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Kim DW, Woo SJ, Joo K, Kim MS. Incidence and risk factors of late-onset intraocular pressure elevation after vitrectomy with silicone oil tamponade. Jpn J Ophthalmol 2025:10.1007/s10384-025-01184-5. [PMID: 40095327 DOI: 10.1007/s10384-025-01184-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2024] [Accepted: 01/18/2025] [Indexed: 03/19/2025]
Abstract
PURPOSE To evaluate the incidence and risk factors of late-onset intraocular pressure (IOP) elevation in patients who underwent pars plana vitrectomy with silicone oil (SO) injection for the management of various vitreoretinal pathologies. STUDY DESIGN A retrospective observational study. METHODS A single-center study involving 135 eyes of 129 patients who underwent vitrectomy with SO injections between January 2018 and May 2023 and maintained SO tamponade for ≥1 month. Eyes with prior glaucoma surgery; a history of SO injection; SO removal or exchange within a month; a follow-up period of <1 month; or those who showed IOP elevation on postoperative day 1 were excluded from the analysis. Late-onset IOP elevation was defined as IOP ≥ 21 mm Hg after postoperative day 7. RESULTS Late-onset IOP elevation developed in 22.2% (30/135 eyes) and the mean onset was 38.0±53.4 days (7-251 days) after surgery. In the multivariate logistic regression analysis, late-onset IOP elevation was associated with pre-existing glaucoma (odds ratio [OR], 7.16; P=0.041), longer axial length (OR, 1.40, P=0.037), and higher preoperative IOP (OR, 1.12; P=0.037). Among the patients with late-onset IOP elevation, 50% (15/30) required oral acetazolamide despite the administration of IOP-lowering eye drops. Among them, surgical intervention was required in 8 cases (53.3%). CONCLUSION Late-onset IOP elevation is a common complication associated with SO tamponade. Risk factors for late-onset IOP elevation are pre-existing glaucoma, longer axial length, and preoperative higher IOP. Since a substantial proportion of eyes require surgical intervention, proactive measures should be considered for effective IOP control.
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Affiliation(s)
- Dong Woo Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 73-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Se Joon Woo
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 73-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Kwangsic Joo
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 73-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Min Seok Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 73-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea.
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Boscia F, Ferreri P, Sisto D, Niro A, Boscia G, Scotti G, Viggiano P, Sborgia A, Sborgia G, Giancipoli E, Alessio G. Xen gel stent implant for persistent glaucoma after silicone oil removal. Eur J Ophthalmol 2025; 35:591-601. [PMID: 39110013 DOI: 10.1177/11206721241272273] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2025]
Abstract
PURPOSE To evaluate the effectiveness and safety of the XEN-Stent for managing unresponsive to medical therapy secondary glaucoma after silicone oil (SO) removal. METHODS This retrospective chart reviewed 12 patients who underwent vitrectomy and SO endotamponade. They experienced intraocular pressure (IOP) elevation after SO removal despite taking the maximum tolerated glaucoma medication. Eleven eyes underwent an XEN-implant, while 1 underwent an XEN-implant with phacoemulsification/IOL implantation. The primary outcome was to achieve success criteria: IOP <18 mmHg and >20% IOP reduction without medication (complete success) or with medication (qualified success) and without a secondary IOP-lowering procedure. IOP, best-corrected visual acuity (BCVA), and the number of glaucoma medications (Glaucoma Medication Score-GMS) were recorded at baseline, 1 day, 1 week, 1 (M1), 3 (M3), 6 (M6), and 12 (M12) months postoperatively. RESULTS Baseline characteristics included males percentage 66.6%, mean age of 61.8 ± 5.7 years, BCVA 0.69 ± 0.3 logMAR, IOP 30 ± 4.2 mmHg, and GMS 3.1 ± 0.5. There was a significant reduction in IOP by 14 ± 1.9 mmHg and GMS by 0.27 ± 0.6 at M12 compared to baseline (p < 0.01), but no significant change in BCVA (p = 0.21). Complete success dropped to 50% (M3), rising to 75% (M6, M12) after needling. Two patients achieved qualified success at M12. Needling was performed in 6 eyes, with 3 requiring a second procedure. Ex-PRESS was required in 1 eye. One eye experienced hypotony and hyphema, which resolved within a week. CONCLUSION XEN implant may be an initial treatment for persistent post SO removal glaucoma with minimal complications. Needling procedures can help maintain or restore surgical success.
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Affiliation(s)
- Francesco Boscia
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, University of Bari, 70124, Bari, Italy
| | - Paolo Ferreri
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, University of Bari, 70124, Bari, Italy
| | - Dario Sisto
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, University of Bari, 70124, Bari, Italy
| | - Alfredo Niro
- Eye Clinic, "SS. ANNUNZIATA" Hospital, ASL TA, 74010, Taranto, Italy
| | - Giacomo Boscia
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, University of Bari, 70124, Bari, Italy
- Eye Clinic Section, Department of Surgical Sciences, University of Turin, 10122, Turin, Italy
| | - Giacomo Scotti
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, University of Bari, 70124, Bari, Italy
| | - Pasquale Viggiano
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, University of Bari, 70124, Bari, Italy
| | - Alessandra Sborgia
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, University of Bari, 70124, Bari, Italy
| | - Giancarlo Sborgia
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, University of Bari, 70124, Bari, Italy
| | - Ermete Giancipoli
- Eye Clinic, Department of Medical and Surgical Sciences, University of Foggia, 71122, Foggia, Italy
| | - Giovanni Alessio
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, University of Bari, 70124, Bari, Italy
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Du Y, Meng J, He W, Qi J, Lu Y, Zhu X. Complications of high myopia: An update from clinical manifestations to underlying mechanisms. ADVANCES IN OPHTHALMOLOGY PRACTICE AND RESEARCH 2024; 4:156-163. [PMID: 39036706 PMCID: PMC11260019 DOI: 10.1016/j.aopr.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 06/15/2024] [Accepted: 06/20/2024] [Indexed: 07/23/2024]
Abstract
Background High myopia is one of the major causes of visual impairment and has an ever-increasing prevalence, especially in East Asia. It is characterized by excessive axial elongation, leading to various blinding complications that extend beyond mere refractive errors and persist immovably after refractive surgery, presenting substantial public health challenge. Main text High myopia-related complications include lens pathologies, atrophic and tractional maculopathy, choroidal neovascularization, peripheral retinal degenerations and retinal detachment, and glaucoma and heightened susceptibility to intraocular pressure (IOP) elevation. Pathological lens changes characteristic of high myopia include early cataractogenesis, overgrowth of lens, weakened zonules, and postoperative capsular contraction syndrome, possibly driven by inflammatory pathogenesis, etc. Dome-shaped macula and cilioretinal arteries are two newly identified protective factors for central vision of highly myopic patients. These patients also face risks of open-angle glaucoma and IOP spike following intraocular surgery. Morphologic alternations of optic nerve in high myopia can complicate early glaucoma detection, necessitating comprehensive examinations and close follow-up. Anatomically, thinner trabecular meshwork increases this risk; conversely lamina cribrosa defects may offer a fluid outlet, potentially mitigating the pressure. Notably, anxiety has emerged as the first recognized extra-ocular complication in high myopia, with an underlying inflammatory pathogenesis that connects visual stimulus, blood and brain. Conclusions High myopia induces multiple ocular and potential mental health complications, underscoring the need to develop more effective strategies to improve both physical and emotional well-being of these patients, among which anti-inflammation might possibly represent a promising new target.
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Affiliation(s)
- Yu Du
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia and Related Eye Diseases, Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Jiaqi Meng
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia and Related Eye Diseases, Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Wenwen He
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia and Related Eye Diseases, Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Jiao Qi
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia and Related Eye Diseases, Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Yi Lu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia and Related Eye Diseases, Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Xiangjia Zhu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia and Related Eye Diseases, Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
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Łątkowska M, Gajdzis M, Kaczmarek R. Emulsification of Silicone Oils: Altering Factors and Possible Complications-A Narrative Review. J Clin Med 2024; 13:2407. [PMID: 38673681 PMCID: PMC11051299 DOI: 10.3390/jcm13082407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/16/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Endotamponade of the vitreous body with silicone oil is a common procedure, being the basis of many vitreoretinal surgeries. However, emulsification may happen, which is a clinically relevant adverse event of silicone oil use. Methods: This review provides a thorough analysis of the emulsification process. It focuses on describing factors affecting this event as well as its possible subsequent complications. Results: The viscosity of silicone oil, the duration of emulsification, the status of the lens and many other factors have an influence on the onset and intensity of emulsification. This phenomenon carries several risks for operated eyes such as increased intraocular pressure, keratopathy or structural changes to the retina. Conclusions: The use of modern imaging techniques, especially optical coherence tomography, enables faster detection of the emulsification process. This allows for an adequate clinical response and more accurate follow-up of the patient.
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Ge L, Su N, Fan W, Yuan S. Risk Factors and Management of Intraocular Pressure Elevation After Vitrectomy Combined with Silicone Oil Tamponade. Int J Gen Med 2024; 17:447-456. [PMID: 38333017 PMCID: PMC10849908 DOI: 10.2147/ijgm.s446617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/24/2024] [Indexed: 02/10/2024] Open
Abstract
Silicone oil has emerged as the common option for intraocular tamponade during complicated retina vitrectomy. However, the postoperative elevation of intraocular pressure (IOP), influenced by numerous factors, remains a significant and frequently encountered complication that poses a potential threat to vision. Extensive research has been conducted to investigate the risk factors associated with elevated IOP following silicone oil tamponade, including silicone oil viscosity, preoperative high IOP, diabetes, and lens status. This comprehensive review aims to gather and summarize the current research findings regarding the risk factors contributing to IOP elevation following silicone oil tamponade, as well as the optimal management strategies for secondary glaucoma. The analysis includes the physicochemical properties of silicone oil, preoperative and intraoperative risk factors, and the effective management of secondary glaucoma. Enhancing our understanding of the primary factors associated with silicone oil-induced IOP elevation will facilitate the guidance of timely and appropriate interventions.
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Affiliation(s)
- Lexin Ge
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, People’s Republic of China
| | - Na Su
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, People’s Republic of China
| | - Wen Fan
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, People’s Republic of China
| | - Songtao Yuan
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, People’s Republic of China
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Fan W, Zhang C, Ge L, Su N, Chen J, Song S, Wang Y, Yuan S. Prediction model for elevated intraocular pressure risk after silicone oil filling based on clinical features. Front Med (Lausanne) 2024; 10:1340198. [PMID: 38264037 PMCID: PMC10803451 DOI: 10.3389/fmed.2023.1340198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 12/28/2023] [Indexed: 01/25/2024] Open
Abstract
Background To evaluate risk factors and further develop prediction models for intraocular pressure elevation (IOP) after vitreoretinal surgery with silicone oil tamponade to support clinical management. Methods A retrospective study analyzed 1,061 eyes of 1,061 consecutive patients that presented to the Jiangsu Province Hospital between December 2015 and December 2020, the IOP was measured from the preoperative visit and at the 1-week, 1-month, 3-month, and 6-month visits, and the final postoperative visit before silicone oil removal. Four machine learning methods were used to carried out the prediction of IOP elevation: Decision Tree, Logistic Regression, Random Forest, and Gradient-Boosted Decision Trees (GBDT) based on features including demographic and clinical characteristics, preoperative factors and surgical factors. Predictors were selected based on the p-value of the univariate analysis. Results Elevated intraocular pressure developed in 26.01% of the eyes postoperatively. Elevated intraocular pressure primarily occurred within 1-2 weeks after surgery. Additionally, the majority of IOP values were distributed around 25-40 mmHg. GBDT utilizing features with p-values less than 0.5 from the hypothesis testing demonstrated the best predictive performance for 0.7944 in accuracy. The analysis revealed that age, sex, hypertension, diabetes, myopia, retinal detachment, lens status and biological parameters have predictive value. Conclusion Age, sex, hypertension, diabetes, myopia, retinal detachment, lens status and biological parameters have influence on postoperative intraocular pressure elevation for patients with silicone oil tamponade after pars plana vitrectomy. The prediction model showed promising accuracy for the occurrence of IOP elevation. This may have some reference significance for reducing the incidence of high intraocular pressure after pars plana vitrectomy combined with silicone oil filling.
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Affiliation(s)
- Wen Fan
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chaohe Zhang
- Key Laboratory of High Confidence Software Technologies, Ministry of Education, Peking University, Beijing, China
- School of Computer Science, Peking University, Beijing, China
| | - Lexin Ge
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Na Su
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jiaqin Chen
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Siyao Song
- School of Computer Science, Peking University, Beijing, China
- National Engineering Research Center of Software Engineering, Peking University, Beijing, China
- Software College, Northeastern University, Shenyang, China
| | - Yasha Wang
- Key Laboratory of High Confidence Software Technologies, Ministry of Education, Peking University, Beijing, China
- National Engineering Research Center of Software Engineering, Peking University, Beijing, China
| | - Songtao Yuan
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Chen S, Zhang J, Tian J, Zhao C, Liu C, Sun X, Gao X, Zhang Y, Wang J, Li N, Liu H, Gao Y, Ma X, Li J, Deng A, Wang T, Yuan G. A Multicenter Prospective Randomized Controlled Study of a New Corneal Wetting Agent During Ophthalmologic Surgery. Ophthalmol Ther 2023; 12:3211-3218. [PMID: 37768528 PMCID: PMC10640533 DOI: 10.1007/s40123-023-00818-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION A multicenter prospective randomized controlled study was used to investigate the effect and safety of a new corneal wetting agent called the Corneal Surface Viscoelastic Protector (CsVisc, Success Bio-Tech Co., Ltd, China), on the corneal epithelium during ophthalmic surgery by comparison with the commercially available Cornea Protect (CP, Valeant Med Sp. zo. o. Leobendorf, Austria). METHODS This multicenter prospective randomized controlled study comprised patients scheduled for cataract surgery and pars plana vitrectomy. The patients were randomly assigned to receive either a new corneal wetting agent (CsVisc) or Cornea Protect (CP, Valeant Med Sp. zo. o. Leobendorf, Austria). Optical clarity during surgery, application frequency, duration of effect, diffusion time of corneal wetting agents, fluorescein staining, intraocular pressure (IOP), tear-film break-up time (TBUT), and Schirmer I test (SIT) were assessed. Adverse events were noted on the designated patient case report forms. RESULTS A total of 149 eyes (149 patients, mean age 62 years; range 25-80 years) were included in the study. There were 74 eyes in the control group and 75 eyes in the study group. In patients who underwent vitrectomy, the frequency of application was 1.62 ± 1.03 in the study group and 1.39 ± 0.66 in the control group, with no significant difference (P = 0.399), and the duration of effect was 19.16 ± 6.94 min in the study group and 19.06 ± 7.22 min in the control group, with no significant difference (P = 0.835). The optical clarity of the study group was not significantly different from that of the control group (P = 0.485). In patients who underwent cataract surgery, the frequency of application was 1.10 ± 0.38 in the study group and 1.07 ± 0.26 in the control group, and the difference was not significant (P = 0.950). The difference between the duration of effect in the study group (8.32 ± 2.50 min) and the control group (7.63 ± 2.52 min) was not significant (P = 0.310). The difference in optical clarity scores between the two groups was not statistically significant (P = 0.600). Among all patients in this study, the diffusion time of the corneal wetting agent was 14.97 ± 10.07 s in the control group and 11.23 ± 8.41 s in the study group, with a statistically significant difference (p = 0.008). The frequency of adverse events was 20.00% (15/75) in the study group and 14.86% (11/74) in the control group, with no statistically significant difference (P = 0.409). There were no serious adverse events related to the test medical device or causing patients to withdraw from the study. CONCLUSIONS The CsVisc is safe and effective in preventing intraoperative corneal epithelial damage due to corneal dryness and can be comparable to the CP. In addition, the CsVisc has a shorter diffusion time.
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Affiliation(s)
- Shijiu Chen
- Qingdao University, Qingdao, Shandong, China
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), 372 Jingsi Road, Jinan, 250021, Shandong, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong, China
| | - Jingjing Zhang
- Qingdao University, Qingdao, Shandong, China
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), 372 Jingsi Road, Jinan, 250021, Shandong, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong, China
- School of Ophthalmology, Shandong First Medical University, Jinan, Shandong, China
| | - Jingyi Tian
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), 372 Jingsi Road, Jinan, 250021, Shandong, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong, China
- School of Ophthalmology, Shandong First Medical University, Jinan, Shandong, China
| | - Can Zhao
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), 372 Jingsi Road, Jinan, 250021, Shandong, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong, China
- School of Ophthalmology, Shandong First Medical University, Jinan, Shandong, China
| | - Chunli Liu
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), 372 Jingsi Road, Jinan, 250021, Shandong, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong, China
- School of Ophthalmology, Shandong First Medical University, Jinan, Shandong, China
| | - Xiaolei Sun
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), 372 Jingsi Road, Jinan, 250021, Shandong, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong, China
- School of Ophthalmology, Shandong First Medical University, Jinan, Shandong, China
| | - Xiang Gao
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), 372 Jingsi Road, Jinan, 250021, Shandong, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong, China
- School of Ophthalmology, Shandong First Medical University, Jinan, Shandong, China
| | - Ying Zhang
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), 372 Jingsi Road, Jinan, 250021, Shandong, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong, China
- School of Ophthalmology, Shandong First Medical University, Jinan, Shandong, China
| | - Jun Wang
- Affiliated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, 261000, Shandong, China
| | - Na Li
- Affiliated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, 261000, Shandong, China
| | - Hong Liu
- Affiliated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, 261000, Shandong, China
| | - Yan Gao
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, 5 Yanerdao Road, Qingdao, 266073, Shandong, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong, China
- School of Ophthalmology, Shandong First Medical University, Jinan, Shandong, China
| | - Xiubin Ma
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, 5 Yanerdao Road, Qingdao, 266073, Shandong, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong, China
- School of Ophthalmology, Shandong First Medical University, Jinan, Shandong, China
| | - Jun Li
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, 5 Yanerdao Road, Qingdao, 266073, Shandong, China.
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong, China.
- School of Ophthalmology, Shandong First Medical University, Jinan, Shandong, China.
| | - Aijun Deng
- Affiliated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, 261000, Shandong, China.
| | - Ting Wang
- Qingdao University, Qingdao, Shandong, China.
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), 372 Jingsi Road, Jinan, 250021, Shandong, China.
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong, China.
- School of Ophthalmology, Shandong First Medical University, Jinan, Shandong, China.
| | - Gongqiang Yuan
- Qingdao University, Qingdao, Shandong, China.
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), 372 Jingsi Road, Jinan, 250021, Shandong, China.
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong, China.
- School of Ophthalmology, Shandong First Medical University, Jinan, Shandong, China.
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Kaźmierczak K, Żuchowski P, Stafiej J, Malukiewicz G. Functional and structural outcomes and complications after pars plana vitrectomy for severe features of proliferative diabetic retinopathy in type 1 and type 2 diabetes mellitus. PLoS One 2023; 18:e0288805. [PMID: 37471387 PMCID: PMC10358898 DOI: 10.1371/journal.pone.0288805] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 07/03/2023] [Indexed: 07/22/2023] Open
Abstract
PURPOSE To evaluate the functional and structural outcomes as well as postoperative complications after pars plana vitrectomy (PPV) for severe features of proliferative diabetic retinopathy (PDR) in type 1 and type 2 diabetes mellitus (DM) patients. METHODS Twenty two eyes of type 1 diabetics (DM1 group) and 27 eyes of type 2 diabetics (DM2 group) were included. Best corrected visual acuity (BCVA), intraocular pressure (IOP), postoperative structural changes in optical coherence tomography (OCT) and postoperative complications such as recurrent vitreous haemorrhage, diabetic macular oedema, secondary glaucoma and persistent tractional retinal detachment (TRD) were assessed and compared between the two groups. RESULTS Complete reattachment of retina was achieved in 88.9% from the DM1 group and in 95.5% from the DM2 group and remained attached in follow-up. BCVA in DM2 group was significantly lower preoperatively (p = 0.04). Mean postoperative BCVA significantly improved in both studied groups, but it was more evident in eyes of type 2 diabetics compared to type 1 diabetics. In eyes in the DM1 group there was perceptible stabilisation of BCVA. Poor visual acuity or lack of improvement in BCVA in the DM1 group was related to preoperative subretinal haemorrhage in macular region, and TRD involving macula, whereas in the DM2 group-to preoperative subretinal haemorrhage and neovascular glaucoma. The postoperative structural changes (disruption of EZ and ELM) were observed more often in DM2 group, but had the greatest impact on BCVA in eyes of type 1 DM. Complications after PPV for PDR were rare and hadn't a significant influence on the final functional outcomes in both groups. CONCLUSIONS Functional improvement after PPV for severe features of proliferative diabetic retinopathy were more noticeable in patients with type 2 DM. Postoperative structural changes had more negative impact on BCVA in type 1 diabetics.
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Affiliation(s)
- Karolina Kaźmierczak
- Department of Ophthalmology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
| | - Paweł Żuchowski
- Clinic of Rheumatology and Connective Tissue Diseases, Jan Biziel University Hospital No. 2, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
| | - Joanna Stafiej
- Department of Ophthalmology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
| | - Grażyna Malukiewicz
- Department of Ophthalmology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
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9
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Yoon JH, Kim JH, Kim CG, Kim JW. Incidence of early complications requiring treatment plan changes after vitreoretinal surgery: a single-center study in South Korea. BMC Ophthalmol 2023; 23:282. [PMID: 37332012 DOI: 10.1186/s12886-023-03030-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/09/2023] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND Information regarding incidence of treatment plan changes may be useful when discussing postoperative treatment plans for patients. Moreover, it may help establish a standardized postoperative treatment plan. This study aimed to evaluate the incidence of early complications requiring treatment plan changes in patients following vitreoretinal surgery and investigate its risk factors. METHODS This single-center retrospective study included 465 patients who had undergone vitreoretinal surgery. The reasons, incidence, and timing of treatment plan changes within 14 days of surgery were identified. Potential factors associated with the changes, such as patient demographics, surgeon's experience, diagnoses, and type of surgery were also analyzed. RESULTS The treatment plan was changed in 76 patients (16.3%) at a mean of 4.0 ± 3.2 days after vitreoretinal surgery. The reasons for the plan changes were increased intraocular pressure (IIOP) in 66(86.8%), intraocular inflammation in 2(2.6%), corneal edema in 3(3.9%), leakage from the sclerotomy wound in 3(3.9%) patients, and combined IIOP and intraocular inflammation in 2(2.6%). The date of discharge was postponed because of treatment plan changes in 17 patients (22.4%). The incidence of plan changes was higher in patients who underwent gas or oil tamponade (P < 0.001) and those who underwent surgery performed by less experienced surgeons (P = 0.034). CONCLUSIONS Treatment plan was changed in 16.3% of patients after vitreoretinal surgery. The risk of treatment plan changes was associated with the surgeon's experience in vitreoretinal surgery and the type of surgery. These results should be considered when establishing standardized care plans for patients who require vitreoretinal surgery.
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Affiliation(s)
- Ji Hyun Yoon
- Department of Ophthalmology, Kim's Eye Hospital, #156 Youngdeungpo-dong 4ga, Youngdeungpo-gu, Seoul, 150-034, South Korea
| | - Jae Hui Kim
- Department of Ophthalmology, Kim's Eye Hospital, #156 Youngdeungpo-dong 4ga, Youngdeungpo-gu, Seoul, 150-034, South Korea.
| | - Chul Gu Kim
- Department of Ophthalmology, Kim's Eye Hospital, #156 Youngdeungpo-dong 4ga, Youngdeungpo-gu, Seoul, 150-034, South Korea
| | - Jong Woo Kim
- Department of Ophthalmology, Kim's Eye Hospital, #156 Youngdeungpo-dong 4ga, Youngdeungpo-gu, Seoul, 150-034, South Korea
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10
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Noguchi A, Nakakura S, Noguchi S. Insertion of Ahmed Implant With Partial Buckle Resection: A Case Report. Cureus 2022; 14:e31453. [DOI: 10.7759/cureus.31453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2022] [Indexed: 11/15/2022] Open
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11
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Rahman S, Sharma N, Valentim CCS, Muste JC, Iyer AI, Li A, Singh RP. Rhegmatogenous Retinal Detachment: Variations in Clinical Presentation and Surgical Outcomes by Socioeconomic Status and Race. Ophthalmic Surg Lasers Imaging Retina 2022; 53:538-545. [DOI: 10.3928/23258160-20220923-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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12
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Guerreiro MF, Bufarah GH, Esporcatte BLB, Tavares IM. Glaucoma e óleo de silicone. REVISTA BRASILEIRA DE OFTALMOLOGIA 2022. [DOI: 10.37039/1982.8551.20220104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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13
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Baur ID, Mayer CS, Storr J, Khoramnia R. Traumatic iridodialysis and mydriasis: Surgical reconstruction of the iris-lens-diaphragm with an iris implant and Intraocular lens. Am J Ophthalmol Case Rep 2022; 26:101545. [PMID: 35514801 PMCID: PMC9062661 DOI: 10.1016/j.ajoc.2022.101545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 03/15/2022] [Accepted: 04/15/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose We present the case of a severe golf related ocular injury that affected the anterior and posterior segment. Treatment included primary surgical closure of the traumatic wound and secondary reconstruction of the iris-lens-diaphragm to correct aphakia and traumatic mydriasis and iridodialysis. Observations A 62-year-old woman presented to our clinic with severe ocular contusion after she had been hit by a golf ball in the right eye. We observed iridodialysis, traumatic mydriasis and luxation of the crystalline lens into the vitreous body as well as Berlin's edema and retinal tears. The patient underwent primary surgical closure of the traumatic wound and, 6 months later, combined Intraocular lens (IOL) and Customflex ArtificialIris (AI, HumanOptics, Erlangen, Germany) implantation. Uncorrected distance visual acuity was hand movement after primary surgical closure of the traumatic wound. After secondary reconstruction of the iris-lens-diaphragm, corrected distance visual acuity was 0.30 logMAR. Subjective impairment from glare could effectively be reduced and the patient was very satisfied with the aesthetic result. Conclusions and Importance Combined AI and IOL implantation can successfully restore visual acuity and reduce sensitivity to glare while providing an excellent aesthetic result in patients with a history of severe blunt ocular trauma, even in cases with a poor visual acuity prognosis.
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Surgical Treatment in Silicone Oil-Associated Glaucoma. Diagnostics (Basel) 2022; 12:diagnostics12041005. [PMID: 35454053 PMCID: PMC9031548 DOI: 10.3390/diagnostics12041005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/11/2022] [Accepted: 04/13/2022] [Indexed: 01/27/2023] Open
Abstract
Glaucoma is a vision threatening, not uncommon complication of eyes that have undergone pars plana vitrectomy with silicone oil endotamponade. Although most patients respond well to medical antiglaucoma therapy, there are refractory cases where surgery is required to control the intraocular pressure. This review, following a comprehensive literature search in the Medline database, aims to present the most important surgical techniques currently in use for glaucoma associated with silicone oil endotamponade and their indication depending on the mechanism of glaucoma. In cases of pupillary block, the presence of a patent iridotomy or iridectomy must be ensured, either by laser or surgically. When silicone oil is in excess and whenever the retinal status permits it, partial or complete removal of the silicone oil should be performed. Trabeculectomy has shown higher failure rates and more complications in these cases compared to other indications, so alternate methods are warranted. For very high intraocular pressures, glaucoma drainage devices and transscleral cyclophotocoagulation are the most used options, with good efficacy and safety profiles, although rarely they may have serious complications. The Ex-PRESS mini shunt has shown excellent results and lower rates of complications. For less important IOP elevations, minimally invasive glaucoma surgery and selective laser trabeculoplasty may be used, either alone or in conjunction with other methods.
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15
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Mayer C, Baur ID, Storr J, Khoramnia R. Complete anterior segment reconstruction: Corneal transplantation and implantation of an iris prosthesis and IOL in a single surgery. Eur J Ophthalmol 2021; 31:3300-3308. [PMID: 33508973 PMCID: PMC8606946 DOI: 10.1177/1120672121991052] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 01/03/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE Patients who have suffered an ocular trauma may present with varying degrees of injury to the anterior segment. In this retrospective interventional case series, we report the outcome of seven patients who underwent complete anterior segment reconstruction in a single surgery. METHODS All patients with posttraumatic corneal decompensation or scar, aphakia, and iris defect underwent human donor corneal graft transplantation and implantation of an intraocular lens combined with a flexible silicone iris prosthesis. Postoperative examinations included assessment of best corrected distance visual acuity, objective refraction, and intraocular pressure. Sensitivity to glare and subjective discontent with the eye's appearance was rated on a scale from 1 to 10, with 1 standing for low and 10 for high severity. RESULTS Mean best corrected distance visual acuity (BCDVA) was 1.51 ± 0.26 logMAR preoperatively and 1.29 ± 0.36 logMAR postoperatively. Mean IOP was 15.71 ± 8.94 mmHg pre-surgery and 13.57 ± 6.52 mmHg post-surgery. The mean sensitivity to glare was reduced from 7.17 ± 2.91 to 3.80 ± 3.43 and subjective cosmetic disfigurement was reduced from 5.33 ± 3.35 to 1.80 ± 1.60. CONCLUSIONS A single surgery technique for entire anterior segment reconstruction in trauma patients can effectively reduce glare and patient discontent with the eye's appearance.
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Affiliation(s)
- Christian Mayer
- Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | | | - Julia Storr
- Ophthalmology Clinic and Polyclinic, Technical University of Munich, Munich, Germany
| | - Ramin Khoramnia
- Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
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16
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Zhang Z, Jiang X, Wei Y, Zhang S. Pars plana subcapsulotomy to remove condense subcapsular opacification in combined surgery of silicone oil removal and phacoemulsification. Int Ophthalmol 2021; 42:903-911. [PMID: 34647218 DOI: 10.1007/s10792-021-02071-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 09/24/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Because of the direct contact of intravitreal silicone oil (SO) with the subcapsular membrane, cataract is one of the main SO-related complications. In a group of patients, condense subcapsular opacification occurs, which adds difficulty and risk when having sequential treatment of it. The aim of the current study is to assess the long-term outcomes of pars plana subcapsulotomy to remove condense subcapsular opacification in combined surgery of SO removal and phacoemulsification. METHODS Retrospective cohort study. Consecutive patients who were scheduled to have combined surgery of SO removal and phacoemulsification, and with condense subcapsular opacification were included. After phacoemulsification and SO removal, circular subcapsulotomy (diameter = 3-5 mm) was performed with a 23-/25-gauge vitrectomy probe on each subject during the combined surgery. Main outcomes were pre- and postoperative best-corrected visual acuity (BCVA), intra- and postoperative complications. RESULTS One hundred and twenty patients (120 eyes) were included. Postoperative logMAR BCVA at day 1, week 1, month 1, and final follow-up examinations was 1.0 ± 0.5, 0.7 ± 0.4, 0.6 ± 0.4, and 0.6 ± 0.3, respectively. Statistically significant median differences of logMAR BCVA occurred between the preoperative examination and each postoperative follow-up examination (all p < 0.001). The sharpest median increase in logMAR BCVA occurred between the day 1 and week 1 postoperative examinations (p < 0.001). CONCLUSIONS For condense subcapsular opacification caused by SO tamponade, pars plana subcapsulotomy with a 23-/25-gauge vitrectomy probe during combined surgery of SO removal and phacoemulsification is effective and safe to have surgical management of it. The systemic approach enables patients to experience rapid and long-lasting vision rehabilitation in a single procedure.
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Affiliation(s)
- Zhaotian Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center of Sun Yat-Sen University, 54S Xianlie Road, Guangzhou, 510060, China
| | - Xintong Jiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center of Sun Yat-Sen University, 54S Xianlie Road, Guangzhou, 510060, China
| | - Yantao Wei
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center of Sun Yat-Sen University, 54S Xianlie Road, Guangzhou, 510060, China
| | - Shaochong Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center of Sun Yat-Sen University, 54S Xianlie Road, Guangzhou, 510060, China.
- Shenzhen Eye Hospital, Shenzhen Key Ophthalmic Laboratory, Health Science Center, Shenzhen University, The Second Affiliated Hospital of Jinan University, Shenzhen, China.
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Jiang B, Dong S, Sun MH, Zhang ZY, Sun DW. Clinical effect of peripheral capsule preservation in eyes with silicone oil tamponade. World J Clin Cases 2021; 9:7729-7737. [PMID: 34621823 PMCID: PMC8462261 DOI: 10.12998/wjcc.v9.i26.7729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/16/2021] [Accepted: 07/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND At present, silicone oil has been widely used in vitrectomy to deal with complex fundus diseases. Usually, cataract extraction is combined with vitrectomy. However, reducing the complications of silicone oil tamponade and facilitating the secondary implantation of intraocular lens (IOL) are still an urgent problem.
AIM To evaluate the clinical effect of vitrectomy combined with peripheral capsule preservation (PCP) in eyes with silicone oil tamponade.
METHODS This single-center retrospective analysis included 70 patients (73 eyes) who underwent vitrectomy and silicone oil tamponade combined with cataract surgery (stage I) between January 2015 and July 2019. All patients underwent selective reoperation for silicone oil extraction and IOL implantation (stage II) more than 3 mo after stage I. These patients were divided into three groups according to the different lens capsule preservation methods: 28 patients (31 eyes) in a whole capsule preserved (WCP) group, 17 (17 eyes) in a capsule absent (CA) group, and 25 (25 eyes) in a peripheral capsule preserved (PCP) group. Intraocular pressure (IOP), best-corrected visual acuity, surgery time, and other complications were recorded at each time point (1 d, 1 wk, and 1 mo after stages I and II).
RESULTS The IOP values were 14.9 ± 8.2 mmHg in the WCP group, 20.3 ± 13.0 mmHg in the CA group, and 14.2 ± 9.7 mmHg in the PCP group (P < 0.05) at 1 mo after stage I operation. Five eyes had IOP higher than 30 mmHg, and one eye in the WCP group appeared to have silicone oil entering the anterior chamber. There was no significant difference in IOP among the three groups at any other time point (P > 0.05). With IOL implantation, visual acuity improved significantly compared to stage I. The incidence rate of posterior capsule opacity was higher in the WCP group than in the other groups (P < 0.001). In the CA group, IOL deviation due to suture relaxation occurred in one case. There was no significant difference in the surgery time among the three groups in stage I (P = 0.618). In stage II, the surgery time of the PCP group and WCP group was significantly shorter than that of the AC group (P = 0.031).
CONCLUSION Preservation of the peripheral capsule in vitrectomy combined with lens removal is a better option. This method has significant advantages in reducing intraoperative and postoperative complications.
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Affiliation(s)
- Bo Jiang
- Department of Ophthalmology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Su Dong
- Department of Ophthalmology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Ming-Hao Sun
- Department of Ophthalmology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Zhong-Yu Zhang
- Department of Ophthalmology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Da-Wei Sun
- Department of Ophthalmology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
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18
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Vidne-Hay O, Platner E, Alhalel A, Moisseiev J. Long-term silicone oil tamponade in eyes with complicated retinal detachment. Eur J Ophthalmol 2021; 32:1728-1734. [PMID: 34109851 DOI: 10.1177/11206721211019551] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To report the visual and anatomic outcomes of eyes with exceedingly long-term silicone oil tamponade. METHODS A retrospective chart review of 43 eyes of 41 patients with silicone oil tamponade for 5 years or more. Rates of retinal reattachment, visual acuity, and complications are presented. Further analysis was performed to identify if silicone oil complications are more common in eyes with lower vision. For this, cases were divided into group A-visual acuity of 20/400 or better and group B-visual acuity of less than 20/400. RESULTS Mean silicone oil duration was 12.6 ± 6.3 years. The etiology at presentation included: recurrent RRD (60.46%), RRD secondary to trauma (25.58%), and TRD (13.95%). Ninety-three percent of eyes underwent at least one ocular surgery before the vitrectomy with silicone oil tamponade. The retinal attachment rate was 55.8%. Mean visual acuity at presentation was 2.03 ± 0.6 logMAR, and at the final follow-up, 1.85 ± 0.78 logMAR (p = 0.166). Emulsification developed in 33.3% of cases, glaucoma in 28.6%, band keratopathy in 21.4%, and corneal decompensation in 16.7%. In 26.2% of eyes, the final visual acuity was 20/400 or better (group A). In 73.8% of eyes, final visual acuity was worse than 20/400 (group B). The rates of silicone oil emulsification and glaucoma were not statistically significant between groups. CONCLUSIONS Long-term silicone oil tamponade is a possible option in eyes with complicated retinal detachment following multiple intravitreal procedures, although the complication rates are relatively high. In 26.2% of eyes, visual acuity of 20/400 or better can be preserved for many years.
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Affiliation(s)
- Orit Vidne-Hay
- Department of Ophthalmology, Sheba Medical Centre, Ramat Gan, Israel
| | - Eva Platner
- Department of Ophthalmology, Sheba Medical Centre, Ramat Gan, Israel
| | - Amir Alhalel
- Department of Ophthalmology, Sheba Medical Centre, Ramat Gan, Israel
| | - Joseph Moisseiev
- Department of Ophthalmology, Sheba Medical Centre, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Mayer CS, Baur ID, Storr J, Khoramnia R. Bilateral Artificial Iris implantation in patients with bilateral iris defects. Am J Ophthalmol Case Rep 2021; 22:101108. [PMID: 34027229 PMCID: PMC8121880 DOI: 10.1016/j.ajoc.2021.101108] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/02/2021] [Accepted: 04/04/2021] [Indexed: 12/19/2022] Open
Abstract
Purpose Binocular traumatic or atraumatic iris defects can lead to an increased sensitivity to glare and cosmetic disfigurement. Surgical iris reconstruction is one approach to alleviate these problems. We report the clinical outcomes after medically indicated bilateral implantation of an Artificial Iris prosthesis in three patients with binocular iris defects with different etiologies. Observations All three patients underwent binocular CUSTOMFLEX ArtificialIris (AI) (HumanOptics AG, Erlangen, Germany) implantation with simultaneous cataract surgery. Corrected distance visual acuity (CDVA), manifest refraction, Contrast sensitivity, endothelial cell density and subjective visual impairment as well as subjective cosmetic disfigurement were measured pre- and postoperatively. CDVA remained stable or improved in all three patients. We observed an increase in contrast sensitivity and reduction of glare sensitivity in two patients. All patients reported satisfaction with the cosmetical result after the implantation. Conclusions and importance The bilateral Artificial Iris implantation is an effective therapeutic option to reduce glare sensitivity and to achieve an aesthetically pleasing result also in selected patients with binocular traumatic or atraumatic iris defects.
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Affiliation(s)
| | | | - Julia Storr
- Ophthalmology Clinic and Polyclinic, Technical University of Munich, Munich, Germany
| | - Ramin Khoramnia
- Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
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20
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Omidtabrizi A, Ghavami V, Shafiee M, Bayani R, Banaee T. Long-Term Intraocular Pressure Changes after Pars Plana Vitrectomy: An 8-Year Study. J Curr Ophthalmol 2021; 32:335-342. [PMID: 33553834 PMCID: PMC7861093 DOI: 10.4103/joco.joco_85_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/23/2020] [Accepted: 07/11/2020] [Indexed: 11/05/2022] Open
Abstract
Purpose: To investigate the long-term changes of intraocular pressure (IOP) after pars plana vitrectomy (PPV). Methods: This was a retrospective historical cohort study. Patients with a history of vitrectomy in one eye by a single surgeon were enrolled. IOP of the operated eye was compared to the fellow eye. Previous scleral buckling, IOP rise due to surgical/anatomic complications, silicone oil (SO) emulsification, and contralateral ocular hypertension/glaucoma at recruitment were exclusion criteria. “Significant IOP rise” (>6.0 mmHg) and development of open angle glaucoma (OAG) were the main outcome measures. Results: Two hundred and twenty-five eyes were included. Mean and median follow-up duration were 20.6 and 9.0 months, respectively. Mean baseline IOP and mean final IOP were 13.53 ± 3.75 mmHg and 16.52 ± 6.95 mmHg, respectively (P < 0.001). Forty-three patients developed “significant IOP rise” with no statistically significant relation to the indication of vitrectomy, the postoperative lens status, and number of vitrectomies (P = 0.410, P = 0.900, and P = 0.160, respectively). SO injection raised the probability of IOP rise in the long-term (P = 0.028). OAG occurred in 17 patients (7.5%) with no association to SO tamponade (P = 0.840). “Significant IOP rise” and OAG occurred in 3 and 1 control eyes, respectively, significantly lower than the rates in study eyes (P < 0.001). Conclusion: Mean IOP slightly rose in the long-term after PPV. SO tamponade was associated with IOP rise in the long-term but not with the incidence of OAG. Both IOP rise and OAG were more probable after vitrectomy.
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Affiliation(s)
- Arash Omidtabrizi
- Retina Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Ophthalmology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Vahid Ghavami
- Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Masoud Shafiee
- Retina Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Ophthalmology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Razieh Bayani
- Retina Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Ophthalmology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Touka Banaee
- Retina Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Ophthalmology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Ophthalmology and Visual Sciences, University of Texas Medical Branch at Galveston, TX, USA
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21
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Incidence of Management Changes at the Postoperative Day One Visit After Pars Plana Vitrectomy for Retinal Detachment. Am J Ophthalmol 2021; 222:271-276. [PMID: 33002487 PMCID: PMC7521411 DOI: 10.1016/j.ajo.2020.09.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/16/2020] [Accepted: 09/18/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the incidence of unexpected management changes on the first day after pars plana vitrectomy (PPV) for retinal detachment repair. DESIGN Retrospective cohort study. METHODS The medical and billing records of a large academic private practice were electronically queried for all cases of PPV for retinal detachment performed between January 1, 2017, and December 31, 2017. All cases of PPV for rhegmatogenous or tractional retinal detachment with completed postoperative day 1 (POD1) and postoperative week 1 (POW1) visits were included. The preoperative consultation, operative report, and POD1 and POW1 (postoperative days 5-14) visits were reviewed. Main outcome measures were incidence of unexpected management changes (change in or extended positioning, additional procedure, change in drop regimen, or shortened interval follow-up) at the POD1 visit after uncomplicated PPV for retinal detachment. RESULTS Overall, 418 surgeries from 364 eyes and 355 patients were included. Eleven cases (2.6%) had an intraocular pressure (IOP) over 30 mm Hg at POD1. IOP-lowering drops were prescribed for 30 cases (7.2%). Silicone oil tamponade was positively associated with high IOP at POD1 (relative risk = 3.23, 95% confidence interval 0.96-10.84, P = 0.06). No additional management changes were made besides treating elevated IOP. CONCLUSIONS Management changes on POD1 after vitrectomy for retinal detachment repair are relatively uncommon and were solely IOP related in this patient group. There may be flexibility regarding the type of POD1 encounter necessary, including an IOP check with an ophthalmic technician or non-retinal eye care provider. Larger, prospective studies are needed to better determine the most efficient follow-up routine.
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Intraocular Pressure Rise Linked to Silicone Oil in Retinal Surgery: A Review. Vision (Basel) 2020; 4:vision4030036. [PMID: 32823618 PMCID: PMC7558829 DOI: 10.3390/vision4030036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 12/20/2022] Open
Abstract
Silicone oil represents the main choice for intraocular tamponade in cases of complicated retinal detachment surgery. The intraocular pressure of an eye filled with silicone oil could increase, driven by a variety of different forces, according to several mechanisms. Two main conditions have been highlighted, depending on the onset: early hypertension or late glaucoma. The different types of silicone oils and their physico-chemical properties are varied and may play a role in the determination of intraocular pressure rise. The current body of literature allows for the illustration and categorization of the incidence and risk factors, as well as the pathogenesis and the management of the early postoperative hypertension subtended by an open- and closed-angle, along with the late onset silicone oil-induced glaucoma. Understanding the leading actors on the stage of ocular pressure elevation concurrently with silicone oil application for retinal surgery could help in guiding the timely and appropriate course of treatment.
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Abstract
PURPOSE OF REVIEW The present article reviews the most common and most serious vision-threatening and life-threatening complications of vitreoretinal surgery. RECENT FINDINGS Serious complications after vitreroretinal surgery are rare. Endophthalmitis for example has recently been estimated to occur in 0.08% of small gague vitrectomy. Other complications such as cataract are almost unavoidable, becoming visually significant in up to 80% of patients. The introduction of smaller gauge vitrectomy systems has reduced surgical times, conjunctival scarring and inflammation, and the rate of some complications such as retinal tears. Ocular venous air embolism is an exceedingly rare complication that is potentially life threating and therefore important for all vitreoretinal surgeons to be aware of. SUMMARY Though vitreoretinal surgery is well tolerated and effective, it is inevitable that all surgeons will experience complications and are therefore best served by understanding the potential complications, strategies to reduce the likelihood of them occurring, and ways to address them when they do happen.
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Kopecky A, Nemcansky J. Changes in the anterior segment of the eye following uncomplicated pars plana vitrectomy. A review. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2019; 163:207-211. [PMID: 30994110 DOI: 10.5507/bp.2019.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 04/03/2019] [Indexed: 11/23/2022] Open
Abstract
Pars plana vitrectomy is currently the most common technique used in retinal surgery. Although primarily involving the posterior segment of the eye it also affects the anterior segment. As this is a less published topic, the aim of this paper was to review the literature on changes in the anterior segment after uncomplicated pars plana vitrectomy using data based literature search. The conclusions are that even in otherwise ophthalmologically healthy patients, complications may occur in the anterior segment. Surgeons need to pay utmost attention in glaucoma patients and in those with endothelial insufficiency who are at highest risk of complications. He/she must also correctly plan a potential cataract surgery if not already done earlier. From the literature, most of the changes in the anterior segment after uncomplicated PPV are found to be temporary.
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Affiliation(s)
- Adam Kopecky
- Clinic of Ophthalmology, University Hospital Ostrava, Czech Republic.,First Faculty of Medicine, Charles University Prague, Czech Republic
| | - Jan Nemcansky
- Clinic of Ophthalmology, University Hospital Ostrava, Czech Republic
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