scholarly journals Pneumatic induction of the posterior vitreous detachment - a minimally invasive method of treating vitreomacular traction syndrome

2017 ◽  
Vol 98 (5) ◽  
pp. 865-868
Author(s):  
D V Petrachkov ◽  
A V Zolotarev ◽  
P A Zamytskiy ◽  
E V Karlova ◽  
T A Podsevakina

To study the efficacy of pneumatic induction of posterior vitreous detachment for the treatment of vitreomacular traction syndrome, the analysis of the results of surgical treatment of 10 patients (10 eyes) with vitreomacular traction syndrome was performed, among them 8 patients (8 eyes) had an accompanied immature age-related cataract and 2 patients (2 eyes) - pseudophakia. The average age of the patients was 64.1±4.6 years, among them 8 women and 2 men. The mean best corrected visual acuity on admission was 0.31±0.15, the average length of vitreomacular adhesion and retina thickness in the fovea by optical coherence tomography were 289.3±75.4 and 367.5±50.3 μm, respectively. Patients with pseudophakia underwent pneumatic induction of the posterior vitreous detachment, and patients with cataract underwent the same surgery in combination with phacoemulsification of the cataract and intraocular lens implantation. Within 1 month of follow-up, all patients had a complete posterior vitreous detachment and increased best corrected visual acuity. Intraocular pressure remained normal throughout the follow-up period in 9 out of 10 patients, 1 patient experienced hypertension on day 1 after the surgery, which required decompression during the gas expansion period. Further on, intraocular pressure was normalized and did not require therapy. Pneumatic induction of posterior vitreous detachment is an effective method of treatment of vitreomacular traction syndrome, which allows eliminating vitreomacular traction; the combination of pneumatic induction of the posterior vitreous detachment with phacoemulsification of cataract allows avoiding hypertension during and after operation and avoiding performing vitrectomy.

2013 ◽  
Vol 13 (2) ◽  
pp. 33-41
Author(s):  
Devendra Maheshwari ◽  
Rengappa Ramakrishanan ◽  
Mohideen Abdul Kader ◽  
Neelam Pawar ◽  
Ankit Gupta

Aim: To evaluate the effect of phacoemulsification with intraocular lens implantation in eyes with pre-existing trabeculectomy.Methods: This prospective single-center clinical study evaluated intraocular pressure in 60 eyes of 60 patients who underwent phacoemulsification and implantation of a foldable intraocular lens after a previous successful trabeculectomy. Patients who had a trabeculectomy more than one year prior to the study were included. Intraocular pressure, number of antiglaucoma medications, bleb appearance, and visual acuity were recorded preoperatively, and at each follow-up examination and 12 months after phacoemulsification.Results: The mean intraocular pressure before phacoemulsification was 12.42 mmHg (SD, 4.60 mmHg), which increased to 14.98 mmHg (SD, 4.18 mmHg), 14.47 mmHg (SD, 3.58 mmHg), 15.44 mmHg (SD, 3.60 mmHg), and 15.71 mmHg (SD, 3.47 mmHg) after one, three, six, and 12 months, respectively. At each follow-up visit, the mean IOP was significantly higher than the preoperative value (p < 0.001, p = 0.015, p ≤ 0.001, and p = 0.001 at month one, three, six, and 12, respectively). The mean preoperative best-corrected visual acuity was 0.98 logMAR (SD, 0.44 logMAR) and the mean postoperative best-corrected visual acuity at 12 months was 0.20 logMAR (SD, 0.21 logMAR) [p = 0.0001]. The mean preoperative number of antiglaucoma medications used was 0.57 (SD, 0.63), which increased to 0.65 (SD, 0.63 ), 0.70 (SD, 0.72 ) 0.68, (SD, 0.70), and 0.67 (SD, 0.77 ) at one, three, six, and 12 months, respectively, but there were no statistically significant differences. Bleb size decreased clinically after phacoemulsification. Nineteen of 60 eyes (32%) developed fibrosis of bleb with decreased bleb size.Conclusion: Phacoemulsification with intraocular lens implantation significantly increased intraocular pressure and increased the number of antiglaucoma medications in eyes with pre-existing functioning filtering blebs.


2020 ◽  
pp. bjophthalmol-2019-315558
Author(s):  
George Varghese Puthuran ◽  
Paul Frederic Palmberg ◽  
Hiruni Kaushalya Wijesinghe ◽  
Thandra Sai Shreya ◽  
S R Krishnadas ◽  
...  

AimTo determine the outcomes of Aurolab aqueous drainage implant (AADI) placed in the superotemporal versus the inferonasal quadrant in adult eyes with refractory glaucoma.MethodsThis was a retrospective study of eyes that had AADI placement and completed a minimum of 2-year follow-up. The choice of the quadrant was at the surgeon’s discretion and mainly depended on the amount of scarring and conjunctival mobility. The cumulative failure rate of the AADI was defined as intraocular pressure (IOP) >21 mm Hg or not reduced by 20% below baseline on two consecutive follow-up visits after 3 months, IOP ≤5 mm Hg on two consecutive follow-up visits after 3 months, reoperation for glaucoma or a complication, or loss of light perception vision.ResultsWe included 84 eyes with AADI in the inferonasal quadrant versus 69 eyes in the superotemporal quadrant. A significant drop in IOP was seen in both groups (18.4±10.4 mm Hg in the inferonasal group vs 17.7±11.1 mm Hg in the superotemporal group; p=0.63) at 3-month follow-up and this was maintained until last follow-up. Best-corrected visual acuity, IOP, number of IOP-lowering medications and complications were similar between the two groups at all time points. The cumulative success rate at 2-year follow-up without IOP-lowering medications was 57.1% (47.1%–68.1%) in the inferonasal group and 50.7% (39.8%–63.1%) in the superotemporal group (p=0.47).ConclusionsInferonasal AADI placement appears to be an equally safe and effective surgical option compared with superotemporal AADI placement and may be helpful in certain clinical situations.


2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Xiang Chen ◽  
Yi Yao ◽  
Xiaolu Hao ◽  
Xiaocui Liu ◽  
Tiecheng Liu

Purpose. The treatment of idiopathic macular holes has been basically modeled, and vitreoretinal surgery is recognized as an effective treatment. However, the postoperative tamponade of gas will still make the patient uncomfortable and may have related complications. The purpose of this study is to investigate whether air as an intraocular tamponade is equivalent to gas and what advantages may exist. Methods. A retrospective study was performed in one hundred and ninety-eight patients from 2013 to 2017; 112 received gas tamponade and 86 received air tamponade. After receiving retinal surgery, the outcomes of best corrected visual acuity, intraocular pressure, slit lamp examination, fundus examination, and imaging of the macula by spectral-domain optical coherence tomography were analyzed. Results. Before operation, there was no statistically significant difference in age, sex, macular hole diameter, or visual acuity between groups. The median follow-up period for the C3F8 group was 26 months, and the median follow-up for the air group was 25 months. After the operation, the best corrected visual acuity and macular hole closure rate were not significantly different between the two groups. The face-down time after the operation, the incidence of lens opacity on the third postoperative day, the intraocular pressure on the third postoperative day, and the operation time were significantly different between the two groups. Conclusions. In idiopathic macular hole surgery, the effect of air as an intraocular tamponade material can be similar to that of C3F8 but has fewer complications. In particular, it is a better choice for patients for whom the face-down position is not suitable.


2021 ◽  
Vol 9 (B) ◽  
pp. 1480-1483
Author(s):  
Hasanain Hasan Attar ◽  
Farooq Mohammed Abbas ◽  
Haider Layikh

Abstract Background: clinically significant macular edema ( CSME) consider as one of the most critical complications of poorly controlled diabetes and it’s the main reason for decreased vision in that kind of patients, we try in this article to find the relation between glycosylated hemoglobin level and the response to bevacizumab injections in people with macular edema   Materials and methods: Ninety-five patients (55 male:40 female) were recruited in this study, all of them had diabetes type2, age of the participants ranging from 42 to 70 years old, Complete ophthalmic examination was done for all the participants including (best-corrected visual acuity), (intraocular pressure) checking, fundus evaluation, and central macular thickness measurement, serum glycosylated hemoglobin (HbA1C) was also measured, Patients were given 0.05ml(1.25mg) of bevacizumab (Avastin)  intravitreally for three successive months, Follow up visit was at 4,8,12 week post-injection. On each follow up detailed examination was done including the( best-corrected visual acuity) examination, (Intraocular pressure), both fundus examination, and OCT of the macula. Results: This study included 111 patients who had type 2 diabetes mellitus who were classified according to HbA1c into two sub-groups, HbA1c ≤ 7 % (n = 45) and HbA1c > 7 % (n = 66) we found no significant difference in mean age and frequency distribution according to gender between study groups (p > 0.05), but, there was a highly significant difference in mean HbA1c % (p < 0.001). when we compare mean OCT and mean VA before and after the intervention in patients who had diabetes mellitus classified according to HbA1c into (HbA1c ≤ 7 % and HbA1c > 7 %) we found that before the intervention, there was no significant difference in mean OCT between study groups (p > 0.05), but after the intervention, there was a reduction in mean OCT and the reduction was more pronounced in the group of HbA1c of less than 7 % (p < 0.001). About visual acuity, we found no significant difference before the intervention and after the intervention, the changes were comparable between both study groups (p > 0.05). Conclusion: intra-vitreal injections of bevacizumab result in anatomical (macular thickness) and functional (vision ) improvement in those patients who had diabetic macular edema and strict glycemic control affecting the outcome of the treatment where strict regulation of glucose level have yield maximum benefit from the given therapy   


2021 ◽  
Author(s):  
Pir Salim Mahar ◽  
Asma Rahman

Abstract Purpose: To evaluate the efficacy of trabeculectomy with intraoperative subtenon injection of Mitomycin C (MMC) in terms of control of Intraocular pressure post-operatively.Study design: Observational studyMethods: A total of 49 patient’s medical records who underwent trabeculectomy with intraoperative subtenon injection of MMC with diagnosis of Primary Open Angle Glaucoma (POAG) from January 2017 to December 2018 were evaluated to see the post-operative outcomes in terms of control of intraocular pressure (IOP) with 12 months follow-up. The medical records were retrieved using the hospital information system. Age, gender, pre-operative IOP, Best-Corrected Visual Acuity (BCVA), co-morbids, previous surgery, Central Corneal Thickness (CCT), fundus findings, number of glaucoma medications and postoperative complications were obtained by using a proforma.Results: Total 72 eyes of 49 patient records were evaluated to see post operative outcomes at three, six and twelve months follow up. The mean IOP preoperatively was 24.68±13.66 mm Hg with maximum anti-glaucoma treatment. After the surgery the mean IOP was 13.69±6.68 mmHg at 3 months follow-up, and 12.68±4.04 and 13.33±4.8 mmHg at 6 and 12 months respectively (P-value 0.001). Preoperatively mean CCT was 529.81±28.75 and at 12 months follow-up after surgery was 530.45±29.43 with P-value 0.245. Best Corrected Visual Acuity outcomes were seen at each follow-up and results were found to be statistically significant (P value ≤ 0.05).Conclusions: Twelve months follow-up of trabeculectomy show that intraoperative subtenon injection of MMC is effective in terms of control of IOP postoperatively with minimal complications in patients with POAG.


2020 ◽  
Vol 76 (5) ◽  
pp. 236-242
Author(s):  
Petra Farraová ◽  
Marta Ondrejková ◽  
Daniela Demianová

Cyclodestructive procedures are an alternative of surgical treatment of medically refractory glaucoma. Aim: To assess efficiency and safety of diode cyclophotocoagulation (CPC). Methods: Retrospective study included 81 eyes with advanced glaucoma operated with CPC for elevated intraocular pressure (IOP) from January 2017 to January 2019. CPC was performed in retrobulbar anesthesia with contact diode laser FOX (A.R.C. Laser, Germany) of wavelength 810 nm, transsclerally to the ciliary body. Energy settings: intensity 2 W, exposition time 2 s, 18 applications in arc of 360°. Decrease of intraocular pressure was investigated during month 1, 6 and 12 after CPC. Safety was evaluated according to the best corrected visual acuity (BCVA) on Snellen optotypes and number of postoperative complications. Results: Study on 31 eyes of 24 patients, 21 (68 %) women and 10 (32 %) men, with follow-up during more than 12 months. Mean follow-up time was 19.5 ± 6.1 (from 12 to 29) months. Average age was 75.9 ± 9.2 (56 - 93) years. Indication for CPC was primary open angle glaucoma in 15 eyes (49 %), primary angle closure glaucoma in 6 eyes (19 %) and secondary glaucomas in 10 eyes (32 %). All patients were on therapy of 4 antiglaucomatic drops and 10 of them (32 %) on acetazolamide pills. IOP before CPC was 25.4 ± 11.0 (13–56) mm Hg. After 1 year IOP decreased to 16.9 ± 6.1 (8–40) mm Hg. Best corrected visual acuity (BCVA) before CPC was 0.39 ± 0.34 (0-1), 1 year after CPC 0.36 ± 0.33 (0-1). 1 year after CPC, 11 eyes (35 %) lost 0.23 ± 0.14 rows. 6 from these (19 %) due to other acquired ocular pathologies. Hypotony occurred in 6 % and uveitis in 10 % eyes. Conclusion: CPC is a safe and effective method of lowering IOP.


2018 ◽  
Vol 29 (2) ◽  
pp. 210-215 ◽  
Author(s):  
Marta Misiuk-Hojlo ◽  
Maria Pomorska ◽  
Malgorzata Mulak ◽  
Marek Rekas ◽  
Joanna Wierzbowska ◽  
...  

Purpose: To assess tolerability and efficacy following a switch from benzalkonium chloride–latanoprost to preservative-free latanoprost in patients with glaucoma or ocular hypertension. Methods: A total of 140 patients with glaucoma or ocular hypertension controlled with benzalkonium chloride-latanoprost for at least 3 months were switched to treatment with preservative-free latanoprost. Assessments were made on days 15, 45, and 90 (D15, D45, and D90) and included best-corrected visual acuity, intraocular pressure, slit lamp examination, fluorescein staining, tear film break-up time, patient symptom evaluation, and subjective estimation of tolerability. Results: Mean best-corrected visual acuity remained unchanged during the study. Mean intraocular pressure compared with baseline (D0) remained stable throughout the study (D0, 15.9 mmHg (standard deviation = 2.6); D90, 15.3 mmHg (standard deviation = 2.4); p < 0.006). Tear film break-up time improved or remained unchanged relative to baseline in 92% of patients at D45 and in 93% at D90. Moderate-to-severe conjunctival hyperemia was seen in 56.8% of patients at D0, but this figure decreased to 13.7%, 2.2%, and 1.6% at D15, D45, and D90, respectively. Subjective assessment of tolerability (0–10 scale) indicated improvement with change of therapy (mean score: 5.3 (standard deviation = 2.2) at D0 versus 1.9 (standard deviation = 1.7) at D90; p < 0.0001). Conclusion: Preservative-free latanoprost has at least the same intraocular pressure-lowering efficacy as benzalkonium chloride–latanoprost, with a better tolerability profile. This may translate into greater control of treatment and improved quality of life.


2021 ◽  
Vol 13 ◽  
pp. 251584142110408
Author(s):  
Burçin Çakır ◽  
Nilgün Özkan Aksoy ◽  
Sedat Özmen ◽  
Özlem Bursalı

Background: Amblyopia is more common in children with high astigmatism, but factors contributing to development of amblyopia and visual outcomes are not fully understood. Objective: To evaluate the effect of amblyopia on the clinical outcomes in children with ⩾1.75 diopter (D) astigmatism. Methods: We reviewed the medical records of children with ⩾1.75 D astigmatism with and without amblyopia (amblyopes group and non-amblyopes group). The mean age, gender, amount and type of ocular deviation, presence of convergence insufficiency (CI), stereopsis, time of initial spectacle use and follow-up time, differences in best-corrected visual acuity (VoD) and spherical equivalent (SE) between eyes were assessed and compared between the groups. Best-corrected visual acuity (BCVA), mean SE, astigmatism measurements were assessed and compared between amblyopic, fellow, and non-amblyopic eyes. Results: The records included 68 eyes of 34 children with amblyopia and 56 eyes of 28 children without amblyopia. The mean age, gender, amount and type of ocular deviation, presence of CI, stereopsis, time of initial spectacle use, follow-up time, and the difference in SE did not differ between groups. In amblyopes, exodeviation was more common and statistically greater in near (33 cm) than at distance (6 m) (p = 0.005). The mean BCVA and astigmatism values were statistically different between amblyopic, fellow, and non-amblyopic eyes. Conclusion: A greater near than distance exodeviation and higher mean astigmatism value were found in amblyopic children with astigmatism.


2020 ◽  
Vol 15 (1) ◽  
pp. 94-97
Author(s):  
Md Abdullah Al Masum ◽  
Md Kamrul Hasan Khan ◽  
Zulfikar Hasan ◽  
Natasha Kajmina

Introduction: Torsional ultrasound energy and burst mode interrupted energy delivery system are recent advancementsin the technique of phacoemulsification surgery. It has been reported that both these advancementshelpto reduce corneal wound burn and thermal induced endothelial cell loss and thereby helps to achieve excellent early postoperative visual outcome Objectives: To evaluate the efficacy of burst mode torsional phacoemulsification surgery in age-related cataract. Materials and Methods: Prospective observational study of 120 cases that underwent phacoemulsificationcataract surgery in which torsional energy was used in burst mode. Phacoemulsification was performed by “vertical –chop” technique. Intraoperatively corneal wound burn, Descemet’s membrane detachment, posterior capsule ruptureetc.were evaluated. Postoperatively corneal oedema, best corrected visual acuity, cystoid macular oedema were evaluated. Postoperatively eyes were examined at day 1, 1 week, 6 weeks and 3 months. Results: Mean age of the patients was 57.28± 8.20 years. Most of the patients 81(67.5%) had nuclear sclerosis grade-II cataract.Intraoperatively, moderate wound burn occurred in 02(1.6%) eyes, localized Descemet’s membrane detachmentin 03(2.5%) eyes and posterior capsule rupture occurred in 03(2.5%) cases. Postoperatively, moderate and severe corneal edema was found in 06(5.0%) and 04(3.3%) eyes respectively at day 1. At the end of 3 months follow-up, 114(95%) eyes maintained a best corrected visual acuity of ≥ 6/18, of which 109(90.8%) eyes achieved ≥ 6/9. Conclusion: Burst mode torsional phacoemulsfication is a very effective and advanced technique of cataract surgery. Intraoperative complications are very less and visual outcome is excellent. Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 94-97


2019 ◽  
Author(s):  
fei you

Abstract Background: malignant glaucoma after cataract surgery is still one of the serious complications, if not handled properly,it may lead to serious consequences. It is notoriously difficult to treat. 25G vitrectomy was performed to evaluate the safety and efficacy for the treatment of malignant glaucoma in pseudophakia. Methods: This is a retrospective, comparative case series study. A total of 20 eyes of 20 patients with malignant glaucoma after phacoemulsification were analyzed retrospectively in The First Affiliated Hospital Of Anhui Medical University from May 2015 to January 2018. All Medical Data including the best corrected visual acuity (BCVA), Change of intraocular pressure (IOP), the length of eye axis, and the depth of anterior chamber were recorded. SPSS 17.0 statistical software was used for analysis .Before surgery, the best corrected visual acuity (BCVA) was 1.8±0.6. The intraocular pressure was between 18-57mmHg, with an average of 35.2±10.4mmHg.The depth of anterior chamber was between 0.9-1.9mm, with an average of 1.3±0.2mm.The length of eye axis was 19.7-22.5mm,with an average of 20.6±0.5mm.All the patients were accomplished with 25G vitrectomy. Besides, anterior chamber inflammatory reaction and other complications were also observed postoperation. Results: The patients were followed up for 6-12 months with an average of 9 months. BCVA at the last follow up improved to 0.8±0.1, and there was significant difference compared to that before operation (P<0.01).IOP was from 12-19mmHg, an average of 16.1±2.5mmHg, there was significant difference compared to that before operation (t=7.6, p<0.01).Only one patient occurred low IOP (6mmHg) after surgery, IOP returned to normal level (14mmHg) after conservative treatment. No serious complications including corneal endothelium decompensation, intraocular lens (IOL) capture, intraocular hemorrhage, endophthalmitis and uncontrolled IOP were observed. Conclusions: 25G minimally invasive vitrectomy can treat malignant glaucoma after cataract surgery safely and effectively


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