Surgical outcomes of 23-gauge transconjunctival pars plana vitrectomy combined with lensectomy for glaucomatous eyes with extremely shallow anterior chamber and cataract

Abstract Background Use of perfluorocarbon liquid (PFCL) has been increasingly growing as an adjuvant in vitreo-retina surgeries. Some commonly encountered complications with its use include subretinal migration, formation of sticky silicone oil or retained PFCL in vitreous cavity and anterior chamber. Scleral rupture during PFCL injection has a rare occurrence. We report an unexpected event of scleral rupture during PFCL injection and discuss the management challenges faced by the surgeon. Case presentation A 66 year indo-aryan male was undergoing pars-plana vitrectomy (PPV) with diagnosis of subtotal rhegmatogenous retinal detachment (RD) with Proliferative Vitreo-retonipathy (PVR)-B. After near total vitrectomy PFCL was being injected and then there was sudden poor visualization of fundus with development of bullous RD and globe hypotony. The surgeon was not able to figure out the cause of hypotony and air was switched on in the infusion cannula. This further complicated the situation resulting in migration of air in the anterior chamber, posterior dislocation of intraocular lens complex, 180° inferior retinal dialysis and ballooning of the conjunctiva which gave a clue of probable scleral rupture. Conjunctival peritomy was performed superiorly and scleral defect was noted. Intraocular tissue incarceration and air leak was visible from the wound. This confirmed scleral rupture during PFCL injection. Repositioning of incarcerated retina was not possible and retinectomy was performed followed by repair of scleral rupture with lots of difficulty in a vitrectomised eye. Conclusion PFCL injection, a crucial step of vitreoretina surgery, should be performed slowly with extreme caution maintaining an optimal intraocular pressure to prevent devastating complications like scleral rupture.

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Response to: Toilet Pars Plana Vitrectomy for surgical cases with shallow anterior chamber

Indian Journal of Ophthalmology ◽

10.4103/ijo.ijo_692_18 ◽

2018 ◽

Vol 66 (6) ◽

pp. 885

Author(s):

Rashmi Deshmukh ◽

Ritika Sachdev ◽

Avnindra Gupta ◽

Ritesh Narula

Keyword(s):

Anterior Chamber ◽

Pars Plana Vitrectomy ◽

Pars Plana ◽

Shallow Anterior Chamber

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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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Changes in anterior segment optical coherence tomography following pars plana vitrectomy without tamponade

International Journal of Retina and Vitreous ◽

10.1186/s40942-021-00285-w ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Alireza Khodabande ◽

Massood Mohammadi ◽

Hamid Riazi-Esfahani ◽

Shahab Karami ◽

Massood Mirghorbani ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Anterior Chamber ◽

Pars Plana Vitrectomy ◽

Anterior Segment ◽

Anterior Chamber Depth ◽

Optical Coherence ◽

Mean Values ◽

Iop Measurement ◽

Pars Plana ◽

The Mean

Abstract Background To evaluate changes in anterior segment morphology on anterior segment optical coherence tomography (AS-OCT) following pars plana vitrectomy (PPV) without tamponade. Methods Patients who underwent PPV without tamponade for epiretinal membrane were evaluated. Eligible patients underwent intraocular pressure (IOP) measurement and AS-OCT preoperatively as well as 1 month and 6 months post-operatively. Anterior chamber width (ACW), anterior chamber depth (ACD), trabecular iris angle (TIA), angle opening distance at 500 and 750 µm (AOD), and trabecular iris space area at 500 and 750 µm (TISA) at four quadrants were recorded and analyzed. Additionally, the mean values of TIA (MTIA), AOD (MAOD), and TISA (MTISA) for each eye (mean of four quadrants) were analyzed. Results 23 patients completed the study. The mean age of participants was 56.4 ± 3.6 years of age and 13/23 (56%) were female. Mean IOP of patients was 18.1 ± 1.1, 18.3 ± 1.1, and 18.1 ± 1.2 preoperatively,1 month post-operatively, and 6 months post-operatively, respectively. (p = 0.83). No difference was detected post-operatively in measurements of ACW, ACD, MTIA, MAOD500, MAOD750, MTISA500, and MTISA750. Conclusion Pars plana vitrectomy without tamponade was not associated with changes in anterior chamber morphology.

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Outcome of 23-Gauge Pars Plana Vitrectomy for Pediatric Vitreoretinal Conditions

Journal of Pediatric Ophthalmology & Strabismus ◽

10.3928/01913913-20131126-01 ◽

2013 ◽

Author(s):

Ramandeep Singh ◽

Neha Kumari ◽

Deeksha Katoch ◽

Gaurav Sanghi ◽

Amod Gupta ◽

...

Keyword(s):

Pars Plana Vitrectomy ◽

Pars Plana ◽

23 Gauge

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Unusual presentation of a choroidal melanoma

BMJ Case Reports ◽

10.1136/bcr-2020-240983 ◽

2021 ◽

Vol 14 (5) ◽

pp. e240983

Author(s):

Sunila Jain ◽

Kar Yen Phoong

Keyword(s):

Intraocular Pressure ◽

Anterior Chamber ◽

Pars Plana Vitrectomy ◽

Visual Loss ◽

Spindle Cell ◽

Choroidal Melanoma ◽

Artificial Eye ◽

History Of ◽

Pars Plana ◽

Eye Clinic

A 49-year-old gentleman presented with a 1-day history of painful deterioration of vision in his right eye. He was lifting heavy weights just before this visual loss. On examination, his vision was perception of light in that eye, with a medically uncontrollable high intraocular pressure and hyphaema almost completely filling his anterior chamber. An ultrasound performed suggested a working diagnosis of a Valsalva related ‘eight ball’ bleed. After an anterior chamber washout, he had another episode of bleeding three days later. A pars plana vitrectomy was performed and the sample obtained was sent off to the laboratory, revealing a choroidal melanoma. Following enucleation, the histology confirmed a large necrotic spindle cell melanoma, with a haemorrhagic background. Fortunately, no liver metastasis was found. Since his diagnosis 3 years ago, he continues to be followed up in an artificial eye clinic and has regular liver scans under the care of his oncologist.

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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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Pars Plana Vitrectomy and the Risk of Ocular Hypertension and Glaucoma: Where Are We?

Journal of Clinical Medicine ◽

10.3390/jcm9123994 ◽

2020 ◽

Vol 9 (12) ◽

pp. 3994

Author(s):

Tommaso Rossi ◽

Guido Ripandelli

Keyword(s):

Anterior Chamber ◽

Ocular Hypertension ◽

Oxygen Tension ◽

Pars Plana Vitrectomy ◽

Open Angle Glaucoma ◽

Crystalline Lens ◽

Cataract Extraction ◽

Oxygen Scavenger ◽

Clinical Series ◽

Pars Plana

Purpose is to review the pathogenic mechanism for ocular hypertension and glaucoma development after pars plana vitrectomy. Both acute and chronic causes are considered, and special attention is paid to the theories and clinical evidence on the risk of developing Open Angle Glaucoma (OAG) after Pars Plana Vitrectomy (PPV). Most existing scientific literature on the issue agree on the role of ascorbate as an oxygen scavenger within the vitreous chamber. Oxygen tension in the vitreous and anterior chamber is maximum inn proximity of the retinal surface and endothelium, respectively and steeply decreases toward the lens, on both sides, and trabecular meshwork. Vitreous removal and, to a lesser extent, liquefaction, greatly reduces oxygen tension gradient in vitreous chamber while cataract extraction has similar effects on anterior chamber oxygen gradients. Oxygen derivatives originated from the cornea and retina are actively reduced by the vitreous gel and/or the crystalline lens. Vitreous removal and cataract extraction reduce drastically this function. Most reported clinical series confirm this hypothesis although protocol difference and follow-up length greatly impact the reliability of results.

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