The Incidence of Retinal Breaks Induced by Posterior Hyaloid Separation During 27-Gauge Pars Plana Vitrectomy

Purpose: As advances are made in smaller-gauge vitrectomy, it is important to characterize the associated risks. This allows the surgeon to anticipate complications and appropriately counsel patients. The incidence of iatrogenic retinal breaks in 25- and 23-gauge (G) vitrectomy is known, but no studies exist looking at the incidence in 27G vitrectomy with an attached posterior hyaloid face (PHF). This study set out to characterize the incidence. Methods: A retrospective, consecutive, observational study of patients undergoing 27G transconjunctival sutureless vitrectomy for macular pathology or floaters was conducted. This was a single-surgeon series conducted between 2015 and 2017 at Calderdale Royal Hospital, United Kingdom. Inclusion criteria included only those with an attached PHF at the disc, identified intraoperatively. Results: Data were collected and analyzed in 94 patients. Preoperative diagnosis frequency was as follows: epiretinal membrane 24 (25.5%), macular hole 47 (50.0%), vitreomacular traction 11 (11.7%), and floaters 12 (12.8%). In 82 out of 94 patients (89.1%), 27G vitrectomy was combined with 2.2 mm microincisional phacoemulsification with lens implantation. The incidence of iatrogenic retinal breaks associated with PHF separation during 27G PPV was 17% (16 cases). Conclusions: This is the first study to report the incidence of peripheral retinal breaks induced by PHF separation during 27G vitrectomy. Our single-surgeon case series of 27G PPV for all elective vitreoretinal indications, in eyes with attached vitreous, yielded an iatrogenic break rate of 17%. However, no postoperative retinal detachments followed. Statistical analysis revealed no specific risk factors to be significantly associated with outcome (incidence of retinal tear).

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Risk factors for iatrogenic retinal breaks induced by separation of posterior hyaloid face during 23-gauge pars plana vitrectomy

Eye ◽

10.1038/eye.2013.6 ◽

2013 ◽

Vol 27 (5) ◽

pp. 652-656 ◽

Cited By ~ 12

Author(s):

R Rahman ◽

C D Murray ◽

J Stephenson

Keyword(s):

Risk Factors ◽

Pars Plana Vitrectomy ◽

Posterior Hyaloid ◽

Retinal Breaks ◽

Pars Plana ◽

23 Gauge

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Combined 20-gauge and 23-gauge pars plana vitrectomy for the management of posteriorly dislocated lens: a case series

Clinical Ophthalmology ◽

10.2147/opth.s11837 ◽

2010 ◽

pp. 625 ◽

Cited By ~ 5

Author(s):

Pipat Kongsap

Keyword(s):

Pars Plana Vitrectomy ◽

Case Series ◽

Pars Plana ◽

23 Gauge

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An Internal Limiting Membrane Plug and Gas Endotamponade for Recurrent or Persistent Macular Hole

Journal of Ophthalmology ◽

10.1155/2019/6051724 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6 ◽

Cited By ~ 4

Author(s):

Fabrizio Giansanti ◽

Ruggero Tartaro ◽

Tomaso Caporossi ◽

Daniela Bacherini ◽

Alfonso Savastano ◽

...

Keyword(s):

Macular Hole ◽

Case Series ◽

Internal Limiting Membrane ◽

Swept Source ◽

Macular Holes ◽

Small Gauge ◽

Pars Plana ◽

The Mean ◽

23 Gauge ◽

Anatomical Success

Introduction. Recurrent or persistent macular holes (MHs) are rare today due to the tendency to carefully peel the internal limiting membrane. Conversely, their treatment is still a challenge for a vitreoretinal surgeon. Materials and Methods. This is a retrospective, consecutive, and nonrandomized study of patients affected by recurrent or persistent MHs treated using small-gauge pars plana vitrectomy (25- or 23-gauge) and an autologous ILM plug, at the Eye Clinic of Azienda Ospedaliera Universitaria Careggi (Florence, Italy) between January 2016 and May 2018. We included 8 eyes of 8 patients in the study. Five patients had a recurrent MH while 3 had a persistent MH. The case series includes patients with myopic eyes and with large macular holes (>400 μ). Patients were followed up with ophthalmoscopic examinations and swept-source optical coherence tomography (SS-OCT). Results. The mean age of the patients was 74 years (±4.81 standard deviation (SD)), 3 patients were men and 5 women. The average axial length was 26.28 mm (±2.84 SD). Four patients had an AL ≧ 26 mm. The mean MH diameter was 436.5 (±49.82 SD). Average preoperative best-corrected visual acuity (BCVA) was 0.81 logMAR (±0.16 SD) and 20/125 Snellen. The ILM plug has been found integrated in the MH in all the follow-ups. Conclusion. In our study, an ILM autologous macular transplant was used successfully in 5 cases of macular hole recurrence and 3 cases of macular hole persistence. The anatomical success was achieved in all the cases; 4 patients improved their BCVA, and 4 patients maintained it. No macular alterations such as RPE or retinal atrophy/dystrophy were observed after 6 months.

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23-Gauge Pars Plana Vitrectomy with Pars Plana Baerveldt Tube Placement for Refractory Glaucoma

European Journal of Ophthalmology ◽

10.5301/ejo.5000027 ◽

2011 ◽

Vol 22 (1) ◽

pp. 90-94 ◽

Cited By ~ 3

Author(s):

Anton M. Kolomeyer ◽

Robert D. Fechtner ◽

Marco A. Zarbin ◽

Neelakshi Bhagat

Keyword(s):

Visual Acuity ◽

Survival Curve ◽

Case Series ◽

Tube Placement ◽

Refractory Glaucoma ◽

Tube Insertion ◽

Combined Procedure ◽

Pars Plana ◽

23 Gauge ◽

Baerveldt Tube

Purpose To describe a case series of combined 23-gauge vitrectomy and pars plana Baerveldt tube insertion for intraocular pressure (IOP) control in eyes with glaucoma resistant to maximum tolerated medical therapy and/or having failed previous IOP-lowering procedures. Methods Eight consecutive patients (8 eyes) undergoing a combined procedure were identified and included in this study. Outcome measures included preoperative and final best-corrected visual acuity (VA), IOP, number of glaucoma medications, and complications. Changes in IOP and glaucoma medications were compared by a paired t test. A Kaplan-Meier survival curve was constructed to evaluate IOP control as a function of time. Results Mean patient age was 70.9 years while the mean follow-up time was 12.1 months. Open angle glaucoma was diagnosed in 5 (68%) eyes. Six (75%) eyes were pseudophakic. All eyes received a 250-mm2 pars plana Baerveldt tube. Vision remained the same or improved in 6 (75%) eyes. Mean preoperative IOP and number of glaucoma medications were significantly (p<0.05) reduced by the combined procedure. Visual acuity of 5 (63%) eyes improved or remained unchanged. Six (75%) eyes encountered minor complications not requiring a return to the operating room. One (13%) eye underwent drainage of hemorrhagic choroidals on postoperative day 12. Conclusions A combined 23-gauge vitrectomy and pars plana Baerveldt tube insertion could be considered a useful procedure in reducing IOP and the number of glaucoma medications in eyes with refractory glaucoma.

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Efficacy and Safety of Intravitreal Conbercept, Ranibizumab, and Triamcinolone on 23-Gauge Vitrectomy for Patients with Proliferative Diabetic Retinopathy

Journal of Ophthalmology ◽

10.1155/2018/4927259 ◽

2018 ◽

Vol 2018 ◽

pp. 1-11 ◽

Cited By ~ 4

Author(s):

Jinglin Cui ◽

Hong Chen ◽

Hang Lu ◽

Fangtian Dong ◽

Dongmei Wei ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Proliferative Diabetic Retinopathy ◽

Silicone Oil ◽

Operation Time ◽

Intravitreal Ranibizumab ◽

Intravitreal Triamcinolone ◽

Retinal Breaks ◽

Pars Plana ◽

Silicone Oil Tamponade ◽

23 Gauge

Introduction. To compare the effect and safety of intravitreal conbercept (IVC), intravitreal ranibizumab (IVR), or intravitreal triamcinolone acetonide (IVTA) injection on 23-gauge (23-G) pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR). Methods. Fifty patients (60 eyes) of varying degrees of PDR were randomly grouped into 3 groups (1 : 1 : 1) (n=20 in each group). The 23-G PPV was performed with intravitreal conbercept or ranibizumab injection 3–7 days before surgery or intravitreal TA injection during surgery. The experiment was randomized controlled, with a noninferiority limit of five letters. Main outcome measures included BCVA, operation time, incidence of iatrogenic retinal breaks, endodiathermy rate, and silicone oil tamponade. Results. At 6 months after surgery, there were no significant differences of BCVA improvements, operation time, incidence of iatrogenic retinal breaks, endodiathermy rate, silicone oil tamponade, vitreous clear-up time, and the incidence of intraoperative bleeding between the IVC and IVR groups (all P values ≥ 0.05), but they were significantly different from the IVTA group (all P values < 0.05). IOP increases did not show significant differences between the IVC and IVR groups, but both were significantly different with the IVTA group. More patients had higher postoperative IOP in the IVTA group. Conclusions. The intravitreal injection of conbercept, ranibizumab, or TA for PDR had a significant different effect on outcomes of 23-G PPV surgery. Conbercept and ranibizumab can reduce difficulty of the operation, improve the success rate of PPV surgery, and decrease the incidence of postoperative complications.

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Comparison of Conjunctival Cytological Alterations following Conventional and Sutureless Sclerotomies

Ophthalmologica ◽

10.1159/000371771 ◽

2015 ◽

Vol 233 (3-4) ◽

pp. 230-235

Author(s):

Mehmet Citirik ◽

Canan Altunkaya ◽

Dilek Soba ◽

Tolga Bicer ◽

Huseyin Ustun

Keyword(s):

Pars Plana Vitrectomy ◽

Early Postoperative Period ◽

Impression Cytology ◽

Transconjunctival Sutureless Vitrectomy ◽

Conjunctival Impression Cytology ◽

Pars Plana ◽

Cytological Changes ◽

23 Gauge ◽

Cytological Alterations ◽

Sutureless Vitrectomy

Purpose: To assess the alterations in conjunctival impression cytology following 23-gauge transconjunctival sutureless versus conventional pars plana vitrectomy. Patients and Methods: Sixty consecutive patients were enrolled in the study. Conjunctival impression cytology was performed on 30 eyes (of 30 subjects) with 23-gauge transconjunctival sutureless vitrectomy and on 30 eyes (of 30 subjects) with conventional vitrectomy. Conjunctival impression cytology was performed preoperatively on the 1st day and in the 3rd month after the surgery. Impression cytology specimens of each group were graded and scored using a range of 0-3 according to Nelson's method. Results: In the conventional pars plana vitrectomy group, statistically significant alterations in the conjunctival impression cytology were detected on the 1st postoperative day (p = 0.001) and in the 3rd postoperative month (p = 0.001), whereas in the 23-gauge transconjunctival sutureless pars plana vitrectomy group, statistically significant changes were observed on the 1st postoperative day. However, no significant changes were observed in the following 3 postoperative months (p = 0.08). Conclusion: The properties of impression cytology were altered in the early postoperative period after sutureless and conventional vitrectomy. These changes were improved in the sutureless vitrectomy group only. Sutureless vitrectomy also had an advantageous effect on the conjunctival cytological changes and conjunctival structure.

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Sympathetic Ophthalmia Two Weeks After 23-Gauge Vitrectomy

10.21203/rs.2.24826/v1 ◽

2020 ◽

Author(s):

Bahaeddin El Khatib ◽

Alexander Hacopian ◽

Menka S. Patel ◽

Monica Dalal ◽

H. Nida Sen ◽

...

Keyword(s):

Rare Disease ◽

Pars Plana Vitrectomy ◽

Silicone Oil ◽

Case Series ◽

Sympathetic Ophthalmia ◽

Ocular Injury ◽

History Of ◽

Pars Plana ◽

23 Gauge ◽

The Uk

Abstract Sympathetic Ophthalmia (SO) is a rare disease that presents as a bilateral, diffuse, granulomatous panuveitis. Sympathetic Ophthalmia is a clinical diagnosis with history of penetrating ocular injury in the inciting eye and presence of panuveitis in the sympathizing eye. Though early enucleation is believed to minimize the risk, there have been reports of SO even after enucleation of inciting eyes. The possible association between vitrectomy and SO has been initially proposed by Gass [9] and later studied extensively in a large cohort in the UK with an estimated SO risk of 1 in 799 vitrectomies [11]. There have been several case series and reports of SO following vitrectomy, however only three documented cases of SO following vitrectomy without use of silicone oil. These cases demonstrated an onset of SO ranging between 4 weeks to 2 months. We present a patient with SO in the sympathizing eye presenting 16 days after an uncomplicated 23-gauge (23G) sutureless pars plana vitrectomy (PPV) without the use of silicone oil.

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Rhegmatogenous retinal detachment with giant retinal tear in a child with Marfan’s syndrome: a rare ocular emergency

BMJ Case Reports ◽

10.1136/bcr-2020-241354 ◽

2021 ◽

Vol 14 (6) ◽

pp. e241354

Author(s):

Parrina Sehgal ◽

Subina Narang ◽

Deepak Chandra

Keyword(s):

Retinal Detachment ◽

Pars Plana Vitrectomy ◽

Rhegmatogenous Retinal Detachment ◽

Marfan’S Syndrome ◽

Marfan's Syndrome ◽

Retinal Tear ◽

Giant Retinal Tear ◽

Pars Plana ◽

23 Gauge ◽

The Right

A 7-year-old boy with Marfanoid habitus presented with sudden and painless decrease in the vision of the right eye. Ocular examination revealed rhegmatogenous retinal detachment with 360° giant retinal tear in the right eye and small peripheral retinal breaks with lattice degeneration in the left eye. The patient underwent a 23-gauge pars plana vitrectomy with scleral buckling in the right eye and laser around the breaks in the left eye. At 1-week follow-up visit, the child presented with similar complaints in the left eye as were seen in the right eye. This was later managed effectively with 23-gauge pars plana vitrectomy only. So, with our case report, we would like to highlight the need for aggressive screening in children who are diagnosed with Marfan’s syndrome and the need for prophylactic treatment in the unaffected eye.

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Risk of Complications of Vitrectomy for Floaters Based on Attached or Detached Status of Posterior Hyaloid Face

Journal of VitreoRetinal Diseases ◽

10.1177/2474126417738626 ◽

2017 ◽

Vol 2 (1) ◽

pp. 16-21

Author(s):

Rubina Rahman ◽

Jack Gormley ◽

John Stephenson

Keyword(s):

Visual Acuity ◽

Prevalence Rate ◽

Primary Outcome ◽

Cox Regression ◽

Cox Model ◽

Case Series ◽

Secondary Outcome ◽

Retinal Break ◽

Posterior Hyaloid ◽

Retinal Breaks

Purpose: To ascertain whether posterior hyaloid face (PHF) status (attached vs detached) affects the risk of intraoperative retinal breaks and number of operations in patients undergoing vitrectomy for floaters. Methods: Consecutive, comparative single-surgeon case series. All patients undergoing vitrectomy for visually disabling floaters between July 2003 and June 2016 were included in this study. Data were collected prospectively into a vitreoretinal database and reviewed retrospectively for the purpose of the study.The following data were collected on each patient: age in years, sex, axial length (mm), presence of myopia, pre- and postoperative visual acuity in logarithm of the minimal angle of resolution. The status of the PHF was ascertained using preoperative clinical and optical coherence tomography assessment that was confirmed intraoperatively. The presence or absence of a retinal break was considered the primary outcome measure. Significant visual loss (reduction in ≥2 log units visual acuity), number of operations, and time from surgery to discharge were considered the secondary outcomes. Sequential multiple logistic and Cox regression analyses were conducted. Results: Data were collected from 97 patients (55 males and 42 females). Indications for surgery were Fuchs heterochromic cyclitis (9 patients), asteroid hyalosis (12 patients), and vitreous syneresis (76 patients). Twenty-one patients were pseudophakic on presentation, while 76 underwent combined phacovitrectomy. Vitreous status was significantly associated with retinal breaks ( P = .010). Controlling for other parameters, the odds of a retinal break in patients with PHF attached were about 5.5 times those in patients with PHF detached (95% confidence interval [CI], 1.52 -20.4). Number of operations was also significantly associated with this outcome ( P = .027); the odds of a retinal break increase by 6.28 times (95% CI, 1.23 -32.1). A substantive difference in the proportion of patients with retinal breaks was observed between the 2 groups, with a 50% prevalence rate in the attached group and a 9.1% prevalence rate in the detached group. Vitreous status was not associated with either secondary outcome measures. Number of operations was also significantly associated with time to discharge ( P = .008; hazard ratio, 2.78; 95% CI, 1.30 -5.91) in a multiple Cox model. Hence an increasing number of operations is associated with longer time to discharge. Conclusion: The analysis has found evidence to link vitreous status with the primary outcome of the presence of a retinal break. Particular care should be taken in, cases with vitreous attached status, to prevent missed breaks and subsequent rhegmatogenous retinal detachment.

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