Journal of Clinical Medicine

Research

10 pages, 1700 KiB

Open AccessArticle

Robot-Assisted Epiretinal Membrane Peeling: A Prospective Assessment of Pre- and Intra-Operative Times and of Surgeons’ Subjective Perceptions

by Ferhat Turgut, Gábor Márk Somfai, Florian M. Heussen, Alexander Eberle, Marc D. de Smet and Matthias D. Becker

J. Clin. Med. 2023, 12(8), 2768; https://doi.org/10.3390/jcm12082768 - 7 Apr 2023

Cited by 2 | Viewed by 1599

Abstract

Purpose: The Preceyes Surgical System (PSS) is a robotic assistive device that may enhance surgical precision. This study assessed pre- and intra-operative times and surgeons’ perceptions of robot-assisted epiretinal membrane peeling (RA-MP). Methods: We analyzed the time requirement of three main tasks: the [...] Read more.

Purpose: The Preceyes Surgical System (PSS) is a robotic assistive device that may enhance surgical precision. This study assessed pre- and intra-operative times and surgeons’ perceptions of robot-assisted epiretinal membrane peeling (RA-MP). Methods: We analyzed the time requirement of three main tasks: the preparation of the PSS (I), patient preparation (II), and surgery (III). Following surgery, the surgeons were asked questions about their experience. Results: RA-MP was performed in nine eyes of nine patients. Task I required an average time of 12.3 min, initially taking 15 min but decreasing to 6 min in the last surgery. Task II showed a mean time of 47.2 (range of 36–65) min. Task III had a mean time of 72.4 (range of 57–100) min. A mean time of 27.9 (range of 9–46) min was necessary for RA-MP. The responses to the questionnaire revealed a trend towards increasing ease and reduced stress as familiarity with the PSS increased. Conclusions: A substantial reduction in pre- and intra-operative times, decreasing to a total of 115 min, was demonstrated. RA-MP was positively anticipated by the surgeons and led to no hand or arm strain while being more complex than manual MP. Full article

(This article belongs to the Special Issue Recent Advances in Vitreoretinal Surgery)

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9 pages, 1716 KiB

Open AccessArticle

Effectiveness, Safety and Choroidal Changes of a Fovea-Sparing Technique for the Treatment of Chronic Central Serous Chorioretinopathy with Yellow Subthreshold Laser

by Beatriz Torrellas, Alejandro Filloy, Lihteh Wu, Jay Chhablani and Pedro Romero-Aroca

J. Clin. Med. 2023, 12(3), 1127; https://doi.org/10.3390/jcm12031127 - 31 Jan 2023

Cited by 4 | Viewed by 1235

Abstract

The aim of this study was to evaluate the effectiveness and safety of a yellow subthreshold laser (STL) for the treatment of chronic central serous chorioretinopathy delivered in a fovea-sparing pattern and to analyze the post-laser changes in the choroidal structure by Swept-Source [...] Read more.

The aim of this study was to evaluate the effectiveness and safety of a yellow subthreshold laser (STL) for the treatment of chronic central serous chorioretinopathy delivered in a fovea-sparing pattern and to analyze the post-laser changes in the choroidal structure by Swept-Source Optical Coherence Tomography. This study was a prospective case series of 43 eyes corresponding to 37 patients. Data were recorded at 6, 12 and 24 weeks after the STL treatment. The best-corrected visual acuity improved in 93% of the patients and remained stable in 7%. The subretinal fluid was completely reabsorbed in 27.9%, 32.6% and 69.8% of the patients at 6, 12 and 24 weeks, respectively. There were reductions in the choroidal thickness of 13.1% and 25.3% at 12 and 24 weeks, which corresponded to reductions of 17.5% and 45.9% in the choriocapillaris and Sattler layer and reductions of 12.2% and 21.2% in the Haller layer at 12 and 24 weeks, respectively (p < 0.05). This might account for the effect of the laser on the inner choroidal vasculature, the dysregulation of which is believed to be at the core of central serous chorioretinopathy. No laser-related complications were detected. Overall, the fovea-sparing STL was safe and effective in this series of patients. Full article

(This article belongs to the Special Issue Recent Advances in Vitreoretinal Surgery)

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7 pages, 397 KiB

Open AccessArticle

Longitudinal Change of Choroidal Thickness after Pars Plana Vitrectomy for Idiopathic Epiretinal Membrane

by Dong-Ik Kim, Ki-Woong Bae and Daniel Duck-Jin Hwang

J. Clin. Med. 2022, 11(23), 6950; https://doi.org/10.3390/jcm11236950 - 25 Nov 2022

Cited by 1 | Viewed by 976

Abstract

This study aimed to investigate changes in choroidal thickness after pars plana vitrectomy (PPV) with and without air tamponade in patients with idiopathic epiretinal membrane (ERM). We retrospectively reviewed 61 patients with ERM who underwent a 25-gauge transconjunctival sutureless PPV. The patients were [...] Read more.

This study aimed to investigate changes in choroidal thickness after pars plana vitrectomy (PPV) with and without air tamponade in patients with idiopathic epiretinal membrane (ERM). We retrospectively reviewed 61 patients with ERM who underwent a 25-gauge transconjunctival sutureless PPV. The patients were divided into two groups: the air tamponade group (30 eyes) and the nontamponade group (31 eyes). Subfoveal choroidal thickness (SFCT) was analyzed over 12 months. No significant differences were seen between the two groups at baseline. For all patients, the SFCT was significantly thicker at 1 month after surgery and significantly thinner at 6 and 12 months after surgery than preoperative values. In the subgroup analysis, there was no significant difference in SFCT 3 months after surgery compared with the preoperative values in both groups, but SFCT was significantly lower 6 months after surgery in both groups. In conclusion, our results showed that choroidal thickness temporarily increased after surgery and then gradually decreased until 12 months after the PPV for ERM. Full article

(This article belongs to the Special Issue Recent Advances in Vitreoretinal Surgery)

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15 pages, 4295 KiB

Open AccessArticle

Visualization and Grading of Vitreous Floaters Using Dynamic Ultra-Widefield Infrared Confocal Scanning Laser Ophthalmoscopy: A Pilot Study

by Gerardo Garcia-Aguirre, Andree Henaine-Berra and Guillermo Salcedo-Villanueva

J. Clin. Med. 2022, 11(19), 5502; https://doi.org/10.3390/jcm11195502 - 20 Sep 2022

Cited by 12 | Viewed by 5899

Abstract

Purpose: To describe the appearance of vitreous opacities using dynamic ultra-widefield infrared confocal scanning laser ophthalmoscopy (IRcSLO). Design: Retrospective case series. Methods: Eyes of patients complaining of myodesopsia were analyzed using dynamic ultra-widefield IRcSLO imaging (Nidek Mirante, Nidek Co., Ltd., Gamagori, Japan), and [...] Read more.

Purpose: To describe the appearance of vitreous opacities using dynamic ultra-widefield infrared confocal scanning laser ophthalmoscopy (IRcSLO). Design: Retrospective case series. Methods: Eyes of patients complaining of myodesopsia were analyzed using dynamic ultra-widefield IRcSLO imaging (Nidek Mirante, Nidek Co., Ltd., Gamagori, Japan), and classified according to a vitreous opacity severity scale. Results: Thirty eyes of 21 patients were included in this study. The average age was 56 years. Symptom duration ranged from 1 to more than 365 days. The most common cause of vitreous floaters was posterior vitreous detachment (63.3%), followed by vitreous syneresis (23.3%), asteroid hyalosis (10%) and vitreous hemorrhage (3.3%). Opacities were classified as Grade 1 in three eyes (10%), Grade 2 in 10 eyes (33.3%), Grade 3 in 11 eyes (36.6%), Grade 4 in two eyes (6.6%) and Grade 5 in four eyes (13.3%). Patients with Grade 1 opacities were younger than patients with opacities Grade 2 or greater. A visible Weiss ring could be identified in 0% of eyes with Grade 1 opacities, 40% of eyes with Grade 2 opacities, 100% of eyes with Grade 3 opacities, and 100% of eyes with Grade 4 opacities. In patients with Grade 5 opacities, a Weiss ring could not be identified. Conclusion: Dynamic ultra-widefield IRcSLO imaging is a useful tool to evaluate patients with vitreous floaters. It allows for accurate visualization of the number, density, and behavior of the shadows that vitreous opacities project over a very wide area of the retina, which has a positive correlation with patient perception of floaters. Full article

(This article belongs to the Special Issue Recent Advances in Vitreoretinal Surgery)

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7 pages, 209 KiB

Open AccessArticle

Long-Term Outcomes of Same Patient Eyes Treated with Pars Plana Vitrectomy in One Eye and Conventional Treatment in the Other for Complications of Proliferative Diabetic Retinopathy

by Maria H. Berrocal, Luis Acaba-Berrocal and Alexandra M. Acaba

J. Clin. Med. 2022, 11(18), 5399; https://doi.org/10.3390/jcm11185399 - 14 Sep 2022

Cited by 4 | Viewed by 1345

Abstract

The purpose of this study was to evaluate the long-term, real-world outcomes of pars plana vitrectomy (PPV) for complications of proliferative diabetic retinopathy. A retrospective review involving 64 patients with proliferative diabetic retinopathy that underwent PPV in their worse-seeing eye were followed for [...] Read more.

The purpose of this study was to evaluate the long-term, real-world outcomes of pars plana vitrectomy (PPV) for complications of proliferative diabetic retinopathy. A retrospective review involving 64 patients with proliferative diabetic retinopathy that underwent PPV in their worse-seeing eye were followed for a minimum of 8 years. The fellow eye underwent conventional treatment. Patients were divided into two groups by age: patients younger than 50 years of age and patients older than 50. In the younger than 50 group, 89% of vitrectomized eyes had improved visual acuity (VA) while 3.6% had decreased VA. A total of 14% of vitrectomized eyes required additional laser and 11% required reoperations. In the conventional treatment eyes, 25% had improved VA while 68% had decreased VA (p < 0.05). A total of 72% required additional laser and 60% required PPV. In the older than 50 group, 86% of vitrectomized eyes had VA improvement and 3% had decreased VA. A total of 8% required laser and 8% required reoperations. In the conventional treatment eyes, 30% improved VA and 48% had decreased VA (p < 0.05). Additional procedures required included laser in 70% and PPV in 17%. In both age groups, eyes that underwent PPV had better final visual outcomes than eyes that received conventional treatment for PDR. Full article

(This article belongs to the Special Issue Recent Advances in Vitreoretinal Surgery)

7 pages, 1698 KiB

Open AccessArticle

A Novel Suturing Technique for Choroidal Avulsion

by Takeshi Iwase, Shungo Nishiyama and Mariko Sato

J. Clin. Med. 2022, 11(18), 5344; https://doi.org/10.3390/jcm11185344 - 12 Sep 2022

Viewed by 1206

Abstract

Ocular trauma has been one of the leading causes of visual impairment, and choroidal avulsion is especially devastating. Surgical treatment of choroidal avulsion is challenging, and very few surgical techniques have been reported. We experienced two cases of globe rupture with 360-degree avulsion [...] Read more.

Ocular trauma has been one of the leading causes of visual impairment, and choroidal avulsion is especially devastating. Surgical treatment of choroidal avulsion is challenging, and very few surgical techniques have been reported. We experienced two cases of globe rupture with 360-degree avulsion of the choroid-ciliary body from the peripheral section. After vitrectomy for a globe rupture, the choroid gradually slid down to the posterior pole over time and vision deteriorated even though the retina was attached. We treated the choroidal avulsion using two surgical methods: a mattress suturing technique using a 10-0 proline long needle and a 7-0 nylon single suture technique. In both methods, the retina-choroid, which had slipped down to the posterior pole, was suspended and fixed to the sclera assisted by a wide-angle viewing system, improving visual acuity. These two methods are considered to be useful surgical procedures for the treatment of an avulsed choroid. Full article

(This article belongs to the Special Issue Recent Advances in Vitreoretinal Surgery)

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Review

Jump to: Research, Other

21 pages, 4423 KiB

Open AccessReview

Advances in Vitreoretinal Surgery

by Lucas Ribeiro, Juliana Oliveira, Dante Kuroiwa, Mohamed Kolko, Rodrigo Fernandes, Octaviano Junior, Nilva Moraes, Huber Vasconcelos, Talita Oliveira and Mauricio Maia

J. Clin. Med. 2022, 11(21), 6428; https://doi.org/10.3390/jcm11216428 - 30 Oct 2022

Cited by 11 | Viewed by 3192

Abstract

Advances in vitreoretinal surgery provide greater safety, efficacy, and reliability in the management of the several vitreoretinal diseases that benefit from surgical treatment. The advances are divided into the following topics: scleral buckling using chandelier illumination guided by non-contact visualization systems; sclerotomy/valved trocar [...] Read more.

Advances in vitreoretinal surgery provide greater safety, efficacy, and reliability in the management of the several vitreoretinal diseases that benefit from surgical treatment. The advances are divided into the following topics: scleral buckling using chandelier illumination guided by non-contact visualization systems; sclerotomy/valved trocar diameters; posterior vitrectomy systems and ergonomic vitrectomy probes; chromovitrectomy; vitreous substitutes; intraoperative visualization systems including three-dimensional technology, systems for intraoperative optical coherence tomography, new instrumentation in vitreoretinal surgery, anti-VEGF injection before vitrectomy and in eyes with proliferative diabetic retinopathy, and new surgical techniques; endoscopic surgery; the management of subretinal hemorrhages; gene therapy; alternative techniques for refractory macular hole; perspectives for stem cell therapy and the prevention of proliferative vitreoretinopathy; and, finally, the Port Delivery System. The main objective of this review is to update the reader on the latest changes in vitreoretinal surgery and to provide an understanding of how each has impacted the improvement of surgical outcomes. Full article

(This article belongs to the Special Issue Recent Advances in Vitreoretinal Surgery)

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19 pages, 8928 KiB

Open AccessReview

Primary Lamellar Macular Holes: To Vit or Not to Vit

by Lihteh Wu and Ryan Bradshaw

J. Clin. Med. 2022, 11(17), 5046; https://doi.org/10.3390/jcm11175046 - 28 Aug 2022

Cited by 5 | Viewed by 4485

Abstract

There is a wide spectrum of macular conditions that are characterized by an irregular foveal contour caused by a break in the inner fovea. These include full-thickness macular hole (FTMH), foveal pseudocyst, lamellar macular hole (LMH) and macular pseudohole (MPH). Clinical examination of [...] Read more.

There is a wide spectrum of macular conditions that are characterized by an irregular foveal contour caused by a break in the inner fovea. These include full-thickness macular hole (FTMH), foveal pseudocyst, lamellar macular hole (LMH) and macular pseudohole (MPH). Clinical examination of vitreomacular interface disorders is notoriously poor in differentiating these conditions. These conditions were initially described with slit-lamp biomicroscopy, and the main goal was to distinguish an FTMH from the others. The introduction of optical coherence tomography (OCT) has revolutionized our understanding of the foveal microstructural anatomy and has facilitated differentiating these conditions from an FTMH. However, the definitions of the other conditions, particularly LMH, has evolved over the past two decades. Initially the term LMH encompassed a wide spectrum of clinical conditions. As OCT became more widely used and observations became more refined, two different phenotypes of LMH became apparent, raising the question of different pathogenic mechanisms for each phenotype. Tractional and degenerative pathological mechanisms were proposed. Epiretinal membranes (ERMs) associated with each phenotype were identified. Typical ERMs were associated with a tractional mechanism, whereas an epiretinal proliferation was associated with a degenerative mechanism. Epiretinal proliferation represents Müller cell proliferation as a reactive process to retinal injury. These two types of ERM were differentiated by their characteristics on SD-OCT. The latest consensus definitions take into account this phenotypic differentiation and classifies these entities into LMH, MPH and ERM foveoschisis. The initial event in both ERM foveoschisis and LMH is a tractional event that disrupts the Müller cell cone in the foveola or the foveal walls. Depending on the extent of Müller cell disruption, either a LMH or an ERM foveoschisis may develop. Although surgical intervention for LMH remains controversial and no clear guidelines exist for pars plana vitrectomy (PPV), eyes with symptomatic, progressive ERM foveoschisis and LMH may benefit from surgical intervention. Full article

(This article belongs to the Special Issue Recent Advances in Vitreoretinal Surgery)

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Other

Jump to: Research, Review

7 pages, 1208 KiB

Open AccessBrief Report

Removal of Sub-Internal Limiting Membrane Hemorrhage Secondary to Retinal Arterial Macroaneurysm Rupture: Internal Limiting Membrane Non-Peeling Technique

by Akari Kimura, Hisanori Imai, Yukako Iwane, Maya Kishimoto, Yasuyuki Sotani, Hiroko Yamada, Wataru Matsumiya, Akiko Miki, Sentaro Kusuhara and Makoto Nakamura

J. Clin. Med. 2023, 12(9), 3291; https://doi.org/10.3390/jcm12093291 - 5 May 2023

Viewed by 1393

Abstract

The appropriate surgical technique to improve the closure rate of perioperative full-thickness macular hole (FTMH) secondary to submacular hemorrhage (SMH) with sub-internal limiting membrane (ILM) hemorrhage caused by retinal arterial macroaneurysm (RAM) rupture remains an unsolved clinical problem. Several ILM transplantation techniques have [...] Read more.

The appropriate surgical technique to improve the closure rate of perioperative full-thickness macular hole (FTMH) secondary to submacular hemorrhage (SMH) with sub-internal limiting membrane (ILM) hemorrhage caused by retinal arterial macroaneurysm (RAM) rupture remains an unsolved clinical problem. Several ILM transplantation techniques have been attempted, but these are challenging. Our new technique can remove sub-ILM hemorrhage with the central fovea ILM intact, without peeling the ILM. The medical records of three eyes from three patients with SMH and sub-ILM hemorrhage secondary to RAM rupture were retrospectively reviewed. During the surgery, a small ILM fissure was made outside the central fovea with ILM forceps, and sub-ILM hemorrhage was washed out through it by manually spraying balanced salt solution. Sub-ILM hemorrhage removal was achieved successfully in all eyes, with no occurrences of FTMH or other complications. Best-corrected decimal visual acuity improved from 0.05 (Snellen equivalent (SE), 20/400), 0.05 (SE, 20/400), and 0.05 (SE, 20/400) preoperatively to 0.3 (SE, 20/63), 0.4 (SE, 20/50), and 0.15 (SE, 20/125) at 3 months postoperatively, respectively. This new technique may help keep the foveal ILM intact and prevent perioperative FTMH formation. Full article

(This article belongs to the Special Issue Recent Advances in Vitreoretinal Surgery)

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