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Value of optical coherence tomography in the detection of macular pathology before the removal of silicone oil
摘要： Purpose: To assess the pathological macular changes with optical coherence tomography (OCT) before the removal of silicone oil (SiO) in eyes that had undergone pars plana vitrectomy for complicated forms of retinal detachment (RD). Patients and methods: Subjects included 48 patients (51 eyes) with complicated RD including proliferative vitreoretinopathy, proliferative diabetic retinopathy, recurrent RD, penetrating trauma, uveitis, giant retinal tears, and macular holes. All the eyes had undergone SiO injection. Furthermore, all eyes had been planned for the removal of SiO 6–12 months after the primary surgery. Finally, all eyes had a fundus examination and OCT examination before the silicone oil removal. Results: OCT findings indicated epiretinal membrane in 41% of the eyes, macular edema in 17%, macular detachment in 13.5%, macular thinning in 13.5%, macular holes in 10%, and subretinal membranes in 2%. Preoperative OCT was normal in only 12% of the eyes, while a clinical fundus examination was normal in 43% (P0.001). Eyes with normal OCT had significantly better mean logMAR (0.35) than eyes with pathological changes detected through OCT (1.28; P0.001). Surgical modifications were made during the removal of SiO in 74.5% of the eyes. Conclusion: OCT detected significantly more pathological changes than a clinical fundus examination. This had an impact on both surgical step modification during the removal of SiO and predictability of visual outcome after the removal of SiO.
关键词： optical coherence tomography,pars plana vitrectomy,silicone oil,proliferative diabetic retinopathy,proliferative vitreoretinopathy
更新于2025-09-23 15:21:01
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Intraocular pharmacokinetics of antia??vascular endothelial growth factor agents by intraoperative subretinal versus intravitreal injection in silicone oila??filled eyes of proliferative diabetic retinopathy: a randomized controlled pilot study
摘要： Purpose: Intraoperative subretinal anti-vascular endothelial growth factor (VEGF) injections have been used clinically in some case, but the pharmacokinetic characteristics have not yet been determined. In this pilot study, we investigate the pharmacokinetic parameters of anti-VEGF agents by intraoperative subretinal or intravitreal injection in silicone oil (SiO)-filled eyes of patients with proliferative diabetic retinopathy (PDR). Methods: Randomized controlled trial including 13 patients (16 eyes) with PDR underwent pars plana vitrectomy (PPV) with SiO tamponade and randomly received a subretinal (8 eyes) or intravitreal (8 eyes) conbercept injection (0.5 mg/0.05 ml) intraoperatively. Aqueous humour (AH) was obtained on the 1st, 3rd, 7th, 10th, 14th, 21st and 28th day after the injection. Drug concentrations in the AH were determined by enzyme-linked immunosorbent assay (ELISA). The last best-corrected visual acuity (BCVA) was examined 6 months postoperatively. Results: The clearance rate of anti-VEGF agents by subretinal injection was reduced in vitrectomized eyes with SiO tamponade (p < 0.05). With the same drug dose, subretinal injection (5.49 (cid:1) 6.11 lg/ml) resulted in higher drug concentrations in the AH when compared with intravitreal injection (0.42 (cid:1) 0.46 lg/ml, p = 0.001) 4 weeks after the treatment. The mean residence time last (MRT0-t) by subretinal injection (11.57 (cid:1) 0.83 days) was significantly longer than the mean MRT0-t by intravitreal injection (7.10 (cid:1) 1.00 days, p < 0.001). A self-paired analysis showed that subretinal injection led to the BCVA improvement by +28.59 letters 6 months postoperatively (p = 0.028) while the BCVA did not improve significantly by intravitreal injection (p = 0.715). Conclusions: The drug maintenance phase was prolonged by intraoperative subretinal injection in SiO-filled eyes of PDR. The results suggest that subretinal injection might be a valuable treatment option for the management of PDR.
关键词： proliferative diabetic retinopathy,pharmacokinetics,subretinal injection,anti-VEGF agents,pars plana vitrectomy
更新于2025-09-16 10:30:52
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FACTORS ASSOCIATED WITH THE USE OF 360-DEGREE LASER RETINOPEXY DURING PRIMARY VITRECTOMY WITH OR WITHOUT SCLERAL BUCKLE FOR RHEGMATOGENOUS RETINAL DETACHMENT AND IMPACT ON SURGICAL OUTCOMES (PRO STUDY REPORT NUMBER 4)
摘要： To determine factors associated with 360-degree laser retinopexy (360LR) during primary pars plana vitrectomy ± scleral buckle for rhegmatogenous retinal detachment (RRD) and its impact on surgical outcomes. This is a multicenter, retrospective, interventional study. Patients undergoing primary pars plana vitrectomy or primary pars plana vitrectomy + scleral buckle for non-complex primary RRD in 2015 were evaluated. Primary outcomes were single surgery anatomical success (SSAS) and final anatomical success. Secondary outcomes included final logarithm of the minimum angle of resolution visual acuity, epiretinal membrane formation, cystoid macular edema development, and number of subsequent vitrectomies. Multivariate regressions were performed. Two thousand two hundred and forty-eight surgeries by 61 surgeons were included; of which, 516 underwent 360LR. Younger age (P = 0.01), more retinal breaks (P = 0.01), more extensive RRD (P , 0.001), and surgeon ID (P , 0.001) were significantly associated with 360LR. No significant associations between 360LR and single surgery anatomical success (P = 0.44), epiretinal membrane formation (P = 0.14), cystoid macular edema development (P = 0.28), or number of subsequent vitrectomies (P = 0.41) were found. Controlling for case complexity, 360LR was significantly associated with lower final anatomical success (P , 0.001) and worse final logarithm of the minimum angle of resolution visual acuity (P , 0.001). Multiple factors influenced whether 360LR was performed during primary pars plana vitrectomy ± scleral buckle for RRD. However, 360LR was not associated with improved surgical outcomes, and in fact, it may be associated with poorer outcomes.
关键词： surgical outcomes,rhegmatogenous retinal detachment,360-degree laser retinopexy,pars plana vitrectomy,scleral buckle
更新于2025-09-12 10:27:22
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NEUROTROPHIC KERATOPATHY AFTER RETINAL DETACHMENT SURGERY COMBINED WITH ENDOLASER PHOTOCOAGULATION
摘要： To report neurotrophic keratopathy after vitreoretinal surgery combined with aggressive photocoagulation. We report a series of three cases with neurotrophic keratopathy after pars plana vitrectomy combined with endolaser photocoagulation. Three patients who had pars plana vitrectomy with different indications were identi?ed. On follow-up, all patients were diagnosed with neurotrophic keratopathy. Two of the patients underwent amniotic membrane transplantation for the treatment of resistant neurotrophic corneal ulcers. Neurotrophic keratopathy may occur after pars plana vitrectomy. The possible mechanism is long ciliary nerve damage related to the extensive endolaser photocoagulation.
关键词： pars plana vitrectomy,neurotrophic keratopathy,endolaser photocoagulation
更新于2025-09-12 10:27:22
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Scleral Fixation of Posterior Chamber Hydrophobic Acrylic Intraocular Lenses Using Gore-Tex Suture
摘要： In the absence of capsular support after cataract surgery or traumatic injuries, scleral-?xated intraocular lens (IOL) using Gore-Tex (W.L. Gore & Associates, Elkton, MD) suture is an attractive option because of its durability and reduced rate of suture-related complications. When performed with pars plana vitrectomy (PPV), the outcomes are favorable.1 One of the more commonly used IOLs with this technique is the Akreos AO60 (Bausch and Lomb, Bridgewater, NJ), a foldable hydrophilic IOL with four eyelets, which allows for four-point ?xation. However, there have been recent reports of optic opaci?cation due to air or gas tamponade.2 To avoid this potential complication, a hydrophobic IOL may be used. However, the surgical approach needs to be adjusted to account for differing IOL design. In this report, we describe our technique for scleral ?xation of the enVista MX60 IOL (Bausch and Lomb) and report a series of 10 cases.
关键词： MX60,dislocated intraocular lens,pars plana vitrectomy,scleral-?xated intraocular lens,Gore-Tex,aphakia,secondary intraocular lens,lens opaci?cation
更新于2025-09-04 15:30:14