ABSTRACT
PURPOSE: To show the results of a trocar spacer for pediatric vitreoretinal surgery with a 3D printed trocar spacer in 2 cases. METHODS: We used standard 27 gauge (ga) and 25 ga trocars and cannulae, and prototyped 1.5â¯mmâ¯×â¯3â¯mm spacers with a Prusa MK3 3D printer (0.4â¯mm nozzle) with Fuse deposition melting (FDM) technology. Parts were printed with a 50⯵m layer height in polylactic acid or polylactide (PLA). The spacer was placed in two places: between the blade's base and the trocar, and between the trocar and the sclera depending on the desired amount of shortening. This prototype was used in 2 vitrectomy cases in pediatric patients. RESULTS: We used this trocar spacer in 2 cases with positive results. CONCLUSIONS: This 3D printed spacer has proved to effectively shorten the introduced trocar into two different small eyes. More studies are needed to validate the efficacy and safety of this spacer in clinical practice.
Subject(s)
Vitreoretinal Surgery , Child , Humans , Printing, Three-Dimensional , Sclera , Surgical Instruments , VitrectomyABSTRACT
Objetivo Mostrar los resultados de un espaciador de trocares para cirugía vitreorretiniana pediátrica con un espaciador de trocar impreso en 3D en 2 casos. Métodos Utilizamos trocares y cánulas estándar de calibres 27 y 25, y espaciadores de 1,5×3mm prototipados con una impresora 3D Prusa MK3 (República Checa), boquilla de 0,4mm, con tecnología fuse deposition melting (FDM). Las piezas se imprimieron con una altura de capa de 50μm en ácido poliláctico o polilactida (PLA). El espaciador lo colocamos en dos lugares: entre la base de la cuchilla y el trocar, y entre el trocar y la esclerótica según la cantidad de acortamiento deseada. Este prototipo se utilizó en 2 casos de vitrectomía en pacientes pediátricos. Resultados Utilizamos este espaciador de trocar en 2 casos con resultado positivo. Conclusiones Este espaciador impreso en 3D ha demostrado acortar eficazmente el trocar introducido en 2 casos de cirugía vitreorretiniana en niños. Serán necesarios más estudios para validar la seguridad y eficacia de este espaciador en la práctica clínica (AU)
Purpose To show the results of a trocar spacer for pediatric vitreoretinal surgery with a 3D printed trocar spacer in 2 cases. Methods We used standard 27 and 25gauge trocars and cannulae, and prototyped 1.5×3mm spacers with a Prusa MK3 3D printer (Czech Republic), 0.4mm nozzle, with Fuse deposition melting (FDM) technology. Parts were printed with a 50μm layer height in polylactic acid or polylactide (PLA). The spacer was placed in two places: between the blade's base and the trocar, and between the trocar and the sclera depending on the desired amount of shortening. This prototype was used in 2 vitrectomy cases in pediatric patients. Results We used this trocar spacer in 2 cases with positive results. Conclusions This 3D printed spacer has proved to effectively shorten the introduced trocar into two different small eyes. More studies are needed to validate the efficacy and safety of this spacer in clinical practice (AU)
Subject(s)
Humans , Male , Female , Infant, Newborn , Child, Preschool , Printing, Three-Dimensional , Vitreoretinal Surgery , Treatment Outcome , Surgical Instruments , VitrectomyABSTRACT
Se presenta un caso de una mujer de 56 años de edad con un agujero macular grande, de larga evolución, a quien se le realizó una cirugía de trasplante autógeno de retina neurosensorial. En el seguimiento con retinografías y tomografía de coherencia óptica de dominio espectral, destacó la presencia de edema del injerto con hiperreflectividad de las capas retinianas internas, en las primeras semanas. Después, se observaron puntos hiperreflectivos, predominantemente en las capas internas de la retina, manteniendo la continuidad de las capas externas y la presencia de un material de aspecto lanudo en la superficie del injerto. Al final del seguimiento hubo una integración completa del injerto en la zona receptora del agujero, con la correspondiente mejoría funcional (AU)
A case is presented of a 56-year-old female patient with a long-standing large macular hole who underwent autologous retina transplant surgery. Fundus images and spectral-domain optical coherence tomography images showed the presence of graft oedema with its corresponding hyper-reflectivity of the inner retinal layers in the first weeks of follow-up. Hyper-reflective dots later appeared mainly in the inner retinal layers. The integrity of the outer retinal layers and a woolly-looking material on the surface of the graft were observed. At the end of follow-up, the graft had integrated with the recipient tissue with functional improvement (AU)
Subject(s)
Humans , Female , Middle Aged , Retinal Perforations/surgery , Retina/transplantation , Tomography, Optical Coherence , Follow-Up Studies , Transplantation, Autologous , Acute DiseaseABSTRACT
A case is presented of a 56-year-old female patient with a long-standing large macular hole who underwent autologous retina transplant surgery. Fundus images and spectral-domain optical coherence tomography images showed the presence of graft oedema with its corresponding hyper-reflectivity of the inner retinal layers in the first weeks of follow-up. Hyper-reflective dots later appeared mainly in the inner retinal layers. The integrity of the outer retinal layers and a woolly-looking material on the surface of the graft were observed. At the end of follow-up, the graft had integrated with the recipient tissue with functional improvement.
ABSTRACT
A 52-year-old male patient is presented. The patient was referred to our service for a pigmented tumor of the inferonasal quadrant of retina in OD. Fundus examination confirmed a pigmented tumor of 3 DD, elevated and dome shaped. Ultrasonography showed a dome shaped lesion of 6.3 mm at the base and 3.29 mm in height, medium internal reflectivity and positive for vascularity. Clinical diagnosis of choroidal melanoma was made and brachytherapy with iodine-125 was performed. Findings recorded at 3-year ultrasonographic follow up are discussed.
Subject(s)
Brachytherapy , Choroid Neoplasms/diagnostic imaging , Iodine Radioisotopes/therapeutic use , Melanoma/diagnostic imaging , Choroid Neoplasms/radiotherapy , Humans , Male , Melanoma/radiotherapy , Middle Aged , UltrasonographyABSTRACT
PURPOSE: To evaluate the visual and anatomical outcomes of macular hole surgery using phacoemulsification, vitrectomy and intraocular gas tamponade without the use of postoperative face down positioning. METHODS: Phacoemulsification with an intraocular lens implant, followed by vitrectomy with internal limiting membrane peeling and perfluoropropane (C3F8), was performed in patients with stage 3 or 4 macular holes. After surgery, patients had to avoid the supine position for 15 days. Patients with a gas level <50% during the first week had a fluid-gas exchange. Visual acuity and closure of the macular hole were evaluated after 1 year of follow-up. RESULTS: 20 eyes of 20 patients, aged 60 to 75 years (median age 68 years), were included in this study. The best initial visual acuity ranged from 0.05 to 0.13 (ETDRS), with the median being 0.06. The final visual acuity was 0.05 to 0.30 with a median of 0.10. A statistically significant improvement (p=0.001, Wilcoxon) was found. The anatomic postoperative results revealed 90% (n=18) of the macular holes were closed while 10% (n=2) were not. CONCLUSIONS: Macular hole surgery has, in general, good results and patients can achieve improvement in their visual acuity without the need for uncomfortable and unbearable post operative posture positions.
Subject(s)
Phacoemulsification , Retinal Perforations/surgery , Vitrectomy , Aged , Data Interpretation, Statistical , Female , Follow-Up Studies , Humans , Lens Implantation, Intraocular , Male , Middle Aged , Postoperative Care , Posture , Time Factors , Visual AcuityABSTRACT
Objetivos: Evaluar los resultados visuales y anatómicosen el tratamiento del agujero macular confacoemulsificación, vitrectomía y gas intraocularsin mantenimiento de posición boca abajo en elpostoperatorio.Material y metodos: Se realizó cirugía de facoemulsificacióncon implante de lente intraocular,vitrectomía con pelado de la membrana limitanteinterna y gas perfluoropropano (C3F8) al 17% enpacientes con diagnóstico de agujero macular gradosIII y IV. En el postoperatorio se indicó evitar laposición supina durante 15 días. Se realizó intercambioliquido gas en los pacientes con menos del50% de gas a la primera semana. Se evaluó la mejoríade la agudeza visual y el porcentaje de cierre delagujero macular después de un año de seguimiento.Resultados: Se incluyeron 20 ojos de 20 pacientescon edad entre 60 y 75 años con una mediana de 68años. La mejor agudeza visual corregida (AVcc)inicial varió de 0,05 a 0,13 con una mediana de0,06. La AVcc final estuvo entre 0,05 a 0,3 con una clasificamedianade 0,10. Al comparar la agudeza visual inicialy final se encontró una mejoría estadísticamentesignificativa de p=0.001(Wilcoxon). Los resultadospostoperatorios en cuanto al estado anatómicofinal del agujero macular fueron exitosos en el 90%(n= 18) y sin éxito en el 10% (n=2).Conclusiones: La cirugía de agujero macular esgeneralmente beneficiosa y los pacientes puedenmejorar su visión sin ser necesario el mantenimientode posiciones incomodas e intolerables paraalgunos pacientes
Purpose: To evaluate the visual and anatomical outcomes of macular hole surgery using phacoemulsification, vitrectomy and intraocular gas tamponade without the use of postoperative face down positioning. Methods: Phacoemulsification with an intraocular lens implant, followed by vitrectomy with internal limiting membrane peeling and perfluoropropane (C3F8), was performed in patients with stage 3 or 4 macular holes. After surgery, patients had to avoid the supine position for 15 days. Patients with a gas level <50% during the first week had a fluid-gas exchange. Visual acuity and closure of the macular hole were evaluated after 1 year of follow-up. Results: 20 eyes of 20 patients, aged 60 to 75 years (median age 68 years), were included in this study. The best initial visual acuity ranged from 0.05 to 0.13 (ETDRS), with the median being 0.06. The final visual acuity was 0.05 to 0.30 with a median of 0.10. A statistically significant improvement (p=0.001, Wilcoxon) was found. The anatomic postoperative results revealed 90% (n=18) of the macular holes were closed while 10% (n=2) were not. Conclusions: Macular hole surgery has, in general, good results and patients can achieve improvement in their visual acuity without the need for uncomfortable and unbearable post operative posture positions
Subject(s)
Male , Female , Aged , Middle Aged , Humans , Retinal Perforations/surgery , Phacoemulsification , Vitrectomy , Treatment Outcome , Postoperative Care/methods , Prospective StudiesABSTRACT
BACKGROUND/AIMS: Ischaemic central retinal vein occlusion (CRVO) accounts for 20-50% of all CRVO. No treatment has been proved to be effective. The efficacy of radial optic neurotomy (RON) was evaluated in eyes with ischaemic CRVO. METHODS: 10 patients with ischaemic CRVO underwent RON. After pars plana vitrectomy, a microvitreoretinal blade was used to incise the scleral ring, cribriform plate, and adjacent sclera at the nasal edge of the optic disc. Best corrected visual acuity (BCVA), intraocular pressure (IOP), fluorescein angiography (FA), multifocal electroretinography (mfERG), and optical coherence tomography (OCT) were measured preoperatively and at 1, 3, and 6 months postoperatively. RESULTS: No visual improvement was noted in the eyes that underwent RON. FA and mfERG showed no increase in retinal perfusion or retinal function postoperatively. Mean macular central thickness changed from 841 (SD 170) mum preoperatively to 162 (SD 34) microm at the sixth postoperative month. One patient had retinal central artery perforation intraoperatively. One patient developed neovascular glaucoma. CONCLUSION: RON in ischaemic CRVO did not improve visual function (by mfERG) or visual acuity although macular thickness did improve. This technique may be associated with potential risks. Randomised studies are needed to corroborate these results.
Subject(s)
Decompression, Surgical/methods , Optic Nerve/surgery , Retinal Vein Occlusion/surgery , Aged , Decompression, Surgical/adverse effects , Electroretinography , Female , Fluorescein Angiography , Humans , Ischemia/pathology , Ischemia/physiopathology , Ischemia/surgery , Macula Lutea/pathology , Male , Middle Aged , Prospective Studies , Retinal Vein Occlusion/pathology , Retinal Vein Occlusion/physiopathology , Tomography, Optical Coherence , Visual Acuity , VitrectomyABSTRACT
BACKGROUND AND OBJECTIVE: Corneal edema during penetrating keratoplasty (PK) precludes the visualization of the fundus required to perform vitreoretinal surgery. In this study, the clearing of the cornea and fundus visualization with dextran 40 following PK was evaluated. PATIENTS AND METHODS: Topical dextran 40 was used in 12 eyes that underwent uncomplicated PK (phase 1) and in 5 eyes that underwent combined PK with vitreoretinal surgery (phase 2). RESULTS: Clearing of the cornea and visualization of the fundus were observed in all eyes after dextran had been instilled for a mean of 4 and 5 minutes in eyes for phase 1 and 2, respectively. Vitreoretinal surgery could successfully be performed after PK in all eyes of phase 2. CONCLUSION: Topical use of dextran 40 following PK produces enough clearing of the cornea to enable visualization of the fundus for further vitreoretinal procedures after the graft has been sutured.
Subject(s)
Corneal Edema/drug therapy , Corneal Transplantation/adverse effects , Dextrans/therapeutic use , Fundus Oculi , Vitreous Body/anatomy & histology , Administration, Topical , Corneal Edema/etiology , Dextrans/administration & dosage , Fluorocarbons , Follow-Up Studies , Humans , Prospective Studies , Treatment Outcome , Visual Acuity , VitrectomyABSTRACT
PURPOSE: A long-standing controversy exists regarding the proper timing for vitrectomy in a traumatized eye. The present study was conducted to assess the influence of timing on the final visual acuity. MATERIALS AND METHODS: A retrospective review was made of 45 consecutive patients who underwent a pars plana vitrectomy procedure for repair of ocular trauma. The patients were divided into two groups according to the timing of the surgery post-trauma: those operated before or after 14 days. Type of trauma and pre- and postoperative visual acuities were compared. RESULTS: A contusion type of trauma was more frequent in the late surgery group. Sharp, penetrating injuries were more common in the early vitrectomy group. No significant difference was found though visual acuity was worse in the patients with a contusion component to their injury. Timing of surgery seems to have very little effect on the final outcome. CONCLUSIONS: Final visual acuity is determined by the type and extent of trauma rather than the timing of surgery.
