Eyeworld

53 EW RESIDENTS August 2018 be around 40 days. 8,12 The authors do include a separate analysis for 40 eyes with extremely short follow-up (less than 1 month). However, one could argue that these eyes should have been excluded from the analy- sis entirely and that the full distri- bution of follow-up periods should have been disclosed. The major goal of this study was to prove safety and efficacy of a one- port pars plana technique; however, there are several future endeavors by which this study could gain broader applicability. It is possible that this technique is only safe in the hands of surgeons experienced in complex anterior segment surgeries; expand- ing use of the one-port technique to multiple surgeons and in mul- tiple surgical environments could further cast light on its true safety profile. In a similar vein, the one- port technique was not compared to a three-port technique used by the same surgeon, whose skill may have offered a better-than-average complication profile, thus negating the one-port's advantage. Finally, a one-port technique has previously been used for selected vitreoretinal disorders using a 25-G incision 13,14 and an indirect ophthal- moscope with condensing lens. It would be interesting to see if these anterior vitrectomies could also be performed with a smaller-gauge port. EW References 1. Coleman AL. How big data informs us about cataract surgery: The LXXII Edward Jackson Memorial Lecture. Am J Ophthalmol. 2015;160:1091–1103. 2. Chalam KV, Shah VA. Successful manage- ment of cataract surgery associated vitreous loss with sutureless small-gauge pars plana vitrectomy. Am J Ophthalmol. 2004;138:79– 84. 3. Jacobs PM. Vitreous loss during cataract surgery: prevention and optimal management. Eye (Lond). 2008;22:1286–9. 4. Chiu CS. 2013 update on the management of posterior capsular rupture during cataract surgery. Curr Opin Ophthalmol. 2014;25:26– 34. 5. Hong AR, et al. Intraoperative management of posterior capsular rupture. Curr Opin Oph- thalmol. 2015;26:16–21 6. Gosse E, et al. The incidence and distribu- vitrectomy was 3.39 in comparison to pneumatic retinopexy with cryo- therapy. 11 Taken together, this sug- gests that vitrectomy may portend a higher risk of vitreous hemorrhage, which must be considered by the anterior segment surgeon desiring to use the single-port pars plana vitrec- tomy technique for limited anterior vitrectomy. This study has a number of strengths. First, it is a relatively large study for a technique that is infrequently performed in the era of modern phacoemulsification. Detec- tion of rare complications requires a large sample size, and 348 instances of one-port pars plana vitrectomy is impressive. Second, the fact that all surgeries were performed by the same surgeon ensures standardiza- tion of the technique, and precludes the need to control for variability in surgeon experience and skill. Third, a wide variety of postop complica- tions were included as main out- come measures. Nevertheless, concerns should be raised about the applicability of the study to a routine cataract sur- gery practice. The introduction and conclusion include much discussion about the management of vitre- ous loss during anterior segment surgery, implying that one goal of this paper is to prove the safety of one-port pars plana vitrectomy in the management of vitreous pro- lapse. However, it is unclear how many of the 348 cases in this study actually involved prolapsed vitreous, as the vast majority of cases (97.7%) were scheduled as planned anterior vitrectomies. Many of the listed indications for vitrectomy do not necessarily imply that vitreous had in fact been prolapsed at any time, either before or during the case. One could speculate that the complica- tion rates might be higher had only cases with vitreous prolapse been included in this study. Another drawback of the study design is the limited/variable follow- up period. Large studies have sug- gested that the median time from cataract surgery to retinal detach- ment may be as long as 11 months, and the average time to onset of pseudophakic macular edema may tion of iatrogenic retinal tears in 20-gauge and 23-gauge vitrectomy. Eye (Lond). 2012;26:140–3. 7. Olsen T, Jeppesen P. The incidence of reti- nal detachment after cataract surgery. Open Ophthalmol J. 2012;6:79–82. 8. Clark A, et al. Risk for retinal detachment after phacoemulsification: a whole-population study of cataract surgery outcomes. Arch Ophthalmol. 2012;130:882–8. 9. Daien V, et al. Incidence, risk factors, and impact of age on retinal detachment after cat- aract surgery in France: a national population study. Ophthalmology. 2015;122:2179–85. 10. Khan MA, et al. Scleral fixation of intra- ocular lenses using Gore-Tex suture: clinical outcomes and safety profile. Br J Ophthalmol. 2016;100:638–43. 11. Brillat E, et al. A case-control study to assess aspirin as a risk factor of bleeding in rhegmatogenous retinal detachment surgery. Graefes Arch Clin Exp Ophthalmol. 2015;253:1899–905. 12. Chu CJ, et al. Risk factors and incidence of macular edema after cataract surgery: a database study of 81984 eyes. Ophthalmolo- gy. 2016;123:316–23. 13. Gualtieri W. One-port pars plana vitrecto- my (by 25-G micro-incision). Graefes Arch Clin Exp Ophthalmol. 2009;247:495–502. 14. Bahar I, Weinberger D. One-port 25-gauge pars plana vitrectomy with indirect ophthal- moscopy for treatment of endophthalmitis. Retin Cases Brief Rep. 2008;2:21–3. Contact information Culican: culican@wustl.edu of single-port pars plana anterior anterior segment surgery" Long-term safety and efficacy of single-port pars plana anterior vitrectomy with limbal infusion during anterior segment surgery Ivey Thornton, MD, Brian McMains, MS, Michael Snyder, MD J Cataract Refract Surg. 2018;44(7). Article in press. Purpose: To report the safety and efficacy of single-port pars plana anterior vitrectomy. Setting: Study performed by a single surgeon (MES) at a single institution over a 6-year time span. Design: This is a retrospective observational chart review of 333 patients (348 eyes) who underwent one-port pars plana anterior vitrectomy. Methods: Eyes that underwent anterior vitrectomy from September 2010 to June 2016 were electronically identified. Charts were reviewed for demographics, history of ocular trauma, underlying ocular or systemic comorbidity, surgical indications, outcomes and postoperative complications. Results: The mean postoperative follow-up was 10.9 months with a mean age of 62.4 years old. Three hundred thirty-five eyes (97.7%) were scheduled as planned anterior vitrectomies, while eight eyes (2.3%) were performed unexpectedly after posterior capsular ruptures. Eighty- two eyes (23.9%) had a history of trauma. Twenty-five eyes (7.3%) had documented postoperative CME, while seven of these eyes had known preoperative CME. There were a total of three eyes (0.9%) with retinal detachments and one eye (0.3%) with a retinal tear without detachment. There were no cases of endophthalmitis and no evidence of residual vitreous prolapse in the anterior chamber in any eyes postoperatively. Conclusions: This study shows that the safety and efficacy profile of the pars plana technique compares favorably against historical data for both coaxial and bimanual limbal clear corneal infusion and cutting. Sutureless pars plana anterior vitrectomy may be considered a safe and reliable solution for the anterior segment surgeon in managing vitreous prolapse during anterior segment surgeries.

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