Positive vitreous pressure: Pathophysiology, complications, prevention, and management

Chronopoulos, Argyrios; Thumann, Gabriele; Schutz, James Scott

doi:10.1016/j.survophthal.2016.10.002

Cited by 26 publications

(31 citation statements)

References 54 publications

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“…PVP is particularly common during open anterior segment surgery, and it has been reported that during PKP, the incidence rate of PVP is 40-50% [5]. The rate could be higher if the surgical patient has an underlying disease, such as iris atrophy, pathological pupil, pseudophakic eyes with broken capsular bags, or an undesirable cataract surgery with some parts of the IOL located outside the capsular bag [6].…”

Section: Discussionmentioning

confidence: 99%

“…1), iris or lens damage, and cystoid macular edema. The first two of these complications, which are secondary to positive vitreous pressure (PVP), are considered the most severe [1,5]. Recent research has partly clarified the pathogenesis and pathophysiology of PVP, and it has identified hypotony resulting from aqueous loss as the fundamental reason for PVP [5].…”

Section: Introductionmentioning

confidence: 99%

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Stepwise Decreasing of Vitreous Pressure by Anterior Vitrectomy: A Novel Method for Preventing Positive Vitreous Pressure During Penetrating Keratoplasty

et al. 2019

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Background: This study evaluates the clinical effects of the stepwise anterior vitrectomy on the prevention of positive vitreous pressure (PVP) during penetrating keratoplasty (PKP). Methods: PKP in conjunction with stepwise anterior vitrectomy was performed on 15 eyes of 15 patients under retrobulbar anesthesia. A preset vitrectomy trocar-cannula was inserted into the vitreous cavity before PKP. During the opening of the anterior chamber, intermittent vitrectomy and corneal incision expansion were performed alternately to keep the lens or artificial intraocular lens (IOL) and iris flat until the entirety of the pathological cornea had been dissected. The main outcome measures include visual acuity, crystalline lens rise (CLR), corneal curvature and diopter, and corneal endothelial cell loss. Results: All surgical procedures were performed successfully without any PVP-related intraoperative complications. The mean time of the stepwise vitrectomies was 3.1 ± 0.7 s, the duration of each vitrectomy was 8.1 ± 5.3 s, and the duration of the total surgery was 60.5 ± 5.3 min. The anterior segment reaction was mild and the shape of the pupil remained normal 1 day after surgery. The mean preoperative and mean 3-month postoperative CLR values were 0.48 ± 0.09 mm and-0.16 ± 0.04 mm, respectively (p \ 0.0001). The mean preoperative endothelial cell density in donor buttons was 2570 ± 171 cells/mm 2 , and the mean 6-and 12-month postoperative endothelial cell density in donor buttons was 2207 ± 127 cells/mm 2 and 2000 ± 198 cells/ mm 2 , respectively. Conclusions: The novel and stabilized PKP procedure, performed in conjunction with the stepwise anterior vitrectomy, effectively avoided the PVP during open-sky surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Stepwise Decreasing of Vitreous Pressure by Anterior Vitrectomy: A Novel Method for Preventing Positive Vitreous Pressure During Penetrating Keratoplasty

et al. 2019

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“…Subsequently, retinal and choroidal capillaries are predisposed to leakage when there is a sudden decrease in IOP (Chronopoulos et al. ; Maumenee & Schwartz ), thus leading to VH, as well as oedema and congestion displacement of the posterior retina, choroid and optic nerve (Pederson et al. ; Brubaker & Pederson ).…”

Section: Discussionmentioning

confidence: 99%

A relatively higher intraocular pressure set at the end of vitrectomy is associated with a more stable and rapid visual recovery for patients with vitreous haemorrhage

Zhou

Zhang

Luo

et al. 2019

Acta Ophthalmologica

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Purpose: To compare structural and functional improvements in patients with vitreous haemorrhage (VH) with different IOPs re-established at the end of pars plana vitrectomy (PPV). Methods: It is a prospective, randomized, comparative, interventional study. Ninety-five patients with nonclearing VH were randomized to receive PPV with normalized IOPs of 15 mmHg (Group I: 32 eyes), 25 mmHg (Group II: 32 eyes) and 35 mmHg (Group III: 31 eyes) at the end of surgery. The grade of vitreous opacity and best-corrected visual acuity (BCVA) on postoperative day 1, week 1, month 1 and month 3 were compared with a mixed model for repeated measures analysis. Results: All 3 groups achieved significant improvement on postoperatively in BCVA (p < 0.01) and vitreous opacity (p < 0.01) compared with the baseline. The group difference was significant at the end of week 1 and showed a trend of higher IOP set at the end of PPV with better anatomical (p < 0.01) and visual recovery (p < 0.01). However, at postoperative month 1 and month 3, equivalent anatomical (month 1: p = 0.56; month 3: p = 0.36) and visual outcomes (month 1: p = 0.16; month 3: p = 0.88) were obtained in the 3 groups. The average effect of IOP on BCVA (group II versus group III: effect size (ES): 0.41, p < 0.01; group I versus group III: ES: 0.66, p < 0.01) and vitreous opacity (group II versus group III: ES: 0.70, p < 0.01; group I versus group III: ES:1.09, p < 0.01) over the course of the study period was statistically significant. The only postoperative complication was recurrent VH in two patients allocating in group I and II, respectively. Conclusions: A relatively higher IOP set at the end of vitrectomy resulted in a more stable and rapid recovery with fewer complications in patients with noncomplex VH.

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“…Vitreal expansion refers to vitreous body behavior in some patients during cataract surgery and is most common in brachycephalic breeds. This expansion is thought to be largely due to extraocular muscle tension and a positive vitreal pressure, causing a forward protrusion of the posterior lens capsule which can significantly increase the difficulty of cataract surgery . It also shallows the anterior chamber, complicates placement of a prosthetic lens implant, and increases the risk for iris prolapse through the corneal incision.…”

Section: Discussionmentioning

confidence: 99%

“…Success rates rely on optimizing intraoperative conditions for ease of surgery. These include maximizing surgical exposure of the globe and lens and minimizing extraocular muscle tension which can compromise globe position and/or lead to vitreal expansion . These conditions have commonly been achieved with systemic neuromuscular blockade (NMB) using nondepolarizing neuromuscular junction blockers as an adjunct to general anesthesia .…”

Section: Introductionmentioning

confidence: 99%

Sub‐Tenon's anesthesia for canine cataract surgery

Bayley

Read

2018

Veterinary Ophthalmology

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Positive vitreous pressure: Pathophysiology, complications, prevention, and management

Cited by 26 publications

References 54 publications

Stepwise Decreasing of Vitreous Pressure by Anterior Vitrectomy: A Novel Method for Preventing Positive Vitreous Pressure During Penetrating Keratoplasty

Stepwise Decreasing of Vitreous Pressure by Anterior Vitrectomy: A Novel Method for Preventing Positive Vitreous Pressure During Penetrating Keratoplasty

A relatively higher intraocular pressure set at the end of vitrectomy is associated with a more stable and rapid visual recovery for patients with vitreous haemorrhage

Sub‐Tenon's anesthesia for canine cataract surgery

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