China
Africa
Explore chapters and articles related to this topic
Surgical Approaches and Steps
Published in Pradeep Venkatesh, Handbook of Vitreoretinal Surgery, 2023
Until about a decade ago, rhegmatogenous retinal detachment was being managed by conventional scleral buckling, pneumatic retinopexy, or vitreoretinal surgery. Vitreoretinal surgery was initially advocated for patients with complex retinal detachments such as giant retinal tear (GRT) or higher grades of proliferative vitreoretinopathy [PVR]. With increasing experience with vitreous surgery and advances in surgical instrumentation, vitreoretinal surgery began to be more frequently used in the primary management of even simple retinal detachments. However, vitreoretinal surgery also has the risk of attracting unanticipated and serious intraoperative complications. To overcome the disadvantages of a full-fledged vitreoretinal surgery in patients with simple retinal detachments, endoillumination-assisted scleral buckling surgery using chandelier illumination was first described by the author at an ophthalmological meeting at Udupi [Karnataka, India] in 2010. Initial attempts at publication in a few peer-reviewed journals was unsuccessful with reviewers surprisingly stating that there was nothing new in the approach. As a result, this approach was published the next year in Retinal Physician, and the surgical video was released on YouTube [in public domain; Video 9.1]. Subsequently, we published our 2-year follow-up outcomes using this procedure. Since the initial description, this procedure has been recognized as a useful alternative in the management of retinal detachment using scleral buckling, as is evidenced by a surfeit of subsequent publications in peer reviewed literature.
Vitreoretinal surgery for idiopathic epiretinal membranes
Published in A Peyman MD Gholam, A Meffert MD Stephen, D Conway MD FACS Mandi, Chiasson Trisha, Vitreoretinal Surgical Techniques, 2019
H Richard McDonald, Robert N Johnson, Robert N Johnson, Everett Ai, J Michael Jumper, Arthur D Fu
Epiretinal membranes (ERMs) have been recognized since the 1930s, and have been referred to by a multitude of synonyms.1–;17 They have been associated with a vast array of ocular conditions and diseases.9–;11,17–;38 When ERMs form in the absence of these entities, they are termed idiopathic ERMs, although the great majority are caused by posterior vitreous detachment.10,11,22,32 Most patients with idiopathic ERMs are asymptomatic and have near-normal vision. However, in some eyes, ERMs may cause visually disabling metamorphopsia, diplopia, and significantly reduced vision. In these eyes, vitreoretinal surgery has been used to remove membranes and restore vision.17,20,22,38–;42
Current Concepts of the Uveitis-Glaucoma-Hyphema (UGH) Syndrome
Published in Current Eye Research, 2023
Meera S. Ramakrishnan, Kenneth J. Wald
Clinical examination findings are often underappreciated. Iris transillumination along the length of the haptic is specific for iris to haptic chafing- other types of transillumination are not (Figure 5). Thereafter, the examination requires a widely dilated pupil for evaluation. Assessment of haptic position is often best by viewing the eye tangentially by rotating the slit lamp (Figure 6). Gonioscopy can be helpful in some cases. Clinical determination of haptic position can be difficult and diagnostic imaging of this area of the eye is limited. Anterior segment OCT does not image posterior to the iris, but can be used to screen for IOL-iris contact or IOL tilt prior to proceeding with UBM.24 Ultrasound biomicroscopy (UBM) has limited depth of field (5 mm) and resolution of 50 microns, requires a water-bath immersion with direct contact to the eye, and longer acquisition times, but can be used to evaluate IOL position relative to the posterior iris. In a case series by Piette et al. UBM identified PCIOL haptic contact with the iris pigment epithelium, pars plicata, or angle recess near a filtering bleb ostium, and one case of ACIOL haptic erosion into the ciliary body.25 Intraoperatively, the area can be analyzed with an endoscope, however the use of this technique in vitreoretinal surgery is rare. The author has worked on a prototype retractable intraocular mirror to be used during vitreous surgery for this purpose.
Changing Trends in Uveitis in the United Kingdom: 5000 Consecutive Referrals to a Tertiary Referral Centre
Published in Ocular Immunology and Inflammation, 2023
N. P. Jones, S. Pockar, L. R. Steeples
Sympathetic ophthalmia has significantly fallen in this study both in incidence and as a proportion of patients seen. In 2000, a UK surveillance study17 prospectively identified a minimum incidence of 0.03/100 000 per annum. The study was reliant upon active reporting and there may have been a significant underestimation of incidence nationwide. As the single uveitis centre in the GM and Lancashire/Cumbria area dealing with this disease, we can say with some confidence that the incidence was approximately 0.31/100 000 pa during quartile 1 and 0.23/100 000 pa in quartile 4. For trauma-induced SO, those figures were 0.20 and 0.08 and for surgery-induced, 0.03 and 0.15. Clearly, the main precipitator of SO has changed during the study period from trauma to intraocular surgery. A recent study18 identified a very low risk of SO following a single vitreoretinal procedure (0.008%) but rising exponentially to as high as 6.67% after 7 procedures. The modern tendency towards multiple vitreoretinal surgery should be tempered by knowledge of this risk.
Influence of the “Inverted U Method” Nd: YAG Laser Posterior Capsulotomy on Anterior Segment Parameters, Decentration and Tilt of Intraocular Lens in Patients after Phaco-vitrectomy
Published in Seminars in Ophthalmology, 2021
Bo Lu, Haoyan Xu, Chunxia Wang, Qichang Yan, Xinling Wang
So far, for the patients with cataract and vitreoretinopathy, it seems to be the right choice to perform vitreoretinal surgery together with cataract surgery for quick visual recovery.21 The PCO rate is higher in patients after the combined procedure of cataract surgery and PPV than in those who have undergone cataract surgery alone, as the combined surgery may induce more inflammation.2 Furthermore, laser capsulotomy may lead to more complications in patients underwent combined phaco-vitrectomy due to the removal of the vitreous body. The effect of “inverted U method” Nd: YAG laser posterior capsulotomy in PCO patients underwent combined phaco-vitrectomy was first evaluated in this study. This study first found that the “inverted U method” Nd: YAG laser posterior capsulotomy decreases tilt and decentration of the IOL, increases ACA and causes no change in ACD, ACV, CCT and IOP in patients after phaco-vitrectomy. These changes make a decrease in cylindrical error and a myopic shift in spherical error. Laser capsulotomy significantly improves the visual acuity. “Inverted U method” was identified to be a safe and effective laser capsulotomy technique in PCO patients underwent combined phaco-vitrectomy.