Inverted ILM Flap Technique in a Pediatric Traumatic Macular Hole—A Case Report

Purpose: To report and describe the clinical course of a pediatric traumatic macular hole (TMH) case and its management. Case Report: A pediatric patient presented a macular hole following blunt ocular trauma. The patient was followed every 2 weeks for 4 months. After the worsening of the macular hole reported by optical coherence tomography (OCT), pars plana vitrectomy with inverted flap technique plus SF6 gas tamponade was performed. Traumatic macular hole appeared closed at the OCT during follow-up. Initial visual acuity was counting finger at 30 cm. After surgery, the patient achieved a visual acuity of 20/100 at 3-month follow-up. Conclusion: This case shows a good anatomic and functional success performing a pars plana vitrectomy with inverted flap technique in a large TMH in a pediatric patient. We underline the importance of the surgical timing in the management of similar cases.

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A Female Case of X-Linked Retinoschisis with Macular Hole Bilaterally

Case Reports in Ophthalmological Medicine ◽

10.1155/2020/8824995 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

A. Altun

Keyword(s):

Visual Acuity ◽

Macular Hole ◽

Pars Plana Vitrectomy ◽

Silicone Oil ◽

Surgical Experience ◽

Flap Technique ◽

Macular Holes ◽

Female Case ◽

Pars Plana

Purpose. We aimed at reminding that X-linked retinoschisis may also be seen in female patients and share our vitreoretinal surgical experience. Methods. The patient underwent pars plana vitrectomy including the closure of the macular holes with inverted ILM flap technique bilaterally. Lens extractions were performed by phacoemulsification during the removal of silicone oil endotamponade. Patient. An 18-year-old girl with X-linked retinoschisis and large macular holes in both eyes presented to the clinic of ophthalmology. It was confirmed that the patient had RS1 mutation Results. Nine-month-follow-up was uneventful for retinal findings. Significant improvement in visual acuity was achieved, and macular holes were remained closed. Conclusion. In cases with large macular holes due to XLR, an inverted ILM flap technique might be safe and effective. Four-month-silicone-endotamponade might be sufficient.

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Eccentric Macular Hole after Pars Plana Vitrectomy for Idiopathic Macular Hole: A Case Report

Case Reports in Ophthalmology ◽

10.1159/000457830 ◽

2017 ◽

Vol 8 (1) ◽

pp. 116-119 ◽

Cited By ~ 1

Author(s):

Irini Chatziralli ◽

George Theodossiadis ◽

Maria Douvali ◽

Alexandros A. Rouvas ◽

Panagiotis Theodossiadis

Keyword(s):

Visual Acuity ◽

Macular Hole ◽

Pars Plana Vitrectomy ◽

Internal Limiting Membrane ◽

Ilm Peeling ◽

Pars Plana ◽

23 Gauge ◽

Retinal Hole ◽

The Right

Introduction: Postoperative eccentric macular hole (MH) formation is an uncommon complication after pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling for epiretinal membrane or MH treatment. Herein, we present a case of eccentric MH formation after PPV with ILM peeling for MH. Case Description: A 72-year-old female patient underwent 23-gauge PPV with ILM peeling for idiopathic MH in her right eye. The visual acuity was 6/24 in the right eye. One week postoperatively the retina was attached and the MH seemed to be closed, while visual acuity was 6/12. One month after PPV, there was a single eccentric retinal hole below the macula, which was detected at the fundoscopy and was confirmed by OCT. The visual acuity was 6/9 and the patient referred no symptoms. No further intervention was attempted, and at the 6-month follow-up the visual acuity and the size of the eccentric MH remained stable. Conclusions: Eccentric MHs can develop after PPV and are usually managed conservatively by observation.

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Microincision 25G Pars Plana Vitrectomy with Peeling of the Inner Limiting Membrane and Air Tamponade in Idiopathic Macular Hole

European Journal of Ophthalmology ◽

10.5301/ejo.5000815 ◽

2016 ◽

Vol 27 (1) ◽

pp. 93-97 ◽

Cited By ~ 7

Author(s):

Libor Hejsek ◽

Alexandr Stepanov ◽

Jaroslava Dusova ◽

Jan Marak ◽

Jana Nekolova ◽

...

Keyword(s):

Visual Acuity ◽

Macular Hole ◽

Pars Plana Vitrectomy ◽

Invasive Technique ◽

Idiopathic Macular Hole ◽

Inner Limiting Membrane ◽

Pars Plana ◽

Air Tamponade ◽

Age Range

Purpose To evaluate the success of a mini-invasive technique for operation of idiopathic macular hole (IMH). Methods We retrospectively examined 29 patients (30 eyes) in whom 25-G pars plana vitrectomy (PPV), peeling of the inner limiting membrane (ILM), and application of air tamponade were performed. The group of the patients included 7 males and 22 females (76%), age range 57-79 years (median 70). The follow-up period was 3-47 months (median 17). Results Pars plana vitrectomy was indicated only in the stages of full-thickness macular hole. Prior to operation, 13 eyes (43%) were in stage 2, 15 eyes (50%) in stage 3, and 2 eyes (7%) in stage 4. The IMH healed in 28 eyes after operation. Persistence of IMH occurred in 2 eyes (7%). After subsequent reoperation with extension of the peeling zone of the ILM and gas tamponade (with 10% C3F8), these macular holes also healed (100%). Prior to carrying out PPV, best-corrected visual acuity (BCVA) ranged between 20/40 and 20/500 (median 20/125). At the end of the follow-up period, BCVA was improved to 20/40 (median). The change in the final BCVA compared to the initial visual acuity was statistically significant (p = 0.008; Wilcoxon). Conclusions The 25-G PPV with peeling of the ILM and air tamponade is an effective technique and presents no increased risks in comparison with routine procedures. The main benefit of the intervention is its good tolerance by the patient, particularly with respect to painfulness and postoperative irritation.

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A pilot study on vitrectomy combined with scleral shortening for eyes with myopic macular retinoschisis—2y follow-up results

International Journal of Ophthalmology ◽

10.18240/ijo.2021.02.13 ◽

2021 ◽

Vol 14 (2) ◽

pp. 263-268

Author(s):

Peng Zhang ◽

◽

Ling-Xin Hou ◽

Yu-Hua Hao ◽

Kun Wang ◽

...

Keyword(s):

Visual Acuity ◽

Retinal Detachment ◽

Macular Hole ◽

Pars Plana Vitrectomy ◽

Macular Retinoschisis ◽

Corrected Visual Acuity ◽

Pars Plana ◽

The Mean ◽

Best Corrected Visual Acuity

AIM: To evaluate the effect of vitrectomy combined with scleral shortening for eyes with myopic macular retinoschisis. METHODS: Thirty-seven patients with myopic macular retinoschisis who underwent pars plana vitrectomy (PPV) combined with scleral shortening were reviewed. Axial length (AL), the height of macular retinoschisis, the height of retinal detachment if existed, the diameter of macular hole if existed and best corrected visual acuity (BCVA) were obtained. The preoperative and postoperative parameters were compared. RESULTS: At postoperative 24mo, the mean AL and height of macular retinoschisis were reduced significantly by 0.79 mm and 256.51 μm (t=8.064, P<0.0001; Z=-5.086, P<0.0001) respectively. In addition, the mean height of retinal detachment and diameter of macular hole were also reduced significantly by 365.38 μm and 183.68 μm (Z=-4.457, P=0.000008; Z=-2.983, P=0.003) respectively. Meanwhile, the postoperative BCVA was improved markedly (Z=-2.126, P=0.033). CONCLUSION: Vitrectomy combined with scleral shortening is an effective surgical method for eyes with myopic macular retinoschisis, whether or not macular hole and retinal detachment are present.

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Anatomical and Functional Outcomes of Relaxing Parafoveal Nasal Retinotomy for Refractory Macular Hole Repair

Journal of VitreoRetinal Diseases ◽

10.1177/2474126420987145 ◽

2021 ◽

pp. 247412642098714

Author(s):

Michael S. Tsipursky ◽

Matthew Byun ◽

Rama D. Jager ◽

Veeral S. Sheth

Keyword(s):

Visual Acuity ◽

Macular Hole ◽

Pars Plana Vitrectomy ◽

Internal Limiting Membrane ◽

Postoperative Outcomes ◽

Aperture Diameter ◽

Internal Limiting Membrane Peeling ◽

Macular Holes ◽

Pars Plana

Purpose: This work aimed to assess postoperative outcomes associated with relaxing parafoveal nasal retinotomy for refractory macular hole repair. Methods: This was a retrospective interventional study of patients with persistent or recurrent macular holes following 1 or more standard repair procedures with pars plana vitrectomy and internal limiting membrane peeling. Patients received an additional pars plana vitrectomy and relaxing parafoveal nasal retinotomy, followed by fluid-air and air-gas exchange. Key postoperative outcomes included the achievement of macular hole closure and changes in visual acuity from baseline. Results: Thirteen patients with refractory macular holes were included, with a median age of 65 years (range, 49-90 years). The aperture diameter of the 13 macular holes ranged from 180 to 799 µm (median, 538 µm). Vitrectomy and relaxing parafoveal nasal retinotomy were performed in all 13 eyes, and after a median follow-up of 12 months (range, 3-34 months), anatomical closure was achieved in 12 of 13 eyes (92.3%). Overall, visual acuity (mean ± SE) improved significantly from 1.20 ± 0.15 logMAR (approximate Snellen equivalent, 20/320) at baseline to 0.84 ± 0.11 logMAR (Snellen, ∼ 20/125) during postoperative follow-up ( P < .05). Central and paracentral scotomas were observed in 8 of 11 eyes with postoperative Humphrey visual field 10-2 and/or 24-2 data available. Conclusions: Relaxing parafoveal nasal retinotomy may be an effective method to promote anatomical closure and improve vision outcomes in patients with recalcitrant macular holes.

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

BMC Ophthalmology ◽

10.1186/s12886-021-01872-z ◽

2021 ◽

Vol 21 (1) ◽

Cited By ~ 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.

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Nucleus Drop or Intraocular Lens Drop Underwent Pars Plana Vitrectomy due to Complication of Cataract Surgery

International Journal of Retina ◽

10.35479/ijretina.2019.vol002.iss002.73 ◽

2019 ◽

Vol 2 (2) ◽

Author(s):

Noviana Kurniasari Vivin ◽

Ari Djatikusumo ◽

Elvioza Elvioza ◽

Gitalisa Andayani ◽

Anggun Rama Yudantha ◽

...

Keyword(s):

Visual Acuity ◽

Cataract Surgery ◽

Intraocular Lens ◽

Pars Plana Vitrectomy ◽

Iol Implantation ◽

Secondary Iol Implantation ◽

Choice Of Procedure ◽

Department Of Ophthalmology ◽

Pars Plana

Abstract Background: The incidence of nucleus drop or intraocular lens (IOL) drop as the complication of phacoemulsification increases due to the increased frequency of phacoemulsification. Pars plana vitrectomy (PPV) followed by endofragmentation and secondary IOL implantation is the choice of procedure for management. This study aims to determine the frequency, outcomes, and complication of PPV in the case of nucleus drop or IOL drop in the Department of Ophthalmology, Fakultas Kedokteran Universitas Indonesia – Rumah Sakit Cipto Mangunkusumo (FKUI-RSCM) Methods: This study is a retrospective descriptive study conducted in the Vitreoretinal Division of the Department of Ophthalmology, FKUI - RSCM. Research data was taken from the medical records of all nucleus drop or IOL drop patients underwent PPV in January 2017-December 2017. Results: There were 19 cases studied. The incidence of nucleus drop occurred in phacoemulsification surgery techniques (94.7%) and ECCE techniques (5.3%). Vitrectomy surgery was performed ≤2 weeks in 31.6% and >2 weeks in 68.4% after the patient first arrived at the vitreoretinal clinic. Most pre-PPV visual acuity was 1/60-6/60 (47.1%). In the final follow-up, visual acuity improved from 6/45 to 6/6 occurred in 42.2% of cases. Complication after PPV and secondary IOL implantation include elevated IOP (10.5%), IOL decentration (5.3%), corneal decompensation (5.3%), macular edema (5.3%), and retinal detachment (5.3%). Conclusion: Nucleus drop or IOL drop generally occurs in phacoemulsification cataract surgery techniques. Improved visual acuity was achieved after PPV and secondary IOL implantation at the end of the follow-up period. Most common post-PPV complication is elevated IOP.

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Recurrent Retinal Detachment after Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment

10.21203/rs.2.21163/v1 ◽

2020 ◽

Author(s):

Yan Fu ◽

Yue-ling Zhang ◽

Zhaohui Gu ◽

Ren-Fei Geng ◽

Xin-Yu Yuan

Keyword(s):

Visual Acuity ◽

Risk Factor ◽

Retinal Detachment ◽

Pars Plana Vitrectomy ◽

Rhegmatogenous Retinal Detachment ◽

Univariate Analysis ◽

Visual Outcomes ◽

Primary Surgery ◽

Pars Plana

Abstract Background The recurrence of retinal detachment (RD) following rhegmatogenous retinal detachment (RRD) is a relatively common complication that threatens vision and needs further surgery. The purpose of this study is to investigate the risk factors and visual outcomes of recurrent RD following pars plana vitrectomy (PPV) for primary RRD.Methods This was a retrospective follow-up of 343 eyes that underwent initial PPV surgery for primary RRD. Patients were divided into a recurrence group and a reattachment group. The main outcome measures included the causative factors, visual outcomes of RD recurrence, and the perioperative factors most affecting the recurrence of RD.Results After retinal reattachment, we observed recurrence of RD after PPV for primary RRD in 42 out of 343 eyes (12.2%) during the follow-up period. Most recurrence (69%) occurred within 6 months after surgery. Univariate analysis showed that the primary risk factor significantly associated with recurrent RD was the presence of proliferative vitreoretinopathy (PVR) ≥ Grade C ( P = 0.003). Logistic regression analysis showed that a PVR ≥ Grade C (odds ration [OR]: 9.421, 95% confidence interval [CI]: 2.432 - 56.39; P =0.020) was a significant predictor for the development of recurrent RD. The recurrence of RD resulted in a significant decline in best-corrected visual acuity (BCVA) at the last follow-up visit compared with the reattachment group ( P =0.000). Eyes with PVR prior to primary surgery or at the diagnosis of re-detachment showed a worse final BCVA.Conclusions The presence of PVR ≥ Grade C was the predominant risk factor for the recurrence of RD. PVR prior to primary surgery, or at the diagnosis of re-detachment, limited the recovery of final visual acuity.

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The outcome of vitrectomy with internal limiting membrane peeling for chronic macular hole at Biratnagar eye hospital: A tertiary eye care center in Nepal

Asian Journal of Medical Sciences ◽

10.3126/ajms.v7i6.15419 ◽

2016 ◽

Vol 7 (6) ◽

pp. 43-46

Author(s):

Lalit Agarwal ◽

Nisha Agrawal ◽

Pratap Karki ◽

Abhishek Anand

Keyword(s):

Macular Hole ◽

Pars Plana Vitrectomy ◽

Internal Limiting Membrane ◽

Internal Limiting Membrane Peeling ◽

Chronic Stage ◽

Visual Improvement ◽

Macular Holes ◽

Pars Plana ◽

Hole Closure

Background: A macular hole is a full-thickness defect of retinal tissue involving the anatomic fovea, thereby affecting central visual acuity. Pars plana vitrectomy and gas tamponade is a recognised modality of treatment for macular hole.Larger holes are more likely to remain open after repair and late reopening after an initially closed macular hole is seen in macular holes larger than 400 μm.Aims and Objective: To evaluate the anatomical and functional outcome of pars plana vitrectomy with internal limiting membrane peeling for chronic stage 3 macular hole.Materials and Methods: Records of 15 patients with stage 3 chronic macular holes operated from 1st January 2013 to 30th June 2013 and completed 1 year of follow up were retrospectively evaluated and included in the study. Preoperative best distance corrected visual acuity (BCVA), preoperative macular hole size, final BCVA and macular hole status at 1 year follow up were recorded. Macular hole closure and visual improvement was calculated. Correlation of macular hole closure and visual improvement with various macular hole parameter was estimated.Results: Eleven (73.3%) macular holes closed at 1 year follow-up. Mean BCVA improved from 1.2 ± 0.27 to 0.89 ± 0.36 logarithm of minimum angle of resolution at 1 year (p<0.001). Visual improvement was seen in only eight (53.3%) eyes. Both macular hole closure and visual improvement showed no correlation with minimum linear diameter, base diameter and hole height.Conclusion: Chronic stage 3 macular hole can be closed successfully in majority of patients with fairly good visual improvement. Macular hole parameters of stage 3 holes may not have any correlation with the anatomical and visual outcome.Asian Journal of Medical Sciences Vol.7(6) 2016 43-46

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An Atypical Presentation of Propionibacterium Acnes Endophthalmitis Following Cataract Surgery

Journal of VitreoRetinal Diseases ◽

10.1177/2474126419895873 ◽

2020 ◽

Vol 4 (4) ◽

pp. 332-336

Author(s):

Itamar Livnat ◽

Jay Daniels ◽

Leanne T. Labriola ◽

Michael S. Tsipursky

Keyword(s):

Visual Acuity ◽

Pars Plana Vitrectomy ◽

Complete Resolution ◽

Propionibacterium Acnes ◽

Visual Outcome ◽

Unusual Presentation ◽

Atypical Presentation ◽

Good Visual Outcome ◽

Pars Plana

Purpose: To describe a case with an unusual presentation of Propionibacterium acnes ( P acnes) with ultimately a good visual outcome. Methods: A case report with review of approaches to P acnes endophthalmitis. Results: We describe a patient with an unusual presentation of P acnes of panuveitis with white, circular preretinal lesions without intracapsular deposits. Diagnosis was made from cultures from pars plana vitrectomy. Eventually, she was definitively managed with capsulectomy, repositioning of her intraocular lens via sutureless intrascleral fixation, and intravitreal vancomycin injection. Conclusion: This is a report of P acnes endophthalmitis presenting with discrete preretinal lesions where surgical and medical management lead to a complete resolution of uveitis and symptoms after a 3-year follow up where the patient’s final visual acuity was Snellen 20/20 OU.

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