ABSTRACT
PURPOSE: To compare the safety and performance clinical outcomes of the 27-gauge (G) two-dimensional cutting vitrectomy probe versus a standard 25-G probe for retinal procedures. METHODS: In this large randomized prospective study, all candidates for epiretinal membrane or macular hole surgery were randomized to the 27-G group or 25-G group. Outcome measures included surgery time, changes in best-corrected distance visual acuity, intraocular pressure, and central macular thickness between baseline and 1-month and 3-month follow-up time points. Moreover, intraoperative and postoperative complications were evaluated as well as the rate of sutureless vitrectomy. RESULTS: A total of 463 patients were included in this study, 227 patients in the 27-G group and 236 patients in the 25-G group. A similar total surgery time was found between both groups ( P = 0.0911). Similar best-corrected distance visual acuity and central macular thickness changes were observed between baseline and the 1-month and 3-month follow-up visits. No significant differences were reported in intraoperative and postoperative complications rates. The rate of sutureless vitrectomy was 96.5% for the 27-G group and 91.1% for the 25-G group ( P = 0.0170). CONCLUSION: These results suggest that 27-G vitrectomy probe is similar to 25-G probe in surgery time and complications, while decreasing the need for vitrectomy sutures.
Subject(s)
Visual Acuity , Vitrectomy , Humans , Vitrectomy/methods , Prospective Studies , Female , Male , Visual Acuity/physiology , Aged , Middle Aged , Epiretinal Membrane/surgery , Epiretinal Membrane/physiopathology , Postoperative Complications , Retinal Perforations/surgery , Retinal Perforations/diagnosis , Intraocular Pressure/physiology , Follow-Up Studies , Intraoperative Complications , Tomography, Optical Coherence/methods , Operative TimeSubject(s)
Anesthesia, Local/methods , Anesthetics, Local/administration & dosage , Pain/etiology , Adolescent , Adult , Aged , Aged, 80 and over , Anesthesia, General/methods , Durapatite , Eye Enucleation/methods , Eye Evisceration/methods , Female , Humans , Male , Middle Aged , Nerve Block/methods , Orbital Implants , Prospective Studies , Prosthesis Implantation , Time Factors , Young AdultABSTRACT
OBJECTIVE: Diabetic retinopathy is associated with progressive retinal capillary activation and proliferation, leading to vision impairment and blindness. Microparticles are submicron membrane vesicles with biological activities, released following cell activation or apoptosis. We tested the hypothesis that proangiogenic microparticles accumulate in vitreous fluid in diabetic retinopathy. RESEARCH DESIGN AND METHODS: Levels and cellular origin of vitreous and plasma microparticles from control (n = 26) and diabetic (n = 104) patients were analyzed by flow cytometry, and their proangiogenic activity was assessed by in vitro thymidine incorporation and neovessel formation in subcutaneous Matrigel plugs in mice. RESULTS: Microparticles of endothelial, platelet, photoreceptor, and microglial origin were identified in vitreous samples. Levels of photoreceptor and microglial microparticles were undetectable in plasmas but were comparable in diabetic and control vitreous samples. Vitreous platelet and endothelial microparticles levels were increased in diabetic patients and decreased following panretinal laser photocoagulation or intravitreal antivascular endothelial growth factor injection in proliferative diabetic retinopathy (PDR). The ratio of vitreous to plasma microparticle levels was calculated to estimate local formation versus potential plasma leakage. In PDR, the endothelial microparticles ratio--but not that for platelet--was greater than 1.0, indicating local formation of endothelial microparticles from retinal vessels and permeation of platelet microparticles from plasma. Isolated vitreous microparticles stimulated by 1.6-fold endothelial proliferation and increased new vessel formation in mice. CONCLUSIONS: The present study demonstrates that vitreous fluid contains shed membrane microparticles of endothelial, platelet, and retinal origin. Vitreous microparticles levels are increased in patients with diabetic retinopathy, where they could contribute to disease progression.
Subject(s)
Diabetic Retinopathy/pathology , Endothelial Cells/pathology , Retinal Vessels/pathology , Vitreous Body/pathology , Aged , Animals , Blood Platelets/pathology , Cell Division/physiology , Collagen , Diabetic Retinopathy/surgery , Diabetic Retinopathy/therapy , Disease Progression , Drug Combinations , Female , Flow Cytometry , Humans , Laminin , Light Coagulation , Male , Mice , Mice, Inbred C57BL , Microglia/pathology , Middle Aged , Neovascularization, Pathologic/pathology , Particle Size , Photoreceptor Cells, Vertebrate/pathology , Proteoglycans , Vitrectomy , Vitreous Body/surgeryABSTRACT
PURPOSE: Vision recovery after corneal graft is sometimes limited by the occurrence of macular edema. The aim of this prospective study of 62 keratoplasty patients was to assess the incidence of macular edema by using optical coherence tomography (OCT 3; Stratus, Carl Zeiss Meditec, Dublin, CA) and to identify factors associated with edema. METHODS: Sixty-two patients who were all operated on by the same surgeon were examined by OCT 3, 1 and 3 months after corneal graft. RESULTS: The incidence of macular edema after keratoplasty was 9.6%. The surgical technique (penetrating vs lamellar keratoplasty) had no influence on the occurrence of edema (P > 0.05), but combined surgery significantly increased the risk of developing an edema (P < 0.05). CONCLUSION: Macular edema after keratoplasty seemed to be less frequent than expected (9.6%) and associated mainly with combined surgery.