Sutureless 25-Gauge Pars Plana Vitrectomy Combined with Retropupillary Fixation of an Iris-Claw Intraocular Lens

Background: The surgical case of a dropped intraocular lens inside the vitreous cavity constitutes a real challenge for the operating surgeon. Herein, we describe a case series where an alternative optical rehabilitation technique for late intraocular lens-bag complex dislocation has been used. Methods: A modern vitrectomy device was used to remove the capsule with the dropped intraocular lens using sutureless 25-gauge pars plana vitrectomy. To ensure a better aesthetic result, with faster patient recovery and a reduced number of operations, the whole procedure was performed during the same operating session; an iris-claw intraocular lens for aphakia was selected for implantation. The implant was passed behind the constricted iris with the concave surface facing it. The lens was grasped with the manufacturer’s holding forceps and fixed onto the posterior surface of the iris using the special enclavation needles. Results: We have operated 12 eyes in two different clinical centres successfully, with minimal intra- and/or postoperative complications. Conclusion: We believe that this is a viable solution for the visual rehabilitation of patients, who would otherwise need more than one operation for a lens exchang

Sutureless 25-Gauge Pars Plana Vitrectomy Combined with Retropupillary Fixation of an Iris-Claw Intraocular Lens

Background: The surgical case of a dropped intraocular lens inside the vitreous cavity constitutes a real challenge for the operating surgeon. Herein, we describe a case series where an alternative optical rehabilitation technique for late intraocular lens-bag complex dislocation has been used. Methods: A modern vitrectomy device was used to remove the capsule with the dropped intraocular lens using sutureless 25-gauge pars plana vitrectomy. To ensure a better aesthetic result, with faster patient recovery and a reduced number of operations, the whole procedure was performed during the same operating session; an iris-claw intraocular lens for aphakia was selected for implantation. The implant was passed behind the constricted iris with the concave surface facing it. The lens was grasped with the manufacturer’s holding forceps and fixed onto the posterior surface of the iris using the special enclavation needles. Results: We have operated 12 eyes in two different clinical centres successfully, with minimal intra- and/or postoperative complications. Conclusion: We believe that this is a viable solution for the visual rehabilitation of patients, who would otherwise need more than one operation for a lens exchang

The effect of phacoemulsification on late bleb failure or intraocular pressure in patients with glaucoma: a systematic review

Vasileios G Peponis,* Spyridon E Chalkiadakis,* Michail C Katzakis, Efstratios A ParikakisOphthalmiatreio Athens Eye Hospital, Second Ophthalmology Department, Athens, Greece*These authors contributed equally in writing the manuscriptAbstract: The purpose of our systematic review is to document the adverse events that follow phacoemulsification in eyes with trabeculectomy due to glaucoma and to determine whether phacoemulsification jeopardizes the survival of the trabeculectomy. Our research was based on English- and non-English-language articles obtained using the Medline, Embase, Web of Science and Scopus databases. Additional studies were identified by searching bibliographies in the British Library and abstracts presented at the Association for Research in Vision and Ophthalmology annual meetings. Search terms included randomized controlled trial, controlled clinical trial, random allocation, double-blind method, matched studies and trabeculectomy failure, glaucoma-filtering operation failure, bleb failure and cataract surgery or phacoemulsification. Only prospective or retrospective matched studies testing the survival of a trabeculectomy alone versus clear corneal phacoemulsification after a trabeculectomy in patients with glaucoma were included. Data were independently extracted by two authors using predefined data fields. PubMed yielded 152 results, Scopus 235, Embase 222, and Web of Science (science citation index) 216. We read the abstracts of all the trials, and after reading the full text of 31 studies, we decided that 13 studies should be comprehensively evaluated. Current evidence does not allow us to draw safe conclusions on the scientific question so far.Keywords: bleb failure, cataract, glaucoma, phacoemulsification, trabeculectom

Hemostatic effects of SF6 after diabetic vitrectomy for vitreous hemorrhage

Purpose: To investigate the hemostatic effects of SF6 gas in preventing post-operative vitreous hemorrhage in diabetic vitrectomy, Methods: A prospective, randomized study of 33 diabetic eyes with vitreous hemorrhage, treated by vitrectomy, In 17 of our cases SF6 20% was injected into the eye at the end of the operation, while in 16 cases BSS remained in the vitreous cavity, Results: The incidence of vitreous hemorrhage recurrence was 17.6% for the SF6 group and 12.5% for the BSS group (statistically not significant). Progression of lens opacities was observed in 23.5% of the SF6 group, and in 18.8% of the BSS group (statistically not significant, with a higher incidence in the SF6 group). Conclusions: SF6 gas did not show hemostatic effects in the cases studied. Furthermore, it may have contributed to cataract progression. Therefore we suggest that the use of SF6 is not recommended as a treatment modality in preventing new vitreous hemorrhage after diabetic vitrectomy

Treatment of myopic choroidal neovascularization with intravitreal ranibizumab injections: the role of age

Dimitrios Karagiannis,1 Georgios A Kontadakis,1,2 Konstantinos Kaprinis,1 Athanassios Giarmoukakis,2 lias Georgalas,3 Efstratios A Parikakis,1 Miltiadis K Tsilimbaris2 1Ophthalmiatreio Eye Hospital of Athens, Athens, Greece; 2Department of Ophthalmology, University Hospital of Heraklion, University of Crete, Heraklio, Greece; 3Department of Ophthalmology, University of Athens, Athens, Greece Purpose: The aim of this study was to explore the role of age as a prognostic factor for the outcome of myopic choroidal neovascularization (CNV) treatment with intravitreal ranibizumab injections.Methods: A retrospective review of charts of patients treated with intravitreal injections of ranibizumab for the treatment of myopic CNV was done. Patients with other ophthalmic disease were excluded. Patients were followed for at least 2 years. The correlation between age and the change in visual acuity and the number of injections during treatment was investigated.Results: Age of the patients was significantly correlated with the number of injections that the patients received (Pearson’s r=0.585, P=0.005). Also, it was significantly correlated with improvement in corrected distance visual acuity, defined as the difference between final and initial LogMAR corrected distance visual acuity (Pearson’s r=0.614, P=0.003).Conclusion: Age significantly affects the visual outcome of myopic CNV treatment with ranibizumab. Younger patients in our study needed fewer intravitreal injections and achieved a more significant improvement in vision. Keywords: myopic choroidal neovascularization, intravitreal injection, ranibizumab, pathologic myopi

Central retinal vein occlusion and pseudoexfoliation syndrome

Dimitrios Karagiannis,1 Georgios A Kontadakis,1,2 Nektarios E Klados,2 Ioannis Tsoumpris,1 Artemios S Kandarakis,1 Efstratios A Parikakis,1 Ilias Georgalas,3 Miltiadis K Tsilimbaris21Ophthalmiatreio Eye Hospital of Athens, Athens, Greece; 2Department of Ophthalmology, University Hospital of Heraklion, University of Crete, Heraklion, Greece; 3Department of Ophthalmology, General Hospital of Athens, Athens, Greece Purpose: The purpose of this study was to investigate the existence of pseudoexfoliation syndrome (PXF) as a risk factor for the development of central retinal vein occlusion (CRVO).Methods: This was a retrospective, comparative study of the prevalence of pseudoexfoliation in three groups of patients: 48 patients with CRVO, 164 patients with branch retinal vein occlusion (BRVO), and 70 control patients (70 eyes). All patients were phakic and had no previous diagnosis of glaucoma. Patients were matched in terms of age and systemic hypertension. All patients had normal intraocular pressure (IOP) at presentation (defined as less than or equal to 21 mmHg).Results: In the CRVO group, 14 out of 48 patients were diagnosed as having PXF (29.17%). In the BRVO group, 14 out of 164 patients had PXF (8.5%), and in the control group, six out of 70 patients had PXF (8.6%). Differences of percentage between groups were statistically significant (P<0.001, χ2 test). When comparing patient subgroup with ischemic CRVO with subgroup with non-ischemic CRVO, we found that in the ischemic CRVO group, 13 out of 27 patients were diagnosed as having PXF (48.15%), and in the non-ischemic CRVO group, one out of 21 patients was diagnosed as having PXF (4.7%; P<0.001, χ2 test). The relative odds of having CRVO in patients with PXF versus patients without PXF were 4.406 (confidence interval [CI], 2.03–9.54).Conclusion: PXF and CRVO, especially ischemic, are strongly associated in our study. Our results indicate that PXF might be an independent factor for CRVO, as it is related with CRVO independently from glaucoma.Keywords: pseudoexfoliation, ischemic and non-ischemic central retinal vein occlusion, branch retinal vein occlusion, glaucom