Intraocular pressure in silicon-oil tamponated eyes using a non-contact pulse synchronous tonometer: IOP measurement in vitrectomized and silicon-oil tamponated eyes by NT-4000

Objective To assess the reliability of intraocular pressure (IOP)measurement by means of NidekNT - 4000 tonometer in vitrectomized and siliconoil tamponaded (VSOT)eyes. Methods IOP was measured by means of NidekNT - 4000 and compared with standard Goldmann applanation tonometer (GAT)in 36 consecutive VSOT eyes and 36 normal eyes. Results In VSOT and nor mal eyes NidekNT - 4000 showed agreement with GAT (VSOT eyes mean difference:1. 83 ± 2. 64,P = 0 55;correlation:P < 0 0001,r = 0 95;Normal eyes mean difference:1 ± 2 8,P = 0 42;correlation:P = 0 0045,r = 0 69 ). Differences were similar be tween groups (P = 0 81). Conclusions NidekNT - 4000 tonometer offers a new affordable method to measure IOP in vitrectomized and siliconoil tamponaded eyes

INTRAVITREAL DEXAMETHASONE IMPLANT FOR REFRACTORY MACULAR EDEMA SECONDARY TO VITRECTOMY FOR MACULAR PUCKER.

Purpose: To study the efficacy of a single 0.7 mg dexamethasone intravitreal implant in vitrectomized eyes with refractory macular edema secondary to combined cataract extraction and macular pucker removal. Methods: In 8 eyes of 8 consecutive patients with refractory macular edema secondary to combined cataract extraction and 25-gauge vitrectomy with internal limiting membrane peeling for macular pucker removal, the injection of the 0.7 mg dexamethasone implant was performed. Best-corrected visual acuity, central retinal thickness measured by spectral domain optical coherence tomography, and intraocular pressure were evaluated at baseline, 1 month, and 6 months. Results: After a mean follow-up of 6.75 +/- 0.71 months, best-corrected visual acuity was significantly increased (P &lt; 0.0001) from 20/50 to 20/23 (P &lt; 0.0001), mean central retinal thickness decreased significantly from 439 +/- 45 [mu]m to 296 +/- 49 [mu]m (P &lt; 0.0001), and intraocular pressure changed significantly (P = 0.02) from 14.63 +/- 1.19 to 16 +/- 0.93. In no case postoperative hypotony or other complication was observed. Conclusion: A single injection of the 0.7 mg dexamethasone intravitreal implant resulted effective in the treatment of refractory macular edema secondary to combined cataract extraction and vitrectomy for macular pucker removal allowing a stable visual acuity recovery

Diathermy of leaking sclerotomies after 23-gauge transconjunctival pars plana vitrectomy: a prospective study.

PURPOSE: To evaluate the efficacy of bipolar diathermy in ensuring closure of leaking sclerotomies after complete 23-gauge transconjunctival sutureless vitrectomy. METHODS: In this prospective, interventional case series, in 136 eyes of 136 patients with at least one leaking sclerotomy at the end of a complete 23-gauge transconjunctival sutureless vitrectomy, external bipolar wet-field diathermy was applied to leaking sclerotomies, including the conjunctiva and sclera. Intraoperative wound closure, and postoperatively, at 6 hours, 1 day and 3 days, sclerotomies leakage, intraocular pressure, hypotony, and hypotony-related complications were evaluated. RESULTS: Intraoperative closure was achieved in 231 of 238 leaking sclerotomies (97%) that received diathermy. One of these with postoperative leakage needed suture. Compared with baseline (14.4 ± 2.8 mmHg), mean intraocular pressure was lower at 6 hours (13.2 ± 3.8 mmHg, Tukey-Kramer P &lt; 0.001) and not different at 24 hours or 72 hours. Hypotony (intraocular pressure &lt;5 mmHg) was observed in 6 eyes (4.5%) at 6 hours, in 2 (1.5%) at 24 hours, and in none at 3 days. Logistic regression analysis showed that, 6 hours postoperatively, hypotony was related to younger age (≤50 years) at surgery (P = 0.031). No hypotony-related complications were recorded. CONCLUSION: Bipolar wet-field diathermy of sutureless sclerotomies is an effective method for ensuring a leaking sclerotomies closure

Cauterization for the prevention of leaking sclerotomies after 23-gauge transconjunctival pars plana vitrectomy: an easy way to obtain sclerotomy closure.

Cauterization for the prevention of leaking sclerotomies after 23-gauge transconjunctival pars plana vitrectomy: an easy way to obtain sclerotomy closure

Oxane HD vs silicone oil and scleral buckle in retinal detachment with proliferative vitreoretinopathy and inferior retinal breaks

BACKGROUND: To compare pars plana vitrectomy (PPV) with 1300 cs silicone oil and scleral buckle (SB) vs PPV with Oxane HD tamponade for rhegmatogenous retinal detachment (RRD) with inferior retinal breaks (IRB). METHODS: Twenty eyes of 20 consecutive patients with primary inferior RRD and PVR &gt;or=CP2 were alternatively assigned to PPV and 1300 cs silicone oil and segmental SB in the inferior periphery (group 1, n = 10) or PPV with Oxane HD (group 2, n = 10) in order of presentation. Silicone oil/Oxane HD removal was performed 12 weeks after surgery. Subjects were followed up for 6 months from oil removal. RESULTS: Operative time was lower in Oxane HD group (P = 0.012). In both groups, the retina was primary reattached at the third month after oil removal in nine eyes (90%). At the end of follow-up, retina was reattached in nine eyes (90%) in group 1 (including one eye with oil in situ), and in eight eyes (80%) in group 2 (P &gt; 0.05). CONCLUSIONS: Silicone oil+SB and Oxane HD appear equal for primary RRD with IRB, but a large multi-centre study is required. Oxane HD permitted a reduced operative time

Macular hole following conventional repair of bullous retinal detachment using air injection (D-ACE procedure).

Abstract PURPOSE: Sequential drainage of subretinal fluid (D), injection of air (A), cryotherapy (C), and application of local explants (E) (D-ACE) sequence was introduced in order to overcome the problems encountered in managing superior bullous detachments from multiple large equatorial breaks. The authors recently observed the occurrence of a full-thickness macular hole in one patient developing the day after he underwent a D-ACE procedure. METHODS: A 61-year-old man presented a bullous retinal detachment in the right eye extending from the 9:30 to the 2 o'clock position, and posteriorly to the vascular arcades two retinal tears were noted, at the equator at 11 o'clock, and anterior to the equator at 12 o'clock. The patient underwent a D-ACE procedure. Subretinal fluid was drained above the lateral rectus muscle at the equator. One and a half milliliters of air were injected 3.5 mm from the limbus midway between the superior and the medial rectus insertions. Cryotherapy was applied to the retinal breaks. A 240 encircling band was used in conjunction with a 276 tyre segment at the level of the tears. RESULTS: One day after surgery, the retina was flat, but a full-thickness macular hole could be seen with a surrounding cuff of subretinal fluid. CONCLUSIONS: The mechanisms proposed to explain the occurrence of full-thickness macular holes after D-ACE may involve the concurrence of scleral elongation and vitreofoveal traction by means of previous partial posterior vitreous detachment with persistent posterior attachments at the fovea

Anterior capsule staining using micronized triamcinolone in the absence of red reflex

We describe a technique to stain the anterior lens capsule with micronized triamcinolone to perform a continuous curvilinear capsulorhexis (CCC) during phacoemulsification in the absence of a red reflex due to vitreous hemorrhage. After a self-sealing clear corneal tunnel incision is performed using a 2.75 mm blade, a dispersive ophthalmic viscosurgical device (OVD) is injected to protect the iridocorneal angle. An air bubble as large as possible is injected into the center of the anterior chamber, and a small amount of micronized triamcinolone is then injected as needed to stain the anterior lens capsule. The OVD injection permits the removal of excessive triamcinolone and protects the corneal endothelium from damage during phacoemulsification. A capsulorhexis forceps is used to perform the CCC. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned