Visualoutcome Pada Pasien Retinopati Diabetik Pasca Operasi Pars Plana Vitrektomi Di Rumah Sakit Pertamina Bintang Amin Provinsi Lampung Tahun 2020/2021

ABSTRACT: VISUAL RESULTS OF DIABETES RETINOPATHY PATIENTS POST PARS PLANA VITRECTOMY OPERATION AT PERTAMINA BINTANG AMIN HOSPITAL Background: Diabetic retinopathy is a neovascular complication that is very specific for type 1 diabetes and type 2 diabetes. Based on data according to Basic Health Research (RISKESDAS) in 2018, diabetes mellitus in 2013 reached 1.5% of patients with diabetes, and is increasing. to 2.0% in 2018. Treatment of diabetes mellitus patients with complications of diabetic retinopathy by performing pars plana vitrectomy surgery which is anoperative management that can improve eye visual or restore visual fuction. Research Objectives: To determine the visual outcome in diabetic retinopathy patients after pars plana vitrectomy surgery at Pertamina Bintang Amin Hospital, Lampung Province in 2020.Research Methods: This type of research was cross -sectional. Sampling was done by total sampling. Bivariate data analysis using Paired T-Test.Results: Statistical analysis using Paired T-Test showed the p-value for visualoutcome analysis in diabetic retinopathy patients before and after pars plana vitrectomy surgery was 0.000 (p-value <0.05).Conclusions: There are significant changes in diabetic retinopathy patients visualoutcome before pars plana vitrectomy surgery and after pars plana vitrectomy surgery at Pertamina Hospital Amin Star Lampung Province 2020. Keywords: Diabetic retinopathy, pars plana vitrectomy operation, Visualoutcome INTISARI: VISUALOUTCOME PADA PASIEN RETINOPATI DIABETIK PASCA OPERASI PARS PLANA VITRECTOMY DI RUMAH SAKIT PERTAMINA BINTANG AMIN Latar Belakang: Retinopati diabetik adalah komplikasi neovaskular yang sangat spesifik untuk diabetes tipe 1 dan diabetes tipe 2. Berdasarkan data menurut Riset Kesehatan Dasar (RISKESDAS) pada tahun 2018, penyakit diabetes melitus di tahun 2013 mencapai 1,5% pasien pengidap diabetes, dan meningkat menjadi 2,0% pada tahun 2018. Penanganan pada pasien diabetes melitus dengan komplikasi retinopati diabetik diantaranya adalah dengan dilakukannya operasi pars plana vitrektomi yang merupakan penatalaksanaan operatif yang dapat memperbaiki visus mata atau memulihkan fungsi penglihatan . Tujuan Penelitian: Untuk mengetahui visualoutcome pada pasien retinopati diabetik pasca operasi pars plana vitrektomi di Rumah Sakit Pertamina Bintang Amin Provinsi Lampung Tahun 2020.Metode Penelitian: Jenis penelitian ini adalah potong silang (Cross-sectioal). Pengambilan sampel dilakukan secara total sampling. Analisis data bivariat dengan Paired T-Test.Hasil Penelitian: Analisis statistik menggunakan uji Paired T-Test menunjukkan p-value untuk analisa visualoutcome pada pasien retinopati diabetic sebelum dan sesudah operasi operasi pars plana vitrektomi sebesar 0,000 (p-value < 0,05).Kesimpulan: Terdapat perubahan yang signifikan pada visualoutcome pasien retinopati diabetik sebelum operasi pars plana vitrektomi dan sesudah operasi pars plana vitrektomi di Rumah Sakit Pertamina Bintang Amin Provinsi Lampung Tahun 2020. Kata Kunci: Retinopati Diabetik, Operasi Pars Plana Vitrektomi, Visualoutcome

Xen45 gel stent ab interno trimming for ostium occlusion: case report

Background Despite the XEN gel stent low-risk profile, various complications following the implant have been described, including internal and external occlusion, with a consequent postoperative rise in intraocular pressure (IOP). In this case report we aimed to present a XEN45 stent internal occlusion successfully treated by trimming in situ its proximal end with a 25 G vitreous scissors using a bimanual technique. Case presentation A 63-year-old male patient affected by primary open angle glaucoma (IOP = 25 mmHg) and a full thickness macular hole in his right eye, underwent ab-interno Xen gel stent implantation and, 1 month later, a 25 G vitrectomy surgery. Despite a significant IOP reduction after stent implant, 6 days after vitrectomy, IOP increased (25 mmHg) and the conjunctival bleb flattened following occlusion of stent internal ostium by a clot of presumed fibrinous material. The Nd:YAG laser failed to remove the clot, so that we decided to snip a small bit of the proximal end of the Xen tube (about 0,5 mm length) with a 25 G vitreous scissors, using a bimanual technique. In the postoperative day 1 and month 1, the IOP was 8 mmHg and 12 mmHg, respectively. The Anterior Segment OCT confirmed a functional, layered, filtering bleb, and the normal appearance and patency of the XEN proximal segment. No side effects from the intervention were observed. Conclusions Ab interno trimming with vitreous scissors of the occluded proximal end of the XEN stent may represent a safe, rapid and efficient method to restore aqueous humor subconjunctival drainage.

A novel temporary keratoprosthesis technique for vitreoretinal surgery

AIM: To investigate the safety of vitreoretinal surgery when using a soft contact lens as a temporary keratoprosthesis (TKP) in patients with severe corneal opacifications. METHODS: Three patients with simultaneous corneal and vitreoretinal pathology were treated with a soft contact lens that was used as a TKP to facilitate vitreoretinal surgery. The soft contact lens was fixated with sutures onto the globe so that no leakage was possible. RESULTS: Vitreoretinal surgery with excellent fundus view was possible in all cases. The soft contact lens allowed safe central and peripheral vitrectomy. Surgery was successful in all cases. CONCLUSION: A soft contact lens properly fixated on the globe can successfully replace a TKP. This surgical procedure has several advantages like one size fits all, low costs, and easy access to the material.

General View to History, Development, and Current Approaches of Vitrectomy

The great developments that the vitrectomy platform has reached today are undoubtedly based on more than half a century of vitrectomy history and their respected ancestors with great effort in this regard. Given the rapid changes in the transition from manual vitrectomy to machine-based vitrectomy, innovations in vitrectomy surgery will continue to evolve with more emphasis on efficiency, safety, and device compatibility. In this article, it is planned to give information about the past, present, and future of vitrectomy.

Current Developments in Vitrectomy: Hypersonic Vitrectomy and 3-Dimensional (3D) Vitrectomy Surgery

With the advancing technology in vitrectomy surgery, revolutionary changes have occurred. Improvements in the imaging and vitrectomy systems have made the operation process more practical and comfortable, and have led to significant success in the postoperative period. 3D imaging systems, which entered into ophthalmology practice in 2008, and hypersonic vitrectomy systems, which started to practice ophthalmology as a new technology in 2017, have gained new perspectives in vitrectomy surgery.

A 27 - Gauge Microincision Vitrectomy Surgery for Posterior Segment Diseases in a Tertiary Centre, Nepal

Introduction: Transconjunctival micro incision vitrectomy surgery (MIVS) with 23 or 25 gauge instrumentation is more advantageous than traditional 20 gauge surgery. We intended to evaluate the visual outcome, complications and indication of various vitreoretinal diseases using 27 Gauge vitrectomy systems. Methods: This study was a prospective, interventional, non-comparative study conducted in Nepal Eye Hospital from June 2017 to July 2018. Fifty-two patients with various vitreoretinal diseases were recruited. The main outcome measures included corrected distance visual acuity (CDVA) preoperative and postoperative, intraocular pressure (IOP) preoperative and postoperative, indication for vitreoretinal surgery, intraoperative complications, and postoperative complications. Results: Fifty two eyes of 52 patients (26 men and 26 women; mean age, 59 years) underwent 27-gauge pars planavitrectomy. Surgical indications included epiretinal membrane (n = 11), full-thickness macular hole (n = 11), rhegmatogenous retinal detachment [n = 14 (12 vitrectomy only and two vitrectomy with scleral buckle)], vitreous haemorrhage (n = 3), vitreous opacities (n = 3), silicon oil removal (n = 3), proliferative diabetic retinopathy [n = 6 (5 vitreous haemorrhage and one tractional retinal detachment)], posterior IOL dislocation (n = 1). Postoperative complications included transient ocular hypertension in eight eyes (15.39%), transient hypotony in five eyes (9.62%) and vitreous haemorrhage in five eyes (9.62%). No cases of postoperative endophthalmitis, sclerotomy - related tears, or choroidal detachments were encountered in the follow-up period. Mean corrected distance visual acuity improved from 20 / 796 (logarithm of the minimum angle of resolution, 1.60 ± 0.64) preoperatively to 20 / 49 (logarithm of the minimum angle of resolution, 0.42 ± 0.26) postoperatively (p = 0.000,) at final follow up. Conclusions: 27-gauge micro-incision vitrectomy surgery was found to be a safe and effective suture-less surgery with favourable outcomes, in terms of vision.