PURPOSE: To evaluate the benefit of pars plana vitrectomy (PPV) and removal of the internal limiting membrane (ILM) in eyes with diffuse diabetic macular edem a refractory to laser photocoagulation.DESIGN: Prospective...PURPOSE: To evaluate the benefit of pars plana vitrectomy (PPV) and removal of the internal limiting membrane (ILM) in eyes with diffuse diabetic macular edem a refractory to laser photocoagulation.DESIGN: Prospective, consecutive, interve ntional case series. METHODS: Diabetic patients with biomicroscopic, angiographi c, and tomographic evidence of diabetic macular edema persisting for at least 3 months after numerous sessions of macular photocoagulation were evaluated for in clusion. Patients with biomicroscopic evidence of epiretinal membrane or taut po sterior hyaloid, previous vitreoretinal surgery, or active proliferative diabeti c retinopathy were excluded. The main outcome measures were macular thickness, a s measured by optical coherence tomography (OCT) and visual acuity (VA). RESULTS : PPV with ILM removal was performed in 11 eyes of 10 patients (four men, six wo men; mean age=58.2 years). Six-month follow-up data were available for 10 eyes (91%). At 6 months postoperatively, central macular thickness had improved by at least 20%in eight of 11 eyes (mean preoperative thickness of 421 μm compare d with mean postoperative thickness of 188 μm; P=.007). Mean VA improved from 2 0/352 to 20/94 at 6 months (P=.002). By the most recent visit (range=6-20 month s postoperatively), VA had improved by at least 2 Snellen lines in 6 of 10 eyes treated with surgery alone. CONCLUSIONS: The early results of this ongoing study suggest that PPV with ILM removal may provide anatomic and visual benefit in so me eyes with chronic diabetic macular edema unresponsive or unamenable to additi onal laser photocoagulation.展开更多
Background: and objective: Current literature review fails to disclose any series describing the use of two-port vitrectomy in adult patients. This study was performed to determine the feasibility and efficacy of pars...Background: and objective: Current literature review fails to disclose any series describing the use of two-port vitrectomy in adult patients. This study was performed to determine the feasibility and efficacy of pars plana vitrectomy surgery using two (rather than three or four)-port access for treatment of diabetic patients with nonclearing vitreous haemorrhage due to retinal neovascularization. Design: Interventional prospective case series: to measure ability to allow for long-term resolution of chronic uncomplicated vitreous haemorrhage in diabetic patients, and to study the frequency and nature of complications associated with this technique. Methods: Two-port pars plana vitrectomy (with endolaser treatment and membrane delamination if necessary) was performed in a prospective series of 12 consecutive diabetic patients with nonclearing vitreous haemorrhage due to retinal neovascularization. Results: Successful removal of vitreous haemorrhage resulted in all patients. No visually significant intraoperative complications occurred. Best postoperative visual acuity correlated with lenticular and macular perfusion status. Conclusion: Two-port pars plana vitrectomy is an efficient (and potentially safer and faster) alternative to the standard three-port vitrectomy in selected patients.展开更多
PURPOSE: To introduce a new non-trocar system for 25-gauge transconjunctival pars plana vitrectomy(PPV). DESIGN: Study of a new surgical instrument. METHODS: This new non-trocar syst em for 25-gauge transconjunctivalP...PURPOSE: To introduce a new non-trocar system for 25-gauge transconjunctival pars plana vitrectomy(PPV). DESIGN: Study of a new surgical instrument. METHODS: This new non-trocar syst em for 25-gauge transconjunctivalPPVconsists of a contact lens ring featuring f our projections containing 1.0-mm diameter holes located 3.0 mm from the ring e dge, a wedge-shaped 25-gauge infusion cannula, and two plugs. RESULTS: The rin g is fixed with 7-0 silk sutures at the 3-and 9-o’clock positions on the lim bus. Using the 25-gauge needle, three conjunctival and scleral incisions (n=3) are made at the projection holes located inferotemporally, superonasally, and su perotemporally. No intra-or postoperative complications were encountered in 14 patients treated by this non-trocar 25-gauge transconjunctival PPV. CONCLUSION : Using the system introduced here, 25-gauge transconjunctival PPVcan be perfor medwithout suturing sclerotomies and without intra-or postoperative complicatio ns.展开更多
Purpose: To report a case of endophthalmitis after triamcinolone acetonide (TA )-assisted par plane vitrectomy (PPV). Methods: A 60-year-old Japanese man de veloped endophthalmitis after TA-assisted PPV for diabetic m...Purpose: To report a case of endophthalmitis after triamcinolone acetonide (TA )-assisted par plane vitrectomy (PPV). Methods: A 60-year-old Japanese man de veloped endophthalmitis after TA-assisted PPV for diabetic macular edema. Preop erative visual acuity was 20/200. Four days after surgery, endophthalmitis assoc iated with anterior chamber hypopyon was noticed; the patient’s vision had dete riorated to hand motion. In spite of severe cell infiltration, the ciliary injec tion and ocular pain were not significant. Results: The additional PPV with irri gation of cefazolin (40 μug/ml) and gentamicin (8 μug/ml) was performed. Endop hthalmitis resolved soon after this treatment. Staphylococcus epidermidis was de tected in the intravitreous samples. The patient’s visual acuity improved to 20 /100. Conclusion: Endophthalmitis may be a complication of TA-assisted PPV with unique signs and symptoms.展开更多
Purpose:To investigate intraocular lens(IOL)tilt and decentration following combined vitrectomy and pars plana lensectomy(PPL)with IOL implantation in patients with proliferative diabetic retinopathy.Methods:We follow...Purpose:To investigate intraocular lens(IOL)tilt and decentration following combined vitrectomy and pars plana lensectomy(PPL)with IOL implantation in patients with proliferative diabetic retinopathy.Methods:We followed 25 patients with proliferative diabetic retinopathy who underwent PPL and IOL(MA60BM)implantation at the time of pars plana vitrectomy(PPL group),and 25 patients who underwent phacoemulsification and IOL(MA60BM)implantation without vitrectomy(PE group).Intraocular lens tilt and decentration were evaluated quantitatively,using the anterior eye segment analysis system,approximately 12 months after surgery.Results:There was no significant difference in IOL tilt(p=0.47)or decentration(p =0.26)between the PPL and PE groups.Conclusions:The present study suggests that tilt and decentration of the IOL are acceptable in combined vitrectomy and pars plana lensectomy.展开更多
目的探讨内窥镜下激光睫状体光凝术联合玻璃体切割术治疗糖尿病新生血管性青光眼的临床疗效。方法选取24例(24眼)糖尿病新生血管性青光眼患者,行内窥镜下激光睫状体光凝术联合玻璃体切割术,术后至少随访6个月。观测指标包括手术前后患...目的探讨内窥镜下激光睫状体光凝术联合玻璃体切割术治疗糖尿病新生血管性青光眼的临床疗效。方法选取24例(24眼)糖尿病新生血管性青光眼患者,行内窥镜下激光睫状体光凝术联合玻璃体切割术,术后至少随访6个月。观测指标包括手术前后患者视力、眼压变化、新生血管消退程度和术后并发症情况。结果术后视力提高14眼,不变8眼,降低2眼。术后第1天眼压为(29.4±10.8)mm Hg(1 k Pa=7.5 mm Hg),1个月时为(21.0±11.9)mm Hg,最终随访时为(20.1±10.8)mm Hg,与术前(46.6±7.3)mm Hg比较,差异均有统计学意义(均为P<0.05)。术后新生血管完全消失10眼,部分消失残留少量无功能血管者12眼,未见明显改善者2眼。术后第1天8例患者发生颜面部浮肿;术后发生球结膜混合充血9眼、角膜水肿4眼、一过性高眼压4眼、复发性玻璃体出血1眼(后行玻璃体腔灌洗术后病情稳定)。结论内窥镜下激光睫状体光凝术联合玻璃体切割术治疗糖尿病新生血管性青光眼短期内临床效果显著,并发症少,患者痛苦少,是一种相对有效、安全的手术方法。展开更多
文摘PURPOSE: To evaluate the benefit of pars plana vitrectomy (PPV) and removal of the internal limiting membrane (ILM) in eyes with diffuse diabetic macular edem a refractory to laser photocoagulation.DESIGN: Prospective, consecutive, interve ntional case series. METHODS: Diabetic patients with biomicroscopic, angiographi c, and tomographic evidence of diabetic macular edema persisting for at least 3 months after numerous sessions of macular photocoagulation were evaluated for in clusion. Patients with biomicroscopic evidence of epiretinal membrane or taut po sterior hyaloid, previous vitreoretinal surgery, or active proliferative diabeti c retinopathy were excluded. The main outcome measures were macular thickness, a s measured by optical coherence tomography (OCT) and visual acuity (VA). RESULTS : PPV with ILM removal was performed in 11 eyes of 10 patients (four men, six wo men; mean age=58.2 years). Six-month follow-up data were available for 10 eyes (91%). At 6 months postoperatively, central macular thickness had improved by at least 20%in eight of 11 eyes (mean preoperative thickness of 421 μm compare d with mean postoperative thickness of 188 μm; P=.007). Mean VA improved from 2 0/352 to 20/94 at 6 months (P=.002). By the most recent visit (range=6-20 month s postoperatively), VA had improved by at least 2 Snellen lines in 6 of 10 eyes treated with surgery alone. CONCLUSIONS: The early results of this ongoing study suggest that PPV with ILM removal may provide anatomic and visual benefit in so me eyes with chronic diabetic macular edema unresponsive or unamenable to additi onal laser photocoagulation.
文摘Background: and objective: Current literature review fails to disclose any series describing the use of two-port vitrectomy in adult patients. This study was performed to determine the feasibility and efficacy of pars plana vitrectomy surgery using two (rather than three or four)-port access for treatment of diabetic patients with nonclearing vitreous haemorrhage due to retinal neovascularization. Design: Interventional prospective case series: to measure ability to allow for long-term resolution of chronic uncomplicated vitreous haemorrhage in diabetic patients, and to study the frequency and nature of complications associated with this technique. Methods: Two-port pars plana vitrectomy (with endolaser treatment and membrane delamination if necessary) was performed in a prospective series of 12 consecutive diabetic patients with nonclearing vitreous haemorrhage due to retinal neovascularization. Results: Successful removal of vitreous haemorrhage resulted in all patients. No visually significant intraoperative complications occurred. Best postoperative visual acuity correlated with lenticular and macular perfusion status. Conclusion: Two-port pars plana vitrectomy is an efficient (and potentially safer and faster) alternative to the standard three-port vitrectomy in selected patients.
文摘PURPOSE: To introduce a new non-trocar system for 25-gauge transconjunctival pars plana vitrectomy(PPV). DESIGN: Study of a new surgical instrument. METHODS: This new non-trocar syst em for 25-gauge transconjunctivalPPVconsists of a contact lens ring featuring f our projections containing 1.0-mm diameter holes located 3.0 mm from the ring e dge, a wedge-shaped 25-gauge infusion cannula, and two plugs. RESULTS: The rin g is fixed with 7-0 silk sutures at the 3-and 9-o’clock positions on the lim bus. Using the 25-gauge needle, three conjunctival and scleral incisions (n=3) are made at the projection holes located inferotemporally, superonasally, and su perotemporally. No intra-or postoperative complications were encountered in 14 patients treated by this non-trocar 25-gauge transconjunctival PPV. CONCLUSION : Using the system introduced here, 25-gauge transconjunctival PPVcan be perfor medwithout suturing sclerotomies and without intra-or postoperative complicatio ns.
文摘Purpose: To report a case of endophthalmitis after triamcinolone acetonide (TA )-assisted par plane vitrectomy (PPV). Methods: A 60-year-old Japanese man de veloped endophthalmitis after TA-assisted PPV for diabetic macular edema. Preop erative visual acuity was 20/200. Four days after surgery, endophthalmitis assoc iated with anterior chamber hypopyon was noticed; the patient’s vision had dete riorated to hand motion. In spite of severe cell infiltration, the ciliary injec tion and ocular pain were not significant. Results: The additional PPV with irri gation of cefazolin (40 μug/ml) and gentamicin (8 μug/ml) was performed. Endop hthalmitis resolved soon after this treatment. Staphylococcus epidermidis was de tected in the intravitreous samples. The patient’s visual acuity improved to 20 /100. Conclusion: Endophthalmitis may be a complication of TA-assisted PPV with unique signs and symptoms.
文摘Purpose:To investigate intraocular lens(IOL)tilt and decentration following combined vitrectomy and pars plana lensectomy(PPL)with IOL implantation in patients with proliferative diabetic retinopathy.Methods:We followed 25 patients with proliferative diabetic retinopathy who underwent PPL and IOL(MA60BM)implantation at the time of pars plana vitrectomy(PPL group),and 25 patients who underwent phacoemulsification and IOL(MA60BM)implantation without vitrectomy(PE group).Intraocular lens tilt and decentration were evaluated quantitatively,using the anterior eye segment analysis system,approximately 12 months after surgery.Results:There was no significant difference in IOL tilt(p=0.47)or decentration(p =0.26)between the PPL and PE groups.Conclusions:The present study suggests that tilt and decentration of the IOL are acceptable in combined vitrectomy and pars plana lensectomy.
文摘目的探讨内窥镜下激光睫状体光凝术联合玻璃体切割术治疗糖尿病新生血管性青光眼的临床疗效。方法选取24例(24眼)糖尿病新生血管性青光眼患者,行内窥镜下激光睫状体光凝术联合玻璃体切割术,术后至少随访6个月。观测指标包括手术前后患者视力、眼压变化、新生血管消退程度和术后并发症情况。结果术后视力提高14眼,不变8眼,降低2眼。术后第1天眼压为(29.4±10.8)mm Hg(1 k Pa=7.5 mm Hg),1个月时为(21.0±11.9)mm Hg,最终随访时为(20.1±10.8)mm Hg,与术前(46.6±7.3)mm Hg比较,差异均有统计学意义(均为P<0.05)。术后新生血管完全消失10眼,部分消失残留少量无功能血管者12眼,未见明显改善者2眼。术后第1天8例患者发生颜面部浮肿;术后发生球结膜混合充血9眼、角膜水肿4眼、一过性高眼压4眼、复发性玻璃体出血1眼(后行玻璃体腔灌洗术后病情稳定)。结论内窥镜下激光睫状体光凝术联合玻璃体切割术治疗糖尿病新生血管性青光眼短期内临床效果显著,并发症少,患者痛苦少,是一种相对有效、安全的手术方法。
