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Fundus autofluorescence and spectral domain optical coherence tomography as predictors for long-term functional outcome in rhegmatogenous retinal detachment
摘要： Purpose To detect pre- and postoperative retinal changes in fundus autofluorescence (AF) and spectral domain optical coherence tomography (SD-OCT) and to correlate these with functional outcome in patients with primary rhegmatogenous retinal detachment (RRD). Methods A prospective, 30-month study of patients operated with 25-gauge vitrectomy for primary RRD. Patients were examined preoperatively and after 6 and 30 months, using ultrawide-field AF images (UWFI) (Optos 200Tx) and SD-OCT (Topcon 3D OCT-2000) imaging. Results Of 84 patients (84 eyes) included at baseline, 100.0 and 86.9% were re-examined at month 6 and 30, respectively. Preoperative findings such as macular attachment, detachment > 750 μm from foveola, lack of intraretinal separation, and subfoveal elevation ≤ 500 μm were all associated with better BCVA at months 6 and 30. Postoperative disruption of the photoreceptor layer was associated with poor BCVA at month 6 (p < 0.001) but not at month 30. At baseline, AF-demarcation of RRD was demonstrated by a hyperfluorescent edge in 92.0% and was associated with visual impairment at months 6 (p = 0.003) and 30 (p = 0.003). Visual outcome at month 30 was good (≤ 0.3 logMAR (≥ 20/40 Snellen)), regardless of the preoperative, macular status. However, with significantly better visual outcome in patients with macula attachments versus partly or totally macular detachments (p < 0.001). Conclusion Fundus AF and SD-OCT is able to identify retinal reestablishment up to 30 months after primary RRD, with good correlation to BCVA. These findings emphasize the importance of long-term studies for final visual recovery.
关键词： Fundus autofluorescence,Rhegmatogenous retinal detachment,Long-term outcome,Vitrectomy,Visual outcome,Optical coherence tomography
更新于2025-09-23 15:23:52
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Microscopic analysis of an opacified OFT CRYL? hydrophilic acrylic intraocular lens
摘要： A 51-year-old patient underwent posterior vitrectomy with perfluoropropane gas injection, phacoemulsification, and implantation of an Oft Cryl? hydrophilic acrylic intraocular lens (IOL) because of traumatic retinal detachment and cataract in the right eye. On the first postoperative day, gas was filling the anterior chamber because of patient’s non-compliance in terms of head positioning, and was reabsorbed within one week. Eight months later, the patient returned complaining of a significant decrease in vision. IOL opacification was noticed by slit-lamp examination. The lens was explanted to undergo gross and light microscopic analysis. The lens was also stained with the alizarin red method for calcium identification. Light microscopic analysis confirmed the presence of granular deposits, densely distributed in an overall circular pattern in the central part of the lens optic. The granules stained positive for calcium. This is the first case of the opacification of this type of hydrophilic lens. Surgeons should be aware of this potential postoperative complication, and the use of hydrophilic IOLs should be avoided in procedures involving intracameral gas because of the risk of IOL opacification.
关键词： Hydrophilic contact lens,Lens implantation,Vitrectomy,Intraocular lens,Capsule opacification
更新于2025-09-23 15:22:29
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Osmolarity and spectrophotometric property of brilliant blue green define the degree of toxicity on retinal pigment epithelial cells exposed to surgical endoilluminator
摘要： Objective: To evaluate the effect of varying concentrations of brilliant blue green (BBG) and their different biochemical characteristics on retinal pigment epithelial (RPE) cells under xenon light source illumination at varying distances to identify safe parameters for intraoperative use. Methods: Human retinal RPE cells (ARPE-19) were exposed to two concentrations (0.25 and 0.50 mg/mL) of BBG and illuminated with a xenon surgical illuminator at varying distances (10 and 25 mm), intensity levels, and time intervals (1, 5, and 15 minutes). Additionally, the effect of osmolarity was examined by diluting BBG in different concentrations of glucose. Cytotoxicity of BBG and osmolarity effects on cell viability were evaluated using a WST-1 assay. Light absorption and emission characteristic of BBG in different solvents were measured using a plate reader at different wavelengths. Lastly, the activity of caspase-3 was also studied. Results: Cell viability of ARPE-19 cells was 77.4%±12.7%, 78.7%±17.0%, and 65.0%±19.7% at 1, 5, and 15 minutes to exposure of high illumination xenon light at 10 mm (P<0.05) compared to controls. At both distances of illumination (10 and 25 mm), similar cell viabilities were seen between 1 and 5 minutes of exposure. However, there was a decline in viability when the illumination was carried out to 15 minutes in all groups (P<0.05). There was no significant reduction in cell viability in presence or absence of xenon light in different osmolar solutions concentrations of glucose (P>0.05). Maximal light absorption of BBG was noted between 540 and 680 nm. Activated caspase-3 level was not significant in both the concentrations of BBG (P>0.05). Conclusion: Our findings suggest that BBG at 0.25 mg/mL during vitreoretinal surgery is safe and not toxic to RPE cells up to 5 minutes under focal high illumination (10 mm) and up to 15 minutes under medium diffuse illumination (25 mm). BBG was safe to be mixed with isotonic glucose solution at the concentration range of 2.5%–10%, regardless of the illumination status.
关键词： human retinal RPE cells,vitrectomy,internal limiting membrane peel,brilliant blue green dye,endoilluminator
更新于2025-09-23 15:22:29
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Case Series of Inappropriate Concentration of Intraocular Sulfur Hexafluoride
摘要： Due to high complexity, vitreoretinal surgery presents a higher number of patient safety incidents compared with other ophthalmic procedures. Intraocular gases are one of the most useful adjuncts to vitrectomy and surprisingly, surgeons commonly admit to having occasional problems with incorrect gas concentration. The aim of this study is to present a consecutive case series of patients with improper concentration of sulfur hexafluoride (SF6) applied during vitrectomy. Three patients underwent 27-gauge vitrectomy and at the end of surgery inappropriate dilution of 100% SF6 was administered. It was attributed to a calculation error, change in the gas supplier, or increased partial pressure of SF6 before dilution. Postoperatively, due to IOP increase, two eyes required intravitreal gas-air exchange. Subsequently, cataract surgery was performed in one eye with concomitant vitrectomy and silicone oil tamponade due to retinal detachment. To prevent such complications, we suggest using intraocular gases with great care, training of ophthalmic personnel, and prompting manufacturers to provide SF6 in a prepared concentration of 20%.
关键词： Intraocular pressure,Vitrectomy,Expandable gas,Intraocular tamponade,Sulfur hexafluoride
更新于2025-09-23 15:21:01
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Spectral-domain optical coherence tomography imaging of macula-off rhegmatogenous retinal detachment
摘要： The timing of repair and the utility of spectral-domain optical coherence tomography (SD-OCT) for macula-off retinal detachment remains a controversial issue. Four patients who presented with macula-off retinal detachment underwent repair at various time points after symptom onset. Postoperative SD-OCT of the macula demonstrated correlation with final visual acuity.
关键词： vitrectomy,scleral buckle,SD-OCT
更新于2025-09-23 15:21:01
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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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Anatomic and functional outcomes of retinectomy for the management of complicated retinal detachment with proliferative vitreoretinopathy
摘要： The aim of this study is to report the anatomic and functional outcomes of retinectomy for the management of rhegmatogenous retinal detachment complicated by proliferative vitreoretinopathy (PVR), comparing them with previously reported data and determining prognostic factors. Fifty-one eyes of 51 patients with established PVR grade C in which retinectomy was performed were retrospectively enrolled in the study. Primary outcome measures were anatomic success rate and final visual acuity. Secondary outcome measures were intraoperative complications, number of re-operations, and postoperative hypotony. Prognostic factors in relation to retinal re-attachment and final visual acuity were retrospectively analyzed. The rate of complete retinal re-attachment after one operation was 80% and after two operations it was 84%. At the end of the follow-up, the macula was attached in 96% of the cases. Mean LogMAR best-corrected visual acuity (BCVA) improved significantly from 2.45±0.66 preoperatively to 1.37±0.75 at the end of the follow-up (P,0.001). BCVA improved in 37 eyes (72%), remained the same in eleven eyes (22%) and worsened in three eyes (6%). Postoperative hypotony was observed in 2% of cases. Postoperative BCVA was significantly correlated with preoperative BCVA (P,0.001), extension of PVR (P=0.013), preoperative use of gas instead of silicone oil (SO) (P=0.01), and removal of SO (P=0.05). SO was left in situ in 35% of eyes. In conclusion, retinectomy is a surgical option providing good anatomical and reasonable visual outcomes in complicated retinal detachment with PVR. Better preoperative visual acuity, lesser extension of PVR, and the use of gas tamponade during the primary repair are relevant factors for a successful outcome whereas re-proliferation of epiretinal membranes seems to be the main reason of anatomical failure.
关键词： retinectomy,retinal detachment,proliferative vitreoretinopathy,vitrectomy
更新于2025-09-23 15:21:01
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Vitrectomya??+a??360?° cyclopexy with transscleral 810a??nm laser application: a novel surgical technique for hypotonic maculopathy
摘要： Traumatic cyclodialysis is always a challenging condition. Evidence is based on single case reports or small case series. Treatment is indicated in the presence of persistent ocular hypotony or disturbance of the posterior segment anatomy due to deformation of the globe caused by extremely low IOP. The first step in the management of a traumatic cyclodialysis should always include a conservative approach with cycloplegic drops and topical, periocular or oral corticosteroids. More invasive options should be reserved for refractory cases and for eyes with risk of irreversible visual loss. We report four cases of 360° traumatic cyclodialisis with favourable results after vitrectomy + transscleral laser cyclophotocoagulation + supine positioning. We highlight the role of the transscleral laser cyclopexy in achieving such early favourable results, with good anatomic and visual results.
关键词： hypotonic maculopathy,cyclopexy,vitrectomy,cyclodialysis,transscleral laser
更新于2025-09-19 17:13:59
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Combined Femtosecond Laser-Assisted Cataract Surgery and 27-Gauge Transconjunctival Sutureless Vitrectomy
摘要： Purpose. To report the outcomes of combined surgery using femtosecond laser-assisted cataract surgery (FLACS) and sutureless 27-gauge pars plana vitrectomy with intravitreal tamponade. Methods. This retrospective clinical study involved 23 eyes of 23 patients on whom combined vitreoretinal surgery was performed. Patients were initially given the femtosecond laser treatment that was performed after selection of capsulotomy and lens fragmentation patterns. The capsulotomy diameter was chosen as 4.9 mm in all patients. After the femtosecond laser, the sutureless phacovitrectomy procedure was performed. At the end of surgery, perfluoropropane or sterile air tamponade was applied. Results. The mean age of patients was 66.43 ± 7.61 (range, 54–83) years. Fifteen patients were females (65.2%). The mean follow-up was 16.09 ± 4.71 (range, 9–25) months. The most common surgical indication was epiretinal membrane (65.3%). The mean preoperative best-corrected visual acuity (BCVA) was 0.71 ± 0.44 (range, 1.7–0.3) logMAR, and the mean postoperative BCVA at 6 months was 0.16 ± 0.14 (range, 0.4–0) logMAR (p < 0.001). The mean target sphere refractive error was ?0.24 ± 0.16 (range, ?0.50–0.11) D, and the mean postoperative spherical equivalent refractive error was ?0.14 ± 0.39 (range, ?1.00–0.50) D at 6 months (p = 0.196). All intraocular lenses (IOLs) remained well centered in the capsular bag during surgery and follow-up. There was no iris capture, posterior synechiae, capsular opacification, or pseudophakic cystoid macular edema. The only complication related to femtosecond laser was two cases of subconjunctival haemorrhage related with suction. Conclusions. FLACS is a safe and effective technique providing the advantage of repeatable, precise capsulorhexis shape and size to achieve a well-centered and stable IOL postoperatively. These advantages can certainly improve the results of vitrectomy, especially in gas-filled eyes. FLACS and 27-gauge sutureless combined surgery may be a future trend in appropriate cases.
关键词： phacovitrectomy,epiretinal membrane,intravitreal tamponade,femtosecond laser-assisted cataract surgery,27-gauge transconjunctival sutureless vitrectomy
更新于2025-09-19 17:13:59
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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