Abstract
Purpose:
To present the concept of a new standard operating procedure (SOP) enhancing the diagnostic examinations and surgical procedures to the exacting needs of patients suffering from symptomatic vitreous opacities.
Methods:
A retrospective study of 102 patients (117 eyes) was performed to evaluate patient satisfaction associated with symptomatic vitreous opacaties. We perform an interactive evaluation to detect the clinical significance of patient’s opacities using (1) quality-of-life questionaires (the NEI-VFQ-25 and a customized FFQ-22 test), (2) pictures drawn by hand on paper and (3) into a scanner and (4) a contrast vision test (CVA). Before surgery, we use biomicroscopy, OCT and eventually ultrasonography to select the preferred device for performing a core pars plana vitrectomy (cPPV) in the individual eye: (a) single-incision-site Intrector®, (b) a two-incision-site Retrector® or (c) a three-port cannula setup.1
Results:
117 eyes were followed over 24 months. No eye showed clinically significant lens changes post cPPV. 95% were satisfied after the initial intervention and 100% after the second one. In one eye we found a retinal hole with a limited retinal detachment. In 86% of cases, the response to a single or two-site 23 g cPPV was immediate. 14% noticed visual perception changes over a time period of 90-120 days. In a subgroup analysis (n = 20), the NEI-VFQ-25 and the FFQ-22 correlated well preoperatively (rho = 0.510, p < 0.05) and postoperatively (rho = 0.476, p < 0.05). The FF-22 described the changes in quality of life (p = 0.001289), wellbeing (p = 0.072834) and the type of vision disorder (p = 0.000082) with significant changes in 85% of eyes (Wilcoxon-matched-pair-test: p = 0.000082). When quality of vision was recorded with the CVA, remarkable details about the vision under mesopic and glare conditions were obvious.
Conclusions:
PVD induced vitreous opacities have a significant impact on the patients quality of life.2 As part of this SOP, performing all tests contributed substantially to the patient’s satisfaction and subsequent decision regarding removal of symptomatic vitreous opacifications in their second eye. 1 Frank H. Koch, MD, PhD; Michael J. Koss, MD, FEBO. Microincision Vitrectomy Procedure Using Intrector Technology. Arch Ophthalmol. 2011;129:1599-1604 2 Jerry Sebag. Am. J. Ophthalmology, 2011; 152 Editorial , 3e.1-4 e.1
Keywords: 762 vitreoretinal surgery •
697 retinal detachment •
445 cataract