Journal of VitreoRetinal Diseases最新文献

Introduction: To describe the technique, safety profile, and outcomes of performing pars plana vitrectomy (PPV) without intravenous (IV) anesthesia. Methods: This retrospective single-surgeon study comprised patients who had PPV without IV sedation between September 2018 and April 2022. Patients elected to undergo PPV without sedation or with oral sedation via sublingual triazolam administered 30 minutes preoperatively. Sub-Tenon bupivacaine and lidocaine were administered at the initiation of each case. A circulating nurse monitored patient vitals and electrocardiogram tracings without anesthesiologist support. Adverse events (AEs), visual acuity (VA), supplemental block administration, and reoperation rates were documented. Results: A total of 357 PPVs in 319 patients (mean age 68.75 ± 11.17 years [SD]; range, 36.82-98.57) were performed for surgical indications including vitreous floaters, intraocular lens or cataract surgery complications, retinal detachment, vitreous hemorrhage, and epiretinal membrane. Twenty-three cases were performed without sedation, and 334 were performed with oral sedation. For eyes with a follow-up longer than 1 month (n = 324), the preoperative VA of 0.68 ± 0.77 logMAR improved to 0.31 ± 0.46 logMAR postoperatively (P < .01). No intraoperative complications, systemic AEs, need to cease surgery prematurely, or conversion to IV sedation occurred. Five eyes (1.77%) required intraoperative supplemental sub-Tenon block administration, and 95% of patients who had a reoperation (n = 10) or fellow-eye surgery (n = 28) requested the same method of anesthesia without IV sedation. Conclusions: Vitreoretinal surgery with a sub-Tenon block and oral sedation can be safely performed without the support of an anesthesiologist. Additional trials are needed to further quantify patient comfort, surgeon experience, and complication rates.

Purpose: To present 2 cases of acute total loss of vision after scleral buckle surgery for rhegmatogenous retinal detachment. Methods: A retrospective chart review of 2 cases and an analysis of the literature were performed. Results: An 18-year-old woman and a 67-year-old woman suffered complete loss of vision in their operative eye after primary scleral buckle surgery with encircling bands. Conclusions: Profound ocular ischemia resulting in total acute vision loss is a rare and devastating outcome of primary scleral buckle procedures and may be caused by strangulation of the eye with an encircling band. Attention paid to the key tenets of this often successful and useful surgical technique may lower the risk for this complication.

Purpose: To describe the multimodal imaging findings associated with benign yellow dot maculopathy. Methods: A case report was analyzed. Results: A healthy 42-year-old White man was evaluated after several weeks of photopsias and an inferior retinal tear in the right eye. The tear was treated with laser retinopexy. A fundus examination showed numerous small, yellow, subretinal lesions in and around the macula of the right eye only. The patient had no known systemic conditions and an unremarkable family and ocular history, with 20/20 visual acuity in both eyes. Multimodal imaging findings were consistent with the newly described phenotype of benign yellow dot maculopathy. Conclusions: This is the second known case of unilateral benign yellow dot maculopathy. Distinct multimodal imaging findings between unilateral cases and bilateral cases may suggest differences in their etiology and manifestation.

Purpose: To report a case of retinal vasculitis after intravitreal faricimab-svoa injection. Methods: A case and its management were reviewed. Results: A 77-year-old woman presented with a painless decrease in visual acuity (VA) to counting fingers after receiving an intravitreal faricimab-svoa injection for neovascular age-related macular degeneration. An examination showed an anterior chamber reaction without hypopyon. Vitritis was present with numerous scattered retinal hemorrhages. Fluorescein angiography showed delayed filling with extensive vascular leakage consistent with nonocclusive vasculitis. The patient was immediately treated with intravenous steroids, resulting in rapid improvement and recovery of her 20/40 baseline VA. The vasculitis resolved without occlusion. Conclusions: Faricimab-svoa can be associated with significant vasculitis. Prompt treatment with intravenous steroids can be beneficial in the recovery of sight.

Purpose: To evaluate a recently developed technique using intraoperative optical coherence tomography (OCT) to measure subretinal tissue plasminogen activator (tPA) volumes in patients with submacular hemorrhage secondary to exudative age-related macular degeneration (AMD). Methods: Three patients (72 to 83 years old) had 25-gauge pars plana vitrectomy, subretinal tPA, and a partial gas fill. An investigational intraoperative OCT system with a modified widefield noncontact indirect viewing apparatus was used to image subretinal tPA blebs. Using the recently developed technique, the volume and surface area in the segmented region of interest were determined. Results: In each case, the delivered tPA volume measured from the syringe differed from the intraoperative OCT-measured subretinal tPA volume: Patient 1, 130 µL from syringe, 118 µL based on intraoperative OCT, 9% difference; Patient 2, 140 µL, 50 µL, 64%; Patient 3, 110 µL, 122 µL, 11%. The total bleb surface area was 129 mm² in Patient 1, 55 mm² in Patient 2, and 106 mm² in Patient 3. Conclusions: This was the first human study to implement and evaluate intraoperative OCT image-based methods to obtain volumetric bleb measurements in patients receiving subretinal tPA for exudative AMD. This proof-of-concept study showed that intraoperative OCT-obtained bleb volume differed from intraoperative recordings, which could be explained by tPA delivery into the vitreous, efflux through the retinotomy, or human error. Intraoperative OCT can provide visualization and quantification of subretinal tPA bleb volume and surface area, which has implications for improved safety, efficacy, and analysis of the effects of subretinal drug delivery.