Clinical and Surgical Predictors of Visual and Anatomical Outcomes Following Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment

Surgical outcome and late-onset complications 5 years after pars plana vitrectomy for myopic traction maculopathy

Background/aims To determine the long-term effects of vitreoretinal surgery to treat myopic traction maculopathy (MTM) and to determine the differences in the postoperative results between fovea-sparing internal limiting membrane (ILM) peeling (FSIP) and total ILM peeling (TP). Methods We studied 209 eyes of 189 patients with high myopia (refractive error >6.0 dioptres (D) or an axial length ≥26.5 mm) that had undergone pars plana vitrectomy (PPV) for MTM. The inclusion criteria were high myopia and a postoperative follow-up period of >5 years. Surgical outcomes were compared between eyes treated with FSIP and those with TP. Results There were 28 eyes in the FSIP group and 38 eyes in the TP group. The preoperative and 1, 3 and 5 years postoperative best-corrected visual acuity was not significantly different between the FSIP group and the TP group. For eyes with a postoperative full-thickness macular hole (MH), there were 4 (14.3%) eyes in the FSIP group and 3 (7.9%) eyes in the TP group. The rate of the development of a postoperative MH was not significantly different between the two groups (p=0.668). There were 0 eyes in the FSIP group and 4 (10.5%) eyes in the TP group that developed postoperative macular atrophy (MA). This difference was not significant (p=0.212). Conclusions Fovea sparing is useful both for improving vision and preventing complications. We suggest that FSIP has the possible benefit of avoiding postoperative MA.

Predictors of Visual Outcomes in Surgically Managed Hemorrhagic Choroidal Detachment.

The findings support delayed intervention until clot liquefaction when appropriate and identify trauma-associated HCD as a higher-risk subgroup.

Methotrexate as an adjunct to pars plana vitrectomy for the prevention and treatment of proliferative vitreoretinopathy in rhegmatogenous retinal detachment: A clinical study.

Clinical and morphological predictors of visual outcomes following inverted internal limiting membrane flap surgery for large macular holes

Purpose: The purpose of the study was to evaluate the anatomical and functional outcomes of the inverted internal limiting membrane (ILM) flap technique in patients with large macular holes (MHs) and identify independent prognostic factors that predict post-operative visual acuity. Methods: This retrospective study included 48 eyes of 48 patients who underwent pars plana vitrectomy and inverted ILM flap technique for idiopathic MHs ≥400 μm. Pre-operative and post-operative best-corrected visual acuity (BCVA), swept-source optical coherence tomography (SS-OCT) parameters, and various clinical factors were evaluated. Multivariate regression analysis was performed to identify independent prognostic factors for the post-operative BCVA. Results: The mean BCVA improved significantly from 1.27±0.41 logMAR preoperatively to 0.62±0.37 logMAR at 6 months postoperatively (p<0.001). U-shaped closure was associated with better BCVA than V-and W-shaped closures (p=0.001). Patients with symptom duration ≤6 months and complete post-operative restoration of the external limiting membrane (ELM) and ellipsoid zone demonstrated significantly better BCVA (p<0.01). Pre-operative BCVA (β=0.637, p<0.001) and MH index (MHI) (β=−0.261, p=0.029) were significant independent determinants of post-operative BCVA. Conclusion: The inverted ILM flap technique provides high anatomical closure rates and significant visual improvement in large MH surgery. Pre-operative BCVA and MHI were significant independent prognostic factors for post-operative visual outcomes. Structural SS-OCT parameters can be clinically useful in predicting post-operative functional outcomes

Surgical management of vitreoretinal complications in X-linked retinoschisis: long-term outcomes in a pediatric population.

Intraoperative Characteristics and Postoperative Complications of Primary Vitrectomy for Vitreous Floaters.

Purpose To investigate patient characteristics, operative patterns, and postoperative complications to aid in the discussion of the safety profile of pars plana vitrectomy (PPV) for visually symptomatic floaters. Methods Preoperative characteristics, intraoperative techniques, and postoperative outcomes were reviewed for patients receiving PPV for floaters. Data were collected on the postoperative course, including incidence, timing, and management of complications. Results Clinical and surgical data on 413 eyes of 288 patients were analyzed (362 complete operative reports available for review). The mean (±SD) age of patients was 65.8 ± 9.6 years. A total of 125 patients (43.4%) underwent PPV for floaters in both eyes. Most eyes were pseudophakic (n = 315, 76.3%), and most had a posterior vitreous detachment (PVD) (n = 364, 88.1%) at the time of PPV. Only 30 eyes (8.3%) had PVD induced at the time of vitrectomy. Most eyes underwent 25-gauge PPV (n = 367, 98.9%). Sub-Tenon block anesthesia was administered with most procedures (n = 329, 90.9%), and most eyes received postprocedure subconjunctival antibiotics (n = 334, 91.3%). Intraoperative endolaser was performed in 34/362 eyes (9.4%). Most eyes underwent sutureless surgery (n = 337, 93.1%), and the majority received aqueous/balanced salt solution tamponade (n = 300, 82.6%). After the procedure, 279 eyes (67.6%) had more than 6 months of follow-up, with 382 eyes (92.5%) achieving a best-corrected visual acuity of 20/20 to 20/30. The most severe complication was endophthalmitis, which was encountered in 5 eyes (1.2%). Vitreous hemorrhage (VH) occurred in 23 eyes (5.6%), and postoperative retinal tear/retinal detachment (RD) occurred in 7 eyes (1.7%). Conclusions This is the largest retrospective case series describing operative patterns and outcomes associated with PPV for floaters. Rates of serious postoperative complications, including endophthalmitis, VH, and retinal tear/RD requiring surgery, were low. Certain surgical patterns were associated with higher rates of complications. In carefully selected patients counseled on serious complications, PPV for floaters is relatively safe and achieves good visual outcomes.