Complication of manual small incision cataract surgery and phacoemulsification in previously vitrectomized eyes with silicone oil tamponade / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To compare the safety between phacoemulsification and manual small incision cataract surgery ( MSICS ) combined with silicone oil removal in previously vitrectomized eyes.?METHODS:A retrospective comparative no-inferiority study to 162 patients ( 162 eyes ) who undergone cataract surgery, either phacoemulsification or MSICS combined with silicone oil removal which had pars plana vitrectomy.?RESULTS:There were no statistically significant different in hypotony between phacoemulsification group ( 21 patients;18. 91％) and MSICS group (8 patients;15. 68％) (P= 0. 666). There was also no statistically significant different between two group in 1mo retinal reattachment rate;8 patients (7. 2％) in phacoemulsification group had redetachment compared with 9 patients ( 17. 64％) in MSICS combined with silicone oil removal group ( P =0. 055).? CONCLUSION: MSICS combined with silicone oil removal has non-inferiority result to phacoemulsification combined with silicone oil removal in hypotony, leakage, choroidal detachment and retinal reattachment rate.

Utilidad del sistema Scheimpflug por Pentacam para la cuantificación de la opacidad de la cápsula posterior en pacientes pseudofáquicos con aceite de silicona / Usefulness of Pentacam Scheimflug system for quantification of the posterior capsule opacity in pseudophakic patients with silicon oil-filled eyes

Objetivo: determinar si el sistema Scheimpflug por Pentacam tiene utilidad en la cuantificación objetiva de la opacidad de la cápsula posterior en los pacientes pseudofáquicos con aceite de silicona. Métodos: se realizó un estudio descriptivo, prospectivo y observacional en el Instituto Cubano de Oftalmología Ramón Pando Ferrer en el período comprendido entre abril del año 2012 y abril de 2014. Se evaluó, mediante sistema Scheimpflug del Pentacam para la cuantificación de la opacidad de cápsula posterior, a un grupo de 31 pacientes seudofáquicos sometidos a una vitrectomía previa con aceite de silicona y se compararon los resultados con los obtenidos en 26 pacientes operados solo de cirugía del cristalino con lente intraocular, para lo cual se utilizaron las variables edad, sexo, opacidad en grados por lámpara de hendidura y la intensidad media de píxeles en un área circular de 3 mm centrales seleccionada en los tomogramas, analizadas por el software Image J 1.42 q. Resultados: en los pacientes pseudofáquicos con aceite de silicona el sistema Scheimpflug no fue capaz de discernir entre los diferentes grados de opacidad de la cápsula posterior(p= 0,210) y no existió concordancia entre ambas mediciones (p= 0,120). Las mediciones realizadas en los pacientes pseudofáquicos con aceite de silicona con la lámpara de hendidura por dos observadores fueron similares (p= 0,042), al igual que existió buena correlación en las realizadas con el sistema Scheimpflug (r= 0,981). Cuando se compararon las mediciones realizadas con el sistema Scheimpflug en los dos grupos de pacientes se observó que las medias de intensidad en los grados 1 y 2 eran superiores a las halladas en los pacientes no vitrectomizados previamente, no así en los grados 3; solo en este último caso la diferencia fue significativa (p= 0,001). Conclusiones: el sistema Scheimpflug no es útil para cuantificar la opacidad de la cápsula posterior en los pacientes vitrectomizados previamente que aún tienen aceite de silicona(AU)

Objective: to determine whether the Pentacam Scheimpflug imaging system is useful for objective quantification of the posterior capsule opacity in pseudophakic patients with silicon oil-filled eyes. Methods: observational, prospective and descriptive study conducted in Ramon Pando Ferrer Cuban Institute of Ophthalmology in the period of April 2012 through April 2014. With the Pentacam Scheimpflug imaging system for the quantification of the posterior capsule opacity, 31 pseudophakic patients, who had undergone previous vitrectomy with silicon oil, were evaluated and their results were then compared with those of patients operated on through crystalline lens surgery and intraocular lens implantation (26 patients). To this end, the analyzed variables were age, sex, opacification degrees measured with slit lamp and average intensity in pixels in a 3mm round area selected from tomographs and analyzed by Image J 1.42 q software. Results: in pseudophakic patients with silicon oil-filled eyes, the Scheimpflug system could not differentiate the different levels of the posterior capsule opacity (p= 0.210) and there was no agreement between both measurements (p= 0.120). The measurements taken by two observers in pseudophakic patients using silicon oil and slit lamp were similar (p= 0.042) and good correlation in those taken with the Scheimpflug system (r= 0.981). When comparing the Scheimpflug system measurements taken in the two groups of patients, it was observed that the intensity means in grades 1 and 2 were higher than those found in non-vitrectomized patients, but in grade 3, the difference was significant (p= 0.001). Conclusions: Scheimpflug system is not useful to measure the posterior capsule opacity in previously vitrectomized patients who still have silicon oil-filled eyes(AU)

A Case of Malignant Glaucoma in a Vitrectomized Eye

PURPOSE: To report a case of malignant glaucoma in an eye vitrectomized 5 years previously due to endophthalmitis. CASE SUMMARY: A 55-year-old male visited clinic due to a painful right eye 2 days in duration. Five years ago, he suffered endophthalmitis in his right eye and underwent pars plana vitrectomy. On slit-lamp examination, shallow anterior chamber depth of 2 central corneal thickness and corneal edema were observed along with remnant cortical lens material behind the intraocular lens. Intraocular pressure was 68 mm Hg measured using applanation tonometry. Maximal medical treatment failed to lower the intraocular pressure on the first day of visit. The very next day, anterior chamber became shallower less than 0.5 central corneal thickness and intraocular pressure was 70 mm Hg. Posterior capsular syndrome was suspected on anterior optical coherence tomography and neodymium:yttrium-aluminum-garnet laser posterior capsulotomy was performed, however, normal anterior chamber could not be restored. Despite continuous medical therapy for 3 weeks, the patient's symptoms worsened and intraocular pressure increased over 99 mm Hg and therefore, the Ahmed glaucoma valve was implanted. One day after the operation, intraocular pressure decreased to 10 mm Hg and anterior chamber depth became deeper with the depth of over 5 central corneal thickness. At the final visit 4 months postoperatively, intraocular pressure and normal anatomy of the anterior segment were well maintained. CONCLUSIONS: Malignant glaucoma syndrome can occur even in vitrectomized eyes and capsular block syndrome can initiate this. Malignant glaucoma syndrome in a vitrectomized eye resistant to maximal medical treatment can be treated with Ahmed valve implantation.

A Case of Secondary Macular Hole Formation after Phacoemulsification in a Vitrectomized Eye

PURPOSE: To report a case of secondary macular hole formed after phacoemulsification in a vitrectomized eye which was treated with macular hole surgery. CASE SUMMARY: A 53-year-old man with a history of pars plana vitrectomy developed a cataract in his left eye. Uncomplicated cataract surgery involving phacoemulsification with posterior chamber intraocular lens implantation was performed. At his routine 3-month post-operative visit, he reported metamorphopsia. Fundus examinations and optical coherence tomography revealed a cystoid macular edema and a full thickness macular hole. He underwent repair of the macular hole including internal limiting membrane peeling and gas injection. Three months later, post-operative examinations showed anatomical closure of the macular hole. CONCLUSIONS: When performing cataract surgery, even in a previously vitrectomized eye, clinicians should be aware of the possibility of cystoid macular edema. A thorough pre- and post-operative assessment, including fundus examinations and optical coherence tomography must be carefully performed in order to detect a macular hole associated with cystoid macular edema. And prompt treatment is required when a macular hole is detected.

A Case of Secondary Macular Hole Formation after Phacoemulsification in a Vitrectomized Eye

PURPOSE: To report a case of secondary macular hole formed after phacoemulsification in a vitrectomized eye which was treated with macular hole surgery. CASE SUMMARY: A 53-year-old man with a history of pars plana vitrectomy developed a cataract in his left eye. Uncomplicated cataract surgery involving phacoemulsification with posterior chamber intraocular lens implantation was performed. At his routine 3-month post-operative visit, he reported metamorphopsia. Fundus examinations and optical coherence tomography revealed a cystoid macular edema and a full thickness macular hole. He underwent repair of the macular hole including internal limiting membrane peeling and gas injection. Three months later, post-operative examinations showed anatomical closure of the macular hole. CONCLUSIONS: When performing cataract surgery, even in a previously vitrectomized eye, clinicians should be aware of the possibility of cystoid macular edema. A thorough pre- and post-operative assessment, including fundus examinations and optical coherence tomography must be carefully performed in order to detect a macular hole associated with cystoid macular edema. And prompt treatment is required when a macular hole is detected.

The 23-Gauge Sutureless Vitreoretinal Surgery in Previously Vitrectomized Eyes

PURPOSE: To investigate the incidence and risk factors of major complications including postoperative hypotony after 23-gauge transconjunctival sutureless vitrectomy in previously vitrectomized eyes. METHODS: The authors retrospectively reviewed medical records of 52 eyes, which underwent 23-gauge transconjunctival sutureless vitrectomy of previously vitrectomized eyes by a single surgeon. Major outcomes were postoperative hypotomy (<6 mmHg), intraoperative sclera shrinkage during sclerotomy,and other postoperative complications. Multiple logistic regression analysis was performed that included 212 eyes with primary vitreoretinal surgery in order to validate secondary vitreoretinal surgery as a significant risk factor of postoperative hypotony. RESULTS: Postoperative hypotony occurred in 4 eyes (7.7%) out of 52 eyes that underwent a second vitrectomy. The odds ratio of the second vitreoretinal surgery (OR=1.15, p=0.283) was not significant by multiple logistic regression analysis that included age, sex, axial length of globe, and the number of surgeries as the independent variables. Choroidal detachment occurred in one eye but disappeared three days later. The intraocular pressure was normalized within one week in all cases. Scleral shrinkage during sclerotomy occurred in five eyes (9.6%), and there were no other major complications, such as endophthalmitis. CONCLUSIONS: A 23-gauge transconjunctival sutureless vitrecomy of previously vitrectomized eyesshowed a 7.7% incidence of postoperative hypotony and favorable prognosis.

Phacoemulsification in Previously Vitrectomized Eyes; Results of a 5-Year Period in Surgical Outcome

PURPOSE: To compare the incidence of complications and the outcome of phacoemulsification surgery in patients with and without previous vitrectomy. METHODS: We retrospectively investigated 60 patients in a study group that received phacoemulsification with posterior chamber IOL implantation (PC-IOL) in the vitrectomized eye and 60 patients in a control group that received only phacoemulsification with PC-IOL implantation from January 2003 to December 2007. The interval from PPV to cataract extraction, sex, age, type of cataract, intraoperative and postoperative complications, pre- and postoperative refraction were reviewed. RESULTS: The most common indication of pars plana vitrectomy was diabetic retinopathy. Nucleosclerosis was the most common type of cataract. The most common intraoperative complication was posterior capsular rupture, but there was no statistical significance when compared with the control group (p=0.116). In addition, the most common postoperative complication was posterior capsular opacity. After phacoemulsification, the rate at which a BCVA of 0.5 or better was obtained was lower in the study group than the control group. The spread between actual and expected refraction showed no statistically significant difference when compared with the control group (p=0.309). CONCLUSIONS: Experienced surgeons can safely perform phacoemulsification and PC-IOL implantation in previously vitrectomized eyes. However, the outcome of visual acuity is limited by vitreoretinal pathology that requires vitrectomy.

The Outcome of Inferonasal Trabeculectomy in Diabetic Patients Who Expected or Had Vitrectomy

PURPOSES: We evaluated the outcome of trabeculectomy using inferonasal bleb in diabetic retinopathy patients awaiting vitrectomy or on whom vitrectomy was performed. METHODS: We retrospectively reviewed the medical records of patients who had undergone trabeculectomy with an inferonasal bleb from December 2002 to May 2005. Seven eyes had neovascular glaucoma secondary to the proliferative diabetic retinopathy, 6 eyes primary open angle glaucoma, and 4 eyes steroid induced glaucoma. We evaluated postoperative complication, intraocular pressure, the number of ocular hypotensive eye drops, and preoperative and postoperative best corrected visual acuity. RESULTS: Mean follow-up period was 20.47+/-5.55 months. Most common complication was early ocular hypotony (4 eyes, 24%), but no blebitis and bleb associated endophthalmitis were observed. Mean intraocular pressure was reduced from 30.77+/-5.61 mm Hg preoperatively to 13.72+/-4.61 mm Hg at the most recent follow-up. The number of preoperative ocular hypotensive eye drops was 2.9+/-0.3 and that of postoperative eye dros was 1.4+/-1.0. The difference between these was statistically significant (p=0.000). Eleven eyes (61.11%) had a stable or improved visual acuity. CONCLUSIONS: Trabeculectomy using an inferonasal bleb appears to be a safe and effective surgical option that may be helpful in certain clinical situations, such as medically uncontrolled glaucomatous eyes with expected vitrectomy or vitrectomized eyes.

Clinical Study on Anterior Chamber Intraocular Lens Implantation in Completely Vitrectomized Eyes

PURPOSE: We studied the result and clinical significance of anterior chamber lens implantation in completely vitrectomized eyes without capsular support. METHODS: We evaluated 15 aphakic eyes of 15 patients. According to the cause of pars plana vitrectomy, there were 6 eyes for lens dislocation, 5 for intraocular foreign body, and 4 for rhegmatogenous retinal detachment. RESULTS: The final available postoperative best-corrected visual acuity was 0.5 or better in 9 eyes (60%). No statistically significant difference was noted in preoperative and postoperative IOP. The average of postoperative astigmatism was 1.14 +/- 0.79D. The most common early complication was temporary increase in IOP, but we could control IOP within normal limit with transient treatment. The postoperative late complications were glaucoma, IOL decentration and cystoid macular edema, but serious postoperative complications such as bullous keratopathy and retinal detachment were not found. CONCLUSIONS: The anterior chamber IOL implantation appears to be well tolerated and represents a simple alternative to transscleral fixation of a posterior chamber IOL in completely vitrectomized aphakic eyes.

Effect of Vitreous on the Anterior Chamber Depth after Cataract Surgery

PURPOSE: To determine the changes of location of intraocular lens (IOL) and refractive errors in the cases of vitrectomized eyes and non-vitrectomized eyes, we evaluated the anterior chamber depth and refractive errors after phacoemulsification and posterior chamber IOL implantation. METHODS: In 21 vitrectomized eyes of 21 patients (group 1) and 22 non-vitrecomized eyes of 22 patients (group 2), the anterior chamber depth was measured with Orbscan II (Bausch and Lomb Surgical, Germany) for the evaluation of changes of anterior chamber depth preoperatively, at 1 month and 3 months postoperatively. We compared the desired refraction by preoperative data, and postoperative manifest refraction of postoperative 1 month and 3 months. RESULTS: In group 1, the anterior chamber was deeper than that of group 2 postoperative 1 month but the result was not statistically significant. After 3 months the chamber depth was significantly deeper in group 1 than group 2, (P=0.047), and refractive errors were significantly more hyperopic in group 1 than group 2. CONCLUSIONS: The vitreous influenced the location of IOL after phacoemulsification and posterior chamber IOL implantation, so in the cases of vitrectomized eyes IOL was more posteriorly located, and thus hyperopic shift was noted.

Sutured Posterior Chamber Intraocular Lens in the Vitrectomized Eye: Comparison of PMMA and Acrysof(R) Foldable Lenses

PURPOSE: To compare the clinical outcomes of scleral fixated posterior chamber intraocular lens in vitrectomized eyes according to IOL types. METHODS: Clinical outcomes of 28 eyes of 28 patients who underwent scleral fixated posterior chamber IOL after pars plana vitrectomy and lensectomy were evaluated according to the IOL type used: 19 eyes with PMMA lens (group 1) and 9 with Acrysof(R) foldable lens (group 2) RESULTS: Postoperative BCVA improved or was stabilized in 7 eyes (36.8%) of group 1, and 7 eyes (77.7%) of group 2 (P=0.04). Mean postoperative change in astigmatism was 1.19 +/- 0.79 diopter in group 1 and 0.62 +/- 0.47 diopter in group 2 (P=0.25). Estimated refractive error was -0.76 +/- 0.26 and -0.74 +/- 0.24 diopter in groups 1 and 2, respectively, and postoperative refractive error was -1.31 +/- 1.27 and -1.23 +/- 1.34 diopter, respectively. This showed a slight myopic shift in both groups. There were postoperative complications such as hyphema in 4 eyes (26.3%) in group 1 and in 1 eye (11.1%) in group 2, and transiently increased IOP in 5 eyes (26.3%) and in 1 eye (11.1%), respectively. The other complications that were found in group 1 were glaucoma, retinal detachment, choroidal detachment, and cystoid macular edema. CONCLUSIONS: Scleral fixation using foldable IOL is thought to be a relevant method in vitrectomized eyes, as it showed less postoperative astigmatism change and complications, and better visual outcome.

Migration of Photoreceptor Cells Into the Subretinal Space in Rabbit Retina

The migration of photoreceptors into the subretinal space has been reported to occur in developing and aged rat retina, in aged human retina, in detached owl monkey, and in detached cat retina. Subretinal photoreceptor cells have been observed in aphakic-vitrectomized rabbit eyes with or without intravitreal saline or antibiotic injection. Variety of photoreceptor cell nuclei can be distinguished. The nuclei of photoreceptor cells change their shape so as to pass easily through the juncition and thereafter they returned to their original shape in sub retinal space. The mechanisms and biological significance of this phenomenon are not yet certain, but it may by one of the important factors contributing to decreased vision with aging.