Purpose. To summarise the surgical advances and evolution of small gauge vitrectomy and discuss its principles and application in modern vitreoretinal surgery. The advent of microincisional vitrectomy systems (MIVS) has created a paradigm shift away from twenty-gauge vitrectomy systems, which have been the gold standard in the surgical management of vitreoretinal diseases for over thirty years. Advances in biomedical engineering and surgical techniques have overcome the technical hurdles of shifting to smaller gauge instrumentation and sutureless surgery, improving surgical capabilities and expanding the indications for MIVS.

No abstract

No abstract

Proliferative vitreoretinopathy is a sophisticated disease that complicates vitreoretinal pathologies like retinal detachments. Since its first description in the 1960s, we have learned a lot about this pathological entity; however, despite a large number of promising laboratory and clinical pharmacological research projects, we are still unable to stop proliferation and are certainly not able to prevent this terrible complication. As a result, vitreoretinal surgeons still have to fight membrane formation in complicated and long vitreoretinal procedures. Fortunately, a revolution has taken place in equipment for these procedures. This chapter will examine the pathophysiology, classification, and pharmacotherapy, and describe the strategy and rationale of how to deal with this recurrent condition and to limit and contain its sequelae.

To evaluate the early effects of triamcinolone acetonide (TA) on inflammation, proliferation, and vascular endothelial growth factor (VEGF) in human choroidal neovascularization (CNV). Methods: Retrospective review of an interventional case series of 29 patients who underwent macular translocation. Fourteen CNV membranes without previous therapy (control CNV group) and 4 CNV membranes excised 3 days after photodynamic therapy (PDT CNV group) comprised the control groups. Eleven patients were treated with intravitreal TA (TA CNV group; n = 5) or PDT and TA combined (PDTϩTA CNV group; n = 6) 3 to 9 days preoperatively. The CNV membranes were stained for cytokeratin 18, CD34, VEGF, intercellular adhesion molecule-1 (ICAM-1), E-selectin, CD68, CD45, Ki-67, and Thy-1. Results: Treatment with TA and PDTϩTA resulted in increased immunostaining of ICAM-1 in endothelial cells and the stroma and a higher percentage of Thy-1 expression than controls. The density of macrophages was significantly increased in PDTϩTA CNV membranes. Leukocyte density and proliferative activity were lower in TA and PDTϩTA CNV membranes. The total VEGF score was significantly increased in TA and PDTϩTA CNV membranes compared with the control CNV membranes. Evidence of VEGF in the retinal pigment epithelium of PDTϩTA CNV membranes was stronger than in control CNV membranes. Conclusions: Triamcinolone acetonide has no inhibitory effect on macrophage infiltration or ICAM-1, Thy-1, or VEGF expression in CNV membranes in the early term. The clinical benefits of TA are probably not based on pure antiinflammatory or VEGF-suppressing mechanisms.