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At least 19 recordsLinked to original sources
PubMed1988

Early vitrectomy for severe proliferative diabetic retinopathy in eyes with useful vision. Clinical application of results of a randomized trial--Diabetic Retinopathy Vitrectomy Study Report 4. The Diabetic Retinopathy Vitrectomy Study Research Group.

Six patients are described, each of whom underwent early vitrectomy for advanced, active, proliferative diabetic retinopathy (PDR) in an eye with useful vision. These cases were selected to illustrate the spectrum of retinopathy severity for which early vitrectomy should be considered and the favorable outcome that can follow this procedure. None of the eyes that had an unfavorable result after early vitrectomy is presented. The eyes most suitable for early vitrectomy are those in which both fibrous proliferations and at least moderately severe new vessels are present, and in which extensive scatter photocoagulation has already been carried out or is precluded by vitreous hemorrhage.

Adult↗
PubMed1988

Early vitrectomy for severe proliferative diabetic retinopathy in eyes with useful vision. Results of a randomized trial--Diabetic Retinopathy Vitrectomy Study Report 3. The Diabetic Retinopathy Vitrectomy Study Research Group.

Three hundred seventy eyes with advanced, active, proliferative diabetic retinopathy (PDR) and visual acuity of 10/200 or better were randomly assigned to either early vitrectomy or conventional management. After 4 years of follow-up, the percentage of eyes with a visual acuity of 10/20 or better was 44% in the early vitrectomy group and 28% in the conventional management group. The proportion with very poor visual outcome was similar in the two groups. The advantage of early vitrectomy tended to increase with increasing severity of new vessels. In the group with the least severe new vessels, no advantage of early vitrectomy was apparent.

Adult↗
PubMed1985

Early vitrectomy for severe vitreous hemorrhage in diabetic retinopathy. Two-year results of a randomized trial. Diabetic Retinopathy Vitrectomy Study report 2. The Diabetic Retinopathy Vitrectomy Study Research Group.

Six hundred sixteen eyes with recent severe diabetic vitreous hemorrhage reducing visual acuity to 5/200 or less for at least one month were randomly assigned to either early vitrectomy or deferral of vitrectomy for one year. After two years of follow-up, 25% of the early vitrectomy group had visual acuity of 10/20 or better compared with 15% in the deferral group (P = .01). In patients with Type I diabetes, who were on the average younger and had more-severe proliferative retinopathy, there was a clear-cut advantage for early vitrectomy, as reflected in the percentage of eyes recovering visual acuity of 10/20 or better (36% vs 12% in the deferral group, P = .0001). No such advantage was found in the Type II diabetes group (16% in the early group vs 18% in the deferral group), but evidence that this advantage differed by diabetes type was of borderline significance.

Adolescent↗
PubMed1995

Results of the Endophthalmitis Vitrectomy Study. A randomized trial of immediate vitrectomy and of intravenous antibiotics for the treatment of postoperative bacterial endophthalmitis. Endophthalmitis Vitrectomy Study Group.

OBJECTIVE: To determine the roles of immediate pars plana vitrectomy (VIT) and systemic antibiotic treatment in the management of postoperative endophthalmitis. DESIGN: Investigator-initiated, multicenter, randomized clinical trial. SETTING: Private and university-based retina-vitreous practices. PATIENTS: A total of 420 patients who had clinical evidence of endophthalmitis within 6 weeks after cataract surgery or secondary intraocular lens implantation. INTERVENTIONS: Random assignment according to a 2 x 2 factorial design to treatment with VIT or vitreous tap or biopsy (TAP) and to treatment with or without systemic antibiotics (ceftazidime and amikacin). MAIN OUTCOME MEASURES: A 9-month evaluation of visual acuity assessed by an Early Treatment Diabetic Retinopathy Study acuity chart and media clarity assessed both clinically and photographically. RESULTS: There was no difference in final visual acuity or media clarity with or without the use of systemic antibiotics. In patients whose initial visual acuity was hand motions or better, there was no difference in visual outcome whether or not an immediate VIT was performed. However, in the subgroup of patients with initial light perception-only vision, VIT produced a threefold increase in the frequency of achieving 20/40 or better acuity (33% vs 11%), approximately a twofold chance of achieving 20/100 or better acuity (56% vs 30%), and a 50% decrease in the frequency of severe visual loss (20% vs 47%) over TAP. In this group of patients, the difference between VIT and TAP was statistically significant (P < .001, log rank test for cumulative visual acuity scores) over the entire range of vision. CONCLUSIONS: Omission of systemic antibiotic treatment can reduce toxic effects, costs, and length of hospital stay. Routine immediate VIT is not necessary in patients with better than light perception vision at presentation but is of substantial benefit for those who have light perception-only vision.

Adult↗
PubMed2000

Comparison of erbium:yttrium-aluminum-garnet-laser vitrectomy and mechanical vitrectomy: a clinical study.

OBJECTIVE: To evaluate the clinical usefulness of the erbium:YAG (yttrium-aluminum-garnet) laser for vitrectomy and to compare it with a conventional mechanical vitrectomy system regarding the intraoperative parameters. DESIGN: Prospective, randomized, clinical trial. PARTICIPANTS: Thirty eyes of 30 patients underwent vitrectomy, 15 eyes in each group. METHODS: For mechanical vitrectomy, a commercially available vitrectomy unit was used. The operating parameters, cutting rate (7 Hz = 420 cpm), maximal suction force (300 mmHg), and aspiration flow (20 ml/min), were held constant. A newly developed erbium (Er):YAG laser unit and handpiece was used for laser vitrectomy with predetermined parameters for cutting rate (70 Hz = 4200 cpm), maximal suction force (50 mmHg), and aspiration flow (20 ml/min). Surgery parameters were recorded in real time and the operation was video recorded. The clinical follow-up time was a minimum of 3 months (average, 6.2 months; range, 3-9 months). MAIN OUTCOME MEASUREMENTS: The surgery time was comparable in both groups. During Er:YAG laser vitrectomy, the average suction force was significantly reduced (P< 0.001) compared with that during mechanical vitrectomy. The mean-square variation in suction as a measure to quantify the forces acting on intraocular structures during surgery was significantly smaller in the Er:YAG laser vitrectomy group (P << 0.001). CONCLUSIONS: Erbium:YAG laser vitrectomy may provide a semicontinuous procedure. This technique minimizes periodical intraoperative forces and movements of intraocular structures and may provide, therefore, a safer vitrectomy.

Aged↗
PubMed2006

Vitrectomy-phacoemulsification-vitrectomy for the management of aqueous misdirection syndromes in phakic eyes.

OBJECTIVE: To describe vitrectomy-phacoemulsification-vitrectomy, a sequential 3-step surgical approach, in the management of malignant glaucoma/aqueous misdirection syndromes in phakic eyes. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: Five eyes (4 angle-closure glaucoma and 1 open-angle glaucoma) of 5 patients with mean age of 66 years (range, 56-78). Four patients presented with aqueous misdirection syndrome and 1 patient presented for cataract extraction, having previously had malignant glaucoma in the fellow eye after phacoemulsification surgery. INTERVENTION: The operation performed had three steps: vitrectomy, phacoemulsification, and vitrectomy. Step 1: Preliminary vitrectomy involved limited core vitrectomy to "debulk" the vitreous and soften the eye. Step 2: Phacoemulsification was performed in a standard manner. Step 3: Residual vitrectomy, zonulohyaloidectomy and peripheral iridectomy (if not already present) were performed to create a free communication between the posterior and anterior segments. MAIN OUTCOME MEASURES: Intraocular pressure, visual acuity, biomicroscopic anterior chamber depth, and complications. RESULTS: The time interval between the onset of malignant glaucoma and surgery ranged from 2 weeks to 3 months. All 4 patients with aqueous misdirection syndrome had relief of the aqueous misdirection postoperatively with anterior chamber deepening. Intraocular pressures on day 1 ranged from 6 to 28 mmHg (mean 15.6, mmHg), and at the last visit ranged from 8 to 30 mmHg (mean, 20.4 mmHg). One eye developed an early choroidal serosanguinous effusion requiring drainage. CONCLUSIONS: The vitrectomy-phacoemulsification-vitrectomy approach was effective in this pilot series in the management of aqueous misdirection syndromes and malignant glaucoma in phakic eyes.

Aged↗
PubMed2006

[Vitrectomy for severe proliferative diabetic retinopathy: a comparison of optical fiber free intravitreal surgery system with traditional vitrectomy].

OBJECTIVE: To compare the optical fiber free intravitreal surgery system with traditional vitrectomy in eyes with severe proliferative diabetic retinopathy (PDR). METHODS: 22 eyes of 18 patients with extensive fibrovascular proliferation associated with PDR were undergone vitrectomy using optical fiber free intravitreal surgery system (OFFISS) with bimanual technique, peeling of epiretinal membrane and/or internal limiting membrane, intraocular laser coagulation, air-fluid exchange, tamponading of air and expansive gases or silicon oil were performed according to the condition of diseases. 22 eyes with similar severity of fibrovascular proliferation treated with traditional vitrectomy were served as control. RESULTS: The operations were finished successfully in both different vitrectomy systems, but fundus cannot be visualized during fluid-gas exchange in phakic eyes, and intraocular illumination had to been used again in OFFISS group. Postoperatively, retina was fully attached in all eyes, best-corrected visual acuity of 19 eyes had improved two lines and more in OFFISS group, and 17 eyes in control group. No significant difference in surgical complications was found between OFFISS and traditional vitrectomy group. Mean duration of peeling membrane was less in OFFISS group than control group. CONCLUSIONS: The efficacy of vitrectomy using different system for severe PDR both are satisfactory and comparable. We consider vitrectomy using OFFISS more safe and effective during complicated surgical manipulations than using traditional vitrectomy system.

Adult↗
PubMed2001

Duration of vitrectomy and postoperative cataract in the vitrectomy for macular hole study.

PURPOSE: To report the association between duration of vitrectomy, as well as other risk factors, and the progression of nuclear sclerosis and posterior subcapsular cataract in the Vitrectomy for Macular Hole Study. DESIGN: A cohort study nested within a randomized controlled clinical trial. METHODS: Using a system similar to the Lens Opacities Classification System II, nuclear sclerosis (NS) and posterior subcapsular cataract (PSC) were scored in the vitrectomy and fellow eye of 74 patients at baseline and at 6, 12, and 24 months postoperatively. Age, baseline blood pressure and refractive power, and duration of surgery were evaluated as risk factors for NS or PSC progression and cataract extraction. RESULTS: The incidence of NS progression in the surgical group of vitrectomy eyes was 81% at 6 months, 98% at 1 year, and 100% at 2 years of follow-up. In contrast, NS progression in the control group of fellow eyes was only 18% at 6 months, 20% at 1 year, and 8% at 2 years. The incidence of PSC progression in the surgical group remained at approximately 11% throughout follow-up, which was not significantly higher than the 3% to 5% incidence in the control group. Vitrectomy was significantly related to progression of NS cataract (P <.001) and cataract extraction (P <.01). No statistically significant differences were found for NS scores, PSC scores, or progression rates between eyes that had less than median surgical duration (60 min.) or more than the median surgical duration. Additionally, no significant differences were found when eyes that experienced 45 minutes or less surgical duration were compared with eyes that endured more than 75 minutes surgical duration. Age, blood pressure, and refractive power were not found to be predictors for NS and PSC progression. CONCLUSIONS: Although vitrectomy is a risk factor for NS progression, the duration of vitrectomy does not increase the risk.

Age Factors↗
PubMed1976

Vitrectomy in endophthalmitis. Results of study using vitrectomy, intraocular antibiotics, or a combination of both.

A rabbit model of endophthalmitis was produced by inoculating Staphylococcus epidermidis and S aureus into the vitreous cavity. Elimination of microorganisms was compared using intravitreal administration of 0.1 mg of gentamicin alone, vitrectomy alone, and a combination of gentamicin and vitrectomy. In the case of S. epidermidis treated 24 hours after inoculation, all untreated eyes were culture-positive at one week, eyes treated with gentamicin alone or intravitreal gentamicin in combination with vitrectomy were all culture-negative, and vitrectomy alone rendered half of the eyes culture-negative. In the case of S aureus, eyes not treated by vitrectomy alone were all culture-positive at one week. Eyes treated with intravitreal gentamicin 25 to 31 hours after infection were culture-negative for S aireus in 33% at one week, while eyes treated with combined vitrectomy plus intraocular gentamicin were culture-negative in 83% of cases. When treatment was delayed 40 to 49 hours after inoculation of S aureus, intravitreal rendered 50% culture-negative at one week, while vitrectomy combined with intravitreal gentamicin eliminated the infection in 100% of eyes.

Animals↗
PubMed1990

Early vitrectomy for severe vitreous hemorrhage in diabetic retinopathy. Four-year results of a randomized trial: Diabetic Retinopathy Vitrectomy Study Report 5.

Six hundred sixteen eyes with recent severe diabetic vitreous hemorrhage reducing visual acuity to 5/200 or less for at least 1 month were randomly assigned to either early vitrectomy or deferral of vitrectomy for 1 year. The proportion of eyes with visual acuity of 10/20 or better was higher in the early vitrectomy group than in the deferral group throughout the 4-year follow-up period. Up to the 18-month visit, the early group had a higher proportion of eyes with visual acuity of no light perception. An increased chance of obtaining good vision with early vitrectomy was clearly present in the type I diabetes group, particularly in patients who developed severe vitreous hemorrhage after less than 20 years of diabetes, a patient group tending to have more severe proliferative retinopathy. This advantage was not found in the type II diabetes group, in which patients were older and tended to have less severe retinopathy. The findings of this and previous Diabetic Retinopathy Vitrectomy Study reports support early vitrectomy in eyes known or suspected to have very severe proliferative diabetic retinopathy as a means of increasing the chance of restoring or maintaining good vision.

Adult↗
PubMed1983

Results of 110 vitrectomies with a portable vitrectomy system.

We retrospectively evaluated the VITAC (vitreous-tissue aspiration cutter), a portable vitrectomy system with an end-cutting vitrectomy probe with a self-sharpening oscillating blade and a monoblock design, in 110 vitrectomy procedures, 34 performed at the University of California Davis Medical Center and 76 performed at the Eye and ENT Hospital in Shanghai, China. The indications for vitrectomy included penetrating injuries (22 eyes), intraocular foreign bodies (28 eyes), vitreous hemorrhages (18 eyes), cataracts (17 eyes), endophthalmitis (seven eyes), pupillary-block glaucoma (five eyes), bullous keratopathy (five eyes), aphakic penetrating keratoplasty (three eyes), pupillary membranes (two eyes), massive preretinal proliferation (one eye), and cystoid macular edema (one eye). Vitrectomy resulted in visual improvement in 19 of 34 eyes in the California series (56%) and in 60 of the 76 eyes in the Shanghai series (79%). This difference was attributable to the higher percentages of cases involving the posterior segment and vitreous hemorrhage in the California series. When results from both institutions were combined, surgery with the VITAC produced visual improvement in 79 of 110 cases (72%), comparable to the results obtained with other vitrectomy systems.

Eye Diseases↗
PubMed2004

Vitrectomy and gas for inferior break retinal detachments: are the results comparable to vitrectomy, gas, and scleral buckle?

AIMS: To compare the success rates of vitrectomy and gas with vitrectomy, gas, and buckle in the treatment of inferior break retinal detachments. METHODS: A retrospective case note review of 86 patients who presented with inferior break retinal detachments was carried out. An inferior break was defined as a horseshoe tear present between 4 and 8 o'clock. Patients were analysed in two groups; group A consisted of 41 patients who underwent a vitrectomy and gas, group B consisted of 45 patients who underwent a vitrectomy, gas, and scleral buckle. The features of the retinal detachment, peroperative and postoperative complications, and outcomes of treatment were recorded for each patient. RESULTS: The primary anatomical success rate at 3 months was 89% in group A versus 73% in group B (p = 0.11). There was no statistical difference in the complication rate between the two groups (p = 0.819). The most common cause of treatment failure was proliferative vitreoretinopathy, 20% (n = 9) in group B compared with 5% (n = 2) in group A and this reached statistical significance (p = 0.0159). There was a higher rate of epiretinal membrane development in group B (p = 0.0004). The final attachment rate was not statistically different between the two groups, 95% (39) in group A and 93% (42) in group B (p = 1.0). CONCLUSION: Vitrectomy and gas without the application of a scleral buckle may be used to safely treat inferior break retinal detachments. It may be used as an alternative to vitrectomy, gas, and buckle which has an increased risk of choroidal haemorrhage, requires a longer operating time, and has all the associated complications of a scleral buckle.

Humans↗
PubMed2004

Pars-plana vitrectomy alone vs vitrectomy with scleral buckling for primary rhegmatogenous pseudophakic retinal detachment.

PURPOSE: To compare primary pars-plana vitrectomy (PPV) alone vs vitrectomy with an encircling scleral buckling procedure for the treatment of primary rhegmatogenous pseudophakic retinal detachment (PsRD). DESIGN: Prospective, nonrandomized, comparative study. METHODS: All 71 eyes of 68 consecutive patients with PsRD presented to our service between 1998 and 2002 were offered either vitrectomy alone (group-A) or vitrectomy in combination with encircling scleral buckling procedure (group-B). Preoperative and postoperative patient characteristics were recorded in detail. Main outcome measures were reattachment with a single surgery, visual acuity, and reattachment surgery-related complications. RESULTS: Retina reattachment with a single surgery was achieved in 97.78% in group A and 92.31% in group B. Visual acuity improved by 3 or more lines in 60% in group A and 69% in group B. Mean postoperative refractive error change (spherical) was -0.05 diopters in group A and -1.43 diopters in group B. Postoperative intraocular pressure on long-term follow-up was elevated in 4.44% (group A) and 34.61% (group B). Average follow-up was 12.45 months (+/-5.23 SD) ranging from 9 to 40 months. We detected additional breaks intraoperatively in 54.9% of cases (both groups). CONCLUSIONS: Vitrectomy is an effective initial treatment for PsRD, whereas the benefit of an additional encircling buckling procedure is questionable.

Adult↗
PubMed2005

Comparison of clear corneal phacoemulsification combined with 25-gauge transconjunctival sutureless vitrectomy and standard 20-gauge vitrectomy for patients with cataract and vitreoretinal diseases.

PURPOSE: To compare effectiveness and outcomes of clear corneal phacoemulsification combined with 25-gauge transconjunctival sutureless vitrectomy and standard 20-gauge vitrectomy system for patients with clinically significant cataract and vitreoretinal diseases. SETTING: Department of Ophthalmology, Tri-Service General Hospital, Taipei, Taiwan, Republic of China. METHODS: Clear corneal phacoemulsification combined with 25-gauge transconjunctival sutureless vitrectomy was performed in the study group (15 eyes). Patients in the control group (15 eyes) had combined surgery with clear corneal phacoemulsification and the existing 20-gauge vitrectomy system, providing a comparison between 2 groups with regard to preoperative and postoperative best corrected visual acuity (BCVA), intraocular pressure, and intraoperative and postoperative complications. The additional outcome measurements in both groups were duration of the surgical procedures, time to return to preoperative corneal clarity, time to achieve stable vision, and subjective ocular irritation postoperatively. RESULTS: Postoperatively, BCVA improved in 12 eyes (80%) in the study group and in 11 eyes (73.3%) in the control group. Mean operative time for opening and closing the sclerotomy was significantly greater in the control group than in the study group. Time to return to preoperative corneal clarity and time to achieve stable vision showed no significant difference between the groups. Compared with the control group, postoperative ocular irritation in patients in the study group was considerably reduced. CONCLUSIONS: Combined sutureless surgery needed shorter setup time for sclerotomy and caused less postoperative ocular irritation than combined surgery with 20-gauge vitrectomy. Therefore, this type of procedure would be a good option for selected cases with cataract and vitreoretinal diseases.

Aged↗
PubMed2004

Perfluorocarbon-perfused vitrectomy: a new method for vitrectomy--a safety and feasibility study.

PURPOSE: To evaluate the safety and feasibility of perfluorocarbon-perfused vitrectomy (PCPV) as a technique during vitrectomy for proliferative diabetic retinopathy (PDR) and rhegmatogenous retinal detachment (RRD). METHODS: In an experimental, prospective, noncomparative and interventional study, 28 eyes of 28 patients were submitted to vitrectomy with the PCPV technique, 18 eyes with PDR and 10 with RRD. In this technique we replaced the traditional balanced saline solution (BSS) in the infusion line (conventional vitrectomy) by perfluorocarbon liquids (PCL). Some patients with PDR were treated with oxygenated PCL. Clinical evaluation, electroretinography (ERG), and endothelial cell count (ECC) were used to assess the safety of this procedure. An arbitrary grading system (grades 0-5) was used to classify the surgery and maneuvers to assess feasibility. RESULTS: No eyes had a significant decrease in ECC, and the patients in whom we could obtain ERG postoperatively showed no significant differences from preoperative ERG. In the PDR group (using oxygenated and nonoxygenated PCL), 77.8% were graded 5/5; in the RRD group 90% were 5/5. PCPV allowed better visualization of vitreous and intraocular structures, rapid retinal reattachment, less blood in the vitreous cavity, subretinal fluid resolution, blood confinement, retinal stabilization, and easier dissection of epiretinal membranes. In all cases at least one surgical step was eliminated. CONCLUSIONS: PCPV in humans is a safe and feasible technique. Probably in selected cases the use of PCL offers several advantages over BSS, because of their properties (gravitational forces, immiscibility with bodily fluids, and ability to transport oxygen). Prospective and comparative studies are necessary to establish formal indications and possible contraindications.

Adult↗
PubMed2006

25-gauge, sutureless vitrectomy and standard 20-gauge pars plana vitrectomy in idiopathic epiretinal membrane surgery: a comparative pilot study.

BACKGROUND: The aim of the study was to evaluate the safety and functional outcome of a small incision, sutureless vitrectomy in the treatment of idiopathic epiretinal membranes (ERM) compared with a standard 20-gauge vitrectomy system. METHODS: Forty-six consecutive patients with idiopathic ERM were recruited for this study and prospectively evaluated. In group 1 (n=26) we used a transconjunctival sutureless 25-gauge vitrectomy system (TSV), patients in group 2 (n=20) were operated on using a standard 20-gauge vitrectomy system. The ERM was removed and the internal limiting membrane (ILM) was peeled in all eyes. Surgery-related complications, operating time, intraoperative balanced salt solution (BSS) consumption, postoperative discomfort, postoperative intraocular inflammation, lens opacification, and long-term visual outcome are reported and compared. RESULTS: No surgery-related complications were observed in either group. Operating time was shorter in group 1 compared with group 2 (mean 15.6 and 29.6 min respectively). Intraoperative amount of BSS consumption was less in group 1 (mean 28 ml in group 1 and 42 ml in group 2). Postoperative discomfort and intraocular inflammation were significantly reduced in the 25-gauge group. In the 20-gauge group cataract formation requiring surgery was observed in two eyes. Visual acuity improved significantly in both groups. The 25-gauge group improved on average by more lines of vision and the improvement in vision was more rapid. CONCLUSION: The TSV system is a safe and efficient surgical technique for ERM surgery. Operating time is significantly reduced, minimizing surgery-induced trauma, and reducing postoperative intraocular inflammation and the patients' discomfort. The incidence of cataract formation may be less using TSV. Postoperative recovery is accelerated.

Aged↗
PubMed1997

Secondary vitrectomy for the treatment of macular holes occurring after vitrectomy.

Tangential foveal traction by the posterior vitreous cortex is regarded as the main cause of full-thickness macular holes. This report documents two cases of full-thickness macular holes that developed after vitrectomy for other diseases in the apparent absence of the cortical vitreous traction. Autologous serum with pars plana vitrectomy was used to treat these cases. Anatomic closure of the holes was achieved. Macular holes developing after vitrectomy may have an etiology other than tangential vitreous traction, and secondary vitrectomy is useful in treating such holes.

Adult↗
PubMed1981

Vitrectomy in penetrating eye injury. Results of a controlled trial of vitrectomy in an experimental posterior penetrating eye injury in the rhesus monkey.

A controlled trial of pars plana vitrectomy for posterior penetrating eye injury was done in rhesus monkeys. After standard injury, each eye was allocated randomly into a treatment or control group. Treatment groups (ten eyes each) had vitrectomy at 1, 14, or 70 days after injury. The control group had 15 eyes. The same techniques were employed as in human eyes. Surgical objectives were lensectomy, then complete posterior vitrectomy and excision of the anterior vitreous to within 1 or 2 mm of the surface of the peripheral retina and pars plana. Results from this controlled trial provide strong support for the effectiveness of vitrectomy techniques in managing selected posterior penetrating injuries in human eyes and in preventing the complication of traction retinal detachment.

Animals↗