Efficacy of vitrectomy with air tamponade for rhegmatogenous retinal detachment: a prospective study

Abstract Rhegmatogenous retinal detachment (RRD) causes a permanent decrease in visual acuity and visual field. During pars plana vitrectomy (PPV) for RRD, long acting gas have been selected for tamponade because gas stays in the eye for a long time. Recently, several studies have showed the efficacy of air tamponade for RRD treatment. Few prospective studies have analyzed the efficacy of air tamponade. We registered 194 eyes from 190 patients who consented to a prospective study of PPV with air tamponade for RRD by a single surgeon from June 2019 to November 2022. These patients were all treated with air tamponade without silicone oil and were followed for > 3 months postoperatively. Primary success rates were 97.9% (190/194) in total cases, with no discernible difference between the uncomplicated (100%:87/87) and complicated (96.3%: 103/107) RRD groups (P = 0.13). There was no considerable difference in primary success rate between upper break (97.9%:143/146) and lower break cases (97.9%:47/48). Proliferative vitreoretinopathy (PVR) grade C was associated with initial failure by multivariate analysis (P = 0.00003). Air tamponade has a sufficient therapeutic effect in cases of RRD less than PVR grade C, regardless of the location of the retinal tear

Factors correlated with visual outcomes at two and four years after vitreous surgery for proliferative diabetic retinopathy.

Proliferative diabetic retinopathy (PDR) is the most severe case of diabetic retinopathy that can cause visual impairment. This study aimed to reveal the factors correlated with better postoperative visual acuity after a long follow-up in patients who underwent vitrectomy for PDR. We retrospectively analyzed the data set including systemic findings, ocular findings, and surgical factors from registered patients who could be completely followed up for 2 or 4 years after vitrectomy. We ultimately enrolled 128 eyes from 100 patients who underwent vitrectomy for PDR between January 2008 and September 2012 and were followed up for >2 years. Among them, 91 eyes from 70 patients could be followed up for 4 years. Factors related to the postoperative visual acuity of ≥20/40 and ≥20/30 after 2 and 4 years were investigated by logistic regression analysis. Better postoperative visual acuity correlated with the following factors: no rubeosis iridis ([≥20/40 at 2 years; odds ratio {OR}, 0.068; 95% confidence interval {CI}, 0.012-0.39; P = 0.003], [≥20/30 at 2 years; OR, 0.07; 95% CI, 0.01-0.40; P = 0.03], [≥20/30 at 4 years; OR, 0.078; 95% CI, 0.006-0.96; P = 0.04]), no fibrovascular membrane [(≥20/40 at 2 years; OR, 0.22; 95% CI, 0.061-0.81; P = 0.02), (≥20/40 at 4 years; OR, 0.26; 95% CI, 0.07-0.94; P = 0.04), (≥20/30 at 4 years; OR, 0.14; 95% CI, 0.04-0.52; P = 0.004)], existing vitreous hemorrhage (≥20/30 at 2 years; OR, 9.55; 95% CI, 1.03-95.27; P = 0.04), and no reoperation ([≥20/40 at 4 years; OR, 0.15; 95% CI, 0.03-0.78; P = 0.02], [≥20/30 at 4 years; OR, 0.06; 95% CI, 0.07-0.54; P = 0.01]). Treatment provision before disease severity and treatment without complications were associated with good postoperative visual acuity

Quantification of the peripheral vitreous after vitreous shaving using intraoperative optical coherence tomography

Objective To evaluate the technique of peripheral vitreous shaving during vitrectomy, we measured the residual peripheral vitreous using intraoperative optical coherence tomography (iOCT).Methods and Analysis This retrospective study included 44 eyes that underwent 25-gauge pars plana vitrectomy with iOCT by a single surgeon. In all cases, the surgery was performed via ocular indentation. Cases in group A were treated with vitreous shaving under slit lamp microscope illumination, whereas cases in group B were treated with vitreous shaving under a wide-angle viewing system. Residual peripheral posterior vitreous-cortex detachment (PVD) was quantified by iOCT.Results iOCT image analysis enabled the visualisation of the angle formed between the retina and peripheral PVD around the vitreous base in all cases. After the completion of vitreous shaving, the mean length of the peripheral PVD was shorter in group A (961.7±214.7 µm) compared with group B (1925.3.7 ± 626.1 µm; p<0.01).Conclusion iOCT enabled the quantification of the residual peripheral vitreous after vitreous shaving. The quantification of the residual peripheral vitreous after different shaving procedures will be important for advocating appropriate vitreous shaving in future