Endoscopy-assisted pars plana vitrectomy in retinal detachments associated with anterior proliferative vitreoretinopathy and epiciliary membranes.

BACKGROUND: Proliferative vitreoretinopathy (PVR) is the leading cause of recurrent retinal detachment. Anterior PVR can contribute to recurrent retinal detachment and is often difficult to remove during conventional pars plana vitrectomy. The purpose of this study is to report surgical outcomes of single endoscopy-assisted pars plana vitrectomy (E-PPV) in patients with tractional retinal detachments associated with anterior proliferative vitreoretinopathy and epiciliary membranes. METHODS: Retrospective review of E-PPV between 2017 and 2021 at a tertiary referral center. Inclusion criteria involved adult patients who underwent E-PPV for tractional retinal detachment with anterior PVR and epiciliary membranes. Data collection included patients' demographics, ophthalmic exam findings, and surgical outcomes. A series of independent sample tests of proportion were conducted using a p-value of 0.05 as the threshold for statistical significance. RESULTS: Eighteen out of 55 patients who underwent E-PPV met the inclusion criteria. There were six females (33%) and 12 males (p-value = 0.096). Age ranged between 27 and 82 years old (mean age 52.1 ± 17.3 years). Nine patients (50%) had a history of ipsilateral retinal detachment repair. Single E-PPV success rate was 100% after three months, and 94.4% at the latest follow up visit. Recurrent retinal detachment with posterior PVR occurred in one patient four months after surgery. Cataract progressed in 57% (8/14) of phakic patients, with 63% (5/8) undergoing cataract extraction surgery within the first postoperative year. CONCLUSION: E-PPV enabled epiciliary membrane and anterior PVR visualization and removal. The single E-PPV success rate remained high at the latest follow up visit. E-PPV enabled the preservation of the phakic lens in all study patients. Larger prospective studies are needed on the role of E-PPV in retina surgeries.

Endoscopic Pars Plana Vitrectomy in Patients With Open-Globe Injury and Corneal Opacity.

Purpose: To determine the 1-year outcomes of endoscopic pars plana vitrectomy (EPPV) and its impact on the corneal transplantation rate in patients with open-globe injury (OGI) and corneal opacity. Methods: This retrospective cohort study collected data between December 2018 and August 2021. All EPPVs were performed at a level I trauma center. Inclusion criteria were adult patients with a history of OGI complicated by corneal opacification that prevented fundus visualization. The main outcome measures were the rate of successful retinal reattachment, final visual acuity (VA), and number of patients who had penetrating keratoplasty (PKP) within 1 year of the OGI. Results: Ten patients (3 women; 7 men) with a mean age of 63.4 ± 22.7 years (SD) met the inclusion criteria. The indications for EPPV were intraocular foreign bodies in 2 patients, dense vitreous hemorrhage in 3 patients (1 with a retinal tear; 1 with a choroidal hemorrhage), and retinal detachment in 5 patients. The final VA ranged from 20/40 to no light perception. All 4 repaired detachments remained attached after 1 year. Corneal opacity was treated with PKP in 3 patients. Conclusions: Results indicate EPPV can be a useful tool to treat posterior segment pathology in patients with a recent OGI and corneal opacity. EPPV can help address posterior segment disease and postpone corneal transplantation until the visual potential can be fully determined. Larger prospective studies are needed.

Prophylactic Laser Treatment Posterior to Pars Plana Vitrectomy Sclerotomy Wounds During Macular Surgery.

Introduction: Sclerotomy related retinal breaks (SRRBs) are a risk factor for postoperative retinal detachment (RD). Endolaser posterior to sclerotomy wounds decreased the risk of SRRBs after 20G pars plana vitrectomy (PPV) for macular disease. However, similar data do not exist for 25G and 23G wounds. Methods: A retrospective cohort study of patients after 23G and 25G PPV for macular pathology was conducted between August 2017 and August 2020. The primary outcome was the postoperative rate of SRRBs or RDs. The secondary outcome was the postoperative rate of pupillary dysfunction and neurotrophic keratopathy. All participants had a minimum postoperative follow-up of one year. Results: One hundred seventeen patients were included in the study (62 in the laser group and 55 in the control group). Mean age was 65.4 ± 11.3 years (56.4% female and 43.6% male). Most of the laser group underwent 23G PPV (90%) while most of the control group underwent 25G PPV (96%). One patient in the control group developed RD secondary to a SRRB. No SRRBs or RDs developed in the laser group. None of the secondary outcomes developed in either group after one year. Conclusions: To the best of the authors' knowledge, this is the first report in the literature on prophylactic laser posterior to small gauge sclerotomies (25G and 23G) during macular surgery. Laser treatment posterior to small gauge sclerotomies (25G and 23G) had a similar incidence of SRRBs as with 20G sclerotomies. Larger prospective studies are needed to further understand the role of laser in lowering SRRB risk.