FIRST FAILED MACULAR HOLE SURGERY OR REOPENING OF A PREVIOUSLY CLOSED HOLE Do We Gain by Reoperating? —A Systematic Review and Meta-analysis
Reid, Gerard A. MB, BCh, BAO, MSc*; McDonagh, Niamh BSc, PGCE†; Wright, David M. BSc, MSc, PhD; Yek, John T. O. BBMed, MChD; Essex, Rohan W. MBBS, MBiostat, FRANZCO; Lois, Noemi MD, PhD, FRCS (Ed), FRCOphth*,†
Retina: January 2020 – Volume 40 – Issue 1 – p 1–15
Purpose:
To evaluate repeated surgery for idiopathic full-thickness macular hole that failed to close (FTC) after first surgery or reopened (RO) once originally closed.
Methods:
Systematic review and meta-analysis. Pubmed.gov and Cochrane Library were searched for studies in English presenting outcomes of idiopathic full-thickness macular hole that FTC or RO (case reports/series of <5 cases excluded).
Outcome Measures:
Anatomical closure, postoperative best-corrected visual acuity, intraoperative/postoperative complications, and patient-reported outcomes. Meta-analysis was performed on aggregate and available individual participant data sets using the metafor package in R.
Results:
Twenty-eight eligible studies were identified. After reoperation, pooled estimates for anatomical closure were 78% (95% confidence interval 71–84%) and 80% (95% confidence interval 66–89%) for FTC and RO groups, respectively. On average, best-corrected visual acuity improved in both groups. However, only 15% (28 of 189 eyes) of FTC eyes achieved best-corrected visual acuity of ≥6/12. The pooled estimated probability of ≥2-line best-corrected visual acuity improvement was 58% in the FTC group (95% confidence interval 45–71%); meta-analysis was not possible in the RO group. The most common complication was cataract.
Conclusion:
Reoperation for FTC or RO idiopathic full-thickness macular hole achieved a clinically meaningful visual acuity improvement in more than half of patients; high levels of vision (≥6/12), however, were uncommon.
ULTRASOUND IN VITRECTOMY: An Alternative Approach to Traditional Vitrectomy Techniques
Rizzo, Stanislao; Fantoni, Gualtiero; Mucciolo, Dario Pasquale; More
Retina. 40(1):24-32, January 2020.
Purpose:
To study a prototype of an ultrasound-based vitrector, and to try to understand the physical phenomena underlying this new technology.
Methods:
We tested the ultrasound-based vitrector prototype (UV) (ultrasonically-driven handpiece obtained from a modified version of the Alcon CONSTELLATION Vision System [Alcon]) using an automatic experimental setup. Balanced saline solution (BSS) and vitreous (from fresh postmortem enucleated porcine eyes) flow rates were analyzed using three different tips.
Results:
In general, BSS solution flow rates increased with increasing aspiration levels and decreased when we used % US power. Vitreous flow rates were influenced by aspiration levels, % US power, and ultrasound-related phenomena: cavitation phenomenon and “jet streaming.”
Conclusion:
Ultrasound-based vitrectomy may represent an important alternative to traditional vitrectomy. Such a tool, capable of liquefying and excising the vitreous body using ultrasound, could overcome all the limits of the guillotine-based technique (GV). Knowledge of the physical phenomena underlying ultrasound-based technology is a necessary prerequisite for further development of this new technology.
INCIDENCE AND RISK FACTORS FOR HYPOTONY AFTER 25-GAUGE PARS PLANA VITRECTOMY WITH NONEXPANSILE ENDOTAMPONADE
Mimouni, Michael; Abualhasan, Hamza; Derman, Laura; More
Retina. 40(1):41-46, January 2020.
Purpose:
The purpose of this study was to assess the incidence and risk factors for early postoperative hypotony after 25-gauge pars plana vitrectomy with nonexpansile endotamponade.
Methods:
A retrospective study of consecutive patients who underwent 25-G pars plana vitrectomy. Hypotony was defined as an intraocular pressure of 5 mmHg or less after surgery and ocular hypertension as an intraocular pressure greater than 21 mmHg.
Results:
Overall, 307 eyes of 307 patients with a mean age of 61.7 ± 14.3 of which 56.7% were males were included. Hypotony was identified in 5.2% of cases (n = 16) at Day 1 and 0.7% (n = 2) at Week 1 with no hypotony-related complications. The hypotony group had a higher number of previous vitreoretinal surgeries (1.5 ± 1.1 vs. 0.4 ± 0.7, P < 0.001) and a higher prevalence of preoperative ocular hypertension (22.2% vs. 4.8%, P = 0.02), pseudophakia (77.8% vs. 48.4%, P = 0.01), silicone oil removal (61.1% vs. 8.3%, P < 0.001), and external diathermy performed (55.6% vs. 20.1%, P = 0.001). In stepwise multivariate analysis, significant parameters were silicone oil removal (R 2 = 16.34%, odds ratio 13.45, P < 0.001), pseudophakia (R 2 = 5.69%, odds ratio 3.65, P = 0.03), and younger age (R 2 = 2.68%, odds ratio 0.96, P = 0.04).
Conclusion:
Silicone oil removal is a significant risk factor for early postoperative hypotony after 25-G pars plana vitrectomy.