27-GAUGE PARS PLANA/PLICATA VITRECTOMY FOR PEDIATRIC VITREORETINAL SURGERY.

Immune hemolytic anemias

Vitreous hemorrhage associated with subarachnoid hemorrhage is known as Terson's Syndrome (TS). However, it is also seen in the literature in cases of traumatic brain injury or intracranial hemorrhage. Management of visual manifestations is necessary in patients with intracranial hemorrhage. A vitreous hemorrhage was found in the evaluation made due to visual symptoms in a patient who presented to the emergency department with intracranial hemorrhage. In addition to clinical findings, imaging techniques have an important place in the diagnosis of TS. Vitreous hemorrhage findings can be detected with imaging studies such as Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). In this case, the diagnostic findings and the importance of diagnosis in CT and MRI examinations in a patient with TS will be discussed. The purpose of this case report is to share the imaging findings of TS.

Purpose: To evaluate the efficacy and intraocular lens (IOL) stability of vitrectomy combined with the surgical removal of anterior capsular opacity (ACO) and posterior capsular opacity (PCO). Methods: Forty-four pseudophakic eyes of 43 patients with retinal disorders underwent vitrectomy with surgical removal after cataract diagnosis. Nineteen eyes of 19 patients (group 1) had ACO and PCO removed while 25 eyes of 24 patients (group 2) had only PCO removed. Total removal of the entire lens capsule, except for the area around the haptics, was performed when capsular opacity with fibrosis was observed around the capsulorrhexis margin. LogMAR best corrected visual acuity (BCVA), intraoperative complications and postoperative complications were compared. Results: The retina was flat and postoperative BCVA improved in both groups. Intraoperative complications of IOL dislocation occurred in 3 eyes (15.8%) in group 1 and in 1 eye (4.0%) in group 2 (p=0.178). Among the 4 IOLs, 3 were open-loop haptic IOLs and 1 was a closed-loop haptic IOL. Late postoperative complications of IOL capture occurred in 1 eye (5.3%) in group 1. Conclusions: Removal of ACO and PCO for better visualization of the peripheral retina resulted in an improved visual recovery while intraoperative complications and postoperative complications were comparable to PCO removal alone. Removal limited to the optic zone would be more stable when considering any adhesion between the lens capsule and the IOL.

Short-term Outcomes of 23-gauge Pars Plana Vitrectomy

Manuscript received November 20. 1997: accepted Februap 20, 1998. From the Department of Ophthalmology (A.M.F.W.. W-C.L.) and the Seuro-ophthalmology Unit (J.A.S). Division of Nturolog!. the Toronto Hospital and the University of Toronto. Ontario. Canada. Address correspondence and reprint requests to Dr. James A. Sharpe. Division of Neurology. the Toronto Hospital. EC 5-04?. 399 Bathurst Street. Toronto. Ontario. Canada M5T 2S8. preretinal. and \-itreous hemorrhage (Fig. 2). Terson's syndrome was diagnosed. and obsenation was recommended. Three months later. the patient's visual acuity was 20125 OL'. and the hemorrhage resolved. Terson's syndrome refers to the occurrence of \.itreous hemorrhage with tSXH) ( 1 ). Intraocular hemorrhagesubretinal. intraretinal. and preretinal (subhyaloidkcan also occur ( 2 ) . Garfinkle et al. (2) observed vitreous hemorrhage in 3% to 5% of patients with SAH. whereas intraocular hemomhage without vitreous hemorrhage occurred in 20% to m% ( 2 ) . The pathogenesis of Terson's syndrome is unclear. One widely accepted theory (3) suggested that the sudden increase in intracranial pressure in SAH is transmitted to the optic nene sheath through the subarachnoid communication between the ovtic canal and intracranial cavity. The optic nerve sheath dilates and compresses both the central retinal vein and retinochoroidal anastomoses. thus reducing retinal venous drainage. with rupture of retinal vessels and hemorrhage into~the vitreous. Patients with Tenon's syndrome have a poor prognosis. with a mortality rate that is twice that ~f'~atie;ts with SAH in whom there is no vitreous hemorrhage (2 ) . For those who sunive. visual recovery is usually good as the intraocular hemorrhage slowly resolves (4), and conservative management is recommended. Patients should be followed for ocular complications sbch as glaucoma and epiretinal membrane. Nonclearing vitreous hemorrhage may benefit from vitrectomy (5).

Purpose: To evaluate the anatomic and functional outcomes and the rate of complications of a novel pars plana vitrectomy approach (airbag vitrectomy), with 25-gauge vitrectomy performed under air infusion, in the treatment of primary pseudophakic rhegmatogenous retinal detachment (PsRD). Methods: Prospective, noncomparative, interventional case series. One hundred forty-one eyes of 141 consecutive patients with primary PsRD uncomplicated by severe proliferative vitreoretinopathy (grade A or B). All patients underwent primary 25-gauge vitrectomy under continuous infusion of air, laser retinopexy of retinal breaks, and air or gas tamponade. Eyes with minimum follow-up of 6 months were evaluated. The Main Outcome Measures were primary anatomical success rate, defined as retinal reattachment at final follow-up after a single operation without additional surgery, visual outcome and rate of complications. Results: At 6 months the retina was reattached successfully after a single surgery in 98% of eyes (138/141). In 3 eyes (2%) retinal detachment recurred during the follow-up period, caused by proliferative vitreoretinopathy in 2 eyes and by new retinal breaks in 1 eye. After surgery, best corrected visual acuity improved significantly (P 21 mmHg), detected in 10 eyes (7%) on postoperative day 1. Conclusions: Primary 25-gauge airbag vitrectomy provides a high anatomic and functional success in eyes with PsRD and is associated with a low rate of complications.

To evaluate the safety and efficacy of the 25-gauge transconjunctival sutureless vitrectomy (TSV) system in the surgical management of posterior capsular opacification (PCO) in pseudophakic children. Pars plana membranectomy was performed for PCO in 10 pseudophakic eyes of six children (mean age 35.1 +/- 37.8 months; range 6-93 months) using the TSV system. Surgical technique, intraoperative problems and postoperative complications including wound leakage, hypotony and the need for suturing were recorded. Wound leakage and other intraoperative problems were not noted in any of the eyes. All eyes showed improvement of visual acuity from a mean of 6/67 before to 6/29 after surgery (P = 0.001). Mean postoperative intraocular pressure (IOP) was 7.8 +/- 3.1 mmHg (range: 3-10 mmHg). Four eyes (40%) had hypotony on the first postoperative day (IOP: 3-5 mmHg), which was transient in three eyes. One eye in a patient with uveitis had persistent hypotony, but hypotony was also present preoperatively, and the postoperative IOP returned to preoperative levels. This eye also developed recurrent PCO and a second capsulotomy was performed using the 25-gauge TSV system. Posterior capsulotomy using the 25-gauge TSV system appears to be a safe and effective approach in the management of PCO in pseudophakic children. Advantages include easier manipulation with the smaller instruments in these small eyes, and it can be considered in appropriate cases.

Terson syndrome: Authors’ reply

We report the visual outcomes and change in the Modified Barthel Index Score (BIS) in four patients with Terson's syndrome treated with vitrectomy. A retrospective study of four patients with Terson's syndrome from Royal Prince Alfred Hospital, Sydney, was carried out. Assessment of visual acuity and physical disability pre- and post-vit rectomy using the Snellen Chart and the Barthel Index, respectively, was performed. All four patients were found to have improved visual acuity and BIS post vitrectomy. Improved vision from treatment of vitreous hemorrhage decreases the disability after intracranial hemorrhage and Terson's syndrome. Early diagnosis and management would shorten the rehabilitation process and improve the quality of life. Ophthalmo logic management depends on the severity of vitreous hemorrhage, whether it is uni lateral or bilateral, and its impact on patient's daily function. Key Words: Terson's syn drome—Subarachnoid hemorrhage—Vitreous hemorrhage—Vitrectomy—Visual acuity—Modified Barthel Score Index.

Terson's syndrome in a pregnant woman: A fatal presentation

The present study reports the case of a 33-year-old male who presented with Terson syndrome with no cerebral hemorrhage secondary to traumatic brain injury (TBI). A computed tomography scan of the patient, who had sustained an impact injury to the right occipital region, showed no cerebral lesion. Ophthalmoscopy clearly demonstrated vitreous hemorrhage in both eye globes. Vitreous hemorrhage, which results from an abrupt increase in intracranial pressure (ICP), is associated with TBI. In this case, the visual disturbance was attributed to Terson syndrome secondary to TBI. Therefore, close ophthalmological and radiological evaluation is required in patients with TBI, in order to enable the diagnosis of Terson syndrome and an early vitrectomy.

Purpose: To report and describe the clinical course of a pediatric traumatic macular hole (TMH) case and its management. Case Report: A pediatric patient presented a macular hole following blunt ocular trauma. The patient was followed every 2 weeks for 4 months. After the worsening of the macular hole reported by optical coherence tomography (OCT), pars plana vitrectomy with inverted flap technique plus SF6 gas tamponade was performed. Traumatic macular hole appeared closed at the OCT during follow-up. Initial visual acuity was counting finger at 30 cm. After surgery, the patient achieved a visual acuity of 20/100 at 3-month follow-up. Conclusion: This case shows a good anatomic and functional success performing a pars plana vitrectomy with inverted flap technique in a large TMH in a pediatric patient. We underline the importance of the surgical timing in the management of similar cases.

The chapter begins by discussing lens anatomy and embryology, before covering the key areas of clinical knowledge, namely acquired cataract, clinical evaluation of acquired cataract, treatment for acquired cataract, intraoperative complications of cataract surgery, infectious postoperative complications of cataract surgery, non-infectious postoperative complications of cataract surgery, congenital cataract, management of congenital cataract, and lens dislocation. Practical skills are then covered, including biometry, local anaesthesia, operating microscope and phacodynamics, intraocular lenses, and Nd:YAG laser capsulotomy. The chapter concludes with three case-based discussions, on age-related cataract, postoperative endophthalmitis, and posterior capsular opacification.

Purpose: To determine role of optical coherence tomography (OCT) in early detection of subclinical cystoid macular edema (CME) after Nd-YAG laser capsulotomy in patients with posterior capsular opacification (PCO).
 Study Design: Descriptive case-series.
 Place and Duration of Study: Department of Ophthalmology Unit 1, Dow University of Health Sciences and Civil Hospital Karachi from 1-July-2015 to 31-Dec-2015.
 Methods: A total of 72 eyes with unilateral or bilateral visually significant PCO following uncomplicated cataract surgery with posterior chamber intraocular lens implantation were included in the study. Patients with corneal opacities, glaucoma, retinopathy, maculopathy, optic neuropathy, complicated cataract surgery, previous ocular surgery other than cataract surgery and High refractive errors were excluded from the study. Best-corrected visual acuity (BCVA), Slit lamp examination, posterior segment examination and macular thickness was measured using spectral domain (TOPCON 3D OCT) optical coherence tomography before laser and at 1 week and at 1 month after laser.
 Results: Mean age was 55.76 ± 5.28 with Confidence interval of 55.02 – 56.49 years. Eighty-one were males and 122 were females. Subclinical cystoid macular edema (CME) was found in 10 (14%) patients. Out of the patients who had CME, 3 were in age group of 40-55 years and seven were in age group of 56-70 years. P value was found to be significant i.e. (P = 0.039).
 Conclusion: Optical coherence tomography OCT is a non invasive and useful tool for early detection and management of subclinical cystoid macular edema after Nd-YAG laser capsulotomy in patients having posterior capsular opacification (PCO).
 Key Words: Cystoid Macular Edema, Nd-YAG laser, Posterior Capsular Opacification. Optical Coherence Tomography (OCT).

We sought to verify the effect of intraoperative optical coherence tomography (iOCT) on vitrectomy for the treatment of proliferative diabetic retinopathy (PDR). Retrospective study. We reviewed 178 eyes with PDR treated with 25-gauge vitrectomy by a single surgeon between April 2013 and December 2017. In total, 98 eyes of 77 patients with PDR (mean age, 52.5 ± 11.7 years) treated with vitrectomy using iOCT (iOCT group) and 80 eyes of 60 patients with PDR (mean age, 53.1 ± 10.9 years) treated without iOCT (non-iOCT group) were included in the study. To determine the effects of combining vitrectomy with iOCT, a comparison was made of patients treated with this combination and patients treated with vitrectomy without iOCT. The effects of these treatments were assessed on the basis of intraoperative complications, reoperation ratios, postoperative complications, operation times, and postoperative visual acuity. The operation time was significantly reduced for the iOCT group (72.9 ± 23.9min) when compared with the non-iOCT group (91.3 ± 31.2min) (P = .001). The incidences of intraoperative complications, reoperation, and postoperative complications did not differ significantly between the 2 groups (P = .542, 0.258, and 0.860 respectively). Six months after surgery, the postoperative visual acuity did not differ significantly between the 2 groups (P = .508). Multiple linear regression analysis revealed that the operation time was significantly correlated with iOCT (beta [standard partial regression coefficient] = - 0.28, P < .001), the fibrovascular proliferative membrane (beta = 0.17, P = .009), cataract surgery (beta = 0.22, P = .016), preoperative retinal photocoagulation (beta = - 0.14, P = .021), intraoperative complications (beta = 0.16, P = .023), and posterior vitreous detachment (beta = - 0.14, P = .04). Use of iOCT reduced the operation time without affecting the incidence rates of intraoperative and postoperative complications, reoperation ratios, or postoperative visual acuities in patients who underwent vitreous surgery for PDR.