Refractive Outcomes of Phacovitrectomy in Retinal Detachment Compared to Phacoemulsification Alone Using Swept-Source OCT Biometry.

BACKGROUND AND OBJECTIVE: To assess the refractive outcomes in patients who underwent combined phacovitrectomy for retinal detachment compared to phacoemulsification and intraocular lens (IOL) implant utilizing newer swept-source optical-coherence-tomography (SS-OCT) biometry and determine the requirement of an adjustment factor for superior predicted refractive outcomes. PATIENTS AND METHODS: Retrospective study of 95 eyes: 52 eyes that underwent phacovitrectomy and 43 eyes with phacoemulsification only that served as the control group. Mean refractive error (ME) and mean absolute error (MAE) were used to compare the groups. RESULTS: No statistically significant postoperative refractive shift was found between phacoemulsification and phacovitrectomy eyes for (1) ME (0.05 D [± 0.51 diopters (D)] and (0.03 [± 0.73 D], respectively; P = .348), (2) MAE (0.41 D ± 0.29 D and 0.60 ± 0.44 D, respectively), or (3) MAE of the control compared to macula-on/off eyes (P = .160 and P = .078, respectively). CONCLUSION: The authors do not recommend an adjustment factor for IOL selection when utilizing SS-OCT biometry, as it provided refractive outcomes superior to those found in previous studies utilizing a partial coherence interferometry system. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:432-437.].

ASSESSING REFRACTIVE OUTCOMES AND ACCURACY OF BIOMETRY IN PHACOVITRECTOMY AND SEQUENTIAL OPERATIONS IN PATIENTS WITH RETINAL DETACHMENT COMPARED WITH ROUTINE CATARACT SURGERY.

PURPOSE: To compare refractive outcomes and accuracy of modern optical biometry, swept-source optical coherence tomography, ultrasound biometry, and effect of the macula status in rhegmatogenous retinal detachment managed with either combined phacovitrectomy or sequential vitrectomy and cataract surgery compared with a control, phacoemulsification alone. METHODS: Retrospective, comparative, consecutive study of 154 eyes; Group 1 underwent phacovitrectomy (n: 70), Group 2 underwent vitrectomy with subsequent cataract surgery (n: 41), and Group 3 underwent cataract surgery alone (n: 43). RESULTS: No difference in the mean absolute error was found between Group 2 (0.41 ± 0.56) and Group 3 (0.41 ± 0.29); both were superior to Group 1 (0.74 ± 0.57). Between Group 1 and Group 2, no statistically significant difference in the mean absolute error was found between macula-on subgroups (P = 0.057), but this was statistically significant between macula-off subgroups (P = 0.009). Subgroup analysis by biometry showed that the difference in the mean absolute error between macula-off optical biometry Group 1 and Group 2 against our control, Group 3, were not significant (P = 0.078 and P = 0.119, respectively); the mean absolute error was significantly different when considering macula-off ultrasound biometry cases (P < 0.001 and P = 0.038, respectively). CONCLUSION: All three groups had comparable refractive outcomes when using optical biometry. However, phacovitrectomy macula-off cases had inferior refractive outcomes when the ultrasound biometry had to be used. In macula-off rhegmatogenous retinal detachment, when optical biometry is not reliable, it is preferable to perform sequential surgery rather than phacovitrectomy.

Preliminary measurement of gas concentrations of perfluropropane using an analytical weighing balance.

We describe the use of an analytical weighing balance of measurement accuracy 0.00001g for determination of concentrations of perfluropropane (C3F8) gas used in ophthalmic surgical vitrectomy procedures. A range of test eyes corresponding to an eye volume of 6.1ml were constructed using 27 gauge needle exit ducts and separately 20 gauge (straight) and 23 gauge (angled) entrance ports. This method allowed determination of concentration levels in the sample preparation syringe and also levels in test eyes. It was determined that a key factor influencing gas concentrations accuracy related to the method of gas fill and the value of dead space of the gas preparation/delivery system and with a significant contribution arising from the use of the particle filter. The weighing balance technique was identified as an appropriate technique for estimation of gas concentrations.

Efficacy of autologous platelets in macular hole surgery.

The introduction of optical coherence tomography has allowed accurate measurement of the size of macular holes. A retrospective consecutive review was performed of 21 patients undergoing macular hole repair with vitrectomy, gas tamponade, and autologous platelet injection and we assessed the effect of macular hole parameters on anatomic and functional outcomes. We looked at the demographic features, final visual outcome, and anatomical closure. Twenty-one patients were included in the study. They underwent routine vitrectomy with gas tamponade (C3F8) and injection of autologous platelets. All patients were advised to maintain a facedown posture for 2 weeks. Anatomical closure was confirmed in all cases and 20 out of 21 of patients had improved postoperative visual acuity by two or more lines. In our series, the macular hole dimensions did not have much effect on the final results. The use of autologous platelets and strict facedown posture seems to be the deciding factor in good anatomical and visual outcome irrespective of macular hole dimensions.

Secondary angle-closure glaucoma due to posterior synechiae formation following phacovitrectomy.

Iris posterior synechiae formation after phacovitrectomy is usually regarded as a trivial problem. We report a case of secondary angle-closure glaucoma due to 360°PS 5 years after a phacovitrectomy for recurrent vitreous haemorrhage secondary to diabetic retinopathy. To our knowledge this is the first such reported case of this potentially sight-threatening complication of phacovitrectomy. We discuss our successful management of our patient, as well as potential risk factors and preventative measures.

Stabilization of anterior chamber depth during phacoemulsification cataract surgery in vitrectomized eyes.

Abnormal fluctuations in anterior chamber (AC) depth including deepening and mydriasis with paradoxical shallowing and miosis have been described during phacoemulsification cataract surgery in previously vitrectomized eyes. Contributory factors include zonular laxity and reduction of vitreous volume. This report describes a technique to stabilize AC depth and allow safer sculpting and removal of lens matter.