Combined treatment of severe forms of diabetic retinopathy

Purpose. To evaluate the efficacy and safety of combined treatment of proliferative diabetic retinopathy (PDR), including primary vitrectomy and delayed single-stage patterned panretinal retinal laser coagulation (PLC). Material and methods. The study included 28 patients (28 eyes) with newly diagnosed PDD complicated by hemophthalmos and / or local traction retinal detachment with or without 1-2 stage gliosis, against the background of sub- or decompensation of the course of diabetes mellitus (DM). At the initial examination, a standard ophthalmological examination was performed, as well as fundus photography (Visucam 500, Carl Zeiss, Germany), optical coherence tomography (OCT) (STRATUS OCT Carl Zeiss, Germany). The best corrected visual acuity (BCVA) at admission ranged from light projection to 0.4. All patients were undergone combined treatment. Results. 1-1.5 months after pattern PLC, patients showed regression of neovascularization, ischemic zones were completely blocked, in cases of iris neovascularization, its regression was noted. According to OCT data, the height of edema in the macular zone did not increase. In all cases, the removal of silicone oil was completed within 1-2 months. The indices of BCVA increased and varied from 0.1 to 0.7 after the removal of the silicone oil. According to OCT data, 17 patients showed a decrease in the height of retinal edema in the macular zone from 73 to 150 µm. Conclusion. In the postoperative period after vitreoretinated surgery in patients with PDR, one-stage patterned PLC allows to stabilize the course of the disease in a shorter time and shorten the time of silicone tamponade of the vitreous cavity. Key words: proliferative diabetic retinopathy, vitrectomy, silicone tamponade of the vitreous cavity, patterned panretinal laser coagulation of the retina.

Vitrectomy Versus Combined Vitrectomy-Scleral Buckling for the Treatment of Pseudophakic and Aphakic Retinal Detachment

There is a disagreement on the ideal intervention for pseudophakic and aphakic retinal detachment. The goal of this thesis is to outline the difference between the two surgical approaches in getting higher reattachment rates and better visual outcomes. The study is a prospective randomised study to evaluate the efficacy of vitrectomy alone versus a combination of both vitrectomy and scleral buckling in the treatment of pseudophakic and aphakic retinal detachment. Aim: The aim of this study is to compare the anatomical and functional results of primary vitrectomy alone versus vitrectomy-scleral buckling for pseudophakic and aphakic retinal detachment. Patients and Methods: A total of 30 eyes with pseudophakic or aphakic retinal detachment will be divided into two groups. Fifteen consecutive pseudophakic or aphakic eyes with retinal detachment will be operated by vitrectomy-scleral buckling (Group-A) and Fifteen additional patients will be operated by vitrectomy alone (Group-B). Results: The two groups of the patients with a postoperative follow-up of at least 6 months continue to maintain an attached retina after one operation. Visual acuity has improved by at least 2 lines on the Snellen chart in 25 patients, remained the same in 2 patients, and decreased in 1 patient. Conclusion: This randomised study shows the same anatomic results when performing a PPV, fluid-air exchange, internal drainage, and endolaser together and SF6 gas injection with or without a scleral buckling for pseudophakic retinal detachment.

Primary vitrectomy for degenerative and tractional lamellar macular holes: A systematic review and meta-analysis

Purpose To assess the efficacy of vitrectomy in degenerative and tractional lamellar macular holes (LMHs) by meta-analysis of published studies. Methods PubMed, Medline and Embase databases were searched up to May 2020. Included cohorts were divided into three groups: degenerative LMH group, lamellar hole associated epiretinal proliferation (LHEP) group and tractional LMH group. LHEP is likely to be associated with degenerative LMHs, but less commonly could be associated with mixed LMHs. To reduce risk of possible misclassification bias, eyes with LHEP which could not have been precisely classified by the authors, were included into the LHEP group. The primary outcome was to investigate the visual change following primary vitrectomy in the degenerative LMH and LHEP group versus the tractional LMH group. A sensitivity analysis excluding the LHEP group was also performed on the primary outcome. Mean difference (MD) in best corrected visual acuity between baseline and post-treatment was calculated, along with 95% confidence interval (CI). Rate of incidence of post-operative full-thickness macular hole (FTMH) was assessed as secondary outcome. Results Thirteen studies were included. Pooled analyses including all groups showed a significant visual improvement following vitrectomy (pre-post MD = -0.17;95%CI = -0.22,-0.12;p<0.001), with no difference in visual improvement between the degenerative LMH and LHEP group and the tractional LMH group. The sensitivity analysis excluding LHEP group confirmed no difference in visual change between the degenerative LMH group (pre-post MD = -0.18;95%CI = -0.24,-0.12;p<0.001) and the tractional LMH group (MD = -0.16;95%CI = -0.26,-0.07;p<0.001). The incidence rate of post-operative FTMH was higher in the degenerative LMH and LHEP group than in the tractional LMH group (p = 0.002). Conclusion Primary vitrectomy for LMH ensured a favorable visual outcome, with no difference in visual gain between degenerative and tractional LMHs. However, a higher incidence of post-operative FTMHs was found in eyes with the degenerative LMH subtype.

Revision Surgery for Idiopathic Macular Hole after Failed Primary Vitrectomy

Purpose. To investigate the anatomical and functional outcomes of revision surgery after failed primary surgery for idiopathic macular hole (MH). Methods. All consecutive patients with MH were identified from a cohort of patients operated between 2014 and 2018 at the CHU de Québec-Université Laval (Québec). The clinical and anatomical features of patients with unclosed MH after primary surgery were retrospectively collected. Our primary outcome was MH nonclosure rate after revision surgery. Our secondary outcomes were best-corrected visual acuity (BCVA) with ETDRS scale and MH size of eyes with revision surgery preoperatively and at 3 and 12 months after revision surgery. Results. In our cohort of 1085 eyes, 926 eyes met inclusion criteria and were analyzed in the study. We identified 22 eyes with failed primary surgery (2.4%), of which 20 underwent revision surgery. We had no bilateral MH in these 22 eyes. The nonclosure rate of MH after revision surgery was 15%. The mean final BCVA for closed MH after revision surgery was 55 ± 19 letters. Compared to the initial presentation, the mean change in visual acuity (VA) for closed MH was +4 ± 31 letters and +16 ± 17 letters at 3 and 12 months after the revision surgery, respectively. At initial presentation, patients with failed primary surgery had a baseline MH size of 665 ± 226 μm. The mean MH size after failed primary surgery was 607 ± 162 μm and 546 ± 156 μm for the three unclosed MHs one month after revision surgery. Conclusion. The success rate of revision surgery in eyes with unclosed MH is 85%. After successful revision surgery, eyes demonstrated an improvement in VA and closure of the MH.

Lens-Induced Uveitis Triggered by Intravitreal Injection 40 Years after Primary Congenital Cataract Surgery with Aphakia

We report a case of a 42-year-old male with a history of bilateral congenital cataract surgery performed at 2 years of age. The patient was left with aphakia, secondary glaucoma, and a history of diabetic macular edema in the setting of diabetes mellitus type 1. The right eye became prephthisical from his congenital surgical repair, and his left eye presented with an acute pseudo-endophthalmitis developing after the seventh intravitreal injection to treat the macular edema. The eye then presented with decrease in vision, periocular injection, and a diffuse inflammatory reaction focused around the anterior residual lens capsule. The patient underwent surgical removal of the residual capsule and primary vitrectomy repair of the eye, achieving a significant improvement in visual symptoms and recovery of visual and anatomic function.