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Suprachoroidal hemorrhage
Published in A Peyman MD Gholam, A Meffert MD Stephen, D Conway MD FACS Mandi, Chiasson Trisha, Vitreoretinal Surgical Techniques, 2019
Uday R Desai, Alexander Rubowitz
Vitrectomy is used to remove vitreous behind the iris; the more peripheral vitreous may be removed by having the assistant depress the sclera with a cotton-tipped applicator. Use of surgical wide-angle lens viewing systems, such as the BIOM 2 noncontact wide-angle viewing system (Insight Instruments, Stuart, FL) can provide an excellent view of the peripheral retina, especially when combined with scleral indentation performed by the assisting surgeon, and may replace frequent examination with the indirect ophthalmoscope.
Panuveitis
Published in Gwyn Samuel Williams, Mark Westcott, Carlos Pavesio, Bushra Thajudeen, Practical Uveitis, 2017
Gwyn Samuel Williams, Mark Westcott
The treatment is the same as with candidiasis above although all cases should be given intravitreal antifungal injections with a vitrectomy performed as soon as is practicable. Close liaison with the physicians is essential. There are many other fungi that can affect the eyes though knowledge of each one of these is more confusing than beneficial. The principles of investigation and treatment of unknown ocular fungi are the same where knowledge of the systemic condition, any growths from blood cultures and the ocular appearance guide treatment. A vitrectomy is both diagnostic and therapeutic but needs to take the overall clinical picture into consideration. A vitreous tap, and even more so an aqueous tap, is rarely useful when dealing with fungi, though polymerase chain reaction (PCR) can yield results when dealing with the more common fungi such as Candida and Aspergillus though its exact role in guiding treatment is yet to be determined.
Ophthalmic Complications in Older Adults with Diabetes
Published in Medha N. Munshi, Lewis A. Lipsitz, Geriatric Diabetes, 2007
Jerry D. Cavallerano, Deborah K. Schlossman, Rola N. Hamam, Lloyd Lloyd
The DRVS demonstrated that early surgery within the eye called vitrectomy was useful in restoring vision and preventing worsening of vision for some persons who have severe vision loss due to vitreous hemorrhage or severe fibrovascular proliferation. Although the treatment benefits demonstrated in the DRVS, which was completed in 1989, are not totally applicable today due to dramatic advances in surgical techniques and the advent of laser endophotocoagulation that have occurred in the intervening years, vitrectomy surgery is a key approach to preserving or improving vision in diabetic patients with severe complications of retinopathy. Since vitrectomy surgery generally requires sedation or occasionally general anesthesia, and since elderly individuals are at greater risk for surgical and anesthetic complications, halting the disease prior to the need for surgery in this population is of further importance.
Hypersonic vitrectomy: a novel approach to vitreous removal
Published in Expert Review of Ophthalmology, 2022
Jacob G Light, Hannah Anderson, Sunir Garg
The goals of vitrectomy are efficient vitreous removal with stable, predictable intraocular fluidics and minimal vitreoretinal traction, and pursuit of these goals have led to refinement of the technology. While the initial guillotine cutters used an electronic solenoid to drive the cutting mechanism, pneumatically powered cutters are lighter and more compact, improving ergonomics and dexterity for the surgeon [12]. The move from larger 20-gauge systems to smaller 23-, 25-, and 27-gauge cutters has helped maintain a controlled intraocular environment with less surgically induced trauma, and often without need for sutures [13–17]. Three major vitrectomy platforms – produced by DORC, Bausch and Lomb, and Alcon – have achieved widespread use in the US, each with some variation in device mechanical properties such as probe stiffness, fluid dynamics control techniques, and user-interface/software [18–21].
Ocular Toxocariasis: Beyond Typical Patterns through the New Imaging Technologies
Published in Ocular Immunology and Inflammation, 2021
I Hernanz, A Moll-Udina, Belles V. Llorenç, Civera A. Adan
Treatment with systemic steroids in active OT has been classically suggested.1,8,10,31,32 Etiologic approach with systemic antihelminthic drugs (i.e.: Albendazole 400 mg given twice a day for 7–14 days) is the recommended standard treatment for systemic toxocariasis33,34 in combination with steroids.33,35 Vitrectomy is restricted to cases of retinal complications.36,37 So far, no controlled trials have been performed for OT and there are no data regarding intraocular penetration of systemic antihelminthic drugs.1 On the other hand, treatment with albendazole in inactive cases of OT has not demonstrated to aggravate ocular inflammation as postulated in some reports on the basis that larva death could lead to a boost of intraocular inflammation.1,10 For this reason, the role of antihelmintic agents remains unclear, and treatment should be monitored individually as shown in our case series.
Etiology of posterior subcapsular cataracts based on a review of risk factors including aging, diabetes, and ionizing radiation
Published in International Journal of Radiation Biology, 2020
Richard B. Richardson, Elizabeth A. Ainsbury, Christina R. Prescott, Frank J. Lovicu
Vitrectomy is a surgical procedure performed for posterior eye segment pathology. During retinal surgery, the vitreous hydrogel is removed (vitrectomy) and replaced with a balanced salt solution. Depending on the vitreoretinal procedure and other factors, vitrectomies increase the risk of cataracts, with a highly variable 6% to 100% of patients (>50 studies) developing cataracts (mainly nuclear sclerosis, with PSC less prevalent) within a few years after vitrectomy (Do et al. 2013; Feng and Adelman 2014). Age at surgery (and the amount of pre- and post-operative inflammation) is an important factor influencing cataract risk within two years or so following vitrectomy, with opacities present in only 7% of patients younger than 50 years compared with 79% in patients older than 50 years (Melberg and Thomas 1995). Vitrectomy – and similarly, age-related posterior vitreous detachment (Giblin et al. (2009) – can increase by several-fold the oxygen tension adjacent to and slightly posterior to the equator of the crystalline lens and in the center of the vitreous (Holekamp et al. 2005; Siegfried et al. 2010). However, the oxygen tension does not change in the anterior chamber immediately before and after vitrectomy. An intact vitreous hydrogel and low oxygen levels protect the lens against oxidative stress and maintains lens transparency. This was demonstrated in rabbits, where the levels of vitreous ascorbate decrease and lens nucleus TGF-β2 increase after vitrectomy or hyperoxia (Yan et al. 2017).