Long-term functional and structural outcomes after large chorioretinectomy for ruptured globe following blunt trauma.

BACKGROUND: The purpose of this study was to present a modified surgical technique involving pars plana vitrectomy with large chorioretinectomy for eyes with rupture of the globe due to severe ocular blunt trauma. METHODS: This retrospective study included consecutive patients with rupture of the globe due to blunt trauma who were treated at the King Khaled Eye Specialist Hospital (Riyadh, Saudi Arabia). All patients underwent 25-gauge pars plana vitrectomy with large chorioretinectomies involving all the tissue around the posterior scleral wounds. Outcome measures included best-corrected visual acuity (BCVA), anatomical success and globe survival, rates of complications. RESULTS: 15 eyes of 15 patients were included. Mean BCVA was 2.88 ± 0.13 logMAR at presentation, and significantly improved to 0.83 ± 0.28 logMAR (P < 0.001), with 10 patients (67%) achieving a final BCVA ≥ 20/200. Anatomical success and globe survival were achieved in 11 (73%) and 15 (100%) of eyes, respectively. Postoperative complications included retinal detachment in 6 eyes (40%), epiretinal membrane in 6 (40%), hypotony in 4 (26%), PVR in 2 (13%). CONCLUSIONS: Pars plana vitrectomy with large chorioretinectomy is an effective treatment for globe rupture following severe blunt trauma, yielding good visual outcomes and anatomical success rates.

Minimally interface vitrectomy for rhegmatogenous retinal detachment with a single break in young patients.

PURPOSE: This study evaluates a new surgical technique consisting of minimal vitreous removal under air (minimal interface vitrectomy; MIV) to reduce postoperative complications while preserving the ability to address surgical factors at the retinal break. METHODS: This retrospective analysis examined the outcomes of minimal interface vitrectomies in consecutive cases, with a minimum 12-month follow-up period, of primary rhegmatogenous retinal detachment (RRD), recurrent RRD after pars plana vitrectomy (PPV), or failed surgery after primary scleral buckling surgery (SBS). RESULTS: Twelve eyes of 12 patients with RRD underwent MIV. The total surgical duration was 190-300 s (mean, 245.25 s). Eight (66.7%) eyes were treated with cryotherapy, and 4 (33.3%) with endolaser to seal the retinal break. Successful, complete retinal reattachment was achieved in all eyes and maintained during follow-up. No intra- or postoperative complications occurred and no patients developed inflammation or cataract during follow-up. CONCLUSION AND IMPORTANCE: We effectively removed traction and subretinal fluid and treated breaks with endolaser or cryotherapy by using a novel minimal interface vitrectomy technique in this selected population.

Macular Hole-Related Retinal Detachment in Children with Knobloch Syndrome.

PURPOSE: To describe the findings and the management of macular hole (MH)-related retinal detachment (RD) in children with Knobloch syndrome. DESIGN: Retrospective interventional case series. PARTICIPANTS: Patients with Knobloch syndrome who presented with MH-related RD. METHODS: Retrospective chart review of patients with Knobloch syndrome who presented with MH-related RD from January 2012 to December 2018. Interventions included pars plana vitrectomy and silicone oil tamponade with or without scleral buckle, drainage retinotomy, or relaxing retinectomy. MAIN OUTCOME MEASURES: MH characteristics and surgical anatomical outcome. RESULTS: The study included 9 eyes of 5 patients (age range 2 months to 5 years; median age 5.5 months). Presenting symptoms were poor fixation and nystagmus. The fellow eye of 1 patient had RD due to peripheral breaks. The MH was clinically visible in 8 eyes and detected only by OCT in 1 eye. The RD was shallow and extended to the anterior equator in 7 eyes and localized to a punched-out atrophic lesion in 1 eye. Seven eyes underwent surgical repair. At the last follow-up examination (follow-up range 11 to 42 months; mean 24 months, standard deviation 11.8 months), retinal reattachment with MH closure was achieved in 5 eyes along with marked improvement in fixation. CONCLUSION: Patients with Knobloch syndrome may develop MH-related RD as early as infancy. The condition may be easily overlooked in children but should be suspected in the setting of high myopia, vitreoretinal degeneration, and encephalocele.

Nitinol basket-assisted pars plana vitrectomy for retained lens material removal.

PURPOSE: To evaluate the usefulness of different types of nitinol baskets to capture, lift and hold the lens material, dropped during a complicated phacoemulsification, as an adjunctive surgical tool in vitreoretinal surgery and to evaluate the outcomes and complication of this new surgical technique in a small series of patients. METHODS: Patients who underwent pars plana vitrectomy (PPV) for retained lens fragments operated during December 2014 and March 2015 at the Academic Medical Center (AMC), Amsterdam, were included in this study. The PPV was performed using different settings and types of nitinol stone extractors (NSE). Three different stone extractors were used for the above-mentioned purpose. Preoperative (pre-op) and postoperative (post-op) data including best corrected visual acuity at 6 months follow-up visit, intra- and postoperative complications were recorded. RESULTS: Seven eyes of seven patients with a follow-up of 6 months were included in this study. All the vitrectomies were performed the same day of the complicated cataract extraction. Mean pre-op Snellen visual acuity was 20/160; mean post-op visual acuity was 20/32. No complications were encountered due to the use of the NSE intraocularly. No retinal breaks were observed due to traction of the catheter at the site of insertion or due to his movement in and out the vitreous cavity. CONCLUSION: The use of the nitinol lens cage seemed feasible and showed no complications in our small group of patients. It made easier the management of dropped nucleus without the need for a larger scleral opening also in case of very hard lens.

Use of a new intra-ocular spectral domain optical coherence tomography in vitreoretinal surgery.

PURPOSE: To describe the use of a novel intra-ocular side-scanning probe enabling the acquisition of spectral-domain optical coherence tomography (SD-OCT) images during surgery in a series of patients with complex forms of retinal detachment. METHODS: A 23-gauge, side-scanning SD-OCT probe (C7 System; LightLab Imaging, Inc/St Jude Medical, St. Paul, MN, USA) in a 20-gauge catheter, was used to acquire the intra-operative OCT images in seven patients with vitreoretinal diseases. Twenty-five gauge pars plana vitrectomy (PPV) was performed in every patient in a standard fashion. After enlarging the temporal sclerotomy to a 20-gauge port, all the patients were scanned with intra-ocular side-scanning SD-OCT, during different steps of the surgery based on surgeon needs. Scans were recorded real time and directly evaluated on a screen during surgery. Optical coherence tomography (OCT) scans were judged beneficial when they would recognize structures otherwise not seen on biomicroscopy. RESULTS: The intra-ocular SD-OCT has been helpful in acquiring extra information during vitreoretinal surgery such as the detection of the presence of otherwise invisible membranes (epiretinal membrane, subretinal membrane), the location of small tears and the identification of the retinal plane under suboptimal conditions for visualization. CONCLUSION: The use of an intra-ocular SD-OCT can expand upon visual cues during surgery, helping in the decision-making process and allowing additional deliberate surgical manoeuvres aimed at improving surgical outcomes.

Straylight measurements in contact lens wear.

PURPOSE: (1) To quantify the effect of contact lens wear on straylight in rigid and soft contact lens wearers and (2) to relate findings to morphological changes and subjective complaints. METHODS: Straylight was measured using the Oculus C-Quant during contact lens wear and after contact lens removal in 30 rigid contact lens wearers and 30 soft contact lens wearers. Semi-quantitative (0-4) slit-lamp grading of anterior segment changes using Efron grading scales and contact lens characteristics were performed. Subjects answered a straylight questionnaire. RESULTS: Soft contact lens wearers had a mean straylight of logarithmic value of the straylight parameter [log(s)] = 0.934 during contact lens wear and after contact lens removal [comparable to log(s) = 0.938 of age-matched normal eyes]. Rigid contact lens wearers had a mean straylight during contact lens wear of log(s) = 1.167. After contact lens removal, log(s) significantly decreased to 0.997 (P < 0.01). Straylight values with rigid contact lenses were strongly increased (P < 0.001) compared with age-matched normal eyes; after contact lens removal, these values decreased but remained elevated. Straylight in rigid contact lens wearers correlated with the amount of deposits on the contact lens (P < 0.01) but not with other variables of the contact lens score. The questionnaire showed more straylight complaints in rigid contact lens wearers than in soft contact lens wearers (P < 0.01). CONCLUSIONS: Rigid contact lens wear leads to increased straylight during contact lens wear and after contact lens removal. This may be because of subclinical effects of contact lens wear on the cornea and is not seen in soft contact lens wearers.

Contributions of the capsulorrhexis to straylight.

OBJECTIVES: To quantify the effect of the capsulorrhexis on straylight and to determine optimal capsulorrhexis size. METHODS: Fifty-six pseudophakic eyes with intact capsulorrhexis were included in the study. Straylight was measured with a straylight meter before and after pupil dilation. Capsulorrhexis and pupil diameter were measured and opacity of the anterior capsule was graded (on a scale of 0-5) with the slitlamp. Capsulorrhexis size and opacity were compared with the difference in straylight values between natural and dilated pupils. RESULTS: The mean capsulorrhexis diameter was 4.5 mm (range, 2.9-6.2 mm). Most anterior capsular rims were opaque in the area of contact with the intraocular lens (62.5% higher than grade 1). Mean straylight before pupil dilation was log(s)=1.25 (range, 0.68-2.13), which increased to 1.46 (range, 0.88-2.22) after pupil dilation, which corresponds to a 62% increase (P <.001). The effect of capsulorrhexis size and opacity on the increase in straylight in scotopic conditions can be quantified by the following formula: Deltas = 19 x (grading of anterior capsular rim) x (fraction of pupil area covered by rhexis). CONCLUSIONS: The influence of size and opacity of the capsulorrhexis via straylight is described in a quantitative model. Capsulorrhexis size must be greater than 4 mm to prevent functional problems at night.