Hirotsugu Takashina

6.5 mm optic AcrySof implantation through a 3.0 mm incision

&NA; An Alcon AcrySof® MA50BM intraocular lens (IOL) with an optic diameter of 6.5 mm can be implanted without further enlarging a 3.0 mm phacoemulsification incision. The IOL is placed in a Monarch® II B cartridge (Alcon) designed for use with the 5.5 mm optic AcrySof SA30AL, and the tip of the cartridge is inserted in the incision but not the anterior chamber. With the cartridge tip pressing against the eye, holding up the inner edge of the corneal incision and pressing down on the outer edge of it, the plunger is advanced to insert the IOL. When the entire optic has been inserted in the eye, the cartridge is withdrawn and the trailing loop is tucked in the capsular bag. We have used this procedure to perform uneventful IOL implantation in 228 consecutive eyes, after which the incisions were 3.0 to 3.1 mm in width.

Changes in corneal thickness following vitreous surgery

Purpose We investigated changes in corneal thickness following vitreous surgery and determined whether such changes can be used to evaluate the invasiveness of a vitrectomy. Patients and methods This retrospective, consecutive, comparative study examined 20 eyes that had undergone 23-gauge vitrectomy. Corneal thickness was measured prior to as well as following 1 week, 1 month, and 3 months after surgery. Measurements were performed at the center and at points 3 mm superior, inferior, nasal, and temporal to the center. Results Across the 20 cases, postoperative data showed a significant increase at 1 week after surgery at all points, but recovery to preoperative levels was evident only 1 month after surgery (P < 0.05, paired t-test test). In the rhegmatogenous retinal detachment group (n = 9), mean corneal thickness 1 week after vitrectomy showed a significant increase at all points, but had recovered to preoperative levels by 1 month. In the proliferative diabetic retinopathy group (n = 5), mean corneal thickness at 1 week after vitrectomy showed a significant increase at central, inferior, and temporal points, but had recovered to preoperative levels by 1 month. In the epiretinal membrane group (n = 6), a significant difference in thickness was apparent only at the superior point between baseline and at 1 week, but had recovered to preoperative levels by 1 month. In all groups, no significant differences in thickness were apparent at any of the measurement points between preoperative measurements and at 3 months after surgery (P < 0.05, Wilcoxon signed-rank test). Conclusions Measurement of corneal thickness is useful for assessing the extent of surgical stress following vitrectomy.

Examination of Self-Sealing Sclerotomy for Vitrectomized Eye under Gas Tamponade in 23-Gauge Transconjunctival Sutureless Vitrectomy

Abstract Introduction: To investigate whether a previous history of vitrectomy affects sclerotomy self-sealing under gas tamponade in 23-gauge transconjunctival sutureless vitrectomy. Materials and Methods: This study retrospectively reviewed two groups, a vitrectomized group (seven consecutive cases) and an initial vitrectomy group (82 consecutive cases), who underwent 23-gauge transconjunctival sutureless vitrectomy at Jikei University School of Medicine Daisan Hospital in Tokyo. Factors affecting sclerotomy self-sealing were examined using multiple regression analysis. The criterion variable was massage time, and independent variables were age, surgical time, axial length, vitreous incarceration, history of vitrectomy, preoperative intraocular pressure (IOP), and postoperative IOP. Results: Age (F = 10.4) was the only significant factor. History of vitrectomy was not a significant factor (F = 0.06). Conclusions: Previous history of vitrectomy does not affect sclerotomy self-sealing under gas tamponade in 23-gauge transconjunctival sutureless vitrectomy.

Factors influencing self-sealing of sclerotomy performed under gas tamponade in 23-gauge transconjunctival sutureless vitrectomy.

Background The purpose of this study was to investigate factors influencing self-sealing of sclerotomy performed under gas tamponade in 23-gauge transconjunctival sutureless vitrectomy. Methods This study was a retrospective review of 84 patients (84 eyes) who underwent 23-gauge transconjunctival sutureless vitrectomy under gas tamponade by a single surgeon. At the end of surgery, the sclerotomy was massaged to promote self-sealing. Factors influencing massage time were examined using multiple regression analysis. Independent variables were age, surgical time, vitreous incarceration, intraocular manipulation, and axial length. Results Significant factors were intraocular manipulation and vitreous incarceration in the examination of all sclerotomies, age only in the examination of infusion sites, and vitreous incarceration only in the examination of manipulation sites. Conclusion In sclerotomy performed with gas tamponade using 23-gauge transconjunctival sutureless vitrectomy, intraocular manipulation influenced self-sealing of sclerotomy the most, followed by vitreous incarceration, and then age.

Perioperative changes of the intraocular pressure during the treatment of epiretinal membrane by using 25- or 27-gauge sutureless vitrectomy without gas tamponade

Purpose The purpose of this study was to compare perioperative intraocular pressures (IOPs) in 25- or 27-gauge microincision vitrectomy surgery (MIVS) and to evaluate the stability of postoperative sclerotomy closure. Materials and methods This is a retrospective review of 147 eyes treated for epiretinal membrane by using 25- or 27-gauge MIVS as the initial vitrectomy (25-gauge phacovitrectomy [25-P group]: 73 eyes, 25-gauge vitrectomy alone [25-A group]: 15 eyes, 27-gauge phacovitrectomy [27-P group]: 47 eyes, and 27-gauge vitrectomy alone [27-A group]: 12 eyes). Statistical analyses of perioperative IOPs on preoperative day (PreOp), postoperative day (POD)1, POD2, postoperative week 1, and postoperative month 1 were performed. Results All self-sealing sclerotomies were obtained without gas tamponade at the end of surgery. Also, no significant differences were noted in the age and axial length among the 4 groups and in the surgical time between 25-P and 27-P groups and between 25-A and 27-A groups. Significant decreases in IOP were found at POD1 and POD2 in the 25-P, 25-A, and 27-P groups compared with PreOP, but not in the 27-A group. Conclusion Even though surgeons confirm that there is no leakage from sutureless sclerotomy and that a normal IOP is preserved at the end of 25- or 27-gauge MIVS, there is a possibility of postoperative sclerotomy leakage on the day of the surgery. Furthermore, postoperative sclerotomy self-sealing of the MIVS in previous intraocular lens implantation cases is considered to be acquired easily than that in phacovitrectomy.

Choroidal neovascularization in angioid streaks following microincision vitrectomy surgery: a case report

BackgroundPatients with angioid streaks are prone to developing subretinal hemorrhage after ocular or head injury due to the brittleness of Bruch’s membrane. However, there have been no reports of any angioid streak patients in whom choroidal neovascularization occurred after vitrectomy surgery. We report herein a patient with angioid streaks who developed choroidal neovascularization after vitrectomy surgery for epiretinal membrane.Case presentationA 76-year-old man presented with distorted vision in his left eye, with a best corrected visual acuity of 1.2 and 0.6 in his right and left eyes, respectively. Fundus examination showed angioid streaks in both eyes and epiretinal membrane only in the left eye. The patient underwent 23-gauge three-port pars plana vitrectomy with removal of the epiretinal membrane combined with cataract surgery. Internal limiting membrane in addition to the epiretinal membrane were successfully peeled and removed, with indocyanine green dye used to visualize the internal limiting membrane. His left best corrected visual acuity improved to 0.8. An elevated lesion with retinal hemorrhage due to probable choroidal neovascularization was found between the fovea and the optic disc in the left eye at 7 weeks after surgery. Since best corrected visual acuity decreased to 0.15 and the hemorrhage expanded, posterior sub-Tenon injection of triamcinolone acetonide was performed. However, no improvement was observed. Even though intravitreal bevacizumab injection was performed a total of five times, his best corrected visual acuity remained at 0.1. Subsequently, we performed a combination treatment of a standard-fluence photodynamic therapy and intravitreal ranibizumab injection, with additional intravitreal ranibizumab injections performed 3 times after this combination treatment. Best corrected visual acuity improved to 0.5 and the size of the choroidal neovascularization markedly regressed at 4 months after the combined treatment.ConclusionDevelopment of choroidal neovascularization could possibly occur in elderly patients with angioid streaks after vitrectomy surgery. In such cases, a combination of photodynamic therapy and intravitreal ranibizumab injection may be considered for initial treatment of the choroidal neovascularization.

Full-Thickness Macular Hole Formation in the Postoperative Period After Initial Vitrectomy for Rhegmatogenous Retinal Detachment

Background and Objective: To evaluate full-thickness macular hole (MH) formation in the postoperative period after initial vitrectomy for rhegmatogenous retinal detachment (rRD). Materials and Methods: We retrospectively reviewed the medical records of 4 consecutive eyes that required additional vitrectomy for full-thickness MH between April 2013 and March 2016 after undergoing an initial vitrectomy for rRD. Results: Epiretinal membrane (ERM) was identified by preoperative optical coherence tomography or intraoperative dye staining in each case. Photocoagulation of retinal breaks prior to initial vitrectomy was performed in Cases 1, 2, and 3 (4–16 days), with yttrium-aluminum-garnet capsulotomy after cataract extraction also performed prior to the retinal break formation in Case 3. At the initial vitrectomy, there was a superior retinal break which crossed the equator in Case 2, and an intentional hole was created in Cases 1 and 4. The mean interval from the initial vitrectomy until MH formation was 27.5 ± 15.8 months. As with Case 2, the intervals in Cases 1 and 4, in which an intentional hole was created, were clearly shorter than in those in Case 3. Finally, MH closure was achieved after an additional vitrectomy (removal of the internal limiting membrane with ERM and gas tamponade) and best-corrected visual acuity improved in each case. Conclusion: ERM was identified in the cases examined in our study. The presence of an intentional hole might shorten the interval of MH formation after vitrectomy for rRD.

Investigation of postoperative intraocular pressure in cases of silicone oil removal using 25-gauge transconjunctival sutureless vitrectomy with oblique incisions

Background The purpose of this study was to investigate postoperative intraocular pressure (IOP) in cases of silicone oil (SO) removal when using 25-gauge transconjunctival sutureless vitrectomy (TSV) with oblique incisions. Methods We enrolled ten consecutive eyes with SO removal (SO group) and eleven consecutive eyes with idiopathic epiretinal membrane (ERM) as the initial vitrectomy (ERM group) in cases using 25-gauge TSV with oblique incisions. Postoperative IOPs were compared between the two groups at each of the four examination periods. Results No significant differences were identified in any of the periods examined. Conclusion The use of 25-gauge TSV with oblique incisions resulted in almost equivalent postoperative IOPs between cases with SO removal and idiopathic ERM as the initial operation. Self-sealing sclerotomy in 25-gauge TSV with oblique incisions may primarily involve the valve architecture, and be complemented by vitreous incarceration.

Factors Predicting Duration of Intraocular Gas Presence After 23-Gauge Transconjunctival Sutureless Vitrectomy for Rhegmatogenous Retinal Detachment

BACKGROUND AND OBJECTIVE To investigate factors predicting duration of intraocular gas presence in 23-gauge transconjunctival sutureless vitrectomy. PATIENTS AND METHODS Retrospective review of 130 eyes that underwent 23-gauge transconjunctival sutureless vitrectomy. At the end of surgery, gas exchange and sclerotomy massage to promote self-sealing were performed. If sclerotomy leakage was suspected despite sclerotomy massage, a suture was placed. Factors predicting duration of intraocular gas presence in 23-gauge transconjunctival sutureless vitrectomy were examined using multiple regression analysis. An F value greater than 2 and P value less than 0.05 were considered statistically significant. RESULTS Significant factors were axial length (F = 7.08; P < .05) and IOP on postoperative day 1 (F = 4.35; P < .05). Age, operation time, preoperative IOP, and number of sutured sclerotomies were not statistically significant. CONCLUSION Factors predicting duration of intraocular gas presence in 23-gauge transconjunctival sutureless vitrectomy were axial length and postoperative IOP on day 1.