Subject(s)
Epiretinal Membrane/etiology , Intraoperative Complications , Postoperative Complications , Retinal Detachment/etiology , Retinal Perforations/etiology , Vitrectomy/adverse effects , Epiretinal Membrane/diagnosis , Epiretinal Membrane/surgery , Follow-Up Studies , Humans , Recurrence , Retinal Detachment/diagnosis , Retinal Detachment/surgery , Retinal Perforations/diagnosis , Retinal Perforations/surgery , Retrospective Studies , Risk Factors , Scleral BucklingABSTRACT
OBJECTIVE: To compare 20-gauge standard pars plana vitrectomy (PPV) with transconjunctival cannulated PPV in the development of intraoperative retinal breaks and postoperative rhegmatogenous retinal detachments (RRDs) in a large series of patients undergoing PPV for macular pucker or macular hole. METHODS: This study was conducted at an academic tertiary care vitreoretinal practice in Milwaukee, Wisconsin. Patients undergoing 3-port PPV with standard 20-gauge instrumentation were compared with patients undergoing 3-port PPV with transconjunctival cannulated systems, including 20 gauge, 23 gauge, and 25 gauge, from January 1, 2003, through December 31, 2009. The main outcome measures were rates of intraoperative retinal breaks and postoperative RRD. RESULTS: Four hundred twenty-six unique eyes met inclusion criteria. Fifty-four of 426 eyes (12.7%) were diagnosed as having new retinal tears intraoperatively as follows: 47 of 204 patients (23.0%) undergoing the standard 20-gauge procedure developed intraoperative retinal tears compared with 7 of 211 patients (3.3%) undergoing the transconjunctival cannulated procedure (risk ratio [RR], 0.12; 95% CI, 0.05-0.26; P < .001). Patients experiencing intraoperative retinal tears were not at increased risk of developing postoperative RRD (RR, 1.4; 95% CI, 0.39-5.0; P = .61). Although a trend was present, transconjunctival cannulated vitrectomy was not significantly protective against the development of postoperative RRD (RR, 0.60; 95% CI, 0.17-1.3; P = .14). CONCLUSION: Transconjunctival cannulated PPV, including 20-gauge, 23-gauge, and 25-gauge systems, is associated with significantly reduced rates of intraoperative retinal tear formation compared with standard 20-gauge PPV.
Subject(s)
Intraoperative Complications , Postoperative Complications , Retinal Detachment/etiology , Retinal Perforations/etiology , Vitrectomy/adverse effects , Catheterization/methods , Conjunctiva/surgery , Female , Follow-Up Studies , Humans , Male , Microsurgery/methods , Retinal Diseases/surgery , Risk Factors , Visual Acuity/physiology , Vitrectomy/methodsABSTRACT
Diabetic retinopathy (DR) is the most common microvascular complication of diabetes. The Joslin Vision Network Diabetes Eye Care Program (JVN) is a validated ocular telemedicine program developed at the Joslin Diabetes Center that has provided diabetes eye care to over 70,000 persons. The JVN allows accurate assessment of level of DR severity, detects the presence of nondiabetic eye disease, and allows determination of appropriate treatment recommendations. The JVN integrates eye care in a comprehensive diabetes program, extends access to evidence-based diabetes eye care, and offers alternative means of diabetes eye care in appropriate settings, ultimately preserving vision and preventing visual loss.
Subject(s)
Delivery of Health Care/organization & administration , Diabetic Retinopathy/diagnosis , Diagnostic Techniques, Ophthalmological , Image Processing, Computer-Assisted/methods , Telemedicine/organization & administration , Boston , Diagnostic Imaging/instrumentation , Diagnostic Imaging/methods , HumansABSTRACT
PURPOSE: To enhance the safety and efficacy of surgical treatment of strabismus, we sought to measure and determine the ultrasound biomicroscopy (UBM) profile of scleral tunnels created with needles commonly used during strabismus surgery, to determine which needles are less likely to create the complication of scleral perforation. METHODS: Adult cadaver eyes were secured in a styrofoam head. Intraocular pressure was maintained between 15 and 21 mm Hg. Then S14, S24, S28 and TG100 needles were used to create scleral tunnels simulating those created during routine strabismus surgery. Ten scleral tunnels were created with each needle type at 3 different sites on the globe, for a total of 120 passes. The thickness of the sclera and the maximum depth and length of each scleral tunnel were measured using UBM. RESULTS: The mean tunnel depth below the scleral surface (+/- SD) was 0.43 +/-0.11 mm, 0.37 +/-0.09, 0.40 +/-0.08 and 0.34 +/-0.07 mm, for the S14, S24, S28 and TG100 needles, respectively (P=0.002, One way ANOVA). For both the S14 and S28 needles, there was a "statistically significant" P 0.05) linear trend of an increase in the depth of the pass as the length of the pass increased (P=0.01 for the S14 and P=0.02 for the S28 {Pearson Correlation 2 tailed test}). A similar trend was found with the S24 needle but the trend was not "statistically significant" (P=0.35). No such trend was found with the TG100 needle. CONCLUSIONS: Needle design had a definite impact on the characteristics of scleral tunnels created to simulate those made during strabismus surgery and may influence needle selection by the surgeon for different or various surgical circumstances, but the differences were not such as to predicate for or against the general use of any of these four needles for strabismus surgery.
