@article {701, title = {Macular Hole Closure With Internal Limiting Membrane Abrasion Technique.}, journal = {JAMA Ophthalmol}, volume = {133}, year = {2015}, month = {2015 Jun}, pages = {635-41}, abstract = {

IMPORTANCE: Internal limiting membrane (ILM) abrasion is an alternative surgical technique for successful full-thickness macular hole (MH) repair.

OBJECTIVE: To study the effects of ILM abrasion as an alternative method of MH repair.

DESIGN, SETTING, AND PARTICIPANTS: Retrospective consecutive case series from January 2006 to December 2008. Demographic data and preoperative, intraoperative, and postoperative examination records of all patients were reviewed for patients who underwent ILM abrasion with a diamond-dusted membrane scraper during vitrectomy for MH repair. A total of 100 eyes underwent ILM abrasion as an alternative to traditional ILM peeling.

MAIN OUTCOMES AND MEASURES: Rate of MH closure and visual acuity (VA) outcomes at 3 months after surgery.

RESULTS: Macular hole closure was achieved with a single surgical procedure in 94 of 100 eyes (94.0\%; 95\% CI, 87.4\%-97.8\%). Among all patients, the median preoperative VA was 20/100 (range, 20/30 to hand motions; 25th quartile, 20/60; and 75th quartile, 20/160), and the median postoperative VA at 3 months after surgery was 20/60 (range, 20/20 to hand motions; 25th quartile, 20/40; and 75th quartile, 20/100). Among all patients with stage 2 MHs, 30 of 38 patients (78.9\%) had at least 2 lines of VA gain: 15 of 23 (65.2\%) were phakic, and 15 of 15 (100\%) were pseudophakic. Four of 38 patients (10.5\%) with stage 2 MHs had at least 2 lines of VA loss, and all were phakic. Among all patients with stage 3 or 4 MHs, 42 of 62 (67.7\%) had at least 2 lines of VA gain, of which 30 of 38 (78.9\%) were phakic and 22 of 24 (91.7\%) were pseudophakic. Six of 62 patients (9.7\%) with stage 3 or 4 MHs had at least 2 lines of VA loss: 4 were phakic, and 2 were pseudophakic. In total, 35.0\% (95\% CI, 25.7\%-44.3\%) of patients achieved 20/40 vision or better, and 52.0\% (95\% CI, 42.2\%-61.8\%) of patients achieved 20/50 vision or better.

CONCLUSIONS AND RELEVANCE: Abrasion of the ILM with a diamond-dusted membrane scraper at the time of vitrectomy achieves high rates of MH closure. This technique avoids complete removal of the retinal ILM basement membrane and subjacent tissues and appears to provide MH closure rates similar to those of traditional ILM peeling.

}, keywords = {Adult, Aged, Aged, 80 and over, Basement Membrane, Endotamponade, Female, Fluorocarbons, Humans, Male, Middle Aged, Ophthalmologic Surgical Procedures, Prone Position, Retinal Perforations, Retrospective Studies, Sulfur Hexafluoride, Tomography, Optical Coherence, Visual Acuity, Vitrectomy}, issn = {2168-6173}, doi = {10.1001/jamaophthalmol.2015.204}, author = {Mahajan, Vinit B and Chin, Eric K and Tarantola, Ryan M and Almeida, David R P and Somani, Riz and Boldt, H Culver and Folk, James C and Gehrs, Karen M and Russell, Stephen R} } @article {755, title = {Elimination of infusion bubbles and uncontrolled reflux in the alcon constellation vitrectomy vision system.}, journal = {Retina}, volume = {33}, year = {2013}, month = {2013 Apr}, pages = {803-6}, abstract = {

PURPOSE: To identify the sources and management of 2 problems associated with the Alcon Constellation Vitrectomy (Alcon Laboratories, Inc) System: 1) infusion bubbles and 2) uncontrolled reflux.

METHODS: Surgical and analytical videos were evaluated to identify the source of intraoperative bubbles, which localized to the duckbill valve (DV). Intraoperatively, the authors modified the infusion tubing and its control by removing the DV. The DV was repurposed as a one-way valve to block reflux originating from the vitrectomy console.

RESULTS: Twenty consecutive 23-gauge vitrectomies in 20 eyes of 20 subjects from 2 surgeons (S.R.R. and E.H.S.) were reviewed. Infusion bubbles at the DV developed with each transitory tubing pressure drop upon opening of the infusion clamp. Removal of the DV from the infusion line eliminated infusion bubbles in 20 consecutive 23-gauge cases. Adding a one-way valve, which was fashioned from the DV, to the aspiration tubing, resulted in elimination of infusion bubbles and console-originated reflux in 20 eyes. Placement of the DV to block reflux eliminated both uncontrolled and purposeful console-originated reflux.

CONCLUSION: Intraoperative modification of Constellation tubing may eliminate two potentially harmful problems until manufacturer correction is instituted. Because the authors{\textquoteright} modified connections represent off-label connectivity, the manufacturer cannot contact potentially affected surgeons or suggest temporary alternative connectivity improvements.

}, keywords = {Gases, Humans, Intraoperative Complications, Microbubbles, Retinal Perforations, Video Recording, Vitrectomy, Vitreoretinal Surgery}, issn = {1539-2864}, doi = {10.1097/IAE.0b013e31826c20c6}, author = {Russell, Stephen R and Sohn, Elliott H and Boldt, H Culver and Folk, James C and Tarantola, Ryan M and Kay, Christine N and Mahajan, Vinit B} } @article {767, title = {Intraoperative sclerotomy-related retinal breaks during 23-gauge pars plana vitrectomy.}, journal = {Retina}, volume = {33}, year = {2013}, month = {2013 Jan}, pages = {136-42}, abstract = {

PURPOSE: To study the incidence and characteristics of intraoperative sclerotomy-related retinal breaks encountered during 23-gauge pars plana vitrectomy.

METHODS: A retrospective consecutive case series was assembled from the surgical logs and charts of patients who underwent 23-gauge pars plana vitrectomy. Demographic data and preoperative, intraoperative, and postoperative records were examined.

RESULTS: A total 548 eyes met the inclusion criteria. Of them, 145 eyes underwent pars plana vitrectomy for repair of a rhegmatogenous retinal detachment (RRD) and 403 eyes for other indications. Sclerotomy-related retinal breaks were found in 8 of 548 (1.45\%) eyes. No breaks were found in the 145 RRD eyes. In non-RRD cases, 8 of 403 (1.98\%) eyes had sclerotomy-related breaks. All breaks were adjacent to the superior sclerotomies. The incidence of postoperative retinal detachment was 0\% (0 of 403) in the non-RRD group. In eyes with breaks, the primary surgical indication was vitreomacular traction in six of eight eyes and epiretinal membrane in two of eight eyes. Posterior vitreous detachment was absent in six of eight eyes, and six of eight eyes were phakic. Eyes with vitreomacular traction had a significantly higher incidence of breaks (P < 0.0001). Eyes with a surgical indication other than RRD had a higher incidence of breaks, but this was not statistically significant when compared with eyes with RRD (P = 0.087).

CONCLUSION: Pars plana vitrectomy (23-gauge) is associated with a low incidence of sclerotomy-related retinal breaks and postoperative retinal detachments. Eyes with breaks are more likely to be phakic and without a preoperative posterior vitreous detachment. The presence of vitreomacular traction may be a risk factor for the development of intraoperative sclerotomy-related breaks.

}, keywords = {Aged, Aged, 80 and over, Female, Follow-Up Studies, Humans, Incidence, Intraoperative Complications, Male, Microsurgery, Middle Aged, Postoperative Complications, Retinal Detachment, Retinal Perforations, Retrospective Studies, Sclerostomy, Tomography, Optical Coherence, Visual Acuity, Vitrectomy}, issn = {1539-2864}, doi = {10.1097/IAE.0b013e31825e1d62}, author = {Tarantola, Ryan M and Tsui, Janet Y and Graff, Jordan M and Russell, Stephen R and Boldt, H Culver and Folk, James C and Mahajan, Vinit B} } @article {777, title = {Re: Intraoperative choroidal detachment during 23-gauge vitrectomy.}, journal = {Retina}, volume = {32}, year = {2012}, month = {2012 Feb}, pages = {411}, keywords = {Choroid Diseases, Drainage, Humans, Incidence, Intraoperative Complications, Microsurgery, Retinal Detachment, Retinal Perforations, Risk Factors, Vitrectomy}, issn = {1539-2864}, doi = {10.1097/IAE.0b013e3182398122}, author = {Tarantola, Ryan M and Mahajan, Vinit B} } @article {159, title = {Effects of vitrectomy on age-related macular degeneration.}, journal = {Ophthalmology}, volume = {117}, year = {2010}, month = {2010 Jul}, pages = {1381-6}, abstract = {

To determine whether vitrectomy alters the long-term progression of age-related macular degeneration (AMD).

}, keywords = {Aged, Aged, 80 and over, Case-Control Studies, Choroidal Neovascularization, Disease Progression, Epiretinal Membrane, Female, Follow-Up Studies, Geographic Atrophy, Humans, Macular Degeneration, Male, Middle Aged, Pilot Projects, Retinal Perforations, Retrospective Studies, Visual Acuity, Vitrectomy}, author = {Roller, A Brock and Mahajan, Vinit B and Boldt, H Culver and Abr{\`a}moff, Michael D and Russell, Stephen R and Folk, James C} }