Continuation of aspirin therapy before pars plana vitrectomy: Safe or not?

2020 ◽  
pp. 112067212094693
Author(s):  
Jin Wang ◽  
Qingjian Li ◽  
Yu Zhang ◽  
Xin Che ◽  
Jing Jiang ◽  
...  
Keyword(s):  
Pars Plana Vitrectomy ◽  
Vitreous Hemorrhage ◽  
Perioperative Period ◽  
Aspirin Therapy ◽  
Bleeding Complications ◽  
Control Group ◽  
Retrobulbar Anesthesia ◽  
Significant Difference ◽  
Hemorrhagic Complications ◽  
Pars Plana

Purpose: To assess the safety of pars plana vitrectomy (PPV) in patients undergoing systemic treatment with aspirin. Methods: This prospective study enrolled consecutive patients undergoing PPV under percutaneous retrobulbar anesthesia between February 2016 and July 2018. Sixty-seven eyes from 67 patients on regular aspirin therapy were randomized into two groups: the continuation group (33 eyes), with aspirin continued during the perioperative period; and the discontinuation group (34 eyes), with aspirin discontinued for 3 to 7 days before surgery. Forty-three eyes from 43 patients who had no antiplatelet/anticoagulant therapy were used as a control group. Results: There was no significant difference in the incidence of hemorrhagic complications or the need for additional operations due to hemorrhagic complications among the three groups ( p = 0.740 and p = 0.324, respectively). None of the patients in these three groups suffered from thromboembolic events during the follow-up period. Except for one case (3.0%) of lid ecchymosis in the continuation group, no eye experienced bleeding complications associated with the retrobulbar local anesthesia. In the continuation group, three eyes (9.1%) demonstrated postoperative hyphema that resolved spontaneously. In the discontinuation group, two eyes (5.9%) suffered from postoperative vitreous hemorrhage, of which one eye required secondary surgery and the other cleared spontaneously. One eye (2.9%) in the discontinuation group demonstrated postoperative hyphema that absorbed spontaneously. Three eyes (7.0%) in the control group experienced hyphema that absorbed spontaneously. Conclusion: The outcomes of our study indicate that PPV under retrobulbar anesthesia can be safely performed without discontinuing systemic aspirin therapy.

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

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

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

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

Aerosol generation through pars plana vitrectomy

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.

scholarly journals 27-Gauge Vitrectomy for Symptomatic Vitreous Floaters with Topical Anesthesia

2017 ◽  
Vol 8 (1) ◽  
pp. 35-39 ◽  
Author(s):  
Zhong Lin ◽  
Nived Moonasar ◽  
Rong Han Wu ◽  
Robin R. Seemongal-Dass
Keyword(s):  
Postoperative Complications ◽  
Minimally Invasive ◽  
Pars Plana Vitrectomy ◽  
Topical Anesthesia ◽  
Retrobulbar Anesthesia ◽  
Vitreous Floaters ◽  
Pars Plana ◽  
Vitrectomy Surgery ◽  
Surgery Duration

Purpose: Traditionally acceptable methods of anesthesia for vitrectomy surgery are quite varied. However, each of these methods has its own potential for complications that can range from minor to severe. The surgery procedure of vitrectomy for symptomatic vitreous floaters is much simpler, mainly reflecting in the nonuse of sclera indentation, photocoagulation, and the apparently short surgery duration. The use of 27-gauge cannulae makes the puncture of the sclera minimally invasive. Hence, retrobulbar anesthesia, due to its rare but severe complications, seemed excessive for this kind of surgery. Method: Three cases of 27-gauge, sutureless pars plana vitrectomy for symptomatic vitreous floaters with topical anesthesia are reported. Results: The vitrectomy surgeries were successfully performed with topical anesthesia (proparacaine, 0.5%) without operative or postoperative complications. Furthermore, none of the patients experienced apparent pain during or after the surgery. Conclusion: Topical anesthesia can be considered for 27-guage vitrectomy in patients with symptomatic vitreous floaters.

scholarly journals Identification of Diagnostic and Prognostic microRNAs for Recurrent Vitreous Hemorrhage in Patients with Proliferative Diabetic Retinopathy

2019 ◽  
Vol 8 (12) ◽  
pp. 2217 ◽  
Author(s):  
Parviz Mammadzada ◽  
Juliette Bayle ◽  
Johann Gudmundsson ◽  
Anders Kvanta ◽  
Helder André
Keyword(s):  
Diabetic Retinopathy ◽  
Proliferative Diabetic Retinopathy ◽  
Vitreous Hemorrhage ◽  
Control Group ◽  
Ocular Tissues ◽  
Recurrent Hemorrhage ◽  
Pars Plana ◽  
And Control ◽  
Insight Into ◽  
Recurrent Vitreous Hemorrhage

MicroRNAs (miRNAs) can provide insight into the pathophysiological states of ocular tissues such as proliferative diabetic retinopathy (PDR). In this study, differences in miRNA expression in vitreous from PDR patients with and without incidence of recurrent vitreous hemorrhage (RVH) after the initial pars-plana vitrectomy (PPV) were analyzed, with the aim of identifying biomarkers for RVH. Fifty-four consented vitreous samples were analyzed from patients undergoing PPV for PDR, of which eighteen samples underwent a second surgery due to RVH. Ten of the sixty-six expressed miRNAs (miRNAs-19a, -20a, -22, -27a, -29a, -93, -126, -128, -130a, and -150) displayed divergences between the PDR vitreous groups and to the control. A significant increase in the miRNA-19a and -27a expression was determined in PDR patients undergoing PPV as compared to the controls. miRNA-20a and -93 were significantly upregulated in primary PPV vitreous samples of patients afflicted with RVH. Moreover, this observed upregulation was not significant between the non-RVH and control group, thus emphasizing the association with RVH incidence. miRNA-19a and -27a were detected as putative vitreous biomarkers for PDR, and elevated levels of miRNA-20a and -93 in vitreous with RVH suggest their biomarker potential for major PDR complications such as recurrent hemorrhage incidence.

Mechanism of Visual Sensations Experienced during Pars Plana Vitrectomy under Retrobulbar Anesthesia

2009 ◽  
Vol 224 (2) ◽  
pp. 103-108 ◽  
Author(s):  
Eiko Sugisaka ◽  
Kei Shinoda ◽  
Ronaldo Yuiti Sano ◽  
Susumu Ishida ◽  
Yutaka Imamura ◽  
...  
Keyword(s):  
Pars Plana Vitrectomy ◽  
Retrobulbar Anesthesia ◽  
Pars Plana

Effect of Rapid Rehabilitation Concepts on Quality of Life and Pain in Patients Undergoing Radical Breast Cancer Surgery in Perioperative Period

2021 ◽  
Vol 7 (5) ◽  
pp. 1538-1544
Author(s):  
Xin Li ◽  
Hai-yan An ◽  
Yi Zhao ◽  
Mingli Ji ◽  
Jing An ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Perioperative Period ◽  
Nursing Intervention ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Control Group ◽  
T Lymphocyte Subsets ◽  
Significant Difference

To study the effect of rapid rehabilitation nursing on patients’ quality of life and pain level during the perioperative period of radical breast cancer surgery. Methods: 126 patients who were hospitalized in our hospital from January 2018 to February 2020 and underwent radical breast cancer surgery were divided into control group and rapid rehabilitation group according to the perioperative period intervention method. Routine nursing intervention and rapid rehabilitation nursing intervention were used respectively. The general conditions of the two groups were recorded, and the differences of T cell subsets before operation and 3 days after operation were detected. Visual analogue pain (VAS) score was used to evaluate the changes of pain degree at 1 day, 3 days and 5 days after operation and on the day of discharge. Postoperative complications and satisfaction were compared between the two groups. Quality of life (QOL) was assessed at 1 month and 3 months after operation using the CARES-SF score. Results: Anesthesia waking time (26.12 ± 5.77) min, off-bed activity time (14.25 ± 2.87) h and hospital stay (7.82 ± 2.15) d in the rapid rehabilitation group were shorter than those in the control group (P < 0.05). The operation time (92.02 ± 14.78) min and intraoperative blood loss (57.96 ± 13.96) mL in the rapid rehabilitation group were not significantly different from those in the control group (P > 0.05). In the control group, 3d after operation, T lymphocyte subsets were decreased gradually than that before operation (P < 0.05), CD3+ was decreased 3d after operation than that before operation in the rapid rehabilitation group (P < 0.05), but CD4+, CD8+, CD4+ / CD8 + 3d after operation had no significant difference than that before operation (P > 0.05). In rapid rehabilitation group, T lymphocyte subsets at 3d after operation were higher than those in the control group (P < 0.05). The postoperative complication rate of the rapid rehabilitation group was lower than that of the control group, and the satisfaction degree was higher than that of the control group, with significant difference (P < 0.05). After follow-up, it was found that the scores of qualities of life, such as physiology, psychosocial, marriage, sexual life and relationship with medical staff in the rapid rehabilitation group were lower than those in the control group at 1 month and 3 months after operation (P < 0.05). Conclusion: The concept of rapid rehabilitation nursing can stabilize the immune function of patients after radical breast cancer surgery, promote the postoperative rehabilitation and improve the quality of life after operation.

A Prospective Clinical Evaluation of the Effects of Intraoperative Systemic Anticoagulation in Patients Undergoing Arteriovenous Fistula Surgery

2010 ◽  
Vol 76 (10) ◽  
pp. 1112-1114 ◽  
Author(s):  
Bonnie R. Wang ◽  
Vincent L. Rowe ◽  
Sung Wan Ham ◽  
Sukgu Han ◽  
Kaushal Patel ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Postoperative Bleeding ◽  
Bleeding Complications ◽  
Controlled Study ◽  
Control Group ◽  
Heparin Group ◽  
Av Fistula ◽  
Fistula Surgery ◽  
Significant Difference ◽  
The Difference

No standard presently exists for the use of systemic heparin during angioaccess surgery to decrease the incidence of postoperative thrombotic complications. Our objective was to study the effects of intraoperatively administered heparin on 30-day patency and postoperative bleeding complications in patients undergoing autogenous arteriovenous (AV) fistula surgery. A prospective, double-blinded, randomized controlled study was performed on 48 patients undergoing AV fistula creation from April 2007 through November 2009. Of the 48 patients, 22 were randomized to the control group and received no heparin. Twenty-six were randomized to receive heparin (75 units/kg intravenously) before clamping of the artery. There was no significant difference in 30-day patency between the heparin and control groups (92% vs 86%, P = 0.65), respectively. Three patients (12%) developed hematomas in the heparin group compared with one (5%) in the control group; however the difference was not statistically significant ( P = 0.61). The results suggest that intraoperative administration of heparin has no statistically significant effect on 30-day patency rates or postoperative bleeding complications. Larger trials with longer term follow-up and assessment of maturation rates are needed to determine the effect of intraoperative anticoagulation on these outcomes of arteriovenous fistula surgery.

scholarly journals A Randomized Controlled Trial of Conbercept Pretreatment before Vitrectomy in Proliferative Diabetic Retinopathy

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Xiaochun Yang ◽  
Jianbiao Xu ◽  
Ruili Wang ◽  
Yan Mei ◽  
Huo Lei ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Diabetic Retinopathy ◽  
Proliferative Diabetic Retinopathy ◽  
Controlled Trial ◽  
Control Group ◽  
Intraoperative Bleeding ◽  
Significant Difference ◽  
Pars Plana ◽  
Effective Adjunct

Purpose.To determine the efficacy and safety of preoperative intravitreal conbercept (IVC) injection before vitrectomy for proliferative diabetic retinopathy (PDR).Methods.107 eyes of 88 patients that underwent pars plana vitrectomy (PPV) for active PDR were enrolled. All patients were assigned randomly to either preoperative IVC group or control group. Follow-up examinations were performed for three months after surgery. The primary bioactivity measures were severity of intraoperative bleeding, incidence of early and late recurrent VH, vitreous clear-up time, and best-corrected visual acuity (BCVA) levels. The secondary safety measures included intraocular pressure, endophthalmitis, rubeosis, tractional retinal detachment, and systemic adverse events.Results.The incidence and severity of intraoperative bleeding were significantly lower in IVC group than in the control group. The average vitreous clear-up time of early recurrent VH was significantly shorter in IVC group compared with that in control group. There was no significant difference in vitreous clear-up time of late recurrent VH between the two groups. Patients that received pretreatment of conbercept had much better BCVA at 3 days, 1 week, and 1 month after surgery than control group. Moreover, both patients with improved BCVA were greater in IVC group than in control group at each follow-up.Conclusions.Conbercept pretreatment could be an effective adjunct to vitrectomy in accelerating postoperative vitreous clear-up and acquiring stable visual acuity restoration for PDR.

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