The deceptive coloboma

Background: Scleral fistulas are known to develop following blunt trauma in patients with retinochoroidal coloboma. These cases can be managed by surgical options such as silicone buckles, or with glue and scleral patch graft. Some cases have been shown to close spontaneously. We report the first?ever case managed by vitrectomy, endophotocoagulation, and gas tamponade. Purpose: We present a rare and interesting case of an atypical choroidal coloboma with traumatic scleral fistula due to blunt trauma manifesting with hypotony?related disc edema, maculopathy, and chorioretinal folds, which was managed surgically with vitrectomy, endophotocoagulation, and gas tamponade with a good anatomical and visual outcome. Synopsis: The video contains the case description and surgical management of a traumatic scleral fistula in a patient with atypical superotemporal choroidal coloboma. The patient developed hypotonic maculopathy and disc edema after 3 months following a blunt trauma sustained in a road traffic accident. A scleral fistula was suspected at the temporal edge of the coloboma but could not be accurately localized. In addition, due to the edge effect of the coloboma, the external repair was difficult. Hence, vitrectomy with internal tamponade was attempted. Highlights: The video highlights a different surgical approach to managing a traumatic scleral fistula at the edge of a retinochoroidal coloboma. There was a risk of leakage of intravitreal fluid into the orbit through the fistula; however, the gas bubble gave a better tamponade due to higher surface tension. It sealed the fistula presumably by creating a trap?door?like effect. The endophotocoagulation helped create adhesion between the tissues at the edge of the coloboma effectively sealing it. This was followed by a rapid recovery of the hypotony?related problems with good vision. Traumatic scleral fistula, at a difficult place such as the edge of a coloboma, can be successfully closed from an internal approach with vitrectomy, endolaser, and gas tamponade.

Investigate the clinical application of anterior segment OCT indescemet's membrane detachment after intraocular surgery / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the clinical application value of anterior segment OCT(AS-OCT)in diagnosis and treatment of descemet's membrane detachment(DMD)after intraocular surgery. <p>METHODS: Totally 23 eyes of 21 patients with corneal edema after intraocular surgery in our hospital from June 2016 to April 2019 were analyzed retrospectively. The degree of corneal edema and the descemet's membrane detachment(DMD)were observed by AS-OCT. The patients with mild or above descemet's membrane detachment were treated with anterior chamber gas tamponade, the patients with other corneal edema were treated with drug conservative treatment, and the corneal edema and adhesion of descemet's membrane were observed.<p>RESULTS: In this study, 21 patients(23 eyes)had corneal edema of different degrees, 14 eyes with descemet's membrane detachment,11 eyes with mild or above descemet's membrane detachment were re-examined by AS-OCT one day after anterior chamber gas tamponade. 10 eyes had good adhesion, 1 eye had poor adhesion, and the adhesion was good after anterior chamber gas tamponade again. After 1mo follow-up, the cornea of all the patients recovered to be transparent and their vision recovered well.<p>CONCLUSION:AS-OCT can timely and accurately diagnose and evaluate descemet's membrane detachment and its therapeutic effect.

Observation of cataract extraction and vitrectomy with gas tamponade for idiopathic macular hole at different stages / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM: To investigate the visual acuity after cataract extraction and vitrectomy with gas tamponade for idiopathic macular hole (IMH) at different stages. ·METHODS: In this study, 75 IMH patients ( 75 eyes ) treated in our hospital from August 2014 to August 2016 were enrolled and underwent cataract extraction, vitrectomy and C3F8gas tamponade. Patients were divided into stage Ⅱ Group ( 18 cases ), stage Ⅲ ( 36 cases) and stageⅣ(21 cases) according to Gass stages, and macular hole closure at 2 and 4wk postoperatively were compared. The routine visual acuity examination before and after surgery were performed, and the visual acuity in each group were compared. The optical coherence tomography ( OCT) was used to measure the macular thickness before and after surgery. ·RESULTS: The closure rate of macular hole in stage Ⅱwas significantly higher than that of stage Ⅲ and IV at the 1mo after operation, that at the stage Ⅲ was significantly higher than that of stageⅣgroup, and the difference was statistically significant (P<0. 05). There was no significant difference in the rate of closure of macular hole between stage Ⅱ and stage Ⅲ at 3mo after operation (P>0. 05). The proportion of eyes with visual acuity of finger counting, 0. 02-0. 08, 0. 10-0. 20, 0. 25-0. 40 and ≥0. 50 was statistically significant different before and after surgery(P<0. 05). The improvement rate of visual acuity was 94% in stage Ⅱ, which was significantly higher than that in stage Ⅲ (83%) and stage Ⅳ (67%). The macular thickness of the stage Ⅱ and Ⅲ was significantly lower after the surgery, but there was no significant difference in the stage Ⅳ before and after surgery (P>0. 05), the decreasing range of the stage Ⅱ and Ⅲ was not statistically significantly different (P>0. 05), which were significantly higher than that of the stage Ⅳ, the difference was statistically significant (P<0. 05). ·CONCLUSION: Cataract extraction, vitrectomy and C3F8 gas tamponade surgery is conducive to the vision recovery after idiopathic macular hole, but the effects with different Gass staging are different, surgery should be performed as early as possible to improve macular hole closure and eyesight recovery.

Comparison of nursing effects in different positions after vitrectomy and gas tamponade / 医学研究生学报

Objective Face-down positioning after vitrectomy and gas tamponade is still the standard position for patients with rhegmatogenous retinal detachment.The study was to compare the nursing effects of face-down position and flexible position after vitrecto-my for the repair of rhegmatogenous retinal detachment. Methods We investigated 120 cases of patients with rhegmatogenous retinal detachment in this study.All patients received vitrectomy with long-acting gas for tamponade, 60 patients in face-down position and 60 in the flexible position.Patients were followed up for 6 months.Observation was made on the rates of anatomical retinal reattachment and postoperative complications between the groups. Results The rates of anatomical retinal reattachment after surgery were 88.33%in the face-down position group and 100% in the flexible position group respectively.As to the satisfaction of position, the flexible position group was 100%, which was much higher than 41.67%in face-down position group(P<0.01). Conclusion Flexible position nurs-ing after vitrectomy and gas tamponade for rhegmatogenous retinal detachment repair is safe and effective.Flexible position can replace face-down position for the comfort of patients with rhegmatogenous retinal detachment after vitrectomy with gas tamponade.

The Effect of Gas Tamponade with Vitrectomy in Lamellar Macular Hole

PURPOSE: To investigate the effect of gas tamponade with vitrectomy for lamellar macular hole. METHODS: This study included 18 eyes of 18 patients with lamellar macular hole who reported visual acuity loss or distorted vision. All patients underwent vitrectomy, epiretinal membrane removal and internal limiting membrane peeling. Intravitreal gas tamponade was performed only in 8 eyes of 8 patients. The patients were divided into 2 groups: 8 eyes in the gas tamponade with vitrectomy group and 10 eyes that did not receive gas tamponade in the control group. The best-corrected visual acuity (BCVA) and appearance based on optical coherence tomography (OCT) were obtained retrospectively. RESULTS: Epiretinal membranes were observed in all cases. Average visual acuity of the gas tamponade group improved from log MAR 0.50 +/- 0.24 to log MAR 0.25 +/- 0.14 (p = 0.041). In the control group, average visual acuity improved from log MAR 0.53 +/- 0.36 to log MAR 0.32 +/- 0.28 (p = 0.041), however, no significant difference was observed in visual acuity between the 2 groups (p = 0.584). Anatomical closure or normalized foveal contour after surgery was confirmed in 6 of 8 eyes in the gas tamponade group and in 7 of 10 eyes in the control group. No significant difference between the 2 groups was observed (p = 1.00). CONCLUSIONS: Gas tamponade combined with vitrectomy for lamellar macular hole did not affect postoperative anatomical and functional recovery.

Centeral Retinal Artery Occlusion after Viterctomy with Gas Tamponade for Retinal Detachment: A Case Report / 계명의대학술지

To introduce a case of Centeral Retinal Artery Occlusion in Gas Tamponade State after Viterctomy for the treatment of Retinal Detachment. A 47-year-old male patient with histories of LASEK surgery 15 years ago and cataract surgery 8 years ago visited our clinic with complaints of sudden visual disturbance in his right eye. He was diagnosed as regmatgenous retinal detachment and underwent pars plana vitrectomy, endolaser photocoagulation, 14% C3F8 gas tamponade, and subtenon triamcinolone injection. After the surgery, the retina was well attached and the visual acuity was improved from finger count 30cm at post-operative day 1 to 0.08 after the 2 weeks of surgery. Intraocular pressure was maintained 20~25 mmHg by Brimonidine/timolol eye drop treatment. The best corrected visual acuity was reduced to hand motion at post-operative day 15. Retinal arteriol attenuation and pale optic disc with 1/3 gas filled vitreous cavity was identified at post-operative day 30. Post-operative 2 years, visual acuity was non light perception with severe narrowing of arteriole and diffuse retinal pigment epithelial atrophy; no retinal vascular flow was observed on fluorescein angiography. Gas tamponade state after viterctomy for the treatment of retinal detachment at high myopia may be risk factors of central retinal artery occlusion.

Posterior Subtenon Triamcinolone Acetonide in Gas-filled Eyes as an Adjunctive Treatment for Complicated Proliferative Diabetic Retinopathy

PURPOSE: To evaluate the effect of adjunctive subtenon injection of triamcinolone acetonide (TA) in gas-filled eyes after vitrectomy for complicated proliferative diabetic retinopathy (PDR). METHODS: This nonrandomized comparative study included 27 patients (27 eyes) who underwent pars plana vitrectomy and gas tamponade for treatment of PDR with tractional or combined tractional-rhegmatogenous retinal detachment and who received subtenon injection of TA (40 mg) at the end of surgery. The study group was compared with the control group (29 eyes), which was matched with the study group for preoperative and intraoperative parameters, but underwent pars plana vitrectomy and gas tamponade without a subtenon injection of TA. RESULTS: Retinal reattachments without reoperation were achieved in 25 eyes (92.6%) and 26 eyes (89.7%) at 6 months (p = 1.000) in the study and control groups, respectively. The study group and the control group did not differ significantly in the frequency of postoperative proliferative vitreoretinopathy, retinal redetachment rate, reoperation rate, macular pucker formation, postoperative vitreous hemorrhage, gain in visual acuity, intraocular pressure, and intraocular inflammation (p > 0.05). CONCLUSIONS: The clinical results of pars plana vitrectomy for complicated PDR are not improved significantly by an adjunctive subtenon TA injection in gas-filled eyes.

Surgical Removal of Retained Subfoveal Perfluorocarbon Liquid through a Therapeutic Macular Hole with Intravitreal PFCL Injection and Gas Tamponade

We report two cases of surgical removal of a retained subfoveal perfluorocarbon liquid (PFCL) bubble through a therapeutic macular hole combined with intravitreal PFCL injection and gas tamponade. Two patients underwent pars plana vitrectomy with PFCL injection for rhegmatogenous retinal detachment. In both cases, a retained subfoveal PFCL bubble was noticed postoperatively by funduscopy and optical coherence tomography. Both patients underwent surgical removal of the subfoveal PFCL through a therapeutic macular hole and gas tamponade. The therapeutic macular holes were completely closed by gas tamponade and the procedure yielded a good visual outcome (best-corrected visual acuity of 20 / 40 in both cases). In one case, additional intravitreal PFCL injection onto the macula reduced the size of the therapeutic macular hole and preserved the retinal structures in the macula. Surgical removal of a retained subfoveal PFCL bubble through a therapeutic macular hole combined with intravitreal PFCL injection and gas tamponade provides an effective treatment option.

The Change in Corneal Endothelial Cell Density after Pars Plana Vitrectomy

PURPOSE: To assess the effect of pars plana vitrectomy and gas tamponade on corneal endothelial cell density. METHODS: The corneal endothelial cell density in 145 eyes that underwent pars plana vitrectomy was examined with a noncontact specular microscope 3 months pre- and post-operation. The subjects were divided as follows: Group 1 (32 eyes) underwent pars plana vitrectomy, group 2 (26 eyes) underwent pars plana vitrectomy combined with gas tamponade, group 3 (34 eyes) underwent pars plana vitrectomy combined with phacoemulsification and group 4 (48 eyes) underwent pars plana vitrectomy combined with phacoemulsification and gas tamponade. The changes in corneal endothelial cell density between groups was compared. RESULTS: The mean endothelial cell loss was more significant in group 2 than in group 1 (p = 0.012), and there was no difference between groups 3 and 4 (p = 0.063). However, after excluding 6 eyes that had blood in the center of the corneal endothelium as a result of being in the prone position following gas tamponade, the mean endothelial cell loss in group 2 was not less than in group 1. In eyes with blood in the corneal endothelium, endothelial cell loss significantly increased (p < 0.001). CONCLUSIONS: The results of this study suggest that ophthalmic surgeons should attempt to carefully control bleeding and sufficiently irrigate the vitreous during pars plana vitrectomy combined with gas tamponade.

Ulnar Neuropathy as a Complication of Retinal Detachment Surgery

PURPOSE: To report a case of ulnar neuropathy as an extraocular complication following retinal detachment surgery and face-down positioning. CASE SUMMARY: A 65-year-old woman was referred to our hospital with decreased visual acuity in the left eye. Fundus examination revealed a rhegmatogenous retinal detachment not involving the macula in the left eye. A vitrectomy with scleral encircling and 18% SF6 gas tamponade was performed. The patient was instructed to assume a face-down position. After 5 days, the patient reported having paresthesia and numbness of the left 4th and 5th fingers. Neurologic exams were performed and the results indicated ulnar neuropathy. There was no improvement in the neurologic symptoms during the 6-month follow-up. CONCLUSIONS: Surgeons performing retinal surgery should caution their patients of ulnar neuropathy when face-down positioning is required. The patients should be instructed to minimize the time spent with their elbows flexed in a stationary position. Additionally, the pressure loaded on the bent elbow should be minimized.

The Results of B-scan Ultrasonography in Different Positions after Vitrectomy and Gas Tamponade

PURPOSE: To determine the proper time frame in which to assess retinal attachment status and to evaluate the superior retinal attachment status by performing B-scan ultrasonography in different positions on patients who have undergone pars plana vitrectomy and gas tamoponade. METHODS: In this prospective study, 23 patients (23 eyes) who had undergone pars plana vitrectomy and gas tamponade were investigated between June 2005 and February 2006. SF6 (18%) was injected into the vitreous cavity of 15 eyes, and C3F8 (14%) was injected into the vitreous cavity of 8 eyes. At postoperative day 1, day 3, week 1, week 2, and week 4, B-scan ultrasonography was performed in the supine, sitting, prone, right decubitus, and left decubitus positions. RESULTS: The proper time to evaluate the retinal attachment status was three days post-operatively in 10 eyes (66.7%) with SF6 (18%) injections and two weeks post-operatively in six eyes (75%) that had C3F8 (14%) injections. The superior retinal attachment status can be evaluated from the summation of B-scan ultrasonography results performed in the right decubitus and left ducubitus positions. CONCLUSIONS: The proper time to evaluate the retinal attachment status was related to the degree of the gas absorption when performing B-scan ultrasonography after pars plana vitrectomy and gas tamponade. To evaluate the entire retina, it is useful to perform B-scan ultrasonograhy in the prone, right decubitus and left decubitus positions.

Postoperative Refractive Error after Vitrectomy In Macular Hole Patients

PURPOSE: To evaluate the postoperative refractive error after vitrectomy and gas tamponade in macular hole patients. METHODS: Thirty patients with full-thickness macular hole were enrolled in this study. Thirty eyes had vitrectomy, internal limiting membrane peeling, and gas tamponade. Preoperative and postoperative refractive errors were compared. Five eyes also had cataract extraction and implantation of an IOL and actual and expected refractive errors were compared. RESULTS: The refraction after vitrectomy and gas tamponade shifted toward myopia by 0.71 diopter compared with preoperative refraction. The actual refractive errors in cataract surgery group shifted toward myopia by 0.65 diopter. CONCLUSIONS: . Use of a gas tamponade in macular hole patients is thought to have induced the myopic change by pressing the crystalline lens forward.

Vitreous surgery for macular holes / 眼科新进展

Objective　To review the anatomic and visual outcomes of a series of patients with macular holes who underwent vitreous surgery without adjunctive therapy.Methods　We performed a retrospective review of 16 patients who underwent vitrectomy, fluid-gas exchange and perflu oropropane(C3 F8) gas temponade for 14 eyes with idiopathic and 2 eyes with traumatic macular holes.Results　Anatomical closure of the macular holes was achieved in 15(93%) of 16 eyes with an average follow-up of 7 months. Only one eye needed performing second surgery. Three(19%) eyes achieved postoperative visual acuity of 0.4, four (25%)eyes 0.2～0.3,and nine(56%)eyes 0.1 or worse. Conclusions　Vitreous surgery without adjunctive therapy with intraocular gas tamponade and postoperative posturing is a well tolerated and effective intervention for idiopathic or some traumatic macular holes. Anatomical closure of the macular hole is associated with a significant improvement in visual acuity in most eyes.

Risk Factors of Intraocular Pressure Elevation after Pars Plana Vitrectomy

The medical records of 206 eyes of 206 consecutive patients who underwent pars plana vitrectomy between March 1994 and October 1998, were reviewed retrospectively to determine the incidence and risk factors of postoperative intraocular pressure elevation. The mean follow-up period was 104.2 weeks. Early(within 7 days of surgery)and late postoperative intraocular pressure elevation(>21mmHg)occurred in 83 eyes(40.3%)and 84 eyes(40.7%), respectively. Injection of the gas increased the incidence of early postoperative intraocular pressure elevation significantly(Chi-square univariate analysis;P=0.046, Multivariate logistic regression analysis;odds ratio=1.928, confidence interval 1.079~3.480). Patients undergoing pars plana vitrectomy with gas tamponade must be carefully followed after surgery due to high incidence of postoperative intraocular pressure elevation.

Intraocular Pressure Changes After Gas Tamponade

100% sulfur hexafluoride(SF6) was injected into the vitreous cavity of nonvitrectomized retinal detachment patients. A total of 0.5ml of gas was injected with a single shot in 3 eyes or two 0.25ml in 3 eyes without lowering of intraocular pressure. And in 3 eyes, single shot of 0.5ml of gas was used after lowering of intraocular pressure. The changes of intraocular pressure were monitored at 5 minute intervals for 60 minutes and at one hour intervals for 8 hours after injection. Marked elevation of intraocular pressure was noted in both single shot group, but the elevation of intraocular pressure of double shot group was much smaller. But in all groups, the intraocular pressures were returned to under 30mmHg within 20 minutes and no re-elevation of intraocular pressure was noted in all cases after initial return to normal. In a case with two 0.3ml shots, the highest pressure was 49mmHg and with 0.35ml shots, the highest pressure was 78mmHg. So the effect of SF6 on intraocular pressure seemed to be negligible so long as the injection volume was limited to 0.5ml or less in single shot; and 0.6ml in double shots.