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It is known that social factors affect the choice of treatments, and special attention has been paid to sex differences. The purpose of this study was to determine whether regional and sex differences exist in the treatment of rhegmatogenous retinal detachment (RD). We used Japan-RD Registry database of 2523 patients aged ≥ 40 years between February 2016 and March 2017 in 5 Japanese regions. Regional differences of patients' perioperative factors were analyzed. The factors affecting the proportion of patients who underwent surgery within one week of the onset, defined as early-surgery, were examined by logistic regression. We observed regional differences in perioperative factors, especially in the use of phacovitrectomy, general anesthesia, and air-tamponade, which was higher in certain regions. (Fisher's exact test, all P = 0.012) The proportion of early-surgery was significantly higher among men in Kyushu region (Odds ratio (OR) 1.83; 95% confidence interval (CI) 1.08-3.12; P = 0.02), and it was also significantly higher after adjusting for covariates (OR 1.89; 95% CI 1.06-3.42; P = 0.02). Regional and sex differences exist in the treatment of RD in Japan. Although there was no significant differences in the anatomical outcomes, women in certain regions of Japan are less likely to receive early surgical intervention for RD., (© 2021. The Author(s).)

To determine the surgical outcomes and prognostic factors of cytomegalovirus (CMV) retinitis-related retinal detachment (RD) in acquired immune deficiency syndrome (AIDS) patients following vitrectomy.A retrospective charts review was carried out on AIDS patients who were diagnosed with CMV retinitis-related RD and treated with vitrectomy between 2002 and 2016. The main outcome measures were the rates of primary anatomical success and final visual acuity (VA) success defined as postoperative VA ≥20/200. Kaplan-Meier curves on the time to retinal redetachment were performed. Multivariate logistic regression models based on a directed acyclic graph were used to identify independent factors associated with achieving VA success.Forty five AIDS patients (52 eyes) were included. Over a mean follow-up period of 41.7 months, primary anatomical success was achieved in 44 eyes (84.6%) and VA success was achieved in 34 eyes (65.4%). Receiving highly active antiretroviral therapy (HAART) prior to RD (adjusted odds ratio [aOR]=4.9, P = .043), better preoperative VA (aOR = 4.3, P = .006), undergoing vitrectomy within 3 months (aOR=6.7, P = .008), absence of optic atrophy (aOR=58.1, P < .001), and absence of retinal redetachment (aOR=38.1, P = .007) increased the odds of achieving final VA success.Vitrectomy provided favorable anatomical reattachment in AIDS patients with CMV retinitis-related RD. Majority of patients was able to retain functional vision postoperatively. The use of HAART and early vitrectomy increased the probability of achieving both anatomical and VA success.

Purpose: To assess the trends in pars plana vitrectomy surgery rates and factors affecting rate change between 2002 and 2013 in South Korea., Methods: Data from National Health Insurance Service-National Sample Cohort 2002-2013, which represents 1,025,340 samples with a sampling rate of 2.2% from the total eligible Korean population, was analyzed., Results: A total of 3,816 vitrectomy procedures were performed (male, 2,010; female, 1,806) from 2002 to 2013. Annual rates of vitrectomy increased from 15.1 (in 2002) to 49.4 (in 2013) per 100,000 individuals, and this trend was prominent in those aged 60 years or older. As for the anesthetic method, vitrectomy under local anesthesia increased more prominently than vitrectomy under general anesthesia. The most common diagnoses associated with vitrectomy were diabetic retinopathy, retinal detachment, epiretinal membrane, and macular hole., Conclusions: The average annual rate of vitrectomy surgery was 31.5 per 100,000 between 2002 and 2013, and the rate has steadily increased., Competing Interests: No potential conflict of interest relevant to this article was reported., (© 2017 The Korean Ophthalmological Society)

Purpose: To establish a quality indicator that could be used in optimizing treatment for rhegmatogenous retinal detachment (RRD)., Methods: The Danish National Patient Registry was used to identify surgery conducted in Denmark for RRD in the period 01 January 2001-31 December 2009. Cases were identified by diagnosis and surgical codes., Results: A total of 6522 cases were operated for a primary RRD in the study period, and 22% (1434 patients) were reoperated for a redetachment. A Cox regression analysis showed that the risk of redetachment was equal to or less than detachment on the fellow eye 1 year after primary surgery with techniques not using silicone oil. The same was true 1.5 years after surgery for techniques using silicone oil. Based on this, we established a quality indicator defining failure as the need for operation for redetachment within 1 year from initial surgery when using techniques without oil and after 1.5 years for techniques using oil. Also the lack of oil removal within 1 year from initial surgery should be noted as an operational failure. We applied the quality indicators on the cohort of 6522 RRDs and found that in Denmark the need for redetachment surgery has decreased over time and also that high-volume departments have better outcome compared to smaller ones., Conclusions: The risk of reoperation for redetachment after initial surgery fulfils the criteria for a good quality indicator and can be used in RRD surgery. This indicator could aid in optimizing the management of RRD patients to minimize morbidity., (© 2015 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: To describe trends, risk factors and outcomes of anterior vitrectomy during cataract and intraocular lens (IOL) surgery., Methods: All patients 16 years and older undergoing cataract and IOL surgery in Western Australia (WA) from January 1980 to December 2001 (n = 115 815) were included. Hospital administrative data were used to identify all cataract and IOL procedures and subsequent admissions for retinal detachment, IOL dislocation, endophthalmitis and pseudophakic corneal oedema. Data were validated with chart review and analysed to identify trends and risk factors for anterior vitrectomy and the risk of subsequent complications., Results: In total, 1390 (1.2%) anterior vitrectomies were performed. The rate increased with change in surgical technique. Significant risk factors for anterior vitrectomy were age <50 years (OR 1.31), male sex (OR 1.23), IOL procedure (OR 11.45) and operations in public hospitals (OR 1.99) or rural/remote (OR 1.40) areas. Anterior vitrectomy was strongly associated with increased risk of retinal detachment (RD) (RR 18.5), endophthalmitis (RR 3.6), IOL dislocation (RR 21.1) and pseudophakic corneal oedema (RR 17.3). Retinal detachments and IOL dislocations occur earlier after anterior vitrectomy., Conclusion: Anterior vitrectomy rates have remained stable since the introduction of phacoemulsification. Anterior vitrectomy is a major risk factor for serious complications compared with uncomplicated surgery, particularly RD and IOL dislocation. We identified an increasing trend in anterior vitrectomy being performed during extracapsular and IOL surgery., (© 2014 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: To analyze trends in rhegmatogenous retinal detachment (RRD) surgery among the members of the Korean Retina Society from 2001 to 2013., Methods: In 2013, surveys were conducted by email and post to investigate the current practice patterns regarding RRD treatment. Questions included how surgeons would manage six cases of hypothetical RRD. Results were compared to those reported in 2001., Results: A total of 133 members (60.7%) in 2013 and 46 members(79.3%) in 2001 responded to the survey. Preference for pneumatic retinopexy has decreased in uncomplicated primary RRD (p = 0.004). More respondents in 2013 selected vitrectomy as the primary procedure when mild vitreous hemorrhage (p = 0.001), myopia (p = 0.044) and history of successful scleral buckling on the fellow eye (p = 0.044) were added to the primary scenario. Vitrectomy was over twice as popular in cases of pseudophakic, macula-off RRD with posterior capsular opacity (p = 0.001)., Conclusions: For RRD with myopia, pseudophakia and media opacity, surgical interventions over the last decade have drastically shifted from scleral buckling and pneumatic retinopexy to vitrectomy.

Retinal detachment repair continues to evolve toward less invasive techniques that can safely, efficiently, and consistently provide optimal outcomes. In fact, 53% of U.S. respondents to the American Society of Retinal Specialists 2013 Preferences and Trends Survey said they would perform a vitrectomy without scleral buckle to treat a retinal detachment with a superior tear, while 25% would perform pneumatic retinopexy, and 21% would use a scleral buckle with or without vitrectomy.11 Compared to in 2005, many more surgeons prefer vitrectomy-only repair, whereas fewer prefer scleral buckle. Interestingly, preferences toward pneumatic retinopexy have slightly declined, which may reflect increased confidence in vitrectomy surgery to repair a detached retina safely and efficiently as an alternative. Even complex detachments can be treated in a minimally invasive fashion with the improvements in instrumentation, trocars, and oil infusion. While trends will likely continue toward minimal invasiveness, some form of scleral buckle, vitrectomy, and pneumatic retinopexy will all persist as treatment options. OCT advancements may allow for individualized discussions of visual prognosis and surgical decision making without the need for any invasive testing.

Purpose: To describe trends and outcomes of vitreoretinal surgery for primary rhegmatogenous retinal detachment in a large Asian tertiary eye center., Methods: Retrospective review of 1,530 eyes with primary retinal detachment between 2005 and 2011 managed at the Singapore National Eye Center by one of the following: scleral buckling (SB), pars plana vitrectomy (PPV), and combined SB and PPV (SB + PPV). Anatomical and functional outcomes were assessed., Results: There was a trend toward PPV and PPV + SB as the primary reattachment procedure from 2005 to 2011. The primary anatomical success rate for PPV (78.6%) was worse than that for SB (88.8%) or SB + PPV (89.0%, P = 0.000). Final anatomical success rates were similar for all 3 procedures: SB 97.7%, PPV 95.2%, and SB + PPV 96.4%. Better functional success was achieved in the SB group (86.1%) than both the PPV (72.5%) and SB + PPV groups (77.5%, P = 0.000), partly attributable to the less complex nature of retinal detachments in the SB group. Older age and proliferative vitreoretinopathy were related to the poor functional outcomes in both phakic and pseudophakic eyes., Conclusion: There was an increasing trend toward PPV and PPV + SB as the primary retinal reattachment surgery from 2005 through to 2011. High rates of anatomical and functional outcomes were achieved with SB, PPV, and SB + PPV, proliferative vitreoretinopathy and older age were negatively correlated with the functional success in both phakic and pseudophakic eyes.

Three ports pars plana vitrectomy has been described 50 years ago. From indications to salvage the peripheral retina function, it has progressively shifted towards functional indications in macular pathologies, trying initially to stabilize and now to improve visual acuity. This has been achieved by improvement, not only of surgical material but also of microscopes, intraoperative rools such as perfluorocarbone liquids and more recently the use of vital dyes., (Copyright © 2012. Published by Elsevier Masson SAS.)

Purpose: To assess trends and outcomes in retinal detachment (RD) surgery based on a retrospective, interventional, bicenter study., Methods: Baseline demographic data, surgical procedures, and outcomes from 230 patients with a diagnosis of primary rhegmatogenous RD, who underwent surgery between January 2007 and December 2008 at the Rudolf Foundation Clinic, Vienna (Center 1) and the Weill Cornell Medical College, New York, (Center 2) were analyzed using a regression model., Results: Besides the baseline parameters, lens status (P = 0.01), refraction (P = 0.01), retinal tears (P < 0.02), proliferative vitreoretinopathy (P = 0.02), and previous treatment (P < 0.02), the primary RD procedure (P < 0.0001) was significantly different between the 2 centers. In Center 1, scleral buckling was the most common primary RD procedure (66.19%) compared with vitrectomy (82.42%) in Center 2. Primary retinal reattachment (88.49% Center 1 vs. 84.62% Center 2, P = 0.43) and best-corrected visual acuity at the final follow-up (best-corrected visual acuity ≥ 0.3 logarithm of minimum angle of resolution 48.92% Center 1 vs. 47.25% Center 2, P = 0.78) were not significantly different between the 2 centers., Conclusion: Although there is a trend toward primary vitrectomy, scleral buckling was preferred in the center in Vienna and primary vitrectomy in the center in New York. Despite the different primary RD procedures, anatomical and visual outcomes were comparable.

Objective: To observe how the treatment of retinal conditions changed over the preceding decade., Methods: Medicare fee-for-service data claims filed between 1997 and 2007 were analyzed., Results: Fewer than 5000 intravitreal injections of a pharmacological agent were performed annually between 1997 and 2001. Thereafter, the annual number of intravitreal injections more than doubled every year through 2006, reaching a high of 812,413 in 2007. Photodynamic therapy procedures decreased 83% from a peak of 133,565 procedures in 2004 to 22,675 procedures in 2007, while laser treatment of choroidal lesions or neovascularization decreased 83% from a peak of 82,089 in 1999 to a minimum of 13,821 in 2007. Vitrectomies for primary retinal detachment (with or without scleral buckling) increased 72% over the study period from 11,212 in 1997 to 19,923 in 2007, while scleral buckles performed without vitrectomy decreased 69% from 8691 to 2660. Substantial volume increases were also observed for vitrectomy with retinal membrane stripping (90% increase from 29,426 in 1997 to 56,051 in 2007) or endolaser panretinal photocoagulation (86% increase from 10,319 in 1997 to 19,154 in 2007). Volumes of pneumatic retinopexy, laser prophylaxis for retinal detachment, laser treatment for retinal edema, and laser treatment for retinopathy all changed less than 25% from 1997 and 2007., Conclusions: Marked changes in the use of several retinal procedures occurred between 1997 and 2007, particularly in the treatment of macular degeneration and retinal detachment. These changes point to greater acceptance and incorporation of vitrectomy and intravitreal injection as treatment modalities.

Objective: To review available peer-reviewed publications to evaluate the safety profile and visual outcomes associated with small-gauge pars plana vitrectomy., Methods: Literature searches of the PubMed and the Cochrane Library databases were last conducted on August 5, 2009, with no date restrictions. The searches were limited to articles published in English. These searches retrieved 328 articles, of which 76 were deemed topically relevant and rated according to strength of evidence., Results: On the basis of level II and level III evidence, the overall safety profile of small-gauge pars plana vitrectomy is similar to that established for conventional 20-gauge pars plana vitrectomy and provides comparable visual acuity results. An increased incidence of infectious endophthalmitis after 25-gauge vitrectomy was reported in 2 comparative studies, but this was not found in multiple, larger, more recent studies, perhaps due to modifications in case selection and surgical technique over time. Compared with 20-gauge vitrectomy, small-gauge vitrectomy is associated with significantly lower levels of patient discomfort and ocular inflammation, and the time required for improvement in visual acuity is shorter., Conclusions: The technological advances of small-gauge vitrectomy seem to afford visual benefit comparable with that seen with traditional 20-gauge surgery, with more rapid healing, less discomfort, and an acceptably low incidence of adverse events comparable with those observed with conventional 20-gauge vitrectomy. As surgical techniques evolve and clinical experience grows, continued close surveillance is necessary for an accurate assessment of complications., (Copyright © 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Crucial to a successful outcome in vitreoretinal surgery is an adequate anaesthesia, both for the surgeon's work as well for the patient's safety and comfort. In this article the most frequently cited anaesthesia techniques for vitrectomy are discussed. Depth of anaesthesia, muscle relaxation, recovery behaviour, and changing times, vomiting, cough and post-operative cardiovascular stability are the main criteria for choosing the specific technique. With increasing aging and multimorbidity in the ophthalmic patient population careful balancing of the advantages and disadvantages of each technique is required and therefore sufficient communication between anaesthesiologist and surgeon is essential., (Georg Thieme Verlag KG Stuttgart, New York.)

Purpose: To compare present surgical techniques for repair of primary retinal detachment. AIM of each technique is closing the retinal break(s), but the approach is either extraocular (e.o.) with scleral buckling or intraocular (i.o.) with pneumatic retinopexy or vitrectomy. The results are similar ranging between 94% and 99% attachment, however, the difference lies in their morbidity and socioeconomic implications which will be compared., Material and Methods: Literature of cerclage, minimal segmental buckling, pneumatic retinopexy and primary vitrectomy are reviewed for anatomical results, postoperative PVR, new breaks, reoperation and secondary complications jeopardizing regained visual acuity., Results: All 4 surgical approaches for repair of a primary retinal detachment, i.e., e.o. or i.o. procedures, have one common premise for sustained success: To find and close the break(s). This is so whether the surgery is limited to the break or extending over the entire detachment or whether it is performed as an e.o. or i.o. procedure. At present the i.o. procedures still harbour a 6-fold higher risk of postoperative PVR and 2.5-fold of reoperation. The recent SPR Study confirms that in a phakic eye postoperative visual function is statistically significant better after scleral buckling than after primary vitrectomy., Conclusion: Since the results after the 4 major techniques for reattaching the retina are similar, therefore, the selected procedure has to fulfill 4 postulates: (1) Retinal attachment with 1 operation, (2) it should harbour a minimum of morbidity, (3) be performed on a small budget and under local anesthesia, (4) it should provide long-term visual function, not jeopardized by secondary complications.

Aim: To describe trends over time and geographical variation in rates of vitreo-retinal surgery in England from 1968 to 2004., Methods: Routinely collected hospital statistics were analysed for England, using the Hospital In-patient Enquiry and Hospital Episode Statistics from 1968 to 2004, and for the Oxford National Health Service Region using the Oxford Record Linkage Study from 1963 to 2004., Results: Annual admission rates in England for surgery were about 5 episodes per 100 000 population in the 1960s, rising gradually to about 10 per 100 000 in the early 1990s, and then more sharply to 30 by 2004. The Oxford Record Linkage Study shows that multiple admissions per person were rare, which confirms that the observed increase represents a real increase in the number of people treated. Annual rates in England for buckle procedures declined to about 6 episodes per 100 000 population in 2004, whereas vitrectomy surgery rose to about 26 episodes per 100 000 population in 2004., Conclusion: Vitreo-retinal surgery has developed over the last 40 years in England, rapidly so over the past 15 years. Vitrectomy surgery has become much more common in England and buckle surgery has shown a steady decline. We demonstrate statistically significant geographical variation in the current annual rate of surgery between local authorities in England.

Purpose: To determine the trends and outcomes for treating primary rhegmatogenous retinal detachment (RRD) in a nationwide population-based study in Taiwan., Methods: We collected admission data during the period of 1997-2005, from the Taiwan National Health Insurance Research Database, a source that covers over 96% of Taiwan's 23 million citizens. Totally 28 911 patients with a first-time admission diagnosis of RRD (ICD-9-CM codes 361 to 361.07) and undergoing surgical treatment (scleral buckling (SB), pars plana vitrectomy (PPV), or their combination) were identified. The utilized operation type, 180-day readmission rate for recurrent retinal detachment, length of hospital stay, and admission charge were obtained. Contingency table/chi (2) test and t-test were employed for the statistical analysis., Results: Primary PPV (with or without SB) was a primary procedure in 47.3% of cases in 1997. This rate rose significantly to 61.2% in 2005. A significant decrease in the total 180-day readmission rate occurred from 18.95% in 1997 to 13.81% in 2005. These rates also significantly decreased for each surgical modality (from 16.30 to 11.38% for SB, from 21.29 to 14.69% for PPV, and from 22.99 to 16.55% for PPV+SB). The length of hospital stay decreased for each surgical modality between 1997 and 2005., Conclusions: There was a significant trend towards more frequently employing primary PPV (with or without SB) for the management of primary RRD. In addition, significant improvements in the primary success rates were shown for each surgical modality group and for total samples between 1997 and 2005.

Background: Pars plana vitrectomy techniques with 25- and 23-gauge transconjunctival systems are rapidly growing in popularity. These systems were mainly used in the treatment of macular diseases. However, an expansion to more complicated vitreoretinal procedures including the treatment of rhegmatogenous retinal detachments can currently be observed. In this review, the results and complications of 25- and 23-gauge vitrectomy techniques are analysed., Material and Methods: A review has been made of the current literature concerning 25- and 23-gauge vitrectomy techniques with particular attention to the treatment of rhegmatogenous retinal detachments., Results: The benefits of 25-gauge and 23-gauge vitrectomy (shorter operating times, decreased inflammation of the anterior segment, increased patient comfort and enhanced visual recovery) are of no clinical significance when treating rhegmatogenous retinal detachments and do not seem to offer an advantage over 20-gauge vitrectomy or scleral buckling techniques. Recently published series with primary anatomic reattachment rates between 71% and 93% and a mean postoperative visual acuity of 20/50 seem to suggest a worsening of the treatment results with these new techniques. In addition, 25-gauge and 23-gauge techniques are technically challenging, associated with significant complications (for example, postoperative hypotony) and increase the risk for exogenous endophthalmitis., Conclusion: New 25-gauge and 23-gauge vitrectomy techniques for rhegmatogenous retinal detachment show no advantage over scleral buckling techniques in phakic patients or 20-gauge vitrectomy in pseudophakic patients. Moreover, these techniques seem to worsen the outcome and increase the postoperative complication rate.

Purpose: To discuss the evolution and current status of 25-, 23-, and 20-gauge vitrectomy instrumentation., Methods: Literature review., Results: There are multiple small case series describing the surgical techniques, clinical outcomes, and complications associated with 25- and 23-gauge vitrectomy. These studies suggest that small-gauge vitrectomy may shorten operating time, improve patient comfort, and speed visual recovery. However, increased complication rates involving hypotony and endophthalmitis have been reported. There are no level 1 evidence-based studies comparing the efficacy and safety of 25-, 23-, and 20-gauge vitrectomy., Conclusion: 25- and 23-gauge vitrectomy techniques may shorten operating time, improve patient comfort, and speed visual recovery. However, larger and better designed evidence-based studies are required to better understand relative values of 25-, 23-, and 20-gauge vitrectomy.

The choice of primary vitrectomy as the first treatment method for rhegmatogenous retinal detachment has grown in popularity over recent years. The main reason behind this trend is the improved control of more complicated situations of retinal detachment. However, clinical trials comparing primary vitrectomy with scleral buckling had failed to demonstrate an advantage of this method regarding anatomical and functional results. The Scleral Buckling Versus Primary Vitrectomy in Rhegmatogenous Retinal Detachment Study (SPR study) is a prospective, randomised, multicentre study comparing primary vitrectomy with or without additional scleral buckling to scleral buckling alone. Overall, 681 patients with more complicated retinal detachments were recruited in 25 centres. In the phakic subgroup of patients, an advantage regarding the main endpoint (change in visual acuity) was found in the scleral buckling group. In the pseudophakic subgroup, no difference in functional outcome could be seen; however, better anatomical results with a lower rate of retina-affecting reoperations was observed in the vitrectomy group, with particularly good results in the subgroup of patients receiving vitrectomy and additional scleral buckling. Based on the available data, primary vitrectomy combined with a scleral buckle is the method of choice in more complicated types of retinal detachment in pseudophakic patients. In contrast, primary vitrectomy does not seem to offer an advantage over scleral buckling in phakic patients.

For many decades, conventional buckling surgery has been the gold standard for treating rhegmatogenous retinal detachment. The surgical technique has not changed markedly during this period; the three main buckling techniques currently used are the radial sponge, segmental sponge, and encircling band. With one of these options, an anatomic success rate of over 90% can be achieved in "simple" forms of retinal detachment. In pseudophakic eyes, however, the primary reattachment rate after buckling procedures is lower. Pneumatic retinopexy, because of its lower success rate, has not found general acceptance in Europe and is used only in selected cases. Concerning the results of the SPR study, many vitreoretinal surgeons were surprised that in the subgroup of phakic eyes, scleral buckling surgery achieved a comparable reattachment rate and better functional results even in this group of patients with complex hole configuration. This gives physicians reason to critically question the current trend of primary vitrectomy even in eyes with uncomplicated preoperative pathology and to reassess scleral buckling surgery. The longer learning curve to perform buckling surgery should be accepted. Because successful repair depends on careful preoperative examination, thorough training in binocular ophthalmoscopy skills with scleral depression should remain an essential part of the surgeon's education.

It has been nearly a century since Jules Gonin performed the first intervention for rhegmatogenous retinal detachment, trans-scleral cautery, achieving successful outcomes in close to 50% of his cases. With the introduction of alternative surgical approaches in the last half-century, including Charles Schepens' scleral buckle technique and Robert Machemer's pars plana vitrectomy, the surgical success rates have risen to close to 90%. Nonetheless, despite dramatic progress in the success of reattachment surgeries, reasonable disagreement exists as to which approach (or combination of approaches) is the best form of surgical intervention for patients with rhegmatogenous retinal detachments. In this review, the authors summarize the current knowledge of retinal detachment, and examine emerging results from the first large scale, prospective, randomized, controlled clinical trials addressing the efficacy of these surgical approaches for retinal detachment, with the hope of identifying the most appropriate (evidence-based) therapeutic intervention for the treatment of rhegmatogenous retinal detachment.

Due to the anatomical dimensions being smaller and the tissue structures being softer and more elastic in the young patient, surgery of paediatric cataracts represents a special challenge for the ophthalmic surgeon. Surgery is performed via a limbal or pars plana approach. The extreme high rate of secondary cataract formation in the paediatric or adolescent eye with closed posterior capsules is countered by means of complicated capsular surgery, special intraocular lens (IOL) implantation techniques, and vitreoretinal surgical procedures. It is customary not to implant IOLs before the children are 1-2 years old as increased axial length growth must be expected during the first 18 months after birth. IOL power is selected so that postoperative refraction is within the hyperopic range and with time, undercorrection will be balanced by bulbus growth. Preoperative and postoperative therapy is highly dependant on the extent of trauma sustained during surgery and should contain anti-inflammatory medication with and without steroids as well as antibiotics. Orthoptic follow-up examinations are also decisive for the long-term result.

Background: The aim of the study was to determine the changing indications for penetrating keratoplasty (PK) over the 20 years from 1.1.1985 through 31.12.2004 at our Ophthalmology Department as well as to identify additional surgical interventions., Patients and Methods: Medical records of all 268 patients (290 eyes) who underwent PK at our Ophthalmology Department Teaching Hospital Maribor over the 20-year period (1985-2004) were reviewed retrospectively. All PK were divided into two groups: the first group comprised 121 eyes operated in the first 10 years (1985-1994) and the second one comprised those operated in the last 10 years (1995-2004)., Results: During the period of 20 years (1984-2004), the most common indication for PK was aphakic/pseudophakic bullous keratopathy (23.1 %). Keratoconus was the second most common indication for PK (21.7 %), followed by corneal scars (21.4 %). In the first 10 years of the study (1985 to 1994) the most common indications were corneal scars (28.9 %), keratoconus (22.3 %) and corneal dystrophy (19.8 %). Over the second 10 years (1995 to 2004) the three most common indications were bullous keratopathy (29 %), keratoconus (21.3 %) and corneal scars (16.9 %). There was a dramatic increase in the number of PK for failed corneal transplants, from 3.3 % in the first to 12.4 % in the second period (+ 275.8 %) and for bullous keratopathy (+ 94.6 %) as well as a decrease for corneal scarring (-41.5 %) and corneal dystrophy (-40.4 %). Additional surgical interventions increased from 21.5 % in the first 10 years to 28.4 % (+ 32.1 %) in the second 10 years., Conclusions: Bullous keratopathy was the leading indication for PK during the last 10 years (1994-2005). Keratoconus was the second leading indication in both 10 year periods. Regrafting showed a significant increasing trend in the last 10 years.

Purpose of Review: We review the current standards, risks, prognosis, and indications for diabetic pars plana vitrectomy and consider recent developments in surgical techniques. We also examine surgery's role as a treatment modality for diabetic eye disease among the other accepted and developing treatment options, such as systemic and intravitreal pharmacotherapy., Recent Findings: Pars plana vitrectomy for diabetic macular edema and for traction retinal detachment is addressed. Techniques to decrease retinal swelling and ischemia are showing promising results. The use of the smaller 25-gauge and 23-gauge vitrectors is gaining acceptance and offers advantages such as less trauma, less postoperative discomfort, and quicker healing. Techniques are being developed and refined to help prevent postoperative vitreous hemorrhage using cryotherapy around sclerotomy sites and/or endolaser in a near-confluent pattern in an effort to quell fibrovascular ingrowth and subsequent hemorrhage. Finally, pharmacological advances include targeting three levels of intervention: achieving the best glycemic control, correcting altered retinal metabolism secondary to increased glucose availability, and employing neuroprotective and vasoprotective agents., Summary: The combination of therapies and interventions as they improve and evolve offers the potential to revolutionize the approach to the complications of diabetic eye disease and may soon render many current interventions obsolete. Diabetic pars plana vitrectomy continues to advance with better anatomic and visual success.

The patients of eye injury of inpatients and outpatients in county and prefecture hospitals were reported in some proportion in the ophthalmologic literature. Eye injury was the leading cause among the blind eyes determined at the discharge from the hospitals. Therefore, the prevention and treatment of eye injury has been the priority for Chinese ophthalmologists. In recent years, the international standard classification of the type and location of eye injury has been accepted and adopted in China. The level of primary wound management for eye injury has been raised in all hospitals. The timing of continued treatment sustaining vitrectomy procedures has been emphasized widely. The indications of primary enucleation have been strictly controlled by ophthalmologists. The remarkable progress has been made in rescue of presumed enucleation candidates. It is essential to establish a nationwide registry system and to conduct the multicenter trial for the control of eye injury in the future.

With the advent of modern vitreoretinal surgical techniques, the spectrum for surgical intervention in various forms of uveitis has been notably expanded. Removal of optically relevant vitreous opacities, improvement of secondary macular edema, delamination of epiretinal membranes, and release of traction in the presence of abnormal vitreoretinal adhesions represent indications for vitreoretinal procedures in uveitis patients. Furthermore, retinal and choroidal biopsies may be obtained if the precise etiology is unknown. This in turn offers the opportunity to better target pharmacological interventions. Combined cataract surgery or intravitreal implantation of drug devices may also be of therapeutic benefit. So far no prospective, controlled clinical trials have been performed to precisely evaluate the role of pars plana vitrectomy (ppV) as a single or combined surgical procedure in patients with intraocular inflammation. Inconsistent data exist regarding prognostic determinants and the role of perioperative immunosuppression. Here, the current knowledge on the subject is reviewed and critically discussed, and recommendations for patient management are given. Further studies are needed.

The developments in treatment modalities for a primary retinal detachment over the last 70 years have been reviewed. There was a change from a surgery limited to the area of the break to a form of prophylactic surgery including the extent of the detachment. In between Rosengren had limited the treatment to the break with an intraocular gas bubble. A change was brought about by Custodis in 1953 who limited surgery to the break and omitted drainage. This procedure had serious postoperative complications which were eliminated by Lincoff by developing the cryosurgical detachment operation which was subsequently refined to extraocular minimal surgery. The ultimate realization of a minimal extraocular approach was the operation with a temporary balloon. Two additional intraocular procedures evolved, pneumatic retinopexy and primary vitrectomy, following one or the other pattern of treatment. With all four methods reattachment can result in 94-99% of the cases but differences can be seen in the morbidity and rate of reoperations.

Aim: To identify trends in vitreoretinal surgery at a tertiary referral centre from 1987 to 1996., Methods: A retrospective study of patients who had undergone vitreoretinal surgery at St Paul's Eye Unit over two 6 month periods in 1987 and 1996. Preoperative ocular status, surgery details, and outcome were collected. chi 2 and Mann-Whitney U tests were used to analyse the data., Results: The two periods under study were July to December 1987 and January to June 1996. 110 operations performed during 1987 (96 patients) and 330 operations during 1996 (289 patients) were analysed. There was a fourfold rise in the number of tertiary referrals and a seven-fold rise in the number of operations performed for conditions other than rhegmatogenous retinal detachment (RRD). Increasing indications for surgery included diabetic eye disease, macular hole, dropped nucleus, endophthalmitis, and subretinal neovascular membrane. There was a rise in the proportion of patients with RRD following cataract surgery (from 19.5% to 29.5%). For both primary repair and reoperation, vitrectomy with internal tamponade was more commonly used in 1996. The anatomical success rate for primary repair changed from 76.6% to 84.7% after one operation and from 89.1% to 94.3% following additional surgery., Conclusions: This study points to a trend towards subspecialisation and tertiary referral in vitreoretinal surgery. Vitrectomy techniques are more commonly used for the primary repair of RRD and are applied to a wider spectrum of diseases.

Ocular trauma remains a common cause of vision loss worldwide. Progress appears to have been made in the treatment of intraocular foreign bodies and traumatic endophthalmitis particularly with the use of early vitrectomy and intravitreal antibiotics. Recent work increasingly supports the benefit of vitrectomy in conjunction with other modern surgical techniques for the treatment of other injuries of the posterior segment. This review highlights much of the literature on ocular trauma from the previous year and discusses the merits of current and future approaches to surgical intervention.