Long-term Clinical Outcomes of Vitrectomy with 360° Laserpexy or Scleral Encircling in Rhegmatogenous Retinal Detachment

Purpose: To compare long-term clinical outcomes of pars plana vitrectomy (PPV) combined with intraoperative 360° laserpexy and pars plana vitrectomy combined with scleral encircling for the treatment of primary rhegmatogenous retinal detachment (RRD).Methods: This retrospective, comparative case study included 70 patients who had at least 1 year of follow-up after vitrectomy for primary uncomplicated RRD from 2015 to 2019. The patients were divided into two groups. Group I included 34 patients who underwent PPV + 360° laserpexy (LP), while group II included 36 patients who underwent PPV + scleral encircling (SE). Main outcome measures were the anatomical success rate, the functional success rate, final best-corrected visual acuity (BCVA), and the incidence of post-operative complications. We also examined the long-term changes in axial length, corneal curvature, and refractive error before and after surgery.Results: LP and SE groups showed no significant differences with respect to the primary anatomical success rate (97.05% and 94.44%, respectively; p = 0.592) or the functional success rate (BCVA ≥ 20/40 at final follow-up; 82.35% and 77.78%, respectively; p = 0.635). Detachment reoccurred in three cases (one in the LP group and two in the SE group) because of proliferative vitreoretinopathy; both cases in the SE group had successful anatomical re-attachment after repeating the PPV procedure. Complications included post-operative epiretinal membrane and cystic macular edema, as well as increased intraocular pressure.Conclusions: Primary vitrectomy combined with 360° laserpexy has effectiveness similar to vitrectomy combined with scleral encircling in patients with RRD in long-term clinical outcomes.

Coats Disease in 9 Patients: A Hispanic Case Series

Background/Aim To describe demographic and clinical characteristics, treatment, and visual prognosis of Coats disease in Hispanic patients. Methods A retrospective chart review was performed on nine patients (ten eyes) diagnosed with Coats disease in our two clinical centrers from 2004 – 2017. Results Mean age at diagnosis was 5.5 years (range 1 – 12 years) and mean follow-up time was 48 months (range 9 – 108 months). Eight patients (89%) were male and had unilateral disease and one (11%) female patient had bilateral disease. In 40% of the cases, patients were asymptomatic. Visual acuity at first presentation was worse than hand motion in 60% of the eyes. Half of the eyes (5/10 eyes, 50%) had exudative retinal detachment (≥ stage IIIA). Vascular ablation with cryotherapy combined with retinal photocoagulation was the most frequent therapeutic approach (40%). Despite anatomical success at 6 months in 100% of the treated eyes, visual outcome at 1 year of treatment was poor (worse than 20/200) in 70% of the cases. Conclusions In our case series, patients were mostly asymptomatic on presentation, with severe stages of Coats disease. Even with anatomical success after surgical treatment in all treated cases, long-term visual prognosis remained very limited.

A New Modification in Endoscopic Endonasal Dacryocystorhi̇nostomy: Scopy-Guided Approach

PurposeTo compare and assess classic endoscopic dacryocystorhinostomy (cEDCR) and scopy-guided endoscopic dacryocystorhinostomy (sEDCR) which is a new approach we developed in cases of primary nasolacrimal duct obstruction (PNLDO).MethodsFifty eyes (7 in both eyes) of 43 patients who applied with epiphora and underwent endoscopic DCR and silicone tube implantation between 2015 and 2019 were prospectively studied. cEDCR was performed on 26 of 50 eyes, and sEDCR was performed on 24 of 50 eyes. In sEDCR application, 5 cc non-ionizing opaque material was injected after punctum dilatation, lateral oblique radiographs were taken from the obstructed side with C-arm scope, and the size and location of the lacrimal sac were made visible. Thence, the most appropriate part of the passage was visualized, and surgical intervention was made through this point. Patients were followed in day 1, week 1, 3rd and 6rd mounth. Functional success was assessed according to Munk scoring, and anatomic success was assessed with nasolacrimal lavage. Two groups were compared according to surgical success, time, and complications.ResultsMean age of the cases were 47.85 (±11.8) in the cEDCR group and 54.29 (±16.23) in the sEDCR group. Female and male gender distribution was 21 (80.8%) - 5 (19.2%) for cEDCR and 15 (62.5%) - 8 (37.5%) for sEDCR, respectively. Functional success was spotted as 92.3% in the cEDCR group and 95.8% in the sEDCR group (p:1.0); anatomical success was spotted as 88.5% in the cEDCR group, and 95.8% in the sEDCR group (p:0,611). There was no significant difference between two groups. Mean surgery time was 43 minutes in the cEDCR group and 48 minutes in the EDCR group. Complications were minor and rare (p >0.05). ConclusionAs we are aware of that, our study is the first in literature in which scopy is used in endoscopic DCR. In our study, the sEDCR approach is assessed as a useful modification which improves success and facilitates surgery.

Laparoscopic Vaginoplasty Procedure Using a Modified Peritoneal Pull-Down Technique with Uterine Strand Incision in Patients with Mayer–Rokitansky–Küster–Hauser Syndrome: Kisu Modification

Various vaginoplasty procedures have been developed for patients with Mayer–Rokitansky–Küster–Hauser (MRKH) syndrome. Here, we describe a novel laparoscopic vaginoplasty procedure, known as the Kisu modification, using a pull-down technique of the peritoneal flaps with additional structural support to the neovaginal apex using the incised uterine strand in patients with MRKH syndrome. Ten patients with MRKH syndrome (mean age at surgery: 23.9 ± 6.5 years, mean postoperative follow-up period: 17.3 ± 3.7 months) underwent construction of a neovagina via laparoscopic vaginoplasty. All surgeries were performed successfully without complications. The mean neovaginal length at discharge was 10.3 ± 0.5 cm. Anatomical success was achieved in all patients, as two fingers were easily introduced, the neovagina was epithelialized, and the mean neovaginal length was 10.1 ± 1.0 cm 1 year postoperatively. No obliteration, granulation tissue formation at the neovaginal apex, or neovaginal prolapse was recorded. Five of the 10 patients attempted sexual intercourse and all five patients were satisfied with the sexual activity, indicating functional success. Although the number of cases in this case series is few, our favorable experience suggests that the Kisu modification of laparoscopic vaginoplasty procedure is an effective, feasible, and safe approach for neovaginal creation in patients with MRKH syndrome.

Repair of progressive retinal detachment complicating degenerative retinoschisis: surgical management and outcomes in phakic eyes

Background Degenerative retinoschisis is a common condition defined by the splitting of the neurosensory retina that may rarely be associated with progressive retinal detachment (RD). Here, we aim to describe the anatomic and functional outcomes of surgical treatment of progressive symptomatic retinal detachment complicating degenerative retinoschisis (PSRDCR) using pars plana vitrectomy (PPV), scleral buckle (SB), or combined PPV/SB procedure. Methods A retrospective chart review of patients with PSRDCR between Jan 1, 2008 and Dec 31, 2019 was conducted. Data regarding demographics, surgical approach, and anatomic/functional outcomes were collected. Results Of the 4973 charts with RD repair during the study period, 36 eyes (0.7%) had retinoschisis with RD. 18 eyes met inclusion criteria (0.4%). The median age was 54 years (range 18–74) and all eyes were phakic. All eyes had outer layer breaks (OLBs) and 16 eyes (89%) had identifiable inner layer breaks. All OLBs were posterior to the equator in charts where position was recorded (16 eyes). The single surgery anatomic success (SSAS) and final anatomical success rates were 66% (12/18) and 100%, respectively. Eyes treated with PPV/SB had an SSAS rate of 75% (9/12), while PPV and SB had SSAS rates of 66% (2/3) and 33% (1/3), respectively. Conclusions PSRDCR is an exceedingly rare complication of degenerative retinoschisis associated with an SSAS rate lower than for uncomplicated rhegmatogenous RD. The majority of PSRDCR were repaired via combined PPV/SB in our study, and the rarity of this complication limits statistical support of an optimal surgical method in our and prior studies. The role of SB combined with PPV for PSRDCR requires further investigation.

Vitreoschisis and retinal detachment: New insight in proliferative vitreoretinopathy

Purpose To assess the occurrence of peripheral vitreoschisis-induced vitreous cortex remnants (p-VCRs) in primary rhegmatogenous retinal detachment (RD) and investigate whether the presence of p-VCRs results in a greater risk of RD recurrence, secondary to Proliferative Vitreoretinopathy (PVR) development after pars plana vitrectomy (PPV). Methods Patients who underwent PPV for primary rhegmatogenous RD between January 2016 and December 2018 were included. The presence of residual p-VCRs was confirmed intraoperatively using triamcinolone acetonide (TA). Patients with p-VCRs were divided into two groups: Group A comprised of patients who underwent PPV without p-VCR removal, while Group B included patients who underwent PPV with p-VCR removal. Results Four hundred-thirteen eyes with evidence of p-VCR were analyzed. Two-hundred-twenty-three eyes underwent PPV without VCR removal (Group A), while 190 eyes underwent PPV with p-VCR removal (Group B). Primary anatomical success was 91.5% in the Group A and 95.4% in the group B. Retinal re-detachment due to PVR occurred in 17 (7.6%) eyes in Group A and in four (2.1%) eyes in Group B within the first 3 months (p = 0.01). Among group A, in 11 eyes, there was a diffuse posterior PVR grade C, while six eyes were focal PVR grade C. In Group B, we observed four retinal re-detachment due to focal PVR grade C. Conclusion The presence of p-VCRs seems to be associated with a higher incidence of PVR development and might also result in more complex RD recurrence, this suggests the need for more aggressive VCRs removal during the first surgery.

269. A Review of Gram Negative Endogenous Endophthalmitis at University Hospital in Newark

Background Endophthalmitis (EO) is an ocular emergency characterized by intraocular inflammation, usually in response to infection. While most cases are exogenous, gram negative (GN) EO account for 10-24% of all cases, and endogenous EO (EEO) account for 2-8% of all cases. Risk factors for EEO include diabetes mellitus (DM), IV drug use, and indwelling catheters. Major sources of infection are urinary tract infections (UTI), liver abscesses, pneumonia, and bacteremia. Common pathogens include K. pneumoniae, P. aeruginosa, and H. influenzae. Outcomes are poor, with only 20% of patients achieving improved visual acuity, and 30-40% requiring enucleation. Methods Retrospective analysis was performed on patients diagnosed with EO (n=89) at University Hospital in Newark from January 2016 to December 2020 using ICD-10 codes H44.0-H44.009, H44.1, and H44.19. Patients included were 18 years of age or older with culture proven GN endogenous EO (GNEEO) (n=7). Outcomes included anatomical success, functional success, and mortality at 28 days and 3 months. Results 7 of 89 patients met criteria for GNEEO (median age 67, 4 males, 71.4% Hispanic/Latino). Comorbidities included hepatobiliary disease (57.1%) and DM (42.9%). All 7 patients presented with ocular symptoms and 3 had non-ocular symptoms. Primary sources of infection included UTI, prostate abscess, and pneumonia/empyema. Eye cultures identified Pseudomonas in 4 patients and Klebsiella in 3 patients. Mean antibiotic length was 17.7 days with 6 patients receiving intravitreal antibiotics. Enucleation was performed in 3 patients. 2 patients had functional success and 4 had anatomical success, with 0 mortality at 28 days and 3 months. Table 1. Ocular symptoms on presentation of cases of gram negative endogenous endophthalmitis Table 2. Positives cultures obtained from cases of gram negative endogenous endophthalmitis Conclusion Although rare, GNEEO causes significant morbidity, with only 2 recovering visual acuity and 3 requiring enucleation. Risk factors, sources of infection, and microbes were all consistent with those in previous reports. Hepatobiliary disease and DM were the most prominent risk factors while sources of infection included UTI and empyema. Eye cultures were positive for K. pneumoniae and P. aeruginosa, two common pathogens previously identified. This case series highlights the importance of prompt recognition and initial treatment of GNEEO with empiric coverage that includes vancomycin and ceftazidime. Disclosures All Authors: No reported disclosures

The Common Indications of Pars plana vitrectomy (PPV) for posterior Segment Ocular diseases in patients from a Private Retina Clinic

Purpose: To evaluate common indications and anatomical outcomes of PPV for posterior segment ocular diseases in patients presenting at private retina clinic in Lahore Study design: Cross sectional survey Methods and materials: Over the period of three years, from 1st April 2017 to 3oth April 2020, all patients fulfilling inclusion criterion, were included in study after approval from hospital ethical committee. After taking history and detailed ocular examination, diagnosis was confirmed by B scan or OCT, Hepatitis B & C screening done. The patient age, gender, laterality of eye, lens status, macular status, type of retinal pathology, type of anesthesia, procedure done and type of vitreous tamponade if used were noted. All procedures were performed by a single surgical team and patients were followed for six months for anatomical success or any complication. Data was analyzed by SPSS 25. Results: Out of 266 total patients, 168 (63.2%) were males and 98 (36.8%) were females. Right eye was involved in 125 (47%) and left in 141 (53%). Age range was from 2 years to 83years, mean age for males was 47.30, for females 48.07 years, median age was 50 years, mean age for GA was 30.62 years and 51.71 for LA patients. The highest incidences of posterior segment ocular problems were observed in patients with age range 51 to 60 years. The commonest indication for posterior segment surgery were RRD seen in 107 (40.23%), ROSO in 51 (19.17%) and vitreous hemorrhage 33 (12.41%). Endophthalmitis was indication in 20 (7.52%), dropped nucleus in 11 (4.13%), Macular hole in 7 (2.63%) and ERM in 3 (1.13%). Asteroid hyalosis, intraocular IOFB and diagnostic vitrectomy were least common indication, each seen in 1 (0.5%) patient. Silicon oil was most commonly used Endo tamponade used in 138 (51.88%) patients. All patients were followed for 6 months with vision and retinal status. All patients who underwent pars plana vitrectomy surgery were stable with anatomical success rate till 6 months postoperatively except 10 (3.76%) who required re do operation for retinal detachment or some other complications. Conclusion: Current practice in ophthalmology shows increased frequencies of internal approach (PPV) for vitreoretinal diseases rather external approach (SB). Silicon oil was most common internal tamponade used. Diabetic retinopathy was important cause of vitreous hemorrhage and TRD. Patients should be educated regarding regular fundoscopy and good systemic control of diabetes. Higher incidence of retinal detachment among all age groups needs awareness and education about its warning ocular symptoms. Key words: PPV (Pars plana vitrectomy), RRD (Rhegmatogenous retinal detachment), SB (Scleral buckling), TRD (Tractional retinal detachment), ROSO (removal of silicon oil), GA (general anesthesia), LA (local anesthesia)

Anatomical and Symptomatic Outcomes in Patients With Le Fort Colpocleisis

Background: We aimed to evaluate the short term anatomical and symptomatic results of elderly patients on whom Le Fort colpocleisis operation was performed due to pelvic organ prolapse (POP) in our clinic. Methods: Medical records of fifty-nine sexually inactive and ≥65 aged women with stage 2 or higher vaginal or uterine prolapse who underwent Le Fort colpocleisis operation were prospectively analysed. Pre-operative and 12 months post-operative data were recorded. Turkish validated Global Pelvic Floor Bother Questionnaire (GPFBQ) were also evaluated at pre-operative and 12 months post-operative period in all patients. Anatomical success was determined as no prolapse of any POP-Q point at or below 1 cm above the hymen. Results: A total of 59 patients were conducted in this study. The average age of the patients was 71.67±7.01 (years). The mean BMI was 27.1±9.52 kg/m2. POP-Q point C as well as, Gh and TVL measurements were significantly higher after surgery than those at preoperative period (p<0.01, p<0.01, p<0.01, respectively). There was no recurrence in any case. Evaluation of complications at the pre-operative and post-operative 12th month revealed significant differences for SUI, urinary frequency, nocturia, and pelvic pain symptoms during post-operative period (p:0.007, p<0.001, p:0.01, p<0.001; respectively). Conclusions: Le Fort colpocleisis is a simple and effective procedure that has been found to provide successful anatomical and symptomatic outcomes in sexually inactive and elderly women for POP. However long-term results of this procedure needs further investigation.

Outcomes of scleral buckle technique performed by trainee doctors in retinal detachment

AIM: To evaluate the outcomes of patients operated for retinal detachment by scleral buckle technique done by trainee doctors pursuing postgraduate course in ophthalmology. METHODS: This study was a non-comparative retrospective case series to evaluate the demography, clinical features and outcomes of patients underwent rhegmatogenous retinal detachment (RRD) repaired by scleral buckle technique from July 2017 to February 2018 at a tertiary care center in India. Records of all these patients were screened. Statistical analyses were performed and using Fisher's exact test, Mann-Whitney test and Nominal Logistic regression. RESULTS: Totally of 41 patients were included out of which, 32 (78.04%) were males and 9 (21.95%) were females. In our study primary anatomical success rate was 95.12%, with significant visual gain. Postoperative complications were raised intraocular pressure (n=2), new breaks (n=2) and re-detachment in 2 patients which was successfully managed by pars plana vitrectomy (PPV) with internal tamponade and laser. CONCLUSION: The study showed that scleral buckle surgeries done by trainee doctors under supervision can achieve a high success rate in patients of RRD both in terms of postoperative anatomical success, visual acuity and complication rates. Thus, scleral buckle surgery can be an acceptable primary procedure for trainee doctors for management of RRD in selected cases despite the various treatment options now available.