RESUMEN
BACKGROUND: To compare anatomical, functional outcomes and complications of high-speed 25-gauge (G) pars plana vitrectomy (PPV) versus 20-G PPV for the management of primary inferior rhegmatogenous retinal detachment (RRD) associated to inferior breaks/holes. METHODS: Eighty-five eyes from 85 patients with a minimum follow-up of 3 months were retrospectively evaluated. Forty-one patients underwent 25-G and 44 patients underwent 20-G PPV. All patients underwent PPV with fluid-air exchange, sulfur hexafluoride (SF6) 20 % gas tamponade and laser or cryo retinopexy. RESULTS: The mean follow-up interval was 6.51(± 2.32) and 6.63 (± 2.58) months in the 25-G and 20-G groups respectively. Single-operation success rate was 92.7 % for the 25-G group and 81.8 % for the 20-G group (P = 0.24). Post-operative hypotony was observed in no case. Redetachment occurred in 3 eyes operated on with 25-G and in 8 eyes operated on with 20-G system. All retinas were attached at final follow-up. Logarithm of the minimum angle of resolution visual acuity significantly improved from 0.69 ± 0.76 to 0.33 ± 0.37 in the 25-G and from 0.47 ± 0.59 to 0.21 ± 0.28 in the 20-G group (P = 0.0007 and P < 0.0001 respectively). CONCLUSIONS: High-speed PPV and SF6 gas tamponade using either 25-G or 20-G PPV system, yields similar single operation anatomical success rates for the repair of uncomplicated, primary inferior RRDs associated to inferior breaks.
Asunto(s)
Microcirugia/métodos , Desprendimiento de Retina/cirugía , Perforaciones de la Retina/cirugía , Vitrectomía/métodos , Criocirugía , Endotaponamiento , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Seudofaquia/complicaciones , Desprendimiento de Retina/fisiopatología , Perforaciones de la Retina/fisiopatología , Estudios Retrospectivos , Hexafluoruro de Azufre/administración & dosificación , Resultado del Tratamiento , Agudeza Visual/fisiologíaRESUMEN
OBJECTIVE: To compare the outcome of air tamponade with gas tamponade in primary vitrectomy for the treatment of rhegmatogenous retinal detachment (RRD). METHODS: We examined the records of 524 cases of 523 patients that underwent primary vitrectomy for RRD with air or sulphur hexafluoride 20% gas tamponade and a follow-up of at least 3 months, excluding cases with inferior retinal breaks. RESULTS: 318 cases were treated with gas and 128 cases with air. Overall, vitrectomy led to an attached retina after a single operation in 85.1% of cases. Eyes treated with air had an 81.0% chance of primary success and those treated with gas had an 86.9% success rate (p=0.083, NS, χ(2) test). Involvement of lower retinal quadrants in the retinal detachment was revealed as a significant confounding factor. After correction for this confounder using a multivariate logistic regression model, air versus gas tamponade became a statistically significant determinant for success rate (OR 1.97; p=0.012). In a sub-analysis, eyes with a retinal detachment that involved the inferior quadrants had significantly lower primary success rates when using air tamponade (69.6%), compared to gas tamponade (84.7%; p=0.009, χ(2) test). CONCLUSIONS: Gas tamponade is superior to air tamponade in retinal detachment cases with involvement of the lower quadrants. These results suggest that air tamponade should only be used in retinal detachments that are restricted to the superior quadrants. Further prospective study is needed to confirm these findings, and to address functional outcome.
Asunto(s)
Aire , Endotaponamiento/métodos , Desprendimiento de Retina/cirugía , Hexafluoruro de Azufre , Vitrectomía/métodos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Desprendimiento de Retina/fisiopatología , Resultado del Tratamiento , Agudeza Visual/fisiologíaRESUMEN
PURPOSE: To describe the incidence and outcome of retinal breaks in vitrectomy for retained lens fragments. METHODS: This is a retrospective noncomparative interventional case series. Medical records of consecutive cases of vitrectomy for retained lens fragments over a period of 4 years were reviewed. Main outcome measures were incidence of breaks, visual acuity outcome, and occurrence of postoperative complications. RESULTS: We included 89 consecutive cases in 89 patients. The median interval between cataract surgery and vitrectomy was 2 days (range, 0-106 days). Visual acuity at last follow-up was ≥ 0.5 in 70% of cases. During surgery, retinal breaks were found in 29% of cases. Induction of a posterior vitreous detachment, the use of a fragmatome, or delay between cataract surgery and vitrectomy did not influence retinal break incidence. Postoperative retinal detachment occurred in only 2% of cases. Other complications were intraoperative choroidal hemorrhage in 1 case, postoperative macular pucker in 2, postoperative macular edema in 1, and glaucoma in 2 cases. CONCLUSION: We identified a high number of retinal breaks during vitrectomy for retained lens fragments. Prophylactic treatment of breaks and other areas of retinal traction seem to reduce the risk of postoperative retinal detachment.
Asunto(s)
Subluxación del Cristalino/cirugía , Desprendimiento de Retina/etiología , Perforaciones de la Retina/etiología , Vitrectomía/efectos adversos , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Subluxación del Cristalino/etiología , Masculino , Persona de Mediana Edad , Facoemulsificación/efectos adversos , Complicaciones Posoperatorias , Desprendimiento de Retina/diagnóstico , Desprendimiento de Retina/fisiopatología , Perforaciones de la Retina/diagnóstico , Perforaciones de la Retina/fisiopatología , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento , Agudeza Visual/fisiologíaRESUMEN
PURPOSE: To quantify the extent of cellular proliferation and immunohistochemically characterize the proliferating cell types in epiretinal membranes (ERMS) from four different conditions: proliferative vitreoretinopathy (PVR), proliferative diabetic retinopathy, post-retinal detachment, and idiopathic ERM. METHODS: Forty-six ERMs were removed from patients undergoing vitrectomy and immediately fixed in paraformaldehyde. The membranes were processed whole and immunolabeled with either anti-MIB-1 or anti-SP6 to detect the K(i)-67 protein in proliferating cells, in combination with anti-glial fibrillary acidic protein or anti-vimentin to identify glia, anti-ezrin to identify retinal pigment epithelial cells, Ricinus communis to identify immune cells, and Hoechst to label nuclei. Digital images were collected using a laser scanning confocal microscope. The cell types were identified, their combined proliferative indices were tabulated as the average number of anti-K(i)-67-positive cells/mm(2) of tissue, and the number of dividing cells was related to the specific ocular condition and estimated disease duration. RESULTS: ERMs of all four types were shown to be highly cellular and contained proliferating cells identified as glia, retinal pigment epithelium, and of immune origin. In general, membranes identified as PVR had many more K(i)-67-positive cells in comparison to those in the other three categories, with the average number of K(i)-67-positive cells identified per mm(2) of tissue being 20.9 for proliferative diabetic retinopathy, 138.3 for PVR, 12.2 for post-retinal detachment, and 19.3 for idiopathic ERM. While all membrane types had dividing cells, their number was a relatively small fraction of the total number of cells present. CONCLUSIONS: The four ERM types studied demonstrated different cell types actively dividing at the time of removal, confirming that proliferation is a common event and does continue over many months. The low number of dividing cells at the time of removal in comparison to the total number of cells present, however, is an indicator that proliferation alone may not be responsible for the problems observed with the ERMs. Treatment strategies may need to take into consideration the timing of drug administration, as well as the contractile and possibly the inflammatory characteristics of the membranes to prevent the ensuing effects on the retina.
Asunto(s)
Proliferación Celular , Retinopatía Diabética/patología , Membrana Epirretinal/patología , Neuroglía/patología , Retina/patología , Desprendimiento de Retina/patología , Epitelio Pigmentado de la Retina/patología , Vitreorretinopatía Proliferativa/patología , Cuerpo Vítreo/patología , Proteínas del Citoesqueleto/análisis , Proteínas del Citoesqueleto/biosíntesis , Retinopatía Diabética/metabolismo , Retinopatía Diabética/cirugía , Membrana Epirretinal/metabolismo , Membrana Epirretinal/cirugía , Femenino , Proteína Ácida Fibrilar de la Glía/análisis , Proteína Ácida Fibrilar de la Glía/biosíntesis , Humanos , Inmunohistoquímica , Antígeno Ki-67/análisis , Antígeno Ki-67/biosíntesis , Masculino , Microscopía Fluorescente , Neuroglía/metabolismo , Retina/metabolismo , Retina/cirugía , Desprendimiento de Retina/metabolismo , Desprendimiento de Retina/cirugía , Epitelio Pigmentado de la Retina/metabolismo , Epitelio Pigmentado de la Retina/cirugía , Factores de Tiempo , Vimentina/análisis , Vimentina/biosíntesis , Vitrectomía , Vitreorretinopatía Proliferativa/metabolismo , Vitreorretinopatía Proliferativa/cirugía , Cuerpo Vítreo/metabolismo , Cuerpo Vítreo/cirugíaRESUMEN
PURPOSE: To describe the functional and anatomic results of retinectomy without scleral buckling for anterior proliferative vitreoretinopathy in eyes that did not undergo previous buckling surgery. DESIGN: Retrospective, nonrandomized, interventional case series. METHODS: We reviewed the results of 123 consecutive cases of retinectomy for rhegmatogenous retinal detachment complicated by anterior proliferative vitreoretinopathy. The primary outcome measure was anatomic success, defined as complete retinal reattachment. Secondary outcome measures were final anatomic success, final visual acuity outcome, number of operations required for retinal reattachment, baseline extent of proliferative vitreoretinopathy, ocular pressure at final follow-up, extent of retinectomy, and occurrence of complications. RESULTS: The anatomic success rate was 77.2%. Final attachment rate was 95.9%, reached after 1 rhegmatogenous retinal detachment reoperation in 21 cases and after 2 rhegmatogenous retinal detachment reoperations in 4 cases. We had a low rate of postoperative hypotony (4.1%). Visual acuity was significantly improved from 2.10 to 1.44 logarithm of the minimal angle of resolution units (P < .001). Improvement was related significantly to retinectomy extent and primary anatomic success. CONCLUSIONS: Our results show that primary retinectomy without scleral buckling has good anatomic and functional results.