Scleral communication between Glaucoma drainage device capsule and the suprachoroidal space simulating amelanotic choroidal melanoma / Comunicação escleral entre a cápsula de dispositivo de drenagem para glaucoma e o espaço supracoroidal simulando melanoma de coroide amelanótico

ABSTRACT This is a case report involving a 56-year-old male patient with a history of pars plana vitrectomy due to a rhegmatogenous retinal detachment in the right eye that resulted in the implantation of a drainage device after the patient developed secondary glaucoma. Two years after the device's implantation, the patient was referred to our care as his visual acuity had decreased to 20/200 (1.00 LogMAR). At the fundus evaluation, a choroidal amelanotic elevation was observed at the upper temporal equator, and a potential diagnosis was made of amelanotic choroidal melanoma. The ultrasound exam visualized the patient's implanted superotemporal justabulbar drainage device, which revealed a transscleral communication from the plate fibrocapsular's draining space to the suprachoroidal space (fistula). The ultrasound also revealed a focal pocket of choroidal detachment in the patient's superotemporal region, simulating an amelanotic choroidal melanoma. A new pars plana vitrectomy was performed to remove the internal limiting membrane without repercussions at the fistula site. The patient's recovery progressed well, and he regained a visual acuity of 20/70 (0.55 LogMAR). To the best of our knowledge, this is the first case report of this condition.

RESUMO Relato de caso de paciente 56 anos, sexo masculino, com histórico de vitrectomia via pars plana por descolamento de retina em olho direito e posterior implante de dispositivo de drenagem por glaucoma secundário. Dois anos após o procedimento foi encaminhado ao serviço por baixa de acuidade visual (AV) de 20/200 (1.00 LogMAR). À fundoscopia, observou-se uma elevação amelanótica temporal no equador com hipótese diagnóstica de melanoma de coroide amelanótico. O exame de ultrassom mostrou implante de dispositivo de drenagem justabulbar temporal superior com comunicação transescleral para espaço subcoroidal (fístula), sugerindo bolsão focal de descolamento de coroide em equador temporal superior simulando melanoma de coroide amelanótico. O paciente foi abordado cirurgicamente devido membrana epirretiniana com nova vitrectomia via pars plana para peeling de membrana limitante interna, sem repercussões no local da fístula, evoluindo bem com acuidade visual de 20/70 (0.55 LogMAR). Ao nosso conhecimento, este é o primeiro caso relatado nessa condição.

Risk factors of postoperative vitreous hemorrhage after pars plana vitrectomy for proliferative diabetic retinopathy / 中华实验眼科杂志

Objective:To investigate the risk factors of postoperative vitreous hemorrhage (PVH) after vitrectomy for proliferative diabetic retinopathy (PDR).Methods:A case-control study was conducted.A total of 1 848 consecutive PDR patients (1 848 eyes) with vitreous hemorrhage receiving first pars plana vitrectomy (PPV) in Tianjin Medical University Eye Hospital from June 2012 to May 2019 were enrolled.There were 979 males and 869 females, with the average age of (55.72±10.39) years.All of the enrolled eyes underwent standard three-channel PPV.The subjects were followed up for 6 to 24 months, with the mean follow-up of (379.34±231.28) days.The eyes were divided into PVH group and non-PVH group according to whether the PVH occurred or not.The PVH group were further divided into early PVH group and late PVH group according to the occurrence time of PVH.There were 170 (9.19%) of 1 848 eyes developed PVH after surgery, including 17.64%(30/170) of eyes with early PVH and 82.36% (140/170) of eyes with late PVH.The PVH occurred at 6 to 450 days after surgery.Baseline systemic parameters including sex, age, diabetes duration, preoperative glycosylated hemoglobin (HbA1c) level, and ocular parameters including whether or not performing panretinal photocoagnlation, whether or not receiving treatment of anti-vascular endothelial growth factor (VEGF) three days before operation, lens status, whether or not being combined with neovascularization of iris (NVI), as well as intraoperative ocular parameters including whether or not having neovascularization of disc (NVD) bleeding, whether or not being combined with cataract phacoemulsification, whether or not receiving postoperative anti-VEGF, were analyzed by multivariate logistic regression analysis to identify the risk factors of PVH after PPV in PDR patients with VH.This study adhered to the Declaration of Helsinki, and the study protocol was approved by an Ethics Committee of Tianjin Medical University Eye Hospital (No.2019KY[L]-09).Results:Multivariate logistic regression analysis revealed that age ( OR=0.940, P<0.01), preoperative high HbA1c level ( OR=1.878, P<0.01), combined with retinal vein occlusion (RVO) ( OR=8.310, P<0.01), diabetes diet to control blood glucose ( OR=3.030, P<0.01), diabetes duration ( OR=1.044, P<0.01), history of hypertension ( OR=1.802, P<0.01), nephropathy or cardiovascular or cerebrovascular diseases ( OR=18.377, P<0.01), preoperative NVI ( OR=7.488, P<0.01), not combined with phacoemulsification surgery ( OR=1.628, P=0.023), NVD bleeding ( OR=2.691, P<0.01), postoperative anti-VEGF treatment ( OR=0.181, P<0.01), postoperative air tamponade ( OR=1.901, P=0.024) were associated with PVH.There were no significant differences in baseline, ocular and intraoperative ocular parameters between early PVH and late PVH groups (all at P>0.05). Conclusions:Younger age, preoperative high HbA1c level, combined with RVO, diabetes diet to control diabetes, diabetes duration, history of hypertension, nephropathy or cardiovascular or cerebrovascular diseases, preoperative NVI, uncombined with cataract surgery, NVD bleeding, without postoperative intravitreal anti-VEGF injection, postoperative air tamponade are the potential risk factors of PVH after PPV for PDR patients with VH.

Analysis of factors on early hemorrhage after vitrectomy with silicon oil tamponade for proliferative diabetic retinopathy / 中华眼底病杂志

Objective To evaluate the factors that may influence the possibility of early hemorrhage after vitrectomy with silicon oil tamponade for proliferative diabetic retinopathy (PDR).Methods Sixty-seven eyes of 60 patients of PDR who received vitrectomy and silicon oil filled in Department of Ophthalmology,China-Japan Friendship Hospital during January 2014 and May 2017 were included in this study.There were 34 males and 26 females,with the mean age of 51.3 ± 12.5 years.Groups were divided depending on the degree of postoperative hemorrhage in 3 days:non-hemorrhage group (NH group) and hemorrhage Group (H group) composed of two sub-group that were called slight hemorrhage (SH) and massive hemorrhage (MH) group.The treatment was conventional 25G or 27G pars plana vitrectomy combined with silicon oil tamponade.Forty eyes received phacoemulsification.The follow-up ranged from 8 to 16 months,with the mean follow-up of 11.2± 5.6 months.The possible related factors of early hemorrhage after vitrectomy with silicon oil tamponade were analyzed.Independent t test,x2 test and Fisher test were used in this study.Results 55 eyes of 48 patients were in the NH group,while 12 eyes of 12 patients were in the H Group.There were statistical significances on the difference of age (t=-3.552,P=0.001),gender (P=0.052),hypertension (P=0.021),HbA1c (t=2.187,P=0.033)and presence of neovascularization of iris (x2=6.414,P=0.011),but there was no difference on diabetes duration (t=-0.451,P=0.654).Of the 12 patients in the H group,7 were in the SH group and 5 were in the MH group.The MH group had a significantly higher HbA1c level (7.8± 1.1)％ compared with the SH Group (9.7±0.7)％,the difference was statistical significant (t=-3.256,P=0.009).Higher systolic blood pressure of MH group 186± 7 mmHg (1 mmHg=0.133 kPa) acquired during operation was observed compared with S H Group 153± 18 mmHg,the difference was statistical significant (t=-3.894,P=0.003).There was no statistical significances on the difference of age (t=1.954),gender,hypertension duration (t=-1.787),diabetes duration (t=-1.079),fasting blood-glucose (t=-0.361),diastolic blood pressure during operation (t=-0.811) between the two groups (P＞0.05).Conclusions Younger age,history of hypertension,presence of neovascularization of iris,higher level of HbA 1 c may predict greater possibility to cause early hemorrhage after vitrectomy with silicon oil tamponade for PDR.The patients with high level of HbA1c and high systolic pressure during the operation are more likely to undergo massive hemorrhage and secondary glaucoma.

Risk factor analysis of postoperative vitreous hemorrhage after minimal vitrectomy without endotamponade for proliferative diabetic retinopathy / 中华眼底病杂志

Objective To investigate the risk factors of postoperative vitreous hemorrhage after minimal vitrectomy without endotamponade for proliferative diabetic retinopathy (PDR).Methods From June 2015 to June 2017,103 eyes of 103 patients with PDR diagnosed and underwent minimalvitrectomy in Henan Provincial People's Hospital were enrolled in the study.There were 58 males and 45 females,with the average age of 58.37± 10.14 years and diabetes duration of 8.7± 7.2 years.Baseline systemic parameters including sex,age,diabetes duration,hypertension,HbA1c,creatinine,whether received anticoagulants,ocular parameters including whether combined with vitreous hemorrhage,whether finished panretinal photocoagulation (PRP),whether received treatment of anti-VEGF,whether combined with iris neovascularization (NVI),lens status preoperatively,whether hypotony postoperatively and intraoperative parameters including whether disc neovascularization (NVD) bleeding,whether fibrovascular membrane (FVM) residual,laser points,whether combined with cataract phacoemulsification were identified by multivariate logistic regression analysis.Results Twenty-nine of 103 eyes (28.15％) developed PVH in 1 day to 6 months after surgery,with self absorption of 18 eyes and reoperation of 11 eyes.Univariate analysis showed there were significant differences in age (t=2.124,P=0.036),anti-VEGF(x2=7.105,P=0.008),NVD bleeding (x2=10.158,P=0.001) and FVM residual(x2=8.445,P=0.004) between patients with and without postoperative vitreous hemorrhage.Sex (x2=0.021,P=0.884),diabetes duration (t=0.87,P=0.386),hypertension (x2=2.004,P=0.157),HbA1c (t=1.211,P=0.229),creatinine (t=0.851,P=0.397),preoperative oral anticoagulants (x2=0.985,P=0.321),preoperative vitreous hemorrhage (x2=0.369,P=0.544),PRP (X2=1.122,P=0.727),NVI (x2=2.635,P=0.105),lens status (x2=0.172,P=0.679),hypotony postoperatively (x2=1.503,P=0.220),laser points (x2=1.391,P=0.238) and combined phacoemulsification surgery (x2=0.458,P=0.499) were not associated with PVH.Multivariate logistic regression analysis revealed the more PVH appeared in younger (OR=1.065,P=0.009) and NVD bleeding (OR=6.048,P=0.001) patients.Conclusion Younger age and NVD bleeding are the important risk factors for PVH after minimal vitrectomy without endotamponade in PDR.

Surgical management of retinal fold after 23-Gauge pars plana vitrectomy retinopexy / Manejamento cirúrgico de dobra de retina após retinopexia com vitrectomia via pars plana de 23-Gauge

Abstract The authors report a case of retinal fold after retinal detachment repair performed using 23-gauge pars plana vitrectomy technic (PPV). The fundus photography and optical coherence tomography (OCT) showed a posterior retinal fold with the retina periphery attached. The patient's best corrected visual acuity (BCVA) was 20/200 with severe metamorphopsia. A 25-gauge PPV, subretinal balanced saline solution (BSS) injection using a 25-39-gauge cannula, and gas-fluid exchange were performed. The patient's BCVA improved significantly after treatment. The retinal fold observed is not a frequent complication and can be managed with PPV, subretinal BSS injection and fluid-air exchange.

Resumo Os autores relatam um caso de dobra retiniana após a cirurgia de reparação de descolamento de retina realizada com vitrectomia via pars plana de 23 gauge (VVPP). A retinografia e a tomografia de coerência óptica (OCT) mostraram uma dobra posterior da retina com a periferia da retina colada. A melhor acuidade visual corrigida do paciente foi de 20/200 e severa metamorfopsia. Foi realizada uma VVPP de 25G, injeção subretiniana de solução salina balanceada (BSS) utilizando uma cânula de calibre 25-39 e troca de fluido-gasosa. A melhor acuidade visual corrigida do paciente melhorou significativamente após o tratamento. A dobra retiniana não é uma complicação freqüente e pode ser tratada com VVPP, realização de injeção subretiniana de BSS e troca fluido-gasosa.

Effect of tear film stability after vitrectomy combined with silicone oil tamponade / 中华眼底病杂志

Objective To observe the effect ofvitrectomy (PPV) combined with silicone oil filling on the stability of the tear film.Methods A total of 72 eyes of 36 patients with vitreous hemorrhage and retinal detachment were enrolled in the study with PPV combined with silicone oil filling.The operation and contralateral eyes were set up in the operation group and the control group respectively,each had 36 eyes.The tear film rupture time (BUT),the base tear secretion test or Schirmer Ⅰ test (S Ⅰ T) and corneal fluorescein staining (CFS) were performed at 7,30,60,and 90 days after operation.The difference of BUT,S Ⅰ T and CFS at different time points after the operation of the two groups were compared.Results After operation 7,30 days,S Ⅰ T and CFS increased,BUT staining is shortened in the surgery group,the differences were statistically significant (t=1.78,P＜0.05);after operation 60,90 days,S Ⅰ T,CFS,BUT were same between the surgery group and the contralateral eyes (t=12.39,P＞0.05).Conclusion PPV combined with silicone oil filling can affect the stability of the tear film,which can be recovered to the preoperative level at postoperative 60 days.

Preliminary evaluation of the safety of the lens and the ora serrata during vitrectomy with scleral incisions at 5.0 mm behind the limbus / 中华眼底病杂志

Objective To evaluate the safety to perform 23G vitrectomy with scleral incisions at 5.0 mm behind the limbus.Methods This is a prospective uncontrolled case study.The data of 140 consecutive primary 23G vitrectomy patients (145 eyes) were enrolled in this study.There were 56 males (59 eyes) and 84 females (86 eyes),with the mean age of (56.34 ± 9.98) years and axial length of (23.99± 2.57) mm.There were 139 phakic eye and 6 aphakic eyes.All the eyes received 23G pars plana vitrectomy with scleral incisions at 5.0 mm behind the limbus.To measure the normal Chinese adult parameters of anteroposterior axis of the eyeball,lens thickness and scleral distances from the limbus to the plane passing through the lens posterior apex,the head CT scans of 105 patients without eye diseases in our hospital were studied during the same period of time for these vitrectomy surgeries.Pearson correlation analysis was used to analyze the relationship between age,anteroposterior axis of eyeball,lens thickness and scleral distances from the limbus to the plane passing through the lens posterior apex.Results Surgical related complications included retinal tears close to the scleral incision sites (3/145 eyes,2.1％) and lens injury (3/121 eyes,2.5％).No other surgical complications occurred,such as retinal hemorrhage,supra-choroidal expulsive hemorrhage and iatrogenic retinal detachment.Based on CT images,the average scleral distance from limbus to the plane passing through the lens posterior apex,anteroposterior axis of eyeball and lens thickness was (6.72± 0.81),(24.39± 0.97),(4.22 ± 0.47) mm,respectively.The results of Pearson correlation analysis showed that age and lens thickness had statistically significant correlation (r=0.328 9,P=0.000 6).Conclusion Primary 23G pars plana vitrectomy with incisions at 5.0 mm posterior to the limbus is safe.

The causes and prognosis of postoperative vitreous hemorrhage after vitrectomy for proliferative diabetic retinopathy / 中华眼底病杂志

Objective To observe and analyze the causes and prognosis of postoperative vitreous hemorrhage (PVH) after vitrectomy for proliferative diabetic retinopathy (PDR).Methods A total of 160 PDR patients (171 eyes) were enrolled in this retrospective study.There were 85 males and 75 females.The patients aged from 33 to 73 years,with the mean age of (56.40±8.97) years.All the patients were performed 25G pars plana vitrectomy by the same doctor.Fibrovascular membrane peeling and panretinal photocoagulation were performed during the operation.Combined phacoemulsification was performed in one hundred and five patients.Vitreous tamponade was used at the end of surgery,including silicone oil (43 eyes),C3F8 (63 eyes),air or fluid (65 eyes).The follow-up ranged from 6 to 22 months,with the mean follow-up of (9.34±6.97) months.The features of PVH were observed.The difference of age,HbA1 c,creatinine level,the severity of the fundus lesions,whether received treatment of anti-vascular endothelial growth factor (VEGF),whether received combined cataract phacoemulsification were analyzed to find out the cause and prognosis of PVH.Results The corrected vision of all the patients after the primary PPV at the latest follow up was finger counting/1 meter.PVH occurred in 15 eyes of 15 patients,the incidence was 8.77％.The PVH occurred 2 weeks to 6 months after surgery.There were significant difference in age (t=2.551),proportion with tractional retinal detachment (x2=7.431),progressive fibrovascular proliferation (x2=4.987) and using anti-VEGF (x2=9.742) between the patients with and without PVH (P＜0.05).There was no significant difference in HbAlc (t=0.501),creatinine level (t=1.529),and the proportion of cataract phacoemulsification (x2=0.452) between the patients with and without PVH (P＞0.05).During follow-up,neovascularization of iris (NVI) occurred in 1 eye and neovascular glaucoma (NVG) occurred in 4 eyes.Seven eyes underwent reoperation,7 eyes were spontaneous recovered,1 eye with NVG give up treatment.Fibrovascular membrane was the major cause of recurrent hemorrhage.At the end of follow-up,hemorrhage was absorbed in all the 14 eyes which were treated,12 eyes had same visual acuity compared to that before postoperative hemorrhage,2 eyes with NVG had decreased vision.There was significant difference in the corrected vision between the patients with and without NVI or NVG (P=0.022).Conclusions PVH after PPV for PDR is closely related to the severity of diabetic retinopathy,fibrovascular membrane is the major cause of recurrent hemorrhage.NVG is an important factor related to vision acuity prognosis.

Changes in ocular surface following minimal vitreoretinal surgery in postmenopausal women patients with proliferative diabetic retinopathy / 中华眼底病杂志

Objective To evaluate ocular surface changes following minimal vitreoretinal surgery in postmenopausal women patients with proliferative diabetic retinopathy (PDR).Methods Sixty-one women PDR patients (61 eyes) underwent vitreous microsurgery were recruited in this prospective study,including 31 postmenopausal women (PMW group) and 30 non-postmenopausal women (non-PMW group).The contralateral eyes were considered as the control group.Corneal fluorescein (FL) staining,tear break-up time (TBUT),Schirmer I test (SIT),central corneal sensitivity and ocular surface disease index (OSDI) were estimated.All tests were carried out 1 day preoperatively and 1 day,10 days,1 month and 3 months postoperatively.The student's t test or Mann-Whitney U and ANOVA for repeat measurements test were used.Results Preoperatively,TBUT of surgery and non-surgery eyes in PMW were shorter than non-PMW (t=-2.115,-2.035;P＜0.05),but higher OSDI scores were found in PMW (t=2.482,2.208;P＜ 0.05).TBUT reduction rate (Z=-2.771,-1.993;P＜0.05) and OSDI rising rate (Z=2.539,2.157;P＜0.05) of surgery eyes in PMW were higher than non-PMW 1 day and 10 days postoperatively.The lower SIT of surgery eyes in PMW were observed at 1 day and 10 days (t=-2.403,-2.029;P＜0.05) after surgery.At 10 days after surgery,FL and OSDI scores of surgery eyes in non-PMW returned to preoperative level (Z=-0.447,-0.513;P＞0.05),but in PMW,the recovery process experienced 1 month (Z=-1.500,-0.853;P＞0.05).TBUT and SIT of surgery eyes in two groups both reached preoperative level at 1 month following surgery (Z=-0.715,-1.266,-1.531,-0.522;P＞ 0.05).Conclnsions PMW with PDR had ocular surface dysfunction,which resulted in aggravated dry eye after minimal vitreoretinal surgery.

Predictive factors for anterior chamber fibrin formation after vitreoretinal surgery / Fatores preditivos para formação de fibrina na câmara anterior após cirurgia vitreorretiniana

Purpose: The aim of this study was to investigate possible predictive factors related to anterior chamber fibrin formation after vitreoretinal surgery in a large series of patients. Methods: The data of 185 eyes of 185 patients submitted to vitreoretinal surgery was reviewed. The following variables were evaluated: the postoperatively presence of fibrin, age, diabetes mellitus, the vitrectomy system gauge (20, 23 or 25 gauge), the type of vitreous substitute, the influence of prior surgical procedures and the combination with cataract extraction. To evaluate predictive factors for anterior chamber fibrin formation, univariate analysis was performed. A multivariate stepwise logistic regression model was adjusted to investigate factors associated with fibrin formation (p<0.05). Results: Fibrinoid anterior chamber reaction was found in 12 (6.4%) patients. For multivariate logistic regression analysis, balanced salt solution (BSS), the chance of fibrin occurrence was 5 times greater (odds ratio 4.83, CI 95% 1.302 - 17.892; p=0.019), while combination with phacoemulsification increased the chance of fibrin formation by 20 times (odds ratio 20, CI 95% 2.480 - 161.347; p=0.005). No significant difference was found regarding other variables. Conclusion: Anterior chamber fibrin formation is an unwanted complication after vitreoretinal surgery. Factors such as combined performance of phacoemulsification and the use of balanced salt solution as a vitreous substitute may predispose the occurrence of this complication. .

Objetivo: Avaliar os possíveis fatores relacionados à formação de fibrina na câmara anterior após cirurgia vitreorretiniana em uma grande série de casos. Métodos: Foi realizado um estudo retrospectivo, observacional, caso-controle, onde os dados de 185 olhos de 185 pacientes submetidos à cirurgia vitreorretiniana foram avaliados. Os seguintes dados foram analisados: presença ou não de fibrina na câmara anterior na primeira semana de pós-operatório, idade, presença ou não de diabetes mellitus, calibre do sistema de vitrectomia utilizado (20,23 ou 25 gauge), substituto vítreo, a influência de cirurgias oftalmológicas prévias e a realização de cirurgia de catarata combinada. Para avaliação dos fatores preditivos para formação de fibrina, a análise univariada foi realizada. O modelo de regressão logística multivariada foi utilizado para investigar os fatores associados com a formação de fibrina (p<0,05). Resultados: A presença de fibrina na câmara anterior foi encontrada em 12 (6,4%) pacientes. Pela análise de regressão logística multivariada, o uso de solução salina balanceada (BSS) como substituto vítreo, a chance da presença de fibrina foi 5 vezes maior (odds ratio 4,83, IC 95% 1,302 - 17,892; p=0,019), enquanto que a realização de cirurgia facoemulsificação combinada aumentou a chance de formação de fibrina 20 vezes (odds ratio 20, IC 95% 2,480 - 161,347; p=0,005). Nenhuma diferença estatisticamente significativa foi encontrada para as outras variáveis. Conclusão: A formação de fibrina na câmara é uma complicação indesejada após cirurgia vitreorretiniana. Fatores como realização de cirurgia de facoemulsificação combinada e ...

The clinical analysis of intraocular pressure elevation after pars plana vitrectomy / 中华眼底病杂志

Objective To investigate the risk factors of the intraocular pressure (IOP) elevation after pars plana vitrectomy (PPV). Methods Eighty eight patients (88 eyes) of postoperative ocular hypertension in a series of 339 patients who had undergone PPV with normal ocular pressure before operation were retrospectively studied. The ocular pressures in both preoperative and postoperative periods were detected by NCT examination, and the ocular hypertension was decided on the level of ≥25 mm Hg. The relationships of occurence of the time of onset and duration of persistence of postoperative ocular hypertension with the different kinds of primary diseases, the techniques of operation, and the condition whether or not the affected eyes had formerly accepted surgical intervention, were analyzed. Results The IOP elevation occures mostly within 1 to 2 weeks postoperatively (77 eyes, 87.5%). In 65 cases (65 eyes) IOP returned to normal in 1 week, and in another 14 cases (14 eyes) in 1 month after treatments. Six patients' (6 eyes ) IOP was under 25 to 30 mm Hg with the medicine. With sustained elevation of IOP over 4 to 6 months, 3 cases (3 eyes ) lost or almost lost their vision finally. The probability of postoperative IOP elevation in the patients suffered from the retinal detachment with proliferative vitreoretinopathy (PVR) ≥grade C 2 was the highest in all the patients in our study (38.2%, P