The aim of this study was to find out the etiology of non-resolving vitreous hemorrhage (VH) and find out its surgical outcome. This is a prospective, interventional hospital-based study extending over 24 months. Patients presenting with non-resolving VH, who had undergone microincision vitrectomy were included in the study. Follow-ups were done up to one 1 year for cases who required more than one intervention and at sixth week for final visual acuity. Around 61 eyes of 59 patients with non-resolving VH were studied within a two-year study period (January 2018 to December 2019). The sample size calculated was 55 or more cases with a prevalence of 0.005. The data followed a normal distribution. Male: Female ratio was 48:11. Right eye: Left eye ratio was 41:20. Mean age of presentation for males was 50.60 ± 15.01 years and for females was 54.27 ± 8.55 years. Dimness of vision was the main presenting complaint in 81.96% ( n = 50 eyes), who had presented in a mean duration of 67.96 ± 79.29 months since the symptoms. Diabetes mellitus was present in 45.7% patients ( n = 27), which was the major systemic cause of VH. Proliferative diabetic retinopathy was the most commonest ocular cause of VH, found in 26 eyes (42.6%). In non-insulin -dependent diabetes mellitus (NIDDM), 9 eyes (33.3%) presented with VH within 0-10 years and in insulin-dependent diabetes mellitus (IDDM), 6 eyes (22.2%) had presented within 11-20 years. Cataract was present in 19 eyes (31.1%). Other systemic causes of VH were hypertension 18.03% ( n = 11), coronary arterial disorder (CAD) and nephropathy 3.38% ( n = 2 each), and anemia, paraplegia, and thyroid disorder 1.69% ( n = 1 each). Other ocular causes of VH were branch retinal vein occlusion (BRVO) 18.03% ( n = 11 eyes), trauma 11.4% ( n = 7 eyes), incomplete posterior vitreous detachment (ICPVD) 6.55% ( n = 4 eyes), Eales periphlebitis and posterior vitreous detachment (PVD) with retinal detachment (RD) 3.27% ( n = 2 eyes each), pseudophakic RD, choroidal neovascular membrane (CNVM), old retinochoroiditis, Falciparum band, macroaneurysm, and central retinal vein occlusion (CRVO) each 1.63% ( n = 1 eye of each). Mean pre-operative visual acuity was 1.21 ± 0.44 and mean postoperative visual acuity was 0.66 ± 0.54 (logarithm of the minimum angle of resolution [logMAR]), which was highly significant ( P -value = 0.000 paired t -test). About 26.2% eyes ( n = 16) had intraocular pressure (IOP) spikes post operatively which were treated with anti- glaucoma drugs. Six (9.8%) of the patients had to undergo re-vitrectomy. Non-resolving VH can be one of the major causes of profound visual loss and can occur with variable pathologies at any age. Early intervention in the form of micro-incision vitrectomy helps to treat the condition with a very good visual outcome.
Interface fluid syndrome (IFS) is a rare complication seen post-laser-assisted in situ keratomileusis (post-LASIK). This report describes two unusual cases in which patients underwent ocular surgeries and developed delayed onset interface fluid. Both the patients had undergone uneventful laser-assisted in situ keratomileusis (LASIK) decades ago; case 1 underwent uneventful phacoemulsification and vitrectomy with gas tamponade and case 2 underwent uneventful phacoemulsification with intraocular lens implantation. Possible causes of IFS could be steroid-induced intraocular pressure (IOP) spike, intraocular inflammation, or both. IFS can be seen any time after refractive surgeries and can be a lifelong complication after LASIK surgery. Inaccurate IOP measurement due to underestimation should be borne in mind while measuring IOP in such patients. This report highlights the challenges in diagnosing IFS and the importance of correct IOP measurement in such cases to avoid irreversible vision loss.
IntroductionRecent technologies and new devices continue to be developed in vitreoretinal surgeries, and they provide more details, enhance safety, improve surgeons' comfort, and better visual and anatomical outcomes. Some devices have been used for better visualization during surgery, and some help the operation performance. They are divided into the following titles: Intraoperative OCT (including hand-held, probe-integrated, and microscope-integrated OCT), three-dimensional visualization system, virtual reality system, endoscopic vitrectomy (fiber optics and non-fiber optics), wide-angle viewing systems (contact and non-contact lenses), endo-illumination, light filters, chromovitrectomy, the retinal prosthesis (including epiretinal, subretinal, and suprachoroidal devices), robot-assisted vitreoretinal surgery, newer Vitreoretinal instruments, gene and cell therapy.Areas coveredIn this narrative review, we focused on PubMed articles between 2010-2023 with these keywords: 'Optical Coherence Tomography,' 'Three-Dimensional,' 'Virtual System,' 'intraoperative,' 'endoscopic,' 'vitrectomy,' 'lens,' 'illumination,' 'filters,' 'chromovitrectomy,' 'prosthesis,' 'robotic surgery,' 'instrument,' 'gene,' 'cell.'Expert opinionThe main aim of this review is to update the reader on the latest progression in intraoperative imaging and surgical vision technologies and to provide an understanding of how each has helped improve operation and surgical outcomes. The surgeons should know recent updates to do their best and achieve the most excellent results.
