PURPOSE: To investigate the clinical outcomes of combined vitrectomy and intrascleral fixation of a new posterior chamber intraocular lens (PC IOL) as a treatment for IOL dislocation. METHODS: We conducted a retrospective interventional study at our medical facility from January 2015 to January 2017. Posteriorly dislocated IOLs were removed with pars plana vitrectomy. Two intrascleral tunnels, 2.0 mm in length, were created 1.5 mm to the limbus at 6 and 12 o'clock positions. Both haptics of new foldable acrylic 3-piece IOLs were inserted into the tunnel until the IOL was secured in a central position. We analyzed the preexisting ocular condition, visual acuity (VA), and refractive error preoperatively and postoperatively, and recorded postoperative complications. RESULTS: Forty-nine patients (50 eyes) were enrolled in the study. The mean follow-up period was 12.8 ± 6.6 months. A best-corrected VA of 6/12 or better was achieved in 43 eyes (86%). The mean VA significantly improved from 0.32 logarithm of the minimum angle of resolution (logMAR) at baseline to 0.18 logMAR at last follow-up (p = 0.03). The refractive status after intrascleral fixation of the PC IOL revealed a mean hyperopic shift of +1.09 ± 1.28 diopters from the predicted spherical equivalent. Postoperative vitreous hemorrhages occurred in six cases and were cleared without visual compromise. Cystoid macular edema was well-controlled by topical nonsteroidal anti-inflammatory drugs (NSAID) medications in two cases. In two cases, IOL dislocation recurred and required re-operation. There were no serious adverse events of suture-related complications, retinal detachment, corneal compromise, or endophthalmitis in any of the patients. CONCLUSIONS: Our data revealed that use of combined vitrectomy and intrascleral fixation of PC IOLs is a safe and efficient technique to correct IOL dislocation. We observed good visual outcomes with only minor complications.
Dislocations ; Endophthalmitis ; Follow-Up Studies ; Humans ; Lenses, Intraocular ; Macular Edema ; Postoperative Complications ; Refractive Errors ; Retinal Detachment ; Retrospective Studies ; Visual Acuity ; Vitrectomy ; Vitreous Hemorrhage

PURPOSE: To evaluate 25-gauge transconjunctival sutureless vitrectomy for primary repair of rhegmatogenous retinal detachment (RRD). METHODS: We performed a retrospective study of 46 consecutive eyes of 46 patients who underwent 25-gauge transconjunctival sutureless vitrectomy to repair primary RRD. Outcome measures included single surgery anatomical success rate, final anatomical success rate, postoperative visual acuity, and surgical complications. RESULTS: Forty eyes were phakic and six eyes were pseudophakic. Twenty-six eyes had superior quadrant retinal tear, 12 eyes had inferior quadrant tear and eight eyes had both. The mean operation time was 56.3 minutes. The single surgery anatomical success rate was 93.48% (43/46). Two eyes with recurrent retinal detachment underwent fluid gas exchange: one received barrier laser treatment in the outpatient clinic, and the other underwent reoperation; the final success rate was 100%. The best corrected visual acuity improved from 1.34 log MAR to 0.48 log MAR (p < 0.01) in macula - off patients (30 eyes) and from 0.32 log MAR to 0.07 log MAR (p = 0.279) in macula - on patients (16 eyes). Postoperative complications included wound leaking (two eyes), cataract progression (13 eyes), vitreous hemorrhage (one eye), transient hypotony (one eye), and increased intraocular pressure (seven eyes). CONCLUSIONS: Primary repair of RRD using 25-gauge transconjunctival vitrectomy resulted in an excellent final anatomical success rate and postoperative visual outcomes.
Ambulatory Care Facilities ; Cataract ; Humans ; Intraocular Pressure ; Outcome Assessment (Health Care) ; Postoperative Complications ; Reoperation ; Retinal Detachment* ; Retinal Perforations ; Retrospective Studies ; Visual Acuity ; Vitrectomy* ; Vitreous Hemorrhage ; Wounds and Injuries

PURPOSE: To review the management of posterior segment metallic intraocular foreign bodies (IOFB) and to compare the use of an external approach using a large electromagnet and an internal approach using vitrectomy and its tools for their removal. METHODS: A retrospective review was performed on 49 eyes of 49 patients who underwent surgical removal of metallic IOFBs with either an internal or an external approach at a single institution between January 2003 and December 2006. We divided 49 eyes into two groups based on the type of approach: 26 external (n=26) and 23 internal (n=23). Visual acuity and the presence of any complications occurring with the two approaches were the main outcome measures studied. RESULTS: Thirty of 49 eyes (61%) showed improvements in visual acuity. When we compared patients treated with an external versus an internal approach, we found no statistically significant difference in regard to visual outcome. Preoperative vitreous hemorrhage and endophthalmitis were more common in the internal approach group. A trend toward a higher rate of reoperation was more common in the external approach group, but they were not statistically significant. Postoperative complications found to be significantly different between the two groups were the rate of postoperative endophthalmitis and retinal detachment, which were more common in the external approach group. CONCLUSIONS: Surgical removal of metallic IOFBs results in significant visual improvement regardless of the approach method. The internal approach by vitrectomy is recommended as the first choice in preoperative conditions such as severe cataracts, vitreous hemorrhage and endophthalmitis, as well as in groups at high risk for postoperative endophalmitis and retinal detachment.
Cataract ; Endophthalmitis ; Eye ; Foreign Bodies ; Humans ; Magnets ; Outcome Assessment (Health Care) ; Postoperative Complications ; Reoperation ; Retinal Detachment ; Retrospective Studies ; Visual Acuity ; Vitrectomy ; Vitreous Hemorrhage

PURPOSE: This study evaluated the effect of tissue plasminogen activator (TPA) on adhesion between the internal limiting membrane and the vitreous cortex in patients with diabetic macular edema. METHODS: This retrospective study included 14 eyes of 14 patients with diabetic macular edema without posterior vitreous detachment. The fourteen eyes were divided into two groups. In the first group, vitrectomy and internal limiting membrane (ILM) removal were performed after intravitreal TPA 0.1 cc (50 ug) injection the day before vitrectomy and in the second group, vitrectomy and ILM removal were performed without previous injection of TPA. We observed the ILM using electron microscopy and verified the effects of the TPA. RESULTS: Spontaneous posterior vitreous detachment occurred in 3 of 7 eyes in the first group. Internal limiting membranes removed by vitrectomy showed a smooth surface in 4 of 7 eyes in the first group and in 1 of 7 eyes in the second group. Seven eyes of the first group and 6 eyes of the second group revealed decreased foveal thickness and increased visual acuity 90 days postoperatively. CONCLUSIONS: Preoperative intravitreal TPA injection was helpful for achieving posterior vitreous detachment and for decreasing possible postoperative complications involving in remnant vitreous cortex in patients with diabetic macular edema.
Eye ; Humans ; Macular Edema ; Membranes ; Microscopy, Electron ; Postoperative Complications ; Retrospective Studies ; Tissue Plasminogen Activator ; Visual Acuity ; Vitrectomy ; Vitreous Detachment

PURPOSE: To evaluate the usefulness of OCT retinal mapping in determining the configuration of a vitreomacular adhesion and selecting a meridian for entry into the subhyaloid space in patients with vitreomacular traction syndrome. METHODS: Six consecutive patients (6 eyes) with vitreomacular traction syndrome underwent vitrectomy with peeling of posterior hyaloid. Ocular coherence tomography (OCT) retinal mapping was performed preoperatively. Access to the subhyaloid space was made by creating an opening with a 25 gauge needle at a location where the detached posterior hyaloid membrane was farthest from the retinal surface. The location was selected based on six preoperative meridional OCT scans. The posterior hyaloid was then gently peeled off in a circular fashion around the fovea with a micropick. Visual acuity and foveal thicknesses were measured before the operation and 3 months afterwards. RESULTS: After the operation, visual acuity improved and central macular thicknesses were reduced significantly in all six patients. The best corrected visual acuity improved from 0.4 to 0.75 with a mean increase by 3.5 lines on a Snellen chart 3 months after the operation. The mean foveal thickness was reduced from 406 micrometer to 241 micrometer. The restoration of foveal pit was observed in five patients. Neither intraoperative nor postoperative complications were observed during the follow up period. CONCLUSIONS: An OCT retinal mapping program is a valuable diagnostic tool in understanding the configuration of vitreomacular adhesion and planning the surgical approach for operating on vitreomacular traction syndrome.
Aged ; Eye Diseases/diagnosis/etiology/*surgery ; Female ; Humans ; Male ; Middle Aged ; Retinal Diseases/diagnosis/etiology/*surgery ; Syndrome ; Tissue Adhesions/etiology/surgery ; *Tomography, Optical Coherence ; Visual Acuity ; Vitrectomy/*methods ; Vitreous Body/pathology/*surgery ; Vitreous Detachment/complications

PURPOSE: To evaluate the effectiveness of a combined procedure of peeling the internal limiting membrane with vitrectomy in diabetic macular edema. METHODS: This study comprised 16 eyes of 16 patients hospitalized during a 1-year period. They were randomized to either a vitrectomy group (10 eyes in 10 patients) or to a combined procedure group (6 eyes in 6 patients). Preoperative and postoperative macular center thickness, best corrected visual acuity and postoperative complications 4 months postoperative were investigated. RESULTS: There were no statistically significant differences in the mean values of preoperative and postoperative best corrected visual acuity (logMAR) between the two groups. The mean values of preoperative and postoperative macular center thickness in the vitrectomy group were respectively 509.50+/-36.77 and 332.60+/-91.73; while in the combined procedure group, they were 516.17+/-55.43 and 333.83+/-51.64. Again, there were no statistically significant differences between the two groups. At the 4-month follow-up, decreased visual acuity was found in 3 eyes of the vitrectomy group and in 2 eyes of the combined procedure group. Vitreous hemorrhage (3 eyes) and tractional retinal detachment (1 eye) were found in the vitrectomy group and vitreous hemorrhage (2 eyes) was diagnosed in the combined group. CONCLUSIONS: In our study, vitrectomy with peeling of the internal limiting membrane was not more effective than vitrectomy alone in decreasing macular edema or in improving best corrected visual acuity. Additional studies of the combined procedure are needed to verify this result.
Follow-Up Studies ; Humans ; Macular Edema* ; Membranes ; Postoperative Complications ; Retinal Detachment ; Traction ; Visual Acuity ; Vitrectomy* ; Vitreous Hemorrhage

PURPOSE: To evaluate the advantages and complications of triamcinolone acetonide (TA)-assisted pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR). METHODS: We retrospectively examined 110 eyes with vitreous hemorrhage or tractional retinal detachment resulting from a PDR after surgery. The TA-assited PPV [TA(+)] consisted of 58 eyes, and the conventional PPV[TA(-)]group consisted of 52 eyes. The improvement in vision, residual vitreous cortex (VC) pattern, and postoperative complications were studied. RESULTS: The residual VC pattern was divided into 3 groups: the focal type in 34 eyes (58.6%): the diffuse type in 22 eyes (37.9%): and no residual VC, seen in 2 eyes (3.4%). The TA (+) group had a lower incidence of rebleeding (p=0.0149) and of a preretinal membrane (p=0.0138) than the TA (-) group. No apparent persistant ocular hypertension occurred in any eyes. CONCLUSIONS: Triamcinolone-assisted PPV appears to be potentially useful to remove residual VC and to protect from postoperative complications.
Diabetic Retinopathy* ; Incidence ; Membranes ; Ocular Hypertension ; Postoperative Complications ; Retinal Detachment ; Retrospective Studies ; Traction ; Triamcinolone Acetonide ; Vitrectomy* ; Vitreous Hemorrhage

PURPOSE: To examine the clinical effect of combination method of laser treatment and intravitreal triamcinolone (TA) injection for patient of macular edema with branched retinal vein occlusion (BRVO). METHODS: fifteen patients, -(15 eyes), 7 malse and 8 females, with macular edema associated with BRVO were included in the study. The mean age was 59.47 years old. The response to treatment was monitored functionally by visual acuity assessment and anatomically by Optical Coherence Tomography(OCT) for macular thickness. Four milligrams of TA were injected into the vitreous cavity. The clinical outcome and complication were reviewed, retrospectively. RESULTS: After the combination method of laser treatment and intravitreal TA injection, 13 (87%), 12 (80%), 13 (87%) of the 15 eyes showed improved the mean visual acuity at 1-, 2-, and 6-month follow-ups retrospectively. Central macular thickness as measured by OCT decreased by 37% (312.5 +/- 9 micrometer), 42% (282.1 +/- 556 micrometer), and 56% (276.9 +/- 76 micrometer), at the same follow-ups from an initial pretreatment mean of 495.9 +/- 114 micrometer. The post-operative complications were intraocular pressure elevation (1 eye, 7%), and cataract (3 eyes, 20%). However, there were no serious postoperative complication such as retinal detachment, vitreous hemorrhage, and endophthalmitis. CONCLUSIONS: The combination method of laser treatment and intravitreal TA injection may be useful for treating patient of macular edema with BRVO.
Cataract ; Endophthalmitis ; Female ; Follow-Up Studies ; Humans ; Intraocular Pressure ; Macular Edema* ; Postoperative Complications ; Retinal Detachment ; Retinal Vein Occlusion* ; Retinal Vein* ; Retinaldehyde* ; Retrospective Studies ; Triamcinolone Acetonide ; Triamcinolone* ; Visual Acuity ; Vitreous Hemorrhage

PURPOSE: To determine the efficacy and safety of intravitreal triamcinolone acetonide given to treat diabetic macular edema that was unresponsive to a prior laser photocoagulation. METHODS: An intravitreal injection of 4 mg triamcinolone acetonide was given to 25 eyes with a clinically significant diabetic macular edema (CSME) that failed to respond to conventional treatment within an average of 7.56 months after laser photocoagulation. There were 13 females and 4 bilateral cases. The mean age was 60.4 +/- 6.9 years. The response to treatment was monitored functionally by a visual acuity assessment and anatomically by an OCT macular thickness at 1-, 2-, and 6-month intervals after the injection. RESULTS: After the intravitreal injection of triamcinolone acetonide, 18 out of 25 eyes (72%), 20 out of 25 eyes (80%), and 13 out of 18 eyes (72%) showed improvement of the mean visual acuity at the 1-, 2-, and 6-month follow-up intervals. The central macular thickness as measured by the OCT decreased by 43%, 45%, and 20%, respectively, over these same intervals from an initial pretreatment mean of 498.7 +/- 131.6 micro meter. The postoperative complications were an intraocular pressure elevation (3 eyes), and cataract (3 eyes). However, there were no serious postoperative complications such as retinal detachment, vitreous hemorrhage and endophthalmitis. CONCLUSIONS: An intravitreal injection of triamcinolone acetonide may be useful for treating a diabetic macular edema that is resistant to conventional laser photocoagulation.
Cataract ; Endophthalmitis ; Female ; Follow-Up Studies ; Humans ; Intraocular Pressure ; Intravitreal Injections* ; Light Coagulation ; Macular Edema* ; Postoperative Complications ; Retinal Detachment ; Triamcinolone Acetonide ; Triamcinolone* ; Visual Acuity ; Vitreous Hemorrhage

PURPOSE: To evaluate the clinical efficacy for primary application of the silicone oil tamponade in vitrectomy for severe proliferative diabetic retinopathy. METHODS: We did retrospective clinical analysis on the preoperative and postoperative fundus findings, visual results, postoperative complications in 26 patients (30 eyes) with severe proliferative diabetic retinopathy who vitrectomy and intravitreal silicone oil injection were performed simultaneously as initial operation. RESULTS: Vitrectomy with silicone oil injection was performed in 14 eyes (46.7%) with severe traction retinal detachment involving macula, 10 eyes (33.3%) showed severe intraoperative hemorrhage among the cases that iatrogenic retinal tear was developed in the eyes with traction retinal detachment and 6 eyes (20.0%) with combined tractional and rhegmatogenous retinal detachment, and silicone oil was removed postoperatively on mean 2.7months (1.4~6.0 months) in 28 eyes of the total of 30 eyes. Final anatomic success was obtained in 26 eyes (86.7%) and functional success in 23 eyes (76.7%), and there was visual improvement of mean 2.8, 1.9 lines and improvement over 2 lines in 17 (56.7%), 11 (36.7%) eyes for best and final visual acuity comparing to preoperative visual acuity, respectively. Postoperative complications included cataract formation and aggravation in 24 or 25 phakic eyes(96.0%), recurrent preretinal membrane in 10 eyes (33.3%), retinal detachment in 10 eyes (33.3%), neovascular glaucoma in 5 eyes (16.7%), vitreous hemorrhage in 3 eyes (10.0%), and phthisis, band keratopathy, endophthalmitis in 1 eye (3.3%) respectively. CONCLUSIONS: In the proliferative diabetic retinopathy that difficulty in the retinal reattachment is predicted or that has high risk of the rebleeding, early application of the silicone oil tamponade is expected to be a useful tool for primary vitrectomy.
Cataract ; Diabetic Retinopathy* ; Endophthalmitis ; Glaucoma, Neovascular ; Hemorrhage ; Humans ; Membranes ; Postoperative Complications ; Retinal Detachment ; Retinal Perforations ; Retinaldehyde ; Retrospective Studies ; Silicone Oils* ; Traction ; Visual Acuity ; Vitrectomy* ; Vitreous Hemorrhage