Pressure During 24-Month Follow-Up: A Retrospective Study of 196 Patients

Medical Science Monitor ◽

10.12659/msm.918114 ◽

2019 ◽

Vol 25 ◽

pp. 9327-9334

Author(s):

Anita Lyssek-Boroń ◽

Katarzyna Krysik ◽

Judyta Jankowska-Szmul ◽

Beniamin Oskar Grabarek ◽

Mateusz Osuch ◽

...

Keyword(s):

Intraocular Pressure ◽

Retrospective Study ◽

Pars Plana Vitrectomy ◽

Comparison Of Methods ◽

Pars Plana ◽

23 Gauge

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Prophylactic effect of brimonidine to minimize the incidence of subconjunctival hemorrhage in the early postoperative period after 23G pars plana vitrectomy

Therapeutic Advances in Ophthalmology ◽

10.1177/25158414211045753 ◽

2021 ◽

Vol 13 ◽

pp. 251584142110457

Author(s):

Mari Carmen Desco ◽

Julio Cesar Molina Martín ◽

Jorge Mataix-Boronat ◽

Isabel Pascual-Camps ◽

Elena Palacios-Pozo ◽

...

Keyword(s):

Pars Plana Vitrectomy ◽

Vitreoretinal Surgery ◽

Phase Iii ◽

Control Group ◽

Preoperative Treatment ◽

Prophylactic Effect ◽

Subconjunctival Hemorrhage ◽

Significant Difference ◽

Pars Plana

Background: Several studies have investigated and demonstrated the prophylactic effect of brimonidine drops in preventing subconjunctival hemorrhage in some microincisional ophthalmic surgeries, such as intravitreal injections or cataract surgery. However, there are no previous studies investigating this prophylactic effect after 23G microincisional vitreoretinal surgery. Aim: The aim of the current study was to determine whether subconjunctival hemorrhage after 23G pars plana vitrectomy (PPV) could be prevented with the use of prophylactic topical brimonidine. Methods: This was a phase III, prospective, interventional, randomized, controlled single-center clinical trial with a follow-up of 2 weeks. A total of 77 eyes (mean age: 68.4 ± 10.7 years) undergoing 23G PPV were included and randomized into two groups: group 1 including 41 patients receiving prophylactic preoperative treatment with brimonidine, and group 2 (control group) including 36 patients not receiving this prophylactic treatment. Differences in terms of number of conjunctival quadrants affected with subconjunctival hemorrhage were evaluated in each of the follow-up visits. Results: The presence of subconjunctival hemorrhage was similar in both groups the first days after surgery ( p > 0.05). At the last visit (10–14 days after surgery), this condition was significantly more frequent in control group where there was a significant difference, being more frequent in the control group (7.3% vs 28.6%, p = 0.022). The number of conjunctival quadrants affected was also similar in both groups, except for the last visit in which most of the patients treated with brimonidine (92.7%) showed no bleeding compared to 71.4% in control group. No effect on the efficacy of brimonidine treatment of the presence of blood hypertension, diabetes, and antiplatelet or anticoagulant treatment was observed. Conclusion: Brimonidine seems to be a useful option to decrease subconjunctival hemorrhage after microincisional vitreoretinal surgery or improve its resolution during the first postoperative week. This finding should be mainly due to the vasoconstrictor effect of brimonidine. Trial registration: EudraCT, 2012-002895-15 (registered 19 December 2012); https://www.clinicaltrialsregister.eu/ctr-search/search?query=2012-002895-15

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Prophylactic Effect of Brimonidine To Minimize The Incidence of Subconjunctival Hemorrhage after 23G Pars Plana Vitrectomy

10.21203/rs.3.rs-126625/v1 ◽

2020 ◽

Author(s):

M. Carmen Desco ◽

Julio Cesar Molina Martín ◽

Jorge Mataix-Boronat ◽

Isabel Pascual-Camps ◽

Elena Palacios-Pozo ◽

...

Keyword(s):

Pars Plana Vitrectomy ◽

Vitreoretinal Surgery ◽

Phase Iii ◽

Control Group ◽

Preoperative Treatment ◽

Prophylactic Effect ◽

Subconjunctival Hemorrhage ◽

Significant Difference ◽

Pars Plana

Abstract BackgroundSeveral studies have already investigated the prophylactic effect of brimonidine drops in preventing subconjunctival hemorrhage in some microincisional ophthalmic surgeries. The aim of the current study was to determine if subconjunctival hemorrhage after 23G pars plana vitrectomy (PPV) could be prevented with the use of prophylactic topical brimonidine.Main textIt was a phase III, prospective, interventional, randomized, controlled single-center clinical trial with a follow-up of 2 weeks. A total of 77 eyes (mean age: 68.4 ± 10.7 years) undergoing 23G PPV were included and randomized into 2 groups: group 1 including 41 patients receiving prophylactic preoperative treatment with brimonidine, and Group 2 (control group) including 36 patients not receiving this prophylactic treatment. Differences in terms of number of conjunctival quadrants affected with subconjunctival hemorrhage were evaluated in each of the follow-up visits. The presence of subconjunctival hemorrhage was similar in both groups the first days after surgery (p > 0.05). At the last visit, this condition was significantly more frequent in control group where there was a significant difference, being more frequent in the control group (7.3% vs. 28.6%, p = 0.022). The number of conjunctival quadrants affected was also similar in both groups, except for the last visit in which most of patients treated with brimonidine (92.7%) showed no bleeding compared to 71.4% in control group. No effect on the efficacy of brimonidine treatment of the presence of blood hypertension, diabetes and antiplatelet or anticoagulant treatment was observed.ConclusionsBrimonidine seems to be a useful option to decrease subconjunctival hemorrhage after micro-incisional vitreoretinal surgery or improve its resolution during the first postoperative week. This finding should be mainly due to the vasoconstrictor effect of brimonidine.Trial registrationEudraCT, 2012-002895-15. Registered 19 December 2012, https://www.clinicaltrialsregister.eu/ctr-search/search?query=2012-002895-15

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

European Journal of Ophthalmology ◽

10.1177/1120672119872056 ◽

2019 ◽

Vol 30 (2) ◽

pp. 396-398

Author(s):

Shriji Patel

Keyword(s):

Intraocular Pressure ◽

Anterior Chamber ◽

Study Design ◽

Medical Management ◽

Pars Plana Vitrectomy ◽

Pars Plana ◽

Design Materials ◽

Aggressive Medical Management ◽

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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Outcomes Following Pars Plana Vitrectomy for Severe Ocular Trauma

Journal of Ophthalmic and Vision Research ◽

10.18502/jovr.v16i3.9449 ◽

2021 ◽

Author(s):

Natalia K. Bober ◽

Neruban Kumaran ◽

Tom H Williamson

Keyword(s):

Visual Acuity ◽

Retinal Detachment ◽

Pars Plana Vitrectomy ◽

Ocular Trauma ◽

Final Visual Acuity ◽

Ocular Injury ◽

Significant Difference ◽

Pars Plana ◽

Type Of Injury

Purpose: To investigate outcomes and presenting characteristics for subjects undergoing pars plana vitrectomy for ocular trauma. Methods: Retrospective study of 113 patients who underwent pars plana vitrectomy for severe ocular trauma at [name deleted to maintain the integrity of the review process] between 1999 and 2018. Data were collected on age, gender, initial and final visual acuity (LogMAR), mode of injury, type of injury, number of surgeries performed, follow-up duration, type of tamponade, presence of phthisis, and retinal detachment. The Birmingham Eye Trauma Terminology System (BETTS) was employed. Results: We identified assault and contusion injuries to be the most common mode and type of ocular injury in our cohort. Furthermore, through follow-up we noted a varied number of operations required by patients presenting with ocular trauma and a statistically significant improvement in visual acuity from 1.73 (±0.86) LogMAR to 1.17 (±1.03; p <0.01) LogMAR. A statistically significant difference in final visual acuity was also noted between BETTS classified type of injury groups (p < 0.01). Notably, only 7.3% and 8.2% of patients developed phthisis or a persisting retinal detachment, respectively, during follow-up. Conclusion: Our study demonstrates that ocular trauma requiring pars plana vitrectomy can require a varied number of operations with a guarded visual prognosis. However, a small percentage will proceed to develop phthisis following intervention.

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Aerosol generation through pars plana vitrectomy

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2020-317214 ◽

2020 ◽

pp. bjophthalmol-2020-317214

Author(s):

Hasan Naveed ◽

Fong May Chew ◽

Hanbin Lee ◽

Edward Hughes ◽

Mayank A Nanavaty

Keyword(s):

Pars Plana Vitrectomy ◽

Ex Vivo ◽

Dynamic Changes ◽

Aerosol Generation ◽

Significant Difference ◽

Optical Particle Counter ◽

Pars Plana ◽

23 Gauge ◽

Set Up ◽

Ex Vivo Study

PurposeTo assess whether pars plana vitrectomy (PPV) is an aerosol-generating procedure (AGP) in an ex vivo experimental model.MethodsIn this ex vivo study on 10 porcine eyes, optical particle counter was used to measure particles ≤10 μm using cumulative mode in the six in-built channels: 0.3 μm, 0.5 μm, 1 μm, 2.5 μm, 5 μm and 10 μm aerosols during PPV. Two parts of the study were as follows: (1) to assess the pre-experimental baseline aerosol count in the theatre environment where there are dynamic changes in temperature and humidity and (2) to measure aerosol generation with 23-gauge and 25-gauge set-up. For each porcine eye, five measurements were taken for each consecutive step in the experiment including pre-PPV, during PPV, fluid–air exchange (FAX) and venting using a flute with 23-gauge set-up and a chimney with 25-gauge set-up. Therefore, a total of 200 measurements were recorded.ResultsWith 23-gauge and 25-gauge PPV, there was no significant difference in aerosol generation in all six channels comparing pre-PPV versus PPV or pre-PPV versus FAX. Venting using flute with 23-gauge PPV showed significant reduction of aerosol ≤1 μm. Air venting using chimney with 25-gauge set-up showed no significant difference in aerosol of ≤1 μm. For cumulative aerosol counts of all particles measuring ≤5 μm, compared with pre-PPV, PPV or FAX, flute venting in 23-gauge set-up showed significant reduction unlike the same comparison for chimney venting in 25-gauge set-up.ConclusionPPV and its associate steps do not generate aerosols ≤10 μm with 23-gauge and 25-gauge set-ups.

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