Corneal epithelial defects following vitreoretinal surgery: incidence and outcomes from the DISCOVER study

AIM: To investigate the incidence, risk factors, clinical course, and outcomes of corneal epithelial defects (CED) following vitreoretinal surgery in a prospective study setting. METHODS: This was a post-hoc analysis of all participants in DISCOVER intraoperative optical coherence tomography study. Subjects with CED 1d after surgery without intraoperative corneal debridement was defined as the postoperative CED group. Subjects who underwent intraoperative debridement were defined as intraoperative debridement group. Eyes were matched 2:1 with controls (eyes without postoperative CED) for comparative assessment. The primary outcomes were the incidence of CED on postoperative day one and the incidence of required intraoperative debridement. Secondary outcomes included time to defect closure, delayed healing (>2wk), visual acuity (VA) and presence of scarring at one year and cornea consult. RESULTS: This study included 856 eyes that underwent vitreoretinal surgery. Intraoperative corneal debridement was performed to 61 (7.1%) subjects and postoperative CED developed spontaneously in 94 (11.0%) subjects. Significant factors associated with postoperative CED included prolonged surgical duration (P=0.003), diabetes mellitus (P=0.04), postoperative ocular hypotension (P<0.001). Prolonged surgical duration was associated with intraoperative debridement. Delayed defect closure time (>2wk) was associated with corneal scar formation at the end of the 1y in all epithelial defect subjects (P<0.001). The overall rate of corneal scarring for all eyes undergoing vitrectomy was 1.8%. CONCLUSION: Prolonged duration of surgery is the strongest factor associated with both intraoperative debridement and spontaneous postoperative CED. Delayed defect closure is associated with a greater risk of corneal scarring at one year. The overall rate of corneal scarring following vitrectomy is low at <2%.

Vitreoretinal Surgery in the Treatment of Dislocations of Intraocular Lens and Nucleus-Lens Particules into the Vitreous Cavity

Drops of lens nucleus/cortex particles into the vitreous cavity or dislocations of intraocular lenses (IOLs) are one of the serious complications of cataract surgery with an increasing relative frequency with the increase in the number of cataract surgeries. In addition, spontaneous and traumatic dislocations are other common case groups that should be treated. In this article, the vitreous dislocations of nucleus/cortex residues or IOL dislocations are discussed with different vitreoretinal surgical techniques.

Vitrectomy in Lens and Glaucoma Pathologies

Pars plana vitrectomy (PPV) is currently used as an effective method in many posterior segment pathologies. Although the most common indication is retina and vitreous pathologies, PPV is also preferred in some cases associated with lens and glaucoma. In case the crystalline lens or artificial intraocular lens, which is a product of industrial development, falls into the vitreous, it is essential to remove it mostly with the PPV approach. In some types of secondary glaucoma, especially malignant glaucoma, successful results are obtained in terms of visual prognosis and complications with vitreoretinal surgery techniques.

Biometry in Silicone Oil Filled Eyes. A Review

The “gold standard” of modern vitreoretinal surgery is silicone oil tamponade of the vitreous cavity. The lens opacity development is in the list of complications of prolonged silicone oil eye filling (from 2 weeks to 2 years). Polydimethylsiloxanes hydrophobicity, direct contact with the front of the silicone bladder, macrophage and toxic reaction, trophic disturbances are the causes leading to the cataract initiation. This makes the problem of cataract surgery and preliminary intraocular lens calculation in silicone oil filled eyes before its removing very relevant as well as cloudy retina visualization and the necessity of minimization of number of operations through their combination. Certainly, the main error in IOL power calculation is associated with axial length measurement inaccuracy, as the most significant term of an equation. Silicone oil filled eyes biometry errors, and, consequently, postoperative refraction biases remain unresolved problem until now. To date authors report only 58 % of cases in which target refraction was achieved after combined surgery. Some researchers figure out that average calculation error after phacoemulsification with IOL implantation in avitreal eyes was 0.8 D despite of the optical biometry usage. Today it is represented by several methods: partial coherent interferometry, optical low-coherence reflectometry and optical coherence tomography, which are implemented in devices such as IOLMaster 500, Lenstar LS 900 and IOLMaster 700, which have their own characteristics and measurement accuracy. Their advantages as well as creation an accurate IOL calculation method for silicone oil filled eyes could reduce postoperative refraction error that outline significant medical and social problem.

Intravitreal injections as a leading cause of acute postoperative endophthalmitis—a regional survey in England

Background To evaluate the characteristics, treatment patterns and outcomes of acute postoperative endophthalmitis. Methods Patients presenting with acute postoperative endophthalmitis between January 2017 to December 2019 were identified from hospital records in this multicentre retrospective cohort study. Clinical records were reviewed for visual acuity (VA) at various timepoints, cause of endophthalmitis, microbiological results, treatments and complications. Results Forty-six eyes of 46 patients were included. Intravitreal injections were the leading cause of acute postoperative endophthalmitis (n = 29; 63%), followed by cataract surgery (n = 8; 17%), vitreoretinal surgery (n = 7; 15%), and secondary intraocular lens insertion (n = 2, 4%). The absolute risk of endophthalmitis was 0.024% (1:4132) for intravitreal injections, 0.016% (1:6096) for cataract surgery, and 0.072% (1:1385) for vitreoretinal surgery. The majority of patients (n = 38; 83%) had better VA at 6 months compared to presentation, although fewer (n = 13; 28%) maintained similar or better VA compared to before the precipitating surgery. Twenty-four cases yielded positive culture results, of which staphylococcus epidermidis was the most commonly isolated organism. Microbiological yield was not associated with better final visual outcomes. Patients who underwent therapeutic vitrectomy (n = 15; 33%) had poorer VA at presentation, but subsequently achieved visual outcomes comparable to those who received medical treatment alone. There was no difference in time to presentation, visual outcome and retinal detachment rates among the different causative procedures. Conclusion Intravitreal injections were the most common cause of endophthalmitis in our region, primarily because of their higher frequency compared to other intraocular procedures. In this cohort, the primary procedure had no effect on presentation, management or visual outcomes.

Bupivacaine-lidocaine versus Ropivacaine-lidocaine Retrobulbar Anesthesia in Vitreoretinal Surgery

Purpose: To compare efficacies of bupivacaine-lidocaine and ropivacaine-lidocaine mixtures in terms of inducing retrobulbar anesthesia during vitrectomy.Methods: Sixty patients who underwent retrobulbar anesthesia during vitrectomy were divided into two groups. Patients in group 1 received a mixture of bupivacaine and lidocaine (n = 30); patients in group 2 received a mixture of ropivacaine and lidocaine (n = 30). The effects of the two combinations were retrospectively compared and analyzed. The onset times of analgesia and akinesia were measured. Two hours after surgery, sensory blockade was assessed by touching the corneas with cotton swabs and by communicating with patients. Ocular movement was evaluated in four gaze direction quadrants. A 10-point visual analog pain scale was used to assess pain during and 2 hours after surgery. Intra- and postoperative complications were recorded.Results: The mean analgesia onset times in groups 1 and 2 were 94.62 ± 28.87 and 92.32 ± 35.53 seconds, respectively (p = 0.071); the mean akinesia onset times were 147.89 ± 59.35 and 132.57 ± 76.38 seconds (p = 0.223), respectively. Patients in group 2 reported significantly less postoperative pain and exhibited less postoperative ocular movement, compared with patients in group 1 (both p = 0.002). One patient in group 1 experienced respiratory depression after retrobulbar blockade.Conclusions: When retrobulbar anesthesia is required during vitrectomy, a ropivacaine-lidocaine mixture and a bupivacaine-lidocaine mixture induce anesthesia with similar rapidity. However, the ropivacaine-lidocaine mixture is safer and affords better-quality intra- and postoperative anesthesia.