We evaluated after-cataract, capsular opacification, following combined lens removal with phacoemulsification or pars plana lensectomy, pars plana vitrectomy and primary or secondary IOL implantation on 34 eyes followed up more than 3 years.For the lens removal 23 eyes had pars plana lensectomy ad 11 eyes phacoemulsification. Nd-YAG capsulotomy is needed on 8/34 eyes(25.5%). Nd-YAG capsulotomy was performed on 3/23 eyes(13%) of pars plana lensectomy and on 5/11 eyes(45.5%) of phacoemulsification. Nd-YAG capsulotomy was performed to 7/22 eyes(31.8%) of primary IOL implantation and 1/12 eyes(8.3%) of secondary IOL implantation. Most patients had systemic vascular disease such as diabetes or hypertension.In conclusion, combined pars plana lensectomy, pars plana vitrectomy and secondary IOL implantation was the least incidence of after-cataract and side effects, so this procedure was thought to be recommended for vitreoretinal surgery.
Humans ; Incidence ; Phacoemulsification ; Vascular Diseases ; Vitrectomy ; Vitreoretinal Surgery

Silicone oil has been used successfully in vitreoretinal surgery for many years. But complications from the use of silicone oil as a long-acting internal tamponade may develop. They include glaucoma, keratopathy, oil emulsification, and cataract. For patients requiring silicone oil removal and cataract surgery, both operations can be performed in a combined procedure. After phacoemulsification, a posterior continuous curvilinear capsulorhexis(PCCC) is performed, followed by irrigation of balanced salt solution(BSS)into vitreous cavity allowing flow out of silicone oil through the PCCC and intraocular lens(IOL)is implanted into remaining capsular bag. This technique offers faster visual rehabilitation, shorter operation time and reduces the risk of peripheral retinal defect, vitreous hemorrhage that may be caused by traditional oil removal through sclerostomy.
Capsulorhexis* ; Cataract ; Glaucoma ; Humans ; Phacoemulsification* ; Rehabilitation ; Retinaldehyde ; Sclerostomy ; Silicone Oils* ; Vitreoretinal Surgery ; Vitreous Hemorrhage

Proliferative vitreoretinopathy is the principal cause of failure in rhegmatogenous retinal detachment surgery. The final cause of anatomic failure is anterior proliferative vitreoretinopathy. Surgical outcome of anterior proliferative vitreoretinopathy is poorer than that of posterior proliferative vitreoretinopathy. Of 147 cases which underwent vitreoretinal surgery from January through December 1993, 16 eyes(l6 patients) had anterior proliferative vitreoretinopathy. Seven eyes had anterior proliferative vitreoretinopathy at initial surgery(group 1). Remaining 9 eyes developed anterior proliferative vitreoretinopathy after primary vitrectomy(group 2). Of 16 eyes, 3 were aphakic, 2 were pseudophakic, and remaining 11 were phakic. Lens was removed in 11 phakic eyes. Meticulous vitreous base dissection and removal of anterior epiretinal membrane were performed. After minimal follow-up of 6 months, retina reattached in 11 eyes(69%) including all nine eyes of group 2. Nine eyes(56%) had postoperative visual acuity of 0.025 or better. These results suggest that both vitreous base dissection and meticulous removal of anterior and posterior epiretinal membrane should be crucial in improving surgical success rate of anterior proliferative vitreoretinopathy.
Epiretinal Membrane ; Follow-Up Studies ; Retina ; Retinal Detachment ; Visual Acuity ; Vitreoretinal Surgery ; Vitreoretinopathy, Proliferative*

PURPOSE: To compare the effects of different volumes of sub-Tenon's anesthetic on intraocular pressure (IOP) and to evaluate the treatment efficacy of vitreoretinal surgery. METHODS: A prospective, clinical trial was conducted on patients undergoing sub-Tenon's anesthesea for vitreoretinal surgery. Patients were randomized to receive either 3 mL, 5 mL or 7 mL of anesthetic solution. IOPs were measured immediately prior to, immediately after, and at 2, 5 and 10 min after the injection. Pain scores were assigned using a numerical visual analogue scale immediately following surgery and again on postoperative day one. RESULTS: A total of 108 patients (119 eyes) were studied, including 35 eyes in the 3 mL group, 48 eyes in the 5 mL group, and 36 eyes in the 7 mL group. There was significant elevation in mean IOP following injection in all groups and a trend toward a larger increase in the group receiving the larger volume (p<0.01). Mean IOPs were elevated immediately after the injections and reduced at all subsequent time intervals. But reduction to the pre-injection level was only achieved in the 3 mL group. There was no significant difference in patient-reported pain scores among the groups when assessed immediately after surgery or on postoperative day one. The incidence of chemosis and high IOP elevation (40 mmHg < or =) was more frequent in the 7 mL group than the other groups (p<0.05). CONCLUSIONS: Sub-Tenon's anesthesia is effective in vitreoretinal surgery. It would appear that a 3-5 mL volume of anesthetic is safe even when complications are considered.
Anesthesia ; Humans ; Incidence ; Intraocular Pressure* ; Prospective Studies ; Treatment Outcome ; Vitreoretinal Surgery*

Perfluorocarbon liquids have been used to facilitate surgery in complicated retinal detachments or giant retinal tears which were difficult to manage. The results of perfluorophenanthrene usage in 26 eyes that had been taken vitreoretinal surgery were analyzed.The causes of retinal detachments were giant retinal tears in five eyes[19%], pseudophakia or aphakia in three[12%]and trauma in three.As tamponades, C3F8 gas was used in 11 eyes and silicone oil in 15 eyes. Overall, anatomical success rate was 73%and functional success rate was 58%.All of the giant retinal tears were successfully reattached and four eyes[80%]were functionally successful.The rates of anatomical success were 75%in eyes with grade C proliferative vitreoretinopathy, and 64%in grade D.Regarding postoperative tamponade materials, there was no significant difference between C3F8 gas and silicone oil.Releasing retinectomy was perfomed in four eyes and there was no functional success. In conclusion, perfluorocarbon liquid is a useful instrument that improves the result of operation of complicated retinal detachment if used selectively.
Aphakia ; Pseudophakia ; Retinal Detachment* ; Retinal Perforations ; Retinaldehyde* ; Silicone Oils ; Vitrectomy ; Vitreoretinal Surgery ; Vitreoretinopathy, Proliferative

Perfluorocarbon liquids have been used as vitreous substitutes for the complicated vitreoretinal surgery. Some authors have reported that perfluorophenanthrene(C14, F24) liquid could be left in the eye for extended term without ocular toxicity. We reviewed 37 eyes that had undergone surgery using perfluorophe-nanthrene(C14, F24) liquid at our hospital since June, 1991 to March, 1996. It was used as intraoperative tool in 20 eyes(Group I), and as postoperative tamponade material in 17 eyes for variable period from 24 hours to 45 days(Group II). Group III includes 11 anatomically successful eyes among group II. Follow up periods were from 111 to 1763(mean 341) days. The rate of anatomical success was 100, 64.7% in group I and II, and the rate of functional success was 70, 70.6, 90.9% in group I, II, III, respectively. Postoperatively, proliferative vitreoretinopathy, recurrent retinal detachment, and elevation of intraocular pressure were observed in both group I and II. According to the above results, it would be better that perflourophenanthrene liquid be used as an intraoperative tool than as a postoprative extended period tamponade.
Follow-Up Studies ; Intraocular Pressure ; Retinal Detachment ; Vitreoretinal Surgery* ; Vitreoretinopathy, Proliferative

BACKGROUND: Most recently, the antiemetic effects of high inspired oxygen have been discussed and various results have been reported according to the types of surgeries and the groups of patients. In ophthalmic surgical patients, surgical procedures involving intraoperative manipulation of the eye and giving rise to residual eye discomfort were associated with the increased incidences of postoperative nausea and vomiting (PONV). The antiemetic effect of 80% inspired oxygen for the patients undergoing vitreoretinal surgery is unknown. Therefore, we examined the efficacy of 80% inspired oxygen in the decrease of the PONV incidences after vitreoretinal surgery under general anesthesia. METHODS: 170 adults under 70 years of age have received standardized sevoflurane anesthesia. After tracheal intubation, they were randomly assigned to two groups: 30% inspired oxygen in air (Group 30), and 80% inspired oxygen in air (Group 80). Postoperative nausea and vomiting were evaluated at the 2, 6, and 24 h postoperatively by an investigator unaware of patients' allocation. RESULTS: There was a significantly lower incidence of PONV during the first 2 h postoperatively in the Group 80 (22%) compared with the Group 30 (40%) (P = 0.024). The Group 80 (33.8%) showed the decreased incidence of PONV during the first 24 h postoperatively compared with the Group 30 (48.8%), but these differences were not statistically significant (P = 0.081). CONCLUSIONS: The use of 80% inspired oxygen during vitreoretinal surgery reduced the incidence of PONV during the first 2 h postoperatively.
Adult ; Anesthesia ; Anesthesia, General ; Antiemetics ; Humans ; Incidence ; Intubation ; Oxygen* ; Postoperative Nausea and Vomiting* ; Research Personnel ; Vitreoretinal Surgery*

We reviewed the records of 23 patients who underwent repeat operation after initial vitreoretinal surgery in Chungnam National University Hospital between January 1993 and December 1993. Of 193 eyes who underwent vitreoretinal surgery in that period, 23(12%) had undergone reoperation. The most common cause of initial anatomic failure and reoperation was either new or recurrent proliferative vitreoretinopathy(10 eyes). Other causes included iatrogenic retinal tears(5 eyes), hidden retinal breaks(4 eyes), vitreous traction(1 eye), inappropriate chorioretinal adhesion(1 eye), and new break(1 eye). We performed vitreous base dissection on all 9 eyes with anterior proliferative vitreoretinopathy. With additional surgery and after a mean follow-up period of 10.4 months, 21(91%) of 23 retinas were reattached. The final cause of anatomic failure was anterior proliferative vitreoretinopathy. Of the 23 reoperated eyes, 20(87%) had postoperative visual acuity of 0.05 or better.
Chungcheongnam-do ; Follow-Up Studies ; Humans ; Reoperation ; Retina ; Retinaldehyde ; Visual Acuity ; Vitreoretinal Surgery* ; Vitreoretinopathy, Proliferative

PURPOSE: The author evaluated the impact of vitreoretinal surgery for proliferative diabetic retinopathy (PDR) on bilateral visual function. METHODS: Anatomic and visual acuity outcomes were reviewed by author for patients who underwent bilateral surgery for PDR. Bilateral visual function was evaluated using the American Medical Association (AMA) Guidelines for Disability scale to quantitate the impact of surgery on visual system disability. RESULTS: There were 18 patients (36 eyes) who underwent vitrectomy for complications of PDR, and the overall anatomic success rate was 100%. Mean visual impairment of the study eyes and visual system according to AMA Guidelines for Disability decreased postoperatively by 22.4% points, and 25.7% points, respectively. A higher functional level of the bilateral visual system resulted postoperatively in 83.2% of all patients, according to eyes with better visual acuity. CONCLUSIONS: Vitreoretinal surgery was associated with a reduction in bilateral visual disability and improved bilateral visual function in patients with PDR.
American Medical Association ; Diabetic Retinopathy* ; Humans ; Vision Disorders ; Visual Acuity ; Vitrectomy* ; Vitreoretinal Surgery

To investigate the usefulness of large relaxing retinectomies in the management of selected complicated retinal detachments. The charts of 25 consecutive patients who underwent large relaxing retinectomy during vitrectomy were reviewed. Penetrating injury(10 eyes) and chronic retinal detachment(11 eyes) were the leading etiologic diagnoses. 22 eyes showed extensive PVR, 14 of them had a PVR Grade C P 12 and 3 eyes had extensive vitreoretinal incarceration. Most eyes (22 eyes) had undergone one or more previous ocular procedures and four eyes were early phthisical preoperatively. Extended tamponade was achieved with either silicone oil(23 eyes) or C3F8 gas (2 eyes). Retinectomy size was larger than 180 degrees in 20 eyes, ranging from 90 degrees to 360 degrees. Total retinal reattachment was achieved in 15 eyes(60%) and subtotal attachment including the macula in 6 eyes(24%). 10 eyes(40%) achieved 5/200 or better. The size of retinectomy or etiologic diagnosis did not influence the anatomic results. Hypotony was seen in 3 eyes and corneal decompensation in 8 eyes. Large retinectomy in selected cases of vitreoretinal surgery seemed to be an effective procedure in eyes otherwise unsuccessful.
Diagnosis ; Humans ; Retinal Detachment* ; Retinaldehyde* ; Silicone Oils ; Vitrectomy* ; Vitreoretinal Surgery ; Vitreoretinopathy, Proliferative