In-Office Sulfur Hexafluoride (SF6) Injection to Close Recently Operated or Reopened Macular Holes: A Minimal Approach Technique.

To describe an in-office minimal approach technique for closing recently operated full thickness macular holes (FTMH), when closure was not fully achieved or there was macular hole re-formation, without performing another pars plana vitrectomy (PPV). Retrospective case series study. Nine patients were included in this case series. All patients were diagnosed with FTMH characterized by a decrease in visual acuity (VA) and metamorphopsias. All patients initially underwent a standard PPV procedure with 20% sulfur hexafluoride (SF6) injection. After 1-16 weeks, no closure or reformation of the macular hole was observed. Fluid-SF6 exchange was performed in the slit lamp, with the aim of injecting a 50% gas bubble of pure SF6 into the vitreous cavity, according to a minimally invasive in-office technique. Postoperatively, all patients achieved successful macular hole closure and VA showed an average improvement of approximately 4 lines on the EDTRS logarithm of the minimum angle of resolution (logMAR) chart. In particular, the mean corrected distance visual acuity improved from 0.99 ± 0.27 logMAR to 0.33 ± 0.23 logMAR (P = 0.03). The minimal surgical in-office technique of SF6 injection for the management of reopened macular holes after a recent PPV procedure shows promising results.

Learning curve of sutureless transconjunctival 20-gauge vitrectomy.

BACKGROUND: To report the learning curve of transition from 20-gauge (20 G) conventional vitrectomy to a 20 G sutureless vitrectomy technique. MATERIALS AND METHODS: This is a retrospective descriptive case study of 32 eyes from 32 consecutive patients who underwent sutureless 20 G pars plana vitrectomy. A 20 G microvitreoretinal blade was introduced, beveled transconjunctivally, slowly, parallel with the limbus, creating a conjunctivoscleral tunnel incision. Study participants were divided into three groups, and surgical time, induced astigmatism, and complications were compared. RESULTS: Of 32 consecutive patients, there was no significant difference in induced astigmatism or maneuvering between the early learning curve and other groups. The true learning curve was the first three patients. There were three cases where suturing the sclerotomy was necessary: one port in each case, three of 32 cases (9.3%), or three of 96 ports (2.9%). CONCLUSION: There were no significant difficulties in surgical maneuvers while performing 20 g sutureless vitrectomy.

Surgical treatment of retinal detachment associated with degenerative retinoschisis.

PURPOSE: Although degenerative retinoschisis is almost always asymptomatic, retinal detachment occurs in some patients with outer layer breaks (OLBs). The purpose of this study is to evaluate the different surgical techniques used for the treatment of this condition. METHODS: Retrospective interventional case series. The patients underwent either a Scleral-Buckling procedure (SB) or a 3-port pars plana vitrectomy (V). Pre-, intra-, and post-operative data were analyzed for the two groups. RESULTS: Thirty eyes of 30 consecutive patients were included in the analysis. There was a statistically significant difference (0.5 ± 0.48 LogMAR units for the SB group, 1.37 ± 1.4 LogMAR units for the V group, p = 0.027) in final BCVA when the two groups were compared, whereas there was no statistically significant difference in the baseline BCVA between the two groups (p = 0.38). The proportion of cases that were successfully attached with one operation was slightly lower in the V group (62% versus 76%). Conversely, the proportion of cases that were successfully attached with more than one operation was similar in both groups (23% and 24%, respectively). CONCLUSION: The present study highlights that retinoschisis-associated RD is a demanding situation to treat and remains a challenge for vitreoretinal surgeons. Scleral buckle procedure was found to be successful in eyes that have peripheral OLBs and not extensive RDs, and PPV should be considered for treating symptomatic, rather extensive schisis-RDs, especially in cases with large or posterior outer layer breaks.

Sutureless Transconjunctival 20 Gauge pars plana Vitrectomy.

PURPOSE: Sutureless Transconjunctival 20 Gauge Vitrectomy (20G STV) is a technique that reduces the operating time and the post-operative inflammation. PATIENTS AND METHOD: Eighty-four eyes underwent this new technique. Conjunctival diathermy over the ports before sclerostomy produced adhesions adequate to stop transoperative conjunctival chemosis. The MVR blade introduced into the conjunctiva-sclera in a bevelled direction. The tunnel incision that was created left without a suture at the end of the operation. RESULTS: Three patients (3,5%) had hypotony (2-6 mmHg) on day 1 that was normalized 3 days later. Two of them had a bleb formation and the rest a very minor leakage through a flat conjunctiva. No other serious complications occurred as a result of this novel transconjunctival approach. Also there were no differences in visual acuity, intraocular pressure, redetachments, or inflammations between the patients who underwent this technique and the patients having the conventional 20-gauge pars plana technique. CONCLUSION: 20G STV is a safe and practical technique for the full spectrum of vitreoretinal surgery. It makes the surgery quicker and is well tolerated by patients.

Perifoveal traction retinal detachment following successful optic disc pit surgery.

A 25-year-old male presented 8 years after a successful vitreoretinal operation for a left optic disc pit (ODP). On presentation his visual acuity had reduced from 6/5 (20/15) to 6/12 (20/40) in his operated eye. On examination an annular serous retinal detachment possibly secondary to tangential traction by either the internal limiting membrane (ILM) or residual lamellar vitreous cortex or both around the peripheral macular area was seen. The central fovea was flat. Following an uncomplicated vitrectomy and ILM peel, visual acuity improved to 6/6 (20/20) postoperatively. The author suggests that traction forces are responsible for the development of the serous detachment in eyes with ODP. Epiretinal membranes together with the ILM should be removed in all patients undergoing therapy for a retinal detachment associated with ODP in an effort to initially achieve a further relief of all forces and to try to avoid the late retinal detachment associated with epiretinal membrane or ILM contraction.