Vitrectomy in Congenital Vitreous Pathologies

Congenital vitreous diseases are the result of embryological development defects of the vitreous. These diseases have a wide spectrum including congenital vitreous disorders and genetically impaired vitreous structure. Also, these diseases are the first diseases that should come to mind in vitreous and retinal pathologies seen in the early age group. In many of them, pars plana vitrectomy has an important role in the treatment. Due to the disease pathophysiology and age of the patients, they differ from the standard pars plana vitrectomy. In this review, congenital vitreous pathologies and the vitrectomy method applied in the treatment of these pathologies will be discussed.

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 Myopic Maculopathy

Myopia is one of the most important causes of low vision in the world. While high myopia causes pathological changes in many tissues in the eye, it also causes degenerative changes in the retina. This review mentions the vitreoretinal surgical approach, difficulties in surgery, and new developments in maculopathies due to pathological myopia.

Vitrectomy in Uveitis

Nowadays, with the development of modern vitreoretinal microsurgery techniques, indications of vitrectomy in uveitis have expanded significantly and visual results have improved. In selected cases, surgeries performed by suppressing inflammation in the required indications affect the visual prognosis positively. However, it should be kept in mind that anatomical and functional success rates are lower in eyes with uveitis compared to other eyes, and the risk of developing postoperative complications is higher. The purpose of this review is to discuss the role of vitrectomy in the treatment of uveitis.

Vitreoretinal Surgical Approaches in Intraocular Tumors

Although primary vitreoretinal techniques are rarely used in the primary treatment of intraocular tumors, they are mostly used for differential diagnosis and as an adjuvant treatment for the actual radiotherapy of these tumors. Especially biopsies are taken for masquerading syndromes, biopsies for prognostic evaluation and alternative/adjuvant treatment methods of intraocular tumors have been emphasized in this paper. The principles of vitreoretinal approaches in these cases are evaluated in light of our clinical experience and current literature data.

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.

Vitrectomy for Vitreous Opacities

Pars plana vitrectomy (PPV) surgery in vitreous opacities is an effective treatment method that increases patient satisfaction. However, due to the risks associated with PPV surgery, its application in vitreous floaters is controversial. Instead, performing sutureless, minimally invasive PPV surgery with 25 gauge trocars on floaters may reduce the risks. For surgical treatment, it is important to select appropriate patients, evaluation of the risk and benefit balance of PPV, and application the treatment.

Vitrectomy in Endophthalmitis

Developing due to infectious and noninfectious causes, endophthalmitis is a serious condition requiring urgent intervention which can lead to eye loss. In recent years, medical and surgical approaches had great improvement in the treatment of endophthalmitis. Early diagnosis and therapy are very important in endophthalmitis. By prompt and accurate treatment, good outcomes are established. In order to get successful results, the combination of intravitreal antibiotic and pars plana vitrectomy approach is the best treatment modality. Early pars plana vitrectomy eliminates infective agents, suitable media, and toxins while amplifying the action of intravitreal antibiotics.

Vitrectomy for Subretinal and Submacular Hemorrhages

Submacular hemorrhage (SMH) is relatively rare in retinal practice. However, it is an important complication of many choroidal and retinal diseases, particularly neovascular age-related macular degeneration (AMD). When untreated the visual prognosis is poor, especially in patients with AMD, and SMHs cannot be effectively treated with only anti-vascular endothelial growth factor (anti-VEGF) injection. The current therapeutic approach is based upon the displacement of the subretinal hemorrhage away from the central retina as soon as possible. The use of tissue plasminogen activator (tPA) has been an important milestone in the treatment of SMHs. Current vitrectomy techniques for SMH management include subretinal tPA injection and aspiration of the blood, and subretinal tPA, and air/anti-VEGF injection with gas tamponade. Submacular surgery, which involves removal of the SMH and choroidal neovascularization (CNV) through a retinotomy, seems to be a technique reserved for selected cases where central retinal pigment epithelium appears to be undiseased/uninvolved. Among the non-surgical treatment options, pneumatic displacement with intravitreal tPA and gas injection may be preferred especially for small-medium sized and thin SMHs. However, the favored approach in real-life conditions is shaped by the physician's experience and the available treatment options. Regardless of the preferred approach, the continuity of the treatment of the underlying pathology is important. As the underlying pathology is usually a CNV, the continuation of anti-VEGF treatment is important for maintaining the visual gain of the initial treatment and reducing the risk of recurrent SMH. The breakthrough development rate of the drugs and the surgical techniques for the treatment of retinal diseases promises in terms of new and more effective treatment approaches.

Editorials: Introduction to the Sixth Year…

Dear Colleagues Thanks to your contributions, we are happy to reach the 6th year of the Current Retina Journal together with you.