RESUMO
OBJECTIVE: To assess the combination of scleral buckling (SB) and pars plana vitrectomy (PPV) versus PPV alone in the primary repair of rhegmatogenous retinal detachments (RRDs). METHODS: The current study was a retrospective, comparative, interventional, consecutive case series of 179 eyes of 174 patients who underwent primary RRD repair by five surgeons between January 1, 2008 and December 31, 2010, utilizing SB with PPV or PPV. Univariate and multivariate analyses were used to compare the efficacy of the two surgical strategies and assess for risk factors of proliferative vitreoretinopathy (PVR). RESULTS: Single surgery anatomic success (SSAS) was similar (P=0.76) between the PPV group (112 of 132 eyes, 85%) and SB with PPV group (39 of 47 eyes, 83%). Final anatomic success was 100% in each group. There was no difference in rates of PVR formation (PPV 16% vs SB with PPV 19%, P=0.70). Final logarithm of the minimum angle of resolution acuity was 0.33 (20/43) in the PPV group and 0.37 (20/47) in the SB with PPV group (P=0.62). Postoperative anterior chamber fibrin was highly correlated with PVR formation (PVR 13% vs no PVR 0.7%, P=0.003; odds ratio =68.37, P=0.007). Separate analysis of medium- to high-complexity cases showed similar SSAS (PPV 86% vs SB with PPV 83%, P=0.45). CONCLUSION: SB with PPV versus PPV alone were similarly efficacious for repair of primary RRDs of varying complexity. SSAS rates, PVR incidence, and final visual acuities were not significantly different.
Assuntos
Oclusão da Veia Retiniana/terapia , Fatores Etários , Inibidores da Angiogênese/uso terapêutico , Angiofluoresceinografia , Glaucoma Neovascular/diagnóstico , Glaucoma Neovascular/etiologia , Glaucoma Neovascular/terapia , Humanos , Fotocoagulação a Laser , Edema Macular/diagnóstico , Edema Macular/etiologia , Edema Macular/terapia , Pessoa de Meia-Idade , Oclusão da Veia Retiniana/diagnóstico , Oclusão da Veia Retiniana/etiologia , Fatores de Risco , Tomografia de Coerência ÓpticaRESUMO
UNLABELLED: We describe a novel "hang-back" surgical approach for repairing an iridodialysis. Instead of repositioning the iris tightly to the sclera, the detached peripheral iris is suspended by a suture inside the normal iris insertion, reducing corectopia and avoiding inadvertent coverage of the trabecular meshwork by peripheral iris. A horizontal mattress suture is placed ab interno via a paracentesis site and tightened to bring the iris periphery to inside and under the limbus, as viewed from the frontal plane. This technique provides an excellent functional and cosmetic result. FINANCIAL DISCLOSURE: Neither author has a financial or proprietary interest in any material or method mentioned.
Assuntos
Traumatismos Oculares/cirurgia , Iris/lesões , Procedimentos Cirúrgicos Oftalmológicos , Técnicas de Sutura , Humanos , Polipropilenos , Ruptura , SuturasRESUMO
Puncturing the anterior capsule in a patient with a very soft lens, an elastic capsule, and/or deficient zonular countertraction can be challenging even with a sharp needle or blade. The crossed-swords, capsule-pinch technique capitalizes on opposing forces from 2 needles directed toward each other with a "pinch" of the capsule between their tips. This affords a controlled and facile puncture of the capsule without creating stress on the zonules or anteroposterior displacement of the lens.