Naša iskustva s 25 G transkonjunktivalnom bešavnom vitrektomijom

The discovery of the 25 gauge minimally invasive vitreoretinal surgery (Fujii et al.) has made possible to perform surgical procedures through small openings in conjunctiva and sclera of no more than 0.55 mm. Today, the procedure becomes ever more popular due to a reduced surgical trauma and faster postoperative recovery. The purpose of this report is to present first cases of minimally invasive transconjunctival sutureless 25 gauge vitreoretinal surgery (25 G TSV) in Croatia and to evaluate advantages of this new procedure. A case series of four patients (eyes) with posterior segment disease are presented. The new technique consisted of transconjunctival insertion of a small diameter cannula (0.5 mm) through sclera after conjunctival displacement. An Accurus 800 basic vitrectomy unit with 25 gauge Alcon system was used. Median postoperative Snellen visual acuity was 0.6 and mean postoperative intraocular pressure 14 mm Hg. Mean total vitrectomy time was 15 minutes. The mean postoperative follow up was 3 months. Intraoperatively, two conjunctival hemorrhages were noted at entry sites. Postoperative complications included retinal rupture without detachment in one eye. According to our initial experience, 25 gauge sutureless vitrectomy is a good choice for selected patients. Postoperative time is reduced and surgical trauma minimal with no signs of inflammation after two weeks.S otkrićem 25 G minimalno invazivne vitreoretinalne kirurgije (Fujii i sur.) omogućeno je izvođenje zahvata na stražnjem segmentu oka kroz spojnicu i rezove na bjeloočnici od 0,55 mm. Prednosti ove operacije su manja upalna reakcija, veći komfor za bolesnika te skraćeno vrijeme zahvata. Cilj rada je prikazati prve slučajeve transkonjuktivalne 25 G bešavne vitrektomije (25 G TSV) u Hrvatskoj te vrednovati prednosti ove metode. Daje se prikaz četvoro bolesnika s bolestima stražnjega očnog segmenta koji su podvrgnuti pars plana vitrektomiji sustavom 25 G Accurus 800 (Alcon). Nova tehnika se sastoji od transkonjuktivalnog i skleralnog postavljanja kanila malog promjera (0,5) mm. Srednja poslijeoperacijska vidna oštrina po Snellenu je bila 0,6, poslijeoperacijski očni tlak 14 mm Hg, a srednje vrijeme trajanja vitrektomije 15 min. Poslijeoperacijsko praćenje bilo je 3 mjeseca. Intraoperacijski su zabilježena dva konjuktivalna krvarenja. Poslijeoperacijske komplikacije uključivale su rupturu mrežnice bez odignuća. Zaključuje se kako je 25 G vitreoretinalna operacija dobar izbor za manje složene slučajeve poremećaja staklovine i mrežnice,jer pojednostavljuje tijek operacijskog zahvata uz ubrzan oporavak bolesnika

High-risk eye disease in the neonatal age

In clinical practice, rare congenital and co-natal eye diseases in newborns require special attention of the ophthalmologist and the neonatologist because of the possible deleterious functional consequences if not recognized and treated on time. Presented are three congenital eye diseases: retinopathy of prematurity, congenital cataract and congenital glaucoma in which surgical treatment is generally successful if performed early, up to the first year of the newborns' life. The pathophysiological development mechanisms, the clinical picture and treatment methods of congenital eye diseases are described. Late treatment represents a risk of developing impaired vision and blindness with all the sociomedical consequences of a handicapped child, with regard to intellectual development, education, socialization and integration into the work-effective population

Endemski glaukom u naseljima Mune i Brgud

In the past century, research into the prevalence of congenital glaucoma among the Mune and Brgud villagers showed that glaucoma was present in 38% of the population. Genealogical studies established the presence of congenital glaucoma through six generations of the villagers. Tradition has it that members of the Šori family have diseased eyes from time immemorial and that other families have through generations been linked to this family, in a repeated circle of conjugal relationships. From the considerable documentation collected, it appears that approximately 50% of the population are genetically linked to the central Šori family. In this group, about half of the offspring show symptoms of this congenital disease. Clinical characteristics of the Mune-Brgud congenital glaucoma are similar to those of the late congenital glaucoma. It is caused by a congenital anomaly of the iridocorneal angle, and is clinically manifested between the age of 10 and 40. It is characterized by goniodysgenesis and high insertion of the iris, remnants of undifferentiated mesodermal embryonic tissue, widening of the trabecular meshwork, decreased aqueous outflow, and regularly present markedly deep anterior chamber. Megalocornea, hypoplasia of the corneal stroma and moderate myopia are present sporadically.U prošlom stoljeću su istraživanja učestalosti kongenitalnog glaukoma kod stanovnika naselja Mune i Brguda pokazala kako je glaukom bio prisutan u 38% ove populacije. Genealoškim ispitivanjem utvrđeno je da se prisutnost kongenitalnog glaukoma prati kroz šest naraštaja stanovnika. Predaja govori kako su članovi obitelji Šori od davnina imali bolesne oči te da su druge obitelji kroz naraštaje bile vezane uz obitelj Šori kroz opetovani krug bračnih veza. Iz obilne sakupljene dokumentacije proizlazi da je oko 50% populacije ovih sela genetski vezano za središnju obitelj Šori. U toj skupini prosječno polovica potomstva pokazuje simptome ove nasljedne bolesti. Kliničke značajke kongenitalnog glaukoma Mune-Brgud slične su onima kod kasnog kongenitalnog glaukoma. Glaukom Mune-Brgud uzrokovan je kongenitalnom anomalijom u iridokornealnom kutu i klinički se očituje u dobi od 10. do 40. godine života. Obilježava ga goniodisgeneza i visoka insercija šarenice, ostatak nediferenciranog embrijskog mezodermalnog tkiva, prošireni trabekulum, smanjeno istjecanje sobne vodice i redovito prisutna izrazito duboka prednja sobica. Megalokornea, hipoplazija rožnične strome i umjerena miopija su rijetko prisutne

Comparison of 23 Gauge and 25 Gauge PPV in the Treatment of Epiretinal Membranes and Macular Holes

The aim of this study was to show the long term recovery after the operative procedure of pars plana vitrectomy (PPV) in patients with epiretinal membranes (ERM) and macular holes. We wanted to show if there is a difference in operative approach and results of 23 and 25 gauge PPV. Twenty eight patients underwent to operative treatment of idiopatic ERM and macular holes grade III and IV. In our study there was not a statistical signifi cant difference in visual acuity (VA) between 23 gauge and 25 gauge operated patients, both ERM and macular holes. Although both approaches are good, morphological restitution do not always follow the functional recovery

High-risk eye disease in the neonatal age

In clinical practice, rare congenital and co-natal eye diseases in newborns require special attention of the ophthalmologist and the neonatologist because of the possible deleterious functional consequences if not recognized and treated on time. Presented are three congenital eye diseases: retinopathy of prematurity, congenital cataract and congenital glaucoma in which surgical treatment is generally successful if performed early, up to the first year of the newborns' life. The pathophysiological development mechanisms, the clinical picture and treatment methods of congenital eye diseases are described. Late treatment represents a risk of developing impaired vision and blindness with all the sociomedical consequences of a handicapped child, with regard to intellectual development, education, socialization and integration into the work-effective population