Pars plana Ex-Press mini shunt for management of persistent glaucoma in vitrectomized eyes: A novel technique

2020 ◽  
Vol 30 (5) ◽  
pp. 1179-1184 ◽  
Author(s):  
Abdussalam Abdullatif ◽  
Heba El-Saied
Keyword(s):  
Intraocular Pressure ◽  
Silicone Oil ◽  
Case Series ◽  
Ultrasound Biomicroscopy ◽  
Secondary Glaucoma ◽  
Antiglaucoma Medication ◽  
Novel Approach ◽  
Pars Plana ◽  
Secondary Refractory

Purpose: To evaluate the safety and efficacy of a novel approach to implant Ex-Press mini shunt via the pars plana under a scleral flap in pseudophakic or aphakic, vitrectomized patients with secondary refractory glaucoma. Methods: A prospective interventional case series of three patients with secondary glaucoma after pars plana vitrectomy. Intraocular pressure was not controlled by silicone oil removal, if the patient was siliconized, nor the maximum medical treatment. Ex-Press mini shunt via the pars plana was implanted. We evaluated the control of intraocular pressure and the development of intraoperative and postoperative complications. Results: During 1-year follow-up, control of intraocular pressure was achieved; 14, 15, and 15 mmHg at the 3 months, and 15, 15, and 16 mmHg at the 6 months in our three cases without antiglaucoma treatment and 16, 16, and 18 with single antiglaucoma medication at 1 year. Blebs were posterior and diffuse. No complications were encountered intraoperatively or postoperatively. Ultrasound biomicroscopy showed suprachoroidal posterior lake of fluid as an additional filtration route without any choroidal or retinal complication. Conclusion: Implantation of Ex-Press mini shunt via the pars plana in aphakic or pseudophakic, vitrectomized eyes is a promising, safe, and effective technique in patients with secondary glaucoma.

Intermediate-term outcomes of pars plana tube insertion of Aurolab aqueous drainage implant for refractory glaucoma

2019 ◽  
pp. bjophthalmol-2019-314639 ◽  
Author(s):  
Naresh Babu ◽  
Girish Baliga ◽  
Hiruni Kaushalya Wijesinghe ◽  
George Varghese Puthuran
Keyword(s):  
Intraocular Pressure ◽  
Refractory Glaucoma ◽  
Tube Insertion ◽  
Safety And Efficacy ◽  
Antiglaucoma Medication ◽  
Kaplan Meier ◽  
Pars Plana ◽  
The Mean ◽  
Cumulative Probabilities

PurposeTo report the safety and efficacy of parsplana tube insertion of Aurolab aqueous drainage implant(AADI) in patients with refractory glaucoma.MethodsCharts of patients with refractory glaucoma who underwent AADI via the parsplana route between June 2014 and June 2018with a minimum follow-up of 6 months were retrospectively reviewed. Success was defined as complete when the intraocular pressure (IOP) was ≥5 and18 mmHg or IOP reduction was >30%from baseline without antiglaucoma medication (AGM) andas qualified if requiring additional AGMs.ResultsThe study included 63 eyes of 63 patients with a mean age of 36.1±20.6 years and a mean follow-up of 19.7±15.7 months. Glaucoma postvitreoretinal surgery was the the most common aetiology (22 eyes, 35%). The mean IOP reduced from 36.6±10.7 mmHg to15.7±8.2 (57.1%), 15.02±7.3 (60%) and 17.2±8.5 mmHg (53%)at 6 months and 1 and 2 years, respectively. Kaplan-Meier estimates showed that the cumulative probabilities of failure were 8% (95% CI4.3% to 22.4%) at 6 months, 23% (95%CI12.8% to 38.6%) at 1 year, 30% (95%CI17.4% to 45.9%) at 18 months and 47% (95% CI13.4% to 64.9%) at the 2 years time points.Vitreous blocking tube tip was noted up to 8% of eyes on follow-up.ConclusionPars plana AADI insertion is a useful procedure for the control of IOP in patients with refractory glaucoma.

scholarly journals Combined Post-Traumatic Total Aniridia and Glaucoma Management

2021 ◽  
pp. 204-207
Author(s):  
Eleni Christodoulou ◽  
Georgios Batsos ◽  
Efstratios Parikakis ◽  
Vlasios Papadopoulos ◽  
Dimitrios Karagiannis ◽  
...  
Keyword(s):  
Silicone Oil ◽  
Insertion Site ◽  
District General Hospital ◽  
Secondary Glaucoma ◽  
Ocular Injury ◽  
Blurred Vision ◽  
Novel Approach ◽  
Pars Plana ◽  
Post Traumatic ◽  
The Right

We report a novel approach for managing traumatic total aniridia associated with secondary glaucoma. A 65-year-old male with symptoms of blurred vision, glare, and photophobia was managed in a district general hospital for post-traumatic aniridia associated with secondary glaucoma affecting the right eye. The patient previously suffered blunt ocular injury associated with rhegmatogenous retinal detachment, which was treated with pars plana vitrectomy and silicone oil (SO) tamponade and subsequent removal of SO (ROSO). Combined trabeculectomy and implantation of a foldable prosthetic iris (Reper NN Ltd) successfully addressed the dual pathology of aniridia and secondary glaucoma. In summary, the utilization of the trabeculectomy fistula can serve as the implant insertion site, which minimizes the requirement for additional incisions.

scholarly journals Outcomes of Vitrectomy in Pediatric Retinal Detachment with Proliferative Vitreoretinopathy

2017 ◽  
Vol 2017 ◽  
pp. 1-6
Author(s):  
Robert Rejdak ◽  
Dominika Nowakowska ◽  
Katarzyna Wrona ◽  
Ryszard Maciejewski ◽  
Anselm G. Junemann ◽  
...  
Keyword(s):  
Retinal Detachment ◽  
Proliferative Vitreoretinopathy ◽  
Intellectual Development ◽  
Silicone Oil ◽  
Case Series ◽  
Functional Results ◽  
Hand Motion ◽  
Common Etiology ◽  
Pars Plana

Aim. To report outcomes of pars plana vitrectomy (PPV) in pediatric retinal detachment (RD) with proliferative vitreoretinopathy (PVR), complications, factors influencing the final anatomical and functional results. Methods. Retrospective consecutive case series of 14 eyes. Average postoperative follow-up period was 34 months. Results. Mean age of patients was 10 years; eleven patients (79%) were males. The most common etiology was trauma (57%), the second—myopia (36%) and one case of uveitis (7%). At the day of presentation, the best-corrected visual acuity (BCVA) was worse than hand motion (50%); macula was detached in 86% of cases. Simultaneous PPV and phacoemulsification with intraocular lens (IOL) implantation were performed in 12 cases (86%). The most common endotamponade during PPV was silicone oil (93%). Anatomic reattachment was accomplished in 86% of cases. Final BCVA was equal or better than 0.1 in 50% of patients. The postoperative complications were found in 5 eyes (36%). Conclusion. Complete PPV was allowed for anatomically reattached retina and preserved vision in pediatric complex RD with PVR. However, visual outcomes were not satisfactory. Preserving vision in children with RD is of great importance for their future motor and intellectual development. This trial is registered with ClinicalTrials.gov Identifier: NCT03208205.

scholarly journals Pars plana vitrectomy with/without encircling scleral band for treatment of retinal detachment associated with buphthalmos

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Hammouda Hamdy Ghoraba ◽  
Sameh Mohamed El Gouhary ◽  
Ali Ahmed Ali Ghali ◽  
Mohamed Ahmed Abdelhafez ◽  
Adel Galal Zaky ◽  
...  
Keyword(s):  
Retinal Detachment ◽  
Pars Plana Vitrectomy ◽  
Silicone Oil ◽  
Case Series ◽  
Social Consequences ◽  
Phthisis Bulbi ◽  
Encircling Band ◽  
Pars Plana ◽  
Anatomical Success

Abstract Background To evaluate the results of pars plana vitrectomy (PPV) and silicone oil (SO) tamponade with or without encircling scleral band for repair of rhegmatogenous retinal detachment (RRD) in children with buphthalmos. Patients and methods Retrospective comparative nonrandomized interventional case series including consecutive patients who underwent PPV with or without encircling band and SO tamponade for RRD associated with buphthalmos. Results The study included 19 eyes of 19 children. Mean age was 8 years, range 3–16 years. Mean follow-up period was 28 months, range 19–63 months. Globe survival has been achieved in 15 out of 19 eyes (79%). Phthisis bulbi was reported in four cases (22%). Eight patients (42%) achieved ambulatory vision. Most eyes initially achieved anatomical success. Conclusion Despite the poor visual and anatomical results of RRD repair in eyes with buphthalmos, globe survival might be the rationale for surgery in such cases. Globe preservation could avoid the psychological and social consequences of phthisis bulbi in non-operated children.

Clinical characteristics and treatment of secondary glaucoma, glaucoma suspects and ocular hypertension after congenital cataract surgery

2021 ◽  
pp. 112067212199135
Author(s):  
Katharina Eibenberger ◽  
Barbara Kiss ◽  
Ursula Schmidt-Erfurth ◽  
Eva Stifter
Keyword(s):  
Intraocular Pressure ◽  
Cataract Surgery ◽  
Ocular Hypertension ◽  
Congenital Cataract ◽  
Case Series ◽  
Secondary Glaucoma ◽  
Visual Axis ◽  
Retrospective Case ◽  
Pediatric Cataract ◽  
Congenital Cataract Surgery

Objective: To evaluate changes in intraocular pressure after congenital cataract surgery in a real-world setting. Methods: This retrospective case series included all children aged 0–2 years undergoing lens extraction due to congenital cataract. Development of an elevated intraocular pressure was divided into three groups: secG, suspG and OHT. Further, risk factors for IOP changes, the therapeutic approach and functional outcome were assessed during follow-up. Results: One hundred and sixty-one eyes of 110 patients aged 0–2 years were included, whereof 29 eyes of 17 children developed secondary glaucoma (secG; 11 eyes/8 patients), glaucoma suspect (suspG; three eyes/three patients) or ocular hypertension (OHT; 15 eyes/10 patients). No difference in surgrical procedure ( p = 0.62) was found, but age at cataract surgery differed significantly ( p = 0.048), with the secG group (1.74 ± 1.01 months) being the youngest (suspG: 3.93 ± 1.80 months; OHT group: 5.91 ± 5.36 months). Secondary surgical intervention was significantly higher in the secG (4.64 ± 3.41) followed by the suspG (2.00 ± 2.65) and OHT groups (0.40 ± 0.74; p < 0.001). Postoperative complications including nystagmus ( p = 0.81), strabismus ( p = 0.98) and amblyopia ( p = 0.73) showed no difference, in contrast to visual axis obscuration which was more common in the secG group ( p = 0.036). Conclusion: Initial lensectomy and anterior vitrectomy procedure together with or without IOL implantation seems to have no influence for the development of IOP changes after pediatric cataract surgery. However, children who developed secondary glaucoma had cataract surgery significantly earlier, within the first 2–3 months of life. Glaucoma surgery was required to achieve final IOP control in most eyes. The development of secondary glaucoma was also associated with a significant increase in surgical re-treatments.

scholarly journals Recurrent Intraocular Lens Dislocation in a Patient with Familial Ectopia Lentis

2021 ◽  
Vol 18 (9) ◽  
pp. 4545
Author(s):  
Tomasz K. Wilczyński ◽  
Alfred Niewiem ◽  
Rafał Leszczyński ◽  
Katarzyna Michalska-Małecka
Keyword(s):  
Intraocular Lens ◽  
Pars Plana Vitrectomy ◽  
Vision Loss ◽  
Silicone Oil ◽  
Single Case ◽  
Recurrent Dislocation ◽  
Ectopia Lentis ◽  
Pars Plana ◽  
The Right

A 36-year-old patient presented to the hospital with recurrent dislocation of the intraocular lens (IOL). The patient with the diagnosis of familial ectopia lentis was first operated on for crystalline lens subluxation in the left eye in 2007 and in the right eye in 2009. In both eyes, lens extraction with anterior vitrectomy and transscleral fixation of a rigid IOL was performed. In 2011, the IOL in the right eye luxated into the vitreous cavity due to ocular trauma. The patient underwent a pars plana vitrectomy with the IOL resuturation to the sclera. Seven years later, a spontaneous vision loss in the right eye was caused by a retinal detachment. The pars plana vitrectomy with silicone oil tamponade and a consequential oil removal three months later were performed in 2018. The follow-up examination revealed recurrent IOL dislocation in the same eye. Due to a history of previous suture-related complications a decision was made to remove the subluxated rigid polymethyl-methacrylate (PMMA) IOL and fixate to sclera a sutureless SOLEKO FIL SSF Carlevale lens. The purpose of this report is to present a single case of a 36-year-old patient who was presented to the hospital with recurrent dislocation of the intraocular lens. In a three-month follow-up period, a good anatomical and functional outcome was finally obtained with transscleral sutureless intraocular lens. This lens is an option worth considering especially in a young patient with a long life expectancy and physically active.

scholarly journals Combined pars plana glaucoma drainage device placement and vitrectomy using a vitrectomy sclerotomy site for tube placement: a case series

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Enchi Kristina Chang ◽  
Sanchay Gupta ◽  
Marika Chachanidze ◽  
John B. Miller ◽  
Ta Chen Chang ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Pars Plana Vitrectomy ◽  
Case Series ◽  
Tube Placement ◽  
Glaucoma Drainage Device ◽  
Drainage Device ◽  
Glaucoma Drainage Devices ◽  
Pars Plana ◽  
Sclerotomy Site

Abstract Purpose The purpose of this study is to report the safety and efficacy of pars plana glaucoma drainage devices with pars plana vitrectomy using one of the vitrectomy sclerotomy sites for tube placement in patients with refractory glaucoma. Methods Retrospective case series of 28 eyes of 28 patients who underwent combined pars plana glaucoma drainage device and pars plana vitrectomy between November 2016 and September 2019 at Massachusetts Eye and Ear. Main outcome measures were intraocular pressure (IOP), glaucoma medication burden, best corrected visual acuity, and complications. Statistical tests were performed with R and included Kaplan-Meier analyses, Wilcoxon paired signed-rank tests, and Fisher tests. Results Mean IOP decreased from 22.8 mmHg to 11.8 mmHg at 1.5 years (p = 0.002), and mean medication burden decreased from 4.3 to 2.1 at 1.5 years (p = 0.004). Both IOP and medication burden were significantly lower at all follow-up time points. The probability of achieving 5 < IOP ≤ 18 mmHg with at least 20% IOP reduction from preoperative levels was 86.4% at 1 year and 59.8% at 1.5 years. At their last visit, three eyes (10.7%) achieved complete success with IOP reduction as above without medications, and 14 eyes (50.0%) achieved qualified success with medications. Hypotony was observed in 1 eye (3.6%) prior to 3 months postoperatively and 0 eyes after 3 months. Visual acuity was unchanged or improved in 23 eyes (82.1%) at their last follow-up. Two patients had a visual acuity decrease of > 2 lines. Two eyes required subsequent pars plana vitrectomies for tube obstruction, and one eye had transient hypotony. Conclusions The results of pars plana glaucoma drainage device and pars plana vitrectomy using one of the vitrectomy sclerotomy sites for tube placement are promising, resulting in significant IOP and medication-burden reductions through postoperative year 1.5 without additional risk of postoperative complications. Inserting glaucoma drainage devices into an existing vitrectomy sclerotomy site may potentially save surgical time by obviating the need to create another sclerotomy for tube placement and suture one of the vitrectomy ports.

Ultrasound Biomicroscopy Documented Anterior Uveal Melanoma Regression after Ruthenium-106 Plaque Therapy

2021 ◽  
pp. 1-9
Author(s):  
Biljana Kuzmanović Elabjer ◽  
Mladen Bušić ◽  
Andrej Pleše ◽  
Mirjana Bjeloš ◽  
Daliborka Miletić ◽  
...  
Keyword(s):  
Uveal Melanoma ◽  
Tumor Regression ◽  
Corneal Thickness ◽  
Case Series ◽  
Ultrasound Biomicroscopy ◽  
Close Monitoring ◽  
Single Institution ◽  
Retrospective Case ◽  
Caucasian Patients

<b><i>Introduction:</i></b> Ultrasound biomicroscopy (UBM) is the only widely used method for the evaluation of anterior uveal melanoma (AUM). <b><i>Objective:</i></b> Documentation of regression of AUM treated with ruthenium-106 (Ru-106) plaque types CCB and CCC using UBM. <b><i>Methods:</i></b> This single institution-based retrospective case series involved 10 Caucasian patients with AUM followed after brachytherapy with UBM from January 2014 until February 2019. The largest prominence of the tumor perpendicular to the sclera or the cornea (including scleral/corneal thickness) (<i>D</i>) and the largest basal dimension (<i>B</i>) were measured in millimeters with UBM for all patients prior to the brachytherapy and at 4-month interval follow-up. Tumor regression was calculated as a percentage of decrease in the initial <i>D</i> and <i>B</i> values. <b><i>Results:</i></b> The study involved 10 patients with a mean age of 64.4 years (yr) (range 46–80 yr). <i>D</i> ranged from 1.82 to 5.5 mm (median 2.99 mm) and <i>B</i> from 2.32 to 12.38 mm (median 4.18 mm). The apical radiation dose in all patients was 100 Gy. The median follow-up was 42.02 months. Regression for <i>D</i> was 21.11 ± 13.66%, 31.09 ± 14.66%, and 34.92 ± 19.86% at 1st, 2nd, and 3rd year of the follow-up, respectively, while for <i>B</i> it was 21.58 ± 16.05%, 28.98 ± 17.71%, and 32.06 ± 18.96%, respectively. Tumor recurrence was documented in 2/10 patients. <b><i>Conclusion:</i></b> The major regression of AUM, treated with Ru-106 plaque types CCB and CCC, was documented in the first 2 years after brachytherapy in our study group. In the following years, only minimal regression was documented that warns of the need for close monitoring and active search for local recurrences.

Retinotomy and retinectomy for anterior inferior proliferative vitreoretinopathy: Can visual outcome be improved?

2021 ◽  
pp. 112067212110128
Author(s):  
Mumin Hocaoglu ◽  
Murat Karacorlu ◽  
M. Giray Ersoz ◽  
Isil Sayman Muslubas ◽  
Serra Arf
Keyword(s):  
Proliferative Vitreoretinopathy ◽  
Rhegmatogenous Retinal Detachment ◽  
Silicone Oil ◽  
Clinical Stage ◽  
Case Series ◽  
Visual Outcome ◽  
Attachment Rate ◽  
Good Visual Outcome ◽  
The Mean

Purpose: To describe the treatment outcomes and prognostic factors of retinotomy/retinectomy for rhegmatogenous retinal detachment (RD) complicated anterior inferior proliferative vitreoretinopathy (PVR). Methods: Retrospective, nonrandomized, single-center case series. The outcomes of 126 cases of retinotomy/retinectomy for RD complicated by advanced (Grade C) anterior inferior PVR managed consistently by one surgeon during a 15-year period were evaluated. Results: Forty-two eyes (33%) had primary RDs and 84 (67%) had recurrent RDs. The extent of retinotomy/retinectomy varied: 90° in 21 eyes (17%), >90° to <180° in 49 eyes (39%), and ⩾180° to ⩽240° in 56 eyes (44%). The retinotomy/retinectomy location was peripheral in 58 eyes (46%) and equatorial in 68 eyes (54%). The mean follow-up period was 43 ± 42 months. The silicone oil (SO) was removed from 98% of the eyes. The single-operation success rate after the primary retinectomy was 87%, and the final attachment rate was 94%. Visual acuity improved from 20/630 to 20/160 ( p < 0.001). Vision ⩾20/200 was achieved in 101 eyes (80%). Good visual outcome was correlated positively with preoperative VA ( p = 0.02), previous vitrectomy with gas tamponade ( p = 0.007), and was negatively correlated with number of previous RD operations ( p = 0.01), larger extent of RD ( p = 0.02) and more extensive retinotomy/retinectomy ( p = 0.04). Conclusions: An appropriate and timely intervention, including vitrectomy alone, inferior relaxing retinotomy/retinectomy and standard SO tamponade provide satisfactory outcomes for RDs complicated by PVR. Lesser extension of grade C PVR at baseline, such as PVR limited to one quadrant should encourage vitreoretinal specialists to consider retinotomy/retinectomy at a milder clinical stage of PVR development.

Results and Complications after Implantation of a Black Iris-Lens Diaphragm in Patients with Traumatically Induced Aphakia and Aniridia

2011 ◽  
Vol 21 (6) ◽  
pp. 754-759 ◽  
Author(s):  
Vasileios Petousis ◽  
Lothar Krause ◽  
Gregor Willerding ◽  
Michael H. Foerster ◽  
Nikolaos E. Bechrakis
Keyword(s):  
Anterior Chamber ◽  
Surgical Repair ◽  
Silicone Oil ◽  
Case Series ◽  
Corrected Visual Acuity ◽  
Time Out ◽  
Anatomic Results ◽  
The Mean ◽  
Positive Effect

Purpose. The black iris-lens diaphragm (ILD) can be used in the treatment of traumatic aniridia and aphakia. The aim of our study was to show postoperative functional and anatomic results and complications in a small case series. Methods. We retrospectively analyzed the files of 16 patients managed with a black ILD or a sole iris diaphragm in the period 1994–2007. Four of them were female and 12 were male. The mean age of the group was 50±17 years. At the time of the implantation, all of the eyes had already undergone primary surgical repair. Results. The preoperative best-corrected visual acuity in half of the patients was ≥0.1 and remained stable after the first postoperative year. During the follow-up years, one eye developed a subluxation of the implant and one eye an anterior chamber hemorrhage. At the same time, out of 8 eyes carrying a silicone tamponade in the vitreous cavity, silicone oil entered the anterior chamber in 3 cases. In one case, enucleation was undertaken due to phthisis. Conclusions. In the case of severely traumatized eyes with aniridia and aphakia, the implantation of a black ILD can have a positive effect on functional and anatomic stabilization.

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