Posterior vitreous detachment (PVD) is a common phenomenon in the aging eye. However, this may be complicated by persistent symptomatic vitreomacular adhesions that exert tractional forces on the macula (vitreomacular traction; VMT). VMT itself may be associated with epiretinal membrane formation and the development of idiopathic macular holes (IMH). Such pathologies may cause visual disturbances, including metamorphopsia, photopsia, blurred vision, and decreased visual acuity, which impact an individual's quality of life. Technologies such as optical coherence tomography allow an increasingly more accurate visualisation of the macular anatomy, including quantification of macular hole characteristics, and this facilitates treatment decision-making. Pars plana vitrectomy remains the primary treatment option for many patients with VMT or IMH; for the latter, peeling of the inner limiting membrane (ILM) of the retina has shown improved outcomes when compared with no ILM peeling. The development of narrow-gauge transconjunctival vitrectomy systems has improved the rate of visual recovery following surgery. Ocriplasmin, by degrading laminin and fibronectin at the vitreoretinal interface, may allow induction of PVD in a non-invasive manner. Indeed, clinical studies have supported its use as an alternative to surgery in certain patient populations. However, further research is still needed with respect to greater understanding of the pathophysiology underlying the development of VMT and IMH.

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Idiopathic vitreomacular traction and macular hole: a comprehensive review of pathophysiology, diagnosis, and treatment

Modern cataract surgery is safe in more than 95 per cent of patients. In the small number of cases where a serious complication occurs, the most common is an intra-operative posterior capsular rupture. This can lead to vitreous loss or a dropped nucleus and can increase the risk of post-operative cystoid macular oedema or retinal detachment. Post-operatively, posterior capsular opacification is the most common complication and can be readily treated with a YAG capsulotomy. The most devastating complication is endophthalmitis, the rate of which is now significantly decreased through the use of intracameral antibiotics. As a clinician, the most important step is to assess the patient pre-operatively to predict higher risk individuals and to counsel them appropriately. In these patients, various pre- or intra-operative management steps can be taken in addition to routine phacoemulsification to optimise their visual outcome.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1444-0938.2010.00516.x

Complications of cataract surgery

Microplasmin intravitreal administration in patients with vitreomacular traction scheduled for vitrectomy: the MIVI I trial.

Purpose:Floaters impact vision but the mechanism is unknown. We hypothesize that floaters reduce contrast sensitivity function, which can be normalized by vitrectomy, and that minimally invasive vitrectomy will have lower incidences of retinal tears (reported at 30%) and cataracts (50–76%).Methods:S

VITRECTOMY FOR FLOATERS: Prospective Efficacy Analyses and Retrospective Safety Profile

Iatrogenic Retinal Breaks in 25-gauge Macular Surgery

Clinical features and outcomes of pars plana vitrectomy in patients with retained lens fragments.

Retinal detachment in eyes undergoing pars plana vitrectomy for removal of retained lens fragments

Retinal Breaks Observed During Pars Plana Vitrectomy

Objective To determine whether a single topical aqueous suppressant applied immediatelyafter pars plana vitrectomy with long-acting gas tamponade prevents intraocularpressure (IOP) elevation. Methods Fifty patients who met the inclusion criteria and underwent pars planavitrectomy with long-acting gas tamponade were randomized to receive a combinationof timolol maleate and dorzolamide hydrochloride, long-acting timolol alone,dorzolamide alone, or placebo at the conclusion of surgery. The IOP was checkedby a portable, handheld tonometer (Tono-Pen) at the conclusion of surgeryand at 5 hours, 1 day, and 1 week after surgery. Results There were no significant differences in IOP among the groups at theconclusion of surgery. The IOP at 5 hours after surgery (27.0 vs 17.4 mm Hg; P P = .01) showed a statistically significant differencebetween the placebo and timolol-dorzolamide groups. The timolol-dorzolamidegroup showed greater IOP control than either the timolol alone or the dorzolamidealone groups at 5 hours ( P = .04 for both). Conclusion The use of a single topical aqueous suppressant (timolol-dorzolamide)given after pars plana vitrectomy with long-acting gas tamponade effectivelyprevents significant postoperative IOP elevation at 5 hours and 1 day aftersurgery.

/pdf/immediate-postoperative-use-of-a-topical-agent-to-prevent-58hbzdcuhx.pdf

Immediate postoperative use of a topical agent to prevent intraocular pressure elevation after pars plana vitrectomy with gas tamponade.

right eye and counting ﬁngers in the left eye. Intraocular pressure was 15 mm Hg in the right eye and 6 mm Hg in the left eye by applanation tonometry. Gonioscopy revealed a cyclodialysis cleft, and funduscopic examina-tion revealed hypotony maculopathy (Fig. 1). Predniso-lone was tapered and argon laser photocoagulation was applied to the cyclodialysis cleft

Jeffrey K. Moore

Papers

Clinical features and outcomes of pars plana vitrectomy in patients with retained lens fragments.

Retinal detachment in eyes undergoing pars plana vitrectomy for removal of retained lens fragments

Retinal Breaks Observed During Pars Plana Vitrectomy

Immediate postoperative use of a topical agent to prevent intraocular pressure elevation after pars plana vitrectomy with gas tamponade.

Cyclodialysis and Hypotony Maculopathy