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Common Vitreoretinal Procedures
Published in Pradeep Venkatesh, Handbook of Vitreoretinal Surgery, 2023
Anatomical closure rates following surgery are reported to be way in excess of 95% in the majority of cases, even in those with prior failed attempts. However, it is the functional outcome that should be taken into consideration before offering surgery. It is important to remember that most macular holes are detected incidentally during routine evaluation, and even after several years, they retain useful vision without any intervention. In addition, these are older adult patients with other comorbidities and social and financial dependency. Also, the risk of having a major complication still remains between 2% to 5%, and it may not be acceptable to accept this risk when dealing with a condition that is relatively stable and whose functional gains are unpredictable and modest and may not be contributing to the patient’s quality of life. So, the only macular holes that should be advised surgery are those that are of a short duration (6–12 months) and less than 600 microns at their narrowest region. If there is already complete posterior vitreous detachment in the fellow eye, surgery could even be avoided in incidentally detected [and likely long-standing] macular holes.
Retinal Tears and Detachments
Published in Amy-lee Shirodkar, Gwyn Samuel Williams, Bushra Thajudeen, Practical Emergency Ophthalmology Handbook, 2019
Haemorrhagic or non-haemorrhagic posterior vitreous detachment: A posterior vitreous detachment (PVD) can elicit similar symptoms to a retinal tear. If the posterior hyaloid face detaches from a retinal vessel it may cause a release of blood into the pre-retinal space. This is known as a haemorrhagic PVD. Depending on the extent and density of the haemorrhage the view of the fundus may be obscured. In mild to moderate cases the peripheral retina can be visualised and peripheral retinal tears excluded. A complete vitreous haemorrhage in a patient without proliferative diabetic retinopathy warrants further investigation with a B-scan with prompt VR referral for potential surgical intervention.
Retinal breaks
Published in A Peyman MD Gholam, A Meffert MD Stephen, D Conway MD FACS Mandi, Chiasson Trisha, Vitreoretinal Surgical Techniques, 2019
Several studies have demonstrated that symptomatic retinal breaks are more likely to lead to retinal detachment than asymptomatic breaks detected during a routine examination.7,9,10 Symptomatic retinal breaks are often the result of vitreoretinal traction (Fig. 2.4). The two most important symptoms associated with vitreoretinal traction are photopsia or ‘flashing lights’ and entopsia or ‘floaters’. Photopsia is caused by the discharge of neural impulses from the peripheral retina as the result of the mechanical force of the vitreous gel on the anterior retina. Entopsia may result from either PVD or bleeding into the vitreous cavity from retinal tears. All patients with photopsia or entopsia should undergo dilated examination of the peripheral fundus to rule out the presence of retinal breaks. Of patients with symptomatic posterior vitreous detachment, 8–10% will develop retinal tears, so a thorough vitreoretinal examination should be performed on all these patients.11
Role of Intralesional Antibiotic for Treatment of Subretinal Abscess – Case Report and Literature Review
Published in Ocular Immunology and Inflammation, 2022
Saurabh Verma, Shorya Vardhan Azad, Pradeep Venkatesh, Vinod Kumar, Abhidnya Surve, Akshaya Balaji, Rajpal Vohra
After appropriate sensitivity testing, the patient was started on empirical treatment with intravenous vancomycin (40 mg/kg/day) and ceftriaxone (100 mg/kg/day) in two divided doses. Topical concentrated antibiotics, steroid and cycloplegics, were also initiated at a high frequency. On the same day, 25-gauge (G) vitreous cutter assisted pars plana vitreous biopsy was sent along with the intravitreal injection of vancomycin (1 mg/0.1 ml) and ceftazidime (2.25 mg/0.1 ml). However, there was no improvement in media clarity and inflammation over the next 3 days. Culture report came positive for Citrobacter species. 25-G pars plana vitrectomy (PPV) was thus performed. After core vitrectomy, posterior vitreous detachment (PVD) was induced and limited peripheral vitrectomy was done. After sufficient clearing of media, a 41-G needle (DORC, international Netherland) was used to inject a combination of piperacillin and tazobactam (122 µg/0.05 ml) directly into the subretinal abscess through a relatively avascular area. Fluid air exchange was done and internal tamponade was provided with 1000 centistroke (cs) silicon oil.
Clinical Features of Endogenous Endophthalmitis Secondary to Minimally Invasive Upper Urinary Tract Calculus Removal
Published in Ocular Immunology and Inflammation, 2022
Bingsheng Lou, Yi Sun, Jialiu Lin, Zhaohui Yuan, Liwen He, Chongde Long, Xiaofeng Lin
All patients received oral voriconazole 6–8 weeks. As shown in Table 2, pars plana vitrectomy (PPV) alone or in combination with other procedures was performed in 11 patients 15 eyes), and 1 patient (2 eyes) was given only repeated intravitreal fluconazole because of lung infection and spinal canal abscess. All 15 eyes underwent complete vitrectomy. During surgery, induced posterior vitreous detachment (PVD) was performed in 6 eyes without natural PVD developed, and no complications of retinal break or retinal detachment ocurred. Epiretinal membrane (ERM) around the retinal exudates existed in 5 eyes. Retinal tears occurred in 2 eyes due to the peeling of ERM (Case 2, Case 6 OS). ERM could not be completely removed and retinal reattachment failed because of the severe and extensive adhesion between the membrane and the detached retina in Case 10. Endophthalmitis reoccurred at 2 weeks postoperatively in one eye (Case 12), another vitrectomy combined with lensectomy and silicon oil replacement was conducted. Macular epiretinal membrane developed at 4 months postoperatively in one eye (Case 1, OS), and ERM removal was performed. Silicon oil was removed 3 to 9 months (mean, 6 ± 2.3 months) after silicon oil tamponade. Significant cataract developed in case 3 and case 4 (OD), and phacoemulsification was conducted with silicon oil removal. No complications such as retinal detachment occurred after silicon oil removal.
Voretigene neparvovec-rzyl for treatment of RPE65-mediated inherited retinal diseases: a model for ocular gene therapy development
Published in Expert Opinion on Biological Therapy, 2020
Thomas A. Ciulla, Rehan M. Hussain, Audina M. Berrocal, Aaron Nagiel
Although subretinal administration of gene therapy via PPV represents the most common technique, it is still an evolving procedure with novel facilitating technology including digital visualization systems, smaller subretinal cannulas, precision infusion pumps, and intra-operative optical coherence tomography (OCT) to precisely monitor proper bleb formation. Two of the authors have had extensive experience in the procedure, and the steps of the surgery performed by one of the authors (AMB) are described herein. This approach differs from the protocol used in the clinical development of VN due to the evolving advancements of vitreoretinal surgery noted above; a surgical video can be accessed at this reference [53]. A 25-gauge PPV is completed with the NGENUITY® ‘Heads-Up’ 3-D Visualization System (Alcon, Fort Worth, Texas, USA). As the majority of the patients are young, a preexisting posterior vitreous detachment is unlikely. After the hyaloid is lifted and a core vitrectomy performed, dilute triescence is injected to ensure that the entire hyaloid is removed. The periphery is shaved with the assistance of scleral depression and examined for retinal breaks.