@article {2037, title = {Intraoperative Complications With Vitreous Biopsy for Molecular Proteomics.}, journal = {Ophthalmic Surg Lasers Imaging Retina}, volume = {54}, year = {2023}, month = {2023 Jan}, pages = {32-36}, abstract = {

OBJECTIVE: To study the incidence of intraoperative complications while collecting a vitreous sample for proteomic biomarker analyses during small-gauge pars plana vitrectomy (PPV).

METHODS: A retrospective case series was assembled from the surgical logs and charts of patients who underwent 23-, 25-, and 27-gauge PPV along with an undiluted vitreous biopsy. Primary surgical indication and detailed operative reports were reviewed. Complications specific to vitreous biopsy were assessed while complications related to vitrectomy in general without biopsy were not tabulated.

RESULTS: In 1190 eyes that underwent vitreous biopsy, the most common indications for PPV were rhegmatogenous retinal detachment (24.2\%), epiretinal membrane (ERM) (21.7\%), vitreous hemorrhage (11.0\%), uveitis (8.3\%), and macular hole (7.5\%). An adequate sample of 0.5 cc to 1.0 cc was obtained in all cases. There was one sclerotomy break associated with biopsy, but no instances of lens touch, retinal contusion, retinal detachment, or intraocular hemorrhage.

CONCLUSIONS: Undiluted vitreous biopsy obtained at the time of small-gauge vitrectomy is a generally safe procedure and may be considered for collection of samples for proteomic analysis. .

}, keywords = {Biopsy, Humans, Intraoperative Complications, Postoperative Complications, Proteomics, Retinal Detachment, Retrospective Studies, Vitrectomy}, issn = {2325-8179}, doi = {10.3928/23258160-20221214-02}, author = {Mishra, Kapil and Velez, Gabriel and Chemudupati, Teja and Tang, Peter H and Mruthyunjaya, Prithvi and Sanislo, Steven R and Mahajan, Vinit B} } @article {673, title = {Chronic Recurrent Pseudophakic Endophthalmitis.}, journal = {JAMA Ophthalmol}, volume = {134}, year = {2016}, month = {2016 Apr}, pages = {455-6}, keywords = {Aged, 80 and over, Chronic Disease, Combined Modality Therapy, Drug Therapy, Combination, Endophthalmitis, Female, Follow-Up Studies, Humans, Mycobacterium chelonae, Mycobacterium Infections, Nontuberculous, Recurrence, Risk Assessment, Slit Lamp, Treatment Outcome, Vancomycin, Vitrectomy}, issn = {2168-6173}, doi = {10.1001/jamaophthalmol.2015.3638}, author = {Chin, Eric K and Almeida, David R P and Mahajan, Vinit B} } @article {645, title = {COMBINED VITRECTOMY AND INTRAVITREAL DEXAMETHASONE (OZURDEX) SUSTAINED-RELEASE IMPLANT.}, journal = {Retina}, volume = {36}, year = {2016}, month = {2016 Nov}, pages = {2087-2092}, abstract = {

PURPOSE: To evaluate the safety and efficacy of combining intravitreal dexamethasone implantation (Ozurdex) with pars plana vitrectomy (PPV).

METHODS: A retrospective review was conducted on cases where Ozurdex injection was performed in the operating room in conjunction with pars plana vitrectomy. Our primary outcome measure was the presence of surgical complications in the perioperative and 3-month postoperative window. We also measured visual acuity, intraocular pressure (IOP), and macular edema at baseline, one, and 3 months after surgery.

RESULTS: Fifteen eyes in 14 cases were reviewed. There were no complications intraoperatively or at 1-month postoperatively. Two patients (2 eyes) with prior retinal detachment developed proliferative vitreoretinopathy and redetachment at 3 months. Visual acuity improved in 7 of 15 eyes, and an average improvement of 2 lines was achieved for the entire cohort. There was no overall change in intraocular pressure although 1 patient developed an increase in intraocular pressure \>5 mmHg. Five of 9 patients with baseline macular edema experienced improvement or resolution at 3 months.

CONCLUSION: Intraoperative Ozurdex in combination with PPV may be safe and effective in treating macular edema caused by many different underlying diseases.

}, keywords = {Adult, Aged, Aged, 80 and over, Combined Modality Therapy, Dexamethasone, Drug Implants, Female, Glucocorticoids, Humans, Intraocular Pressure, Intravitreal Injections, Macular Edema, Male, Middle Aged, Retinal Vein Occlusion, Retrospective Studies, Tomography, Optical Coherence, Uveitis, Posterior, Visual Acuity, Vitrectomy, Wet Macular Degeneration}, issn = {1539-2864}, doi = {10.1097/IAE.0000000000001063}, author = {Zheng, Andrew and Chin, Eric K and Almeida, David R P and Tsang, Stephen H and Mahajan, Vinit B} } @article {683, title = {ELEVATED INTRAOCULAR PRESSURE FOLLOWING PARS PLANA VITRECTOMY DUE TO TRAPPED GAS IN THE POSTERIOR CHAMBER.}, journal = {Retin Cases Brief Rep}, volume = {10}, year = {2016}, month = {2016 Fall}, pages = {334-7}, abstract = {

PURPOSE: Elevated intraocular pressure is relatively common following pars plana vitrectomy and intraocular gas tamponade. We discuss a series of patients who experienced elevated intraocular pressure from pupillary block and angle closure secondary to trapped gas in the posterior chamber.

METHODS: Case series.

RESULTS: Case 1 is a patient who underwent pars plana vitrectomy for retinal detachment repair. The intraocular pressure was elevated on postoperative Day 3 because of trapped gas in the posterior chamber, and it did not lower with prone positioning, maximal medical therapy, and laser peripheral iridotomies. Aspiration of the trapped gas was done with the patient sitting upright using a 27-gauge needle at the limbus, which was curative. Case 2 provides anterior-segment optical coherence tomography images that confirmed the location of the trapped gas resulting in angle closure. Case 3 demonstrates the unfortunate sequelae of a central retinal artery occlusion following delayed recognition of this entity. Case 4 highlights the challenges encountered when migratory gas is also seen elsewhere in the eye.

CONCLUSION: Clinicians should be aware of elevated intraocular pressure secondary to trapped gas in the posterior chamber, which may be recalcitrant to medical therapy. Aspiration of the trapped gas can alleviate both pupillary block and angle closure without compromising the gas tamponade.

}, keywords = {Aged, Endotamponade, Female, Gases, Humans, Intraocular Pressure, Male, Middle Aged, Ocular Hypertension, Posterior Eye Segment, Vitrectomy}, issn = {1937-1578}, doi = {10.1097/ICB.0000000000000256}, author = {Chin, Eric K and Almeida, David R P and Strohbehn, Austin L and Mahajan, Vinit B and Russell, Stephen R and Folk, James C} } @article {643, title = {Intravitreal Foscarnet With Concurrent Silicone Oil Tamponade for Rhegmatogenous Retinal Detachment Secondary to Viral Retinitis.}, journal = {Retina}, volume = {36}, year = {2016}, month = {2016 Nov}, pages = {2236-2238}, keywords = {Antiviral Agents, Combined Modality Therapy, Endotamponade, Eye Infections, Viral, Foscarnet, Humans, Intravitreal Injections, Retinal Detachment, Retinitis, Silicone Oils, Vitrectomy}, issn = {1539-2864}, doi = {10.1097/IAE.0000000000001174}, author = {Xu, Kunyong and Chin, Eric K and Mahajan, Vinit B and Almeida, David R P} } @article {647, title = {Management of Pediatric Aphakic Glaucoma With Vitrectomy and Tube Shunts.}, journal = {J Pediatr Ophthalmol Strabismus}, volume = {53}, year = {2016}, month = {2016 Nov 01}, pages = {339-343}, abstract = {

PURPOSE: To review the impact of vitrectomy and tube shunts on mean intraocular pressure (IOP) and number of glaucoma medications in pediatric aphakic glaucoma.

METHODS: A retrospective review of pediatric patients who underwent combined vitrectomy and glaucoma tube shunt surgery for aphakic glaucoma was conducted. Inclusion criteria were: age 18 years or younger, diagnosis of aphakic glaucoma, preoperative IOP data, and postoperative IOP data for at least 6 months. Mean IOP lowering at 1 year, number of glaucoma medications at 1 year, and surgical complications, including tube occlusion in the postoperative period, were noted.

RESULTS: The mean \± standard deviation preoperative IOP was 33.9 \± 10.6 mm Hg (range: 18 to 57 mm Hg) with a mean of three topical IOP-lowering medications. A total of 5 (36\%) Ahmed and 9 (64\%) Baerveldt tube shunts were placed. One of the Baerveldt tube shunt procedures was combined with revision of a traumatically dislocated tube. The mean IOP at 12 months postoperatively was 16.6 \± 5.8 mm Hg (range: 6 to 28 mm Hg; P \< .01, t = 3.74, df = 13) with a mean of 2.3 glaucoma medications. There were no cases of tube occlusion, corneal decompensation, endophthalmitis, or retinal detachment over the 12 months of follow-up.

CONCLUSIONS: Combined vitrectomy and placement of a glaucoma tube shunt can be safe and effective in lowering IOP based on mean IOP values and number of glaucoma medications at 1 year. [J Pediatr Ophthalmol Strabismus. 2016;53(6):339-343.].

}, keywords = {Adolescent, Aphakia, Postcataract, Cataract, Cataract Extraction, Child, Child, Preschool, Female, Glaucoma, Glaucoma Drainage Implants, Humans, Infant, Intraocular Pressure, Male, Retrospective Studies, Visual Acuity, Vitrectomy}, issn = {1938-2405}, doi = {10.3928/01913913-20160818-01}, author = {Elshatory, Yasser M and Gauger, Elizabeth H and Kwon, Young H and Alward, Wallace L M and Boldt, H Culver and Russell, Stephen R and Mahajan, Vinit B} } @article {681, title = {SURGICAL EMBOLECTOMY FOR FOVEA-THREATENING ACUTE RETINAL ARTERY OCCLUSION.}, journal = {Retin Cases Brief Rep}, volume = {10}, year = {2016}, month = {2016 Fall}, pages = {331-3}, abstract = {

PURPOSE: To describe a technique of surgical intraocular embolectomy in patients with acute fovea-threatening branch retinal artery occlusion.

METHODS: Pars plana vitrectomy with embolectomy involving embolus isolation, dissection, and removal in patients with an acute fovea-threatening arterial occlusion without a patent cilioretinal artery.

RESULTS: The surgical technique involves a core vitrectomy. The blocked artery is incised using a microvitreoretinal blade, and microsurgical forceps are used to retrieve the embolus. No significant complications were noted. The study technique offers an excellent safety profile and minimizes the risk of vitreous hemorrhage by carefully dissecting the vascular adventitial sheath and isolating the embolus.

CONCLUSION: Surgical embolectomy is a viable technique for patients with acute fovea-threatening arterial occlusions without patent cilioretinal artery. Careful dissection and retrieval of the embolus minimizes the risk of vitreous hemorrhage, which is an important improvement in previous techniques for management of acute retinal arterial occlusions.

}, keywords = {Acute Disease, Embolectomy, Humans, Retinal Artery Occlusion, Treatment Outcome, Vitrectomy}, issn = {1937-1578}, doi = {10.1097/ICB.0000000000000257}, author = {Almeida, David R P and Mammo, Zaid and Chin, Eric K and Mahajan, Vinit B} } @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 {685, title = {Management of Choroidal Granulomas Involving the Macula in Corticosteroid-Intolerant Patients.}, journal = {JAMA Ophthalmol}, volume = {133}, year = {2015}, month = {2015 Nov}, pages = {1351-2}, keywords = {Adult, Choroid Diseases, Combined Modality Therapy, Dexamethasone, Drug Therapy, Combination, Drug Tolerance, Folic Acid Antagonists, Glucocorticoids, Granuloma, Humans, Interferon-gamma Release Tests, Intravitreal Injections, Macula Lutea, Male, Methotrexate, Tuberculoma, Tuberculosis, Ocular, Vitrectomy}, issn = {2168-6173}, doi = {10.1001/jamaophthalmol.2015.1951}, author = {Chin, Eric K and Almeida, David R P and Mahajan, Vinit B} } @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 {113, title = {23-gauge pediatric vitrectomy using limbus-based trocar-cannulas.}, journal = {Retina (Philadelphia, Pa.)}, volume = {32}, year = {2012}, month = {2012 May}, pages = {1023-7}, keywords = {Catheters, Child, Child, Preschool, Female, Glaucoma Drainage Implants, Humans, Infant, Male, Microsurgery, Retinal Detachment, Retrospective Studies, Vitrectomy, Vitreous Hemorrhage}, author = {Kay, Christine N and Quiram, Polly H and Mahajan, Vinit B} } @article {129, title = {Proteomic analysis of vitreous biopsy techniques.}, journal = {Retina}, volume = {32}, year = {2012}, month = {2012 Nov-Dec}, pages = {2141-9}, abstract = {

PURPOSE: To compare vitreous biopsy methods using analysis platforms used in proteomics biomarker discovery.

METHODS: Vitreous biopsies from 10 eyes were collected sequentially using a 23-gauge needle and a 23-gauge vitreous cutter instrument. Paired specimens were evaluated by UV absorbance spectroscopy, sodium dodecyl sulfate-polyacrylamide gel electrophoresis, and liquid chromatography tandem mass spectrometry (LC-MS/MS).

RESULTS: The total protein concentration obtained with a needle and vitrectomy instrument biopsy averaged 1.10 mg/mL (standard error of the mean = 0.35) and 1.13 mg/mL (standard error of the mean = 0.25), respectively. In eight eyes with low or medium viscidity, there was a very high correlation (R = 0.934) between the biopsy methods. When data from 2 eyes with high viscidity vitreous were included, the correlation was reduced (R = 0.704). The molecular weight protein sodium dodecyl sulfate-polyacrylamide gel electrophoresis profiles of paired needle and vitreous cutter samples were similar, except for a minority of pairs with single band intensity variance. Using LC-MS/MS, equivalent peptides were identified with similar frequencies (R \≥ 0.90) in paired samples.

CONCLUSION: Proteins and peptides collected from vitreous needle biopsies are nearly equivalent to those obtained from a vitreous cutter instrument. This study suggests both techniques may be used for most proteomic and biomarker discovery studies of vitreoretinal diseases, although a minority of proteins and peptides may differ in concentration.

}, keywords = {Adolescent, Aged, Biological Markers, Biopsy, Chromatography, Liquid, Electrophoresis, Polyacrylamide Gel, Eye Diseases, Eye Proteins, Female, Humans, Male, Middle Aged, Proteomics, Spectrophotometry, Ultraviolet, Tandem Mass Spectrometry, Vitrectomy, Vitreous Body, Young Adult}, author = {Skeie, Jessica M and Brown, Eric N and Martinez, Harryl D and Russell, Stephen R and Birkholz, Emily S and Folk, James C and Boldt, H Culver and Gehrs, Karen M and Stone, Edwin M and Wright, Michael E 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} }