Department of Vitreoretinal Surgery, The Rotterdam Eye Hospital, Rotterdam, the Netherlands.
The Rotterdam Ophthalmic Institute, Rotterdam, the Netherlands.
Acta Ophthalmol. 2019 Aug;97(5):e747-e752. doi: 10.1111/aos.13991. Epub 2018 Dec 7.
Unremoved vitreoschisis-induced vitreous cortex remnants (VCR) are associated with macular pathology. When present on the retinal periphery, they may play a role in proliferative vitreoretinopathy and retinal detachment after vitrectomy. Existing instruments for their removal involve substantial risk of iatrogenic retinal damage. Purpose of this study was to evaluate the use of a new technique, Vitreous Wiping, for removal of VCR during vitrectomy.
Proof-of-concept case series of six eyes (six patients) treated with vitrectomy for various pathologies (macula-on and macula-off retinal detachment, macular hole, macular pucker and vitreous floaters). Vitreous cortex remnants on the surface of the retina were visualized with triamcinolone and removed by Vitreous Wiping with a rectangular piece of polyvinyl alcohol (PVA) held with intra-ocular forceps. Visual acuity and clinical course were assessed during a follow-up of 6 months. All eyes underwent postoperative macular optical coherence tomography. Eyes without preoperative macular pathology, underwent retinal sensitivity testing and eyes without paracentral pathology underwent visual field analysis.
Vitreous cortex remnants could be removed completely in all eyes. There were no intra- or postoperative complications. We observed that PVA is soft like a sponge and vitreous sticks to it, making Vitreous Wiping easier and safer, compared to alternative instruments. Visual acuity improved in all eyes. Microperimetry and visual field analysis revealed no abnormalities related to Vitreous Wiping.
Vitreoschisis-induced VCR can be removed effectively and safely from the retinal surface by Vitreous Wiping. Larger studies are needed to confirm this promising finding and its potential impact.
未清除的玻璃体后皮质残余物（VCR）与黄斑病变有关。当它们位于视网膜周边时，可能在玻璃体切割术后增殖性玻璃体视网膜病变和视网膜脱离中起作用。现有的清除这些残余物的器械存在很大的医源性视网膜损伤风险。本研究旨在评估一种新的技术，即玻璃体擦拭术，用于在玻璃体切割术中清除 VCR。
对 6 只眼（6 例患者）进行玻璃体切割术治疗各种病变的概念验证性病例系列研究（黄斑区视网膜脱离和黄斑区脱离、黄斑裂孔、黄斑前膜和玻璃体浮游物）。用曲安奈德将视网膜表面的玻璃体皮质残余物可视化，并通过用眼内镊子夹住的矩形聚乙烯醇（PVA）片进行玻璃体擦拭术将其清除。在 6 个月的随访期间评估视力和临床过程。所有眼睛均行术后黄斑光学相干断层扫描。无术前黄斑病变的眼睛行视网膜敏感度测试，无旁中心病变的眼睛行视野分析。
所有眼睛的玻璃体皮质残余物均能完全清除。无术中或术后并发症。我们观察到，与其他器械相比，PVA 柔软如海绵，玻璃体可粘在其上，这使得玻璃体擦拭术更简单、更安全。所有眼睛的视力均有所提高。微视野和视野分析未发现与玻璃体擦拭术相关的异常。
玻璃体后皮质诱导的 VCR 可以通过玻璃体擦拭术有效地从视网膜表面清除，且安全可靠。需要更大的研究来证实这一有前途的发现及其潜在影响。
