Francesca Viti

Iatrogenic retinal breaks in 25-gauge vitrectomy under air compared with the standard 25-gauge system for macular diseases.

Purpose: To evaluate the incidence rates of iatrogenic retinal breaks in eyes that underwent 25-gauge vitrectomy under air compared with 25-gauge standard vitrectomy for idiopathic macular holes or idiopathic epiretinal membranes. Methods: In this retrospective, comparative interventional study, 435 eyes were enrolled. In all patients after core vitrectomy and epiretinal/inner limiting membrane peeling, complete vitrectomy of the base was performed, respectively under air (air group) or under fluid infusion (standard group). Results: The number of eyes with iatrogenic retinal breaks was significantly lower in the air group than in standard group (4/197 and 16/238, 2% and 7%, respectively; P = 0.035). A postoperative retinal detachment developed in 2 eyes (1%) in the standard group, and in no eyes of the air group (0%). Factors related to the occurrence of retinal breaks were surgically induced posterior vitreous detachment (P = 0.006), standard vitrectomy (P = 0.023), and surgery for macular hole (P = 0.030). Conclusion: The 25-gauge vitrectomy under air is associated with a lower incidence rate of retinal breaks compared with the standard 25-gauge vitrectomy.

STANDARD CUT RATE 25-GAUGE VITRECTOMY VERSUS ULTRAHIGH-SPEED 25-GAUGE SYSTEM IN CORE VITRECTOMY: A Randomized Clinical Trial.

Purpose: The aim of this study was to compare the efficiency and safety of ultrahigh-speed cut rate 25-gauge system and standard cut rate 25-gauge vitrectomy system. Methods: In this single-center, prospective randomized study, all consecutive eyes that underwent 25-gauge vitrectomy at the Eye Clinic of the University of Ancona from September 2014 to November 2014 were randomized to receive 25-gauge vitrectomy with 7,500 cuts per minute (cpm) probes (7,500 Group) or 25-gauge vitrectomy with 5,000 cpm probes (Standard Group). Exclusion criteria were previously vitrectomized eye, trauma cases, retinal detachment with proliferative vitreoretinopathy, and endophthalmitis. Main outcome measure was core vitrectomy duration. Secondary outcome was the incidence of iatrogenic retinal breaks and other complications related to surgery. Results: Overall, 62 eyes were enrolled; 31 eyes received 25-gauge 7,500 cpm vitrectomy and 31 eyes received 25-gauge 5,000 cpm vitrectomy. The duration of core vitrectomy was significantly lower in the 7,500 Group (P = 0.030, t-test for independent samples). Mean ± standard deviation core vitrectomy time was 161.32 ± 39.10 seconds in the 7,500 Group and 184.10 ± 41.69 seconds in the Standard Group. The observed difference in mean core vitrectomy duration between subjects treated with 7,500 cpm probes and those in the Standard Group was equal −22 seconds (95% confidence interval: −43.3 to −2.2). There was no difference in the incidence of iatrogenic breaks between the 2 groups, and there were no other complications over a 3-month follow-up period. Conclusion: The 25-gauge 7,500 cpm vitrectomy is an effective and safe surgical procedure, and it can significantly reduce core vitrectomy time in eyes undergoing vitreoretinal surgery.

Non-vitrectomizing surgery for idiopathic macular pucker using a 25-gauge synergetics high-flow infusion with a 27-gauge light (Photon™ II, Synergetics USA, Inc.)

To describe a case of macular pucker treated by non-vitrectomizing vitreoretinal surgery using a 25-gauge high-flow infusion cannula with a 27-gauge illumination source (Photon™ II; both from Synergetics USA Inc., O’Fallon, MO). A 42-year-old man complaining of visual reduction and metamorphopsia was referred to the Vitreoretinal Surgery Unit, where he underwent full ophthalmic examination. Best corrected visual acuity (BCVA) at baseline was 0.5 in the left eye (LE) and 1.0 in the right eye. He was diagnosed with epiretinal membrane (ERM) in the LE. The surgical procedure envisaged two-port sclerotomy, one for the infusion line of the 27-gauge Photon™ II light source, the other for the 25-gauge trocar in the superotemporal quadrant. The ERM was removed with a 25-gauge disposable forceps. The infusion line was placed for safety in the event of additional intraocular pressure being needed, but was not required. The 27-gauge light source afforded good visualization of the posterior pole and the ERM. At 12 months, the patient’s BCVA had improved to 1.0, and his cataract has not progressed. A 25-gauge infusion line used with the photon illumination may further improve non-vitrectomizing surgery, minimizing risk and optimizing outcome. Further trials are required to validate these preliminary observations.

PERIPAPILLARY RETINAL NERVE FIBER THICKNESS CHANGES AFTER VITRECTOMY FOR EPIRETINAL MEMBRANE IN EYES WITH AND WITHOUT VITREOUS DETACHMENT.

Purpose: To compare the changes in postoperative peripapillary retinal nerve fiber layer (p-RNFL) thickness after vitrectomy for epiretinal membrane in eyes with preexisting posterior vitreous detachment (PVD) and eyes with surgically induced PVD. Methods: This study included consecutive patients who underwent 25-gauge vitrectomy for epiretinal membrane. Eyes were divided, according to intraoperative PVD status, into a preexisting PVD group and surgically induced PVD group. Best-corrected visual acuity, p-RNFL thickness, and central retinal thickness were performed before and at 1, 3, and 6 months after surgery. Results: One hundred and twenty eyes of 120 patients were enrolled: 64 eyes in the preexisting PVD group and 56 eyes in the surgically induced PVD group. In the preexisting PVD group at 6 months, the mean global p-RNFL thickness did not change, whereas it was reduced in the temporal sector (P = 0.034). In the surgically induced PVD group at 6 months, significant decreases were observed in global p-RNFL thickness (P = 0.027), temporal (P = 0.021), temporal inferior (P = 0.030), and nasal inferior sectors (P = 0.010). At 6 months, the two groups differed significantly in temporal (P < 0.001) and temporal inferior sectors (P = 0.004). The preoperative mean best-corrected visual acuity improved significantly at 6 months in both groups. Conclusion: Postoperative p-RNFL thickness after vitrectomy for epiretinal membrane tended to decrease in the temporal sector in all eyes and in the temporal inferior and nasal inferior sectors in eyes with surgically induced PVD.

Primary 25-Gauge Airbag Vitrectomy in Pseudophakic Rhegmatogenous Retinal Detachment

Purpose: To evaluate the anatomic and functional outcomes and the rate of complications of a novel pars plana vitrectomy approach (airbag vitrectomy), with 25-gauge vitrectomy performed under air infusion, in the treatment of primary pseudophakic rhegmatogenous retinal detachment (PsRD). Methods: Prospective, noncomparative, interventional case series. One hundred forty-one eyes of 141 consecutive patients with primary PsRD uncomplicated by severe proliferative vitreoretinopathy (grade A or B). All patients underwent primary 25-gauge vitrectomy under continuous infusion of air, laser retinopexy of retinal breaks, and air or gas tamponade. Eyes with minimum follow-up of 6 months were evaluated. The Main Outcome Measures were primary anatomical success rate, defined as retinal reattachment at final follow-up after a single operation without additional surgery, visual outcome and rate of complications. Results: At 6 months the retina was reattached successfully after a single surgery in 98% of eyes (138/141). In 3 eyes (2%) retinal detachment recurred during the follow-up period, caused by proliferative vitreoretinopathy in 2 eyes and by new retinal breaks in 1 eye. After surgery, best corrected visual acuity improved significantly (P 21 mmHg), detected in 10 eyes (7%) on postoperative day 1. Conclusions: Primary 25-gauge airbag vitrectomy provides a high anatomic and functional success in eyes with PsRD and is associated with a low rate of complications.

Atypical Presentation of Antiphospholipid Syndrome: A Case Report

We report an atypical presentation of Antiphospholipid syndrome (APS) with concomitant subhyaloid hemorrhage, engorged and tortuous retinal veins, intraretinal hemorrhages, and cotton wool spots in a 38-year-old female. Medical treatment was preferred to any invasive treatment. The subhyaloid hemorrhage resolved spontaneously and the patient recovered a visual acuity of 20/20 in her right eye 3 months after the initial episode. A prompt diagnosis of this condition is fundamental to consider a systemic treatment to avoid any further thrombosis.