Clinical outcomes of pars plicata anterior vitrectomy: 2‑year results.

Purpose: To demonstrate the safety and outcome of a surgical approach that uses pars plicata site for anterior vitrectomy during phacoemulsification procedure complicated by posterior capsule rupture and residual cortical matter. Design: Single center, retrospective, interventional, noncomparative study. Materials and Methods: Medical records of a consecutive series of 35 eyes of 35 patients who underwent pars plicata anterior vitrectomy (PPAV) were reviewed. The main outcome measures were corrected and uncorrected distance visual acuity (CDVA, UDVA), early and late postoperative complications and intraocular pressure (IOP). Ultrasound biomicroscopic (UBM) evaluation of sclerotomy site and spectral domain optical coherence tomography analysis for central macular thickness (CMT) was performed. The final visual outcome at 2 years was evaluated. Results: At 2 years follow‑up, the mean postoperative UDVA (logarithm of the minimum angle of resolution [logMAR]) and CDVA (logMAR) was 0.49 ± 0.26 and 0.19 ± 0.14, respectively. There was no significant change in the IOP (P = 0.061) and the mean CMT at 2 years was 192.5 ± 5.54 μm. The postoperative UBM image of the sclerotomy site at 8 weeks demonstrated a clear wound without any vitreous adhesion or incarceration. Intraoperative hyphema was seen in 1 (2.8%) case and postoperative uveitis was seen in 2 (5.7%) cases, which resolved with medications. No case of an iatrogenic retinal break or retinal detachment was reported. Conclusions: PPAV enables a closed chamber approach, allows thorough cleanup of vitreous in the pupillary plane and anterior chamber and affords better access to the subincisional and retropupillary cortical remnant with a significant visual outcome and an acceptable complication rate.

A Case of Pupillary Block and Increased Intraocular Pressure after Nd:YAG Laser Posterior Capsulotomy

PURPOSE: To report a case of pupillary block and increased intraocular pressure caused by vitreous prolapse after Nd:YAG laser posterior capsulotomy. CASE SUMMARY: A 70-year-old male visited the hospital for decreasing visual acuity and ocular pain in the left eye. Two days earlier, he had undergone Nd:YAG laser posterior capsulotomy in the left eye. Best corrected visual acuity (BCVA) was 0.63 in the right eye and FC 60 cm in the left eye. Intraocular pressure (IOP) was 14 mm Hg in the right eye and 64 mm Hg in the left eye. Slit-lamp examination revealed diffuse corneal stromal edema and iris bombe with vitreous prolapse in the anterior chamber. Gonioscopy confirmed a closed angle. Pupillary block and increased intraocular pressure were diagnosed. A Nd:YAG laser iridotomy was performed. Three days after the iridotomy, BCVA was 0.2 and IOP was 11 mm Hg in the treated eye. Slit-lamp examination revealed reduced vitreous prolapse in the anterior chamber. CONCLUSIONS: This is the first report of pupillary block and increased IOP caused by vitreous prolapse after Nd:YAG laser posterior capsulotomy in Korea. Physicians should be aware that pupillary block could be caused by prolapsed vitreous after Nd:YAG laser posterior capsulotomy and Nd:YAG laser iridotomy could be performed effectively in such cases.

A Case of Vitreous Prolapse through Iridectomy Site after Trabeculectomy

PURPOSE: To report the results of anterior vitrectomy for obstruction of the aqueous outflow shunt by prolapsed vitreous strands after trabeculectomy. CASE SUMMARY: Trabeculectomy was performed on a pseudophakic primary open angle glaucoma patient with uncontrolled intraocular pressure under maximum tolerable medical therapy. Three months after trabeculectomy, the bleb flattened and the intraocular pressure elevated. On gonioscopic examination, vitreous strands prolapsed through the iridectomy site obstructing the inner ostium. The maximum tolerable medical therapy and Nd:YAG laser vitreolysis were attempted, but the intraocular pressure was not controlled. Anterior vitrectomy was performed to remove the prolapsed vitreous strands. After anterior vitrectomy, the bleb regained filtering function and the intraocular pressure was stabilized. CONCLUSIONS: In a case with a prolapsed vitreous into the anterior chamber obstructing the outflow shunt of the aqueous humor after trabeculectomy, anterior vitrectomy showed therapeutic effects.

A Case of Vitreous Prolapse through Iridectomy Site after Trabeculectomy

PURPOSE: To report the results of anterior vitrectomy for obstruction of the aqueous outflow shunt by prolapsed vitreous strands after trabeculectomy. CASE SUMMARY: Trabeculectomy was performed on a pseudophakic primary open angle glaucoma patient with uncontrolled intraocular pressure under maximum tolerable medical therapy. Three months after trabeculectomy, the bleb flattened and the intraocular pressure elevated. On gonioscopic examination, vitreous strands prolapsed through the iridectomy site obstructing the inner ostium. The maximum tolerable medical therapy and Nd:YAG laser vitreolysis were attempted, but the intraocular pressure was not controlled. Anterior vitrectomy was performed to remove the prolapsed vitreous strands. After anterior vitrectomy, the bleb regained filtering function and the intraocular pressure was stabilized. CONCLUSIONS: In a case with a prolapsed vitreous into the anterior chamber obstructing the outflow shunt of the aqueous humor after trabeculectomy, anterior vitrectomy showed therapeutic effects.