International Journal of Retina and Vitreous最新文献

{"title":"Photobiomodulation efficacy in age-related macular degeneration: a systematic review and meta-analysis of randomized clinical trials.","authors":"Tiago N O Rassi, Lucas M Barbosa, Sacha Pereira, Eduardo A Novais, Fernando Penha, Luiz Roisman, Mauricio Maia","doi":"10.1186/s40942-024-00569-x","DOIUrl":"10.1186/s40942-024-00569-x","url":null,"abstract":"<p><strong>Background: </strong>Age-related macular degeneration (AMD) is a leading cause of vision loss. Photobiomodulation (PBM) offers a controversial approach for managing dry AMD, aiming to halt or reverse progression through mitochondrial activity modulation. However, the efficacy and clinical relevance of PBM as a potential approach for managing dry AMD remain debated.</p><p><strong>Methods: </strong>We systematically searched PubMed, Embase, and Cochrane databases for randomized controlled trials (RCTs) comparing PBM versus a sham in patients with dry AMD. We performed trial sequential analysis (TSA) and minimal clinically important difference (MCID) calculations to assess statistical and clinical significance applying a random-effects model with 95% confidence intervals (CI).</p><p><strong>Results: </strong>We included three RCTs comprising 247 eyes. The pooled analysis showed that PBM significant improved BCVA (MD 1.76 letters; 95% CI: 0.04 to 3.48) and drusen volume (MD -0.12 mm³; 95% CI: -0.22 to -0.02) as compared with a sham control. However, the TSA indicated that the current sample sizes were insufficient for reliable conclusions. No significant differences were observed in GA area. The MCID analysis suggested that the statistically significant results did not translate into clinically significant benefits. In the quality assessment, all studies were deemed to have a high risk of bias.</p><p><strong>Conclusion: </strong>This meta-analysis points limitations in the current evidence base for PBM in dry AMD treatment, with issues around small sample sizes. Statistically significant improvements do not translate into clinical benefits. The research underscores need for larger RCTs to validate PBM's therapeutic potential for dry AMD.</p>","PeriodicalId":14289,"journal":{"name":"International Journal of Retina and Vitreous","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11328488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141987974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term functional, anatomical outcome, and qualitative analysis by OCTA, as a predictor of disease recurrences in patients with choroidal neovascularization secondary to angioid streaks.","authors":"Raul Velez-Montoya, Hillary K Osorio-Landa, K Carolina Franco-Ramirez, Victor Martínez-Pacheco, J Abel Ramirez-Estudillo, Jaime Francisco Rosales-Padrón, Gerardo Ledesma-Gil, Jans Fromow-Guerra","doi":"10.1186/s40942-024-00568-y","DOIUrl":"10.1186/s40942-024-00568-y","url":null,"abstract":"<p><strong>Background: </strong>To report the risk of exudation recurrence and long-term outcomes in patients with choroidal neovascularization secondary to angioid streaks, according to its morphology and characteristics by optical coherence tomography angiography.</p><p><strong>Methods: </strong>Retrospective analysis of electronic medical records from three hospitals. We enrolled patients with a clinical diagnosis of angioid streaks choroidal neovascularization that had a minimum follow-up of 12 months. From each record, we extracted general demographic data, best corrected visual acuity (baseline, before and after each disease recurrence and last on file), type of treatment, time between last intravitreal injection and disease recurrence, and classification of the neovascular lesion morphology by optical coherence tomography, and optical coherence tomography angiography. Patients with myopic choroidal neovascularization were used as controls. Interobserver agreement was assessed with a Cohen-Kappa test. The Odds ratio was calculated with a chi2 test for significance. Visual acuity change through time was evaluated with an ANOVA for repeated measurements with an alpha value of 0.05 for statistical significance.</p><p><strong>Results: </strong>We enrolled 30 patients in the study group and 14 in the control group. In the study group, the baseline and final BCVA were 0.861 ± 0.59 and 1.095 ± 0.61 logMAR (p = 0.1) respectively.</p><p><strong>Control group: </strong>1.045 ± 0.57 and 0.617 ± 0.53 logMAR (p < 0.05). In the study group, the predominant CNV type by OCTA was mixed (37%), and interlacing (57%) in the control group. Mixed and cog-wheel patterns at baseline had increased Odds for recurrence in the study group (p = 0.09). Patients in the study group required more intravitreal injections on each recurrence episode to achieve disease control (3.5 ± 1.5 vs.1.4 ± 0.2, p < 0.01).</p><p><strong>Conclusions: </strong>The benefits of anti-VEGF treatment are lost over time in patients with angioid streaks and CNV. Lesion characteristics by optical coherence tomography angiography could help physicians predict the risk of recurrence.</p><p><strong>Trial registration: </strong>Retrospective registered, and IRB approved.</p>","PeriodicalId":14289,"journal":{"name":"International Journal of Retina and Vitreous","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11285434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141792473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vitamin D deficiency in patients with retinal vein occlusion: a systematic review and meta-analysis.","authors":"Kimia Daneshvar, Mohammadreza Akhlaghi, Shila Iranpour, Matin Irajpour, Mohsen Pourazizi","doi":"10.1186/s40942-024-00571-3","DOIUrl":"10.1186/s40942-024-00571-3","url":null,"abstract":"<p><strong>Background: </strong>This review aims to substantiate the correlation between vitamin D and retinal vein occlusion (RVO) within the medical literature.</p><p><strong>Method: </strong>A systematic review and meta-analysis were conducted in PubMed, SCOPUS, Web of Science, and Embase until December 10th, 2023. A meticulous literature search was undertaken to identify and analyze all observational-analytical papers reporting vitamin D levels in RVO patients. The principal outcome measures centered on the comparative assessment of vitamin D levels between patients with RVO (cases) and those devoid of RVO (controls). The protocol was registered in PROSPERO (code: CRD42024499853).</p><p><strong>Results: </strong>A total of six relevant studies consisting of 589 participants were included in this meta-analysis. The results indicated a significant association between vitamin D deficiency and increased risk of RVO (Odds ratio = 14.51; 95% CI: [1.71, 122.59], P = 0.014); and patients with RVO exhibited a significant decrease in serum vitamin D levels by 1.91ng/mL (95% CI: [-2.29, -1.54], P < 0.001). Moreover, there was no significant difference observed in vitamin D levels between central RVO (CRVO) and branch RVO (BRVO) subtypes (P = 0.63).</p><p><strong>Conclusion: </strong>RVO patients have more vitamin D deficiency than healthy controls. These results contribute to the growing body of evidence highlighting the intricate role of vitamin D supplementation as both a prophylactic and a treatment strategy in RVO.</p><p><strong>Prospero registration identifier: </strong>CRD42024499853.</p>","PeriodicalId":14289,"journal":{"name":"International Journal of Retina and Vitreous","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11282712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141788015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal changes of funduscopic optic disc size, color and cup-to-disc ratio in school children.","authors":"Seiji Sameshima, Takehiro Yamashita, Hiroto Terasaki, Ryo Asaoka, Naoya Yoshihara, Naoko Kakiuchi, Taiji Sakamoto","doi":"10.1186/s40942-024-00570-4","DOIUrl":"10.1186/s40942-024-00570-4","url":null,"abstract":"<p><strong>Background: </strong>To investigate the relationship between changes in the optic disc size and color, cup-to-disc (C/D) ratio, and axial elongation in schoolchildren.</p><p><strong>Methods: </strong>A prospective cohort study was performed in 75 right eyes of elementary school students for six years (from 8.5 to 14.5 years old). In the first and last year, all participants underwent optical axial length measurement and color fundus photography. The optic disc color was calculated by dividing the intensity of red by the sum of the intensity of red, green, and blue. The optic disc area was calculated by modifying the number of pixels according to Bennett's formula. The C/D ratio was calculated by dividing the vertical cup diameter by vertical optic disc diameter. Wilcoxon signed rank test was used to compare these optic disc parameters and axial length in the first and last year.</p><p><strong>Results: </strong>Mean axial length in the last year (24.82 mm) was significantly longer than that in the first year (23.34 mm). Likewise, the mean optic disc size was significantly smaller in the last year (41,946 pixels) than that in the first year (46,144 pixels). The mean optic disc color in the last year (0.49) was significantly more reddish than that in the first year (0.46), while the mean C/D ratio in last year (0.50) was significantly smaller than that in first year (0.52).</p><p><strong>Conclusions: </strong>During the period from 8.5 years to 14.5 years of age, both the optic disc size and C/D ratio became smaller, while the color became more red.</p>","PeriodicalId":14289,"journal":{"name":"International Journal of Retina and Vitreous","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11270882/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141758619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modified ILM flap techniques versus classical inverted ILM flap technique for large macular holes: a systematic review and meta-analysis of randomized controlled trials.","authors":"Sarah A Alghamdi, Faisal F Aljahdali, Rahaf K Sharif, Jumanah J Homsi, Asma A Alzahrani, Lugean K Alomari, Amro Abukhashabah","doi":"10.1186/s40942-024-00567-z","DOIUrl":"10.1186/s40942-024-00567-z","url":null,"abstract":"<p><strong>Background: </strong>Macular holes (MHs) constitute a vitreoretinal interface disorder that occurs when structural abnormalities in the fovea lead to impaired central vision. The standard treatment for MHs is mainly surgical. Using an inverted internal limiting membrane (ILM) flap has enhanced the success rates of MH surgeries. This systematic review and meta-analysis aimed to compare the classical inverted ILM flap technique to modified ILM flap techniques for managing large MHs.</p><p><strong>Methods: </strong>We searched Medline, Embase, and CENTRAL. We included randomized controlled trials (RCTs) that compared the classic inverted ILM flap technique to modified ILM flap techniques as initial surgical treatment of eyes with large MHs of more than 400 microns. We sought to evaluate the following outcomes: (1) MH closure. (2) Best-corrected visual acuity (BCVA). (3) Foveal closure type (4) Rate of ellipsoid zone (EZ) defects and external limiting membrane (ELM) defects. The standardized mean difference (SMD) was used to represent continuous outcomes, while the risk ratio (RR) was used to represent dichotomous outcomes.</p><p><strong>Results: </strong>Four RCTs that enrolled 220 participants were deemed eligible. The analysis revealed no statistically significant differences in MH closure between both groups (95% CI: 0.20, 7.96; P = 0.81). No statistically significant differences in mean BCVA were found at 1 and 3 months between both groups (SMD: 0.04; 95% CI: -0.16, 0.23; P = 0.70 and SMD: -0.167; 95%CI: -1.240, 0.906; P = 0.760, respectively). In addition, there were no significant differences between the two groups in the pattern of foveal closure, namely U-shape, V-shape, and flap open at 3, 6, and 12 months (RR: 0.87; 95% CI: 0.67, 1.12; P = 0.28, RR: 0.96; 95% CI: 0.58, 1.61; P = 0.89, and RR: 1.95, 95% CI: 0.26, 14.50; P = 0.51, respectively). Finally, the analysis showed no statistically significant difference in both groups' EZ and ELM defect rates at 3, 6, and 12 months (RR: 1; 95% CI: 0.85; 1.18: P = 1 and RR: 1.14; 95% CI: 0.90, 1.45; P = 0.27).</p><p><strong>Conclusion: </strong>Macular holes (MHs) constitute a vitreoretinal interface disorder that occurs when structural abnormalities in the fovea lead to impaired central vision. The standard treatment for MHs is mainly surgical. Using an inverted internal limiting membrane (ILM) flap has enhanced the success rates of MH surgeries. This systematic review and meta-analysis aimed to compare the classical inverted ILM flap technique to modified ILM flap techniques for managing large MHs.</p>","PeriodicalId":14289,"journal":{"name":"International Journal of Retina and Vitreous","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11271051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141758668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The forbidden touch: mechanical clearing of gas-induced crystalline lens feathering during vitrectomy surgery.","authors":"Murtaza M Mandviwala, Matthew K Adams, Andrew J Barkmeier","doi":"10.1186/s40942-024-00565-1","DOIUrl":"10.1186/s40942-024-00565-1","url":null,"abstract":"<p><strong>Background and objective: </strong>Lens feathering due to intraocular gas may cause significant challenges with intraoperative visualization during posterior segment surgery. Herein, we describe an intraoperative technique for improving posterior segment visualization impacted by lens feathering.</p><p><strong>Methods: </strong>New technique to improve visualization in vitrectomy from gas-induced cataract.</p><p><strong>Results: </strong>The light pipe is used to gently massage posterior subcapsular lens vacuoles to improve the surgical view intraoperatively.</p><p><strong>Conclusion: </strong>We report an effective and efficient technique to improve lens feathering during vitreoretinal surgery without need for cataract extraction.</p>","PeriodicalId":14289,"journal":{"name":"International Journal of Retina and Vitreous","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11265171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141748072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world efficacy of intravitreal faricimab for neovascular age-related macular degeneration: a systematic review.","authors":"Nasratullah Nasimi, Safiullah Nasimi, Jakob Grauslund, Anna Stage Vergmann, Yousif Subhi","doi":"10.1186/s40942-024-00566-0","DOIUrl":"10.1186/s40942-024-00566-0","url":null,"abstract":"<p><strong>Background: </strong>To systematically review the real-world outcomes of intravitreal faricimab treatment in patients with neovascular age-related macular degeneration (nAMD) to evaluate its efficacy and safety in clinical settings. This study was conducted due to the need for real-world evidence to complement the findings from controlled clinical phase-III trials.</p><p><strong>Methods: </strong>A systematic literature search was conducted on March 17, 2024, across 11 databases, utilizing search terms specifically tailored each database. All studies were reviewed qualitatively with specific focus on the outcomes of interest: the best-corrected visual acuity (BCVA), the central retina thickness (CRT), and the burden of therapy.</p><p><strong>Results: </strong>We identified a total of 22 eligible studies of 1762 eyes from 1618 patients with nAMD. Studies reported that intravitreal faricimab injections maintained BCVA in patients with previously treated eyes and demonstrated statistically significant improvement in patients with treatment-naïve eyes. The CRT was reduced after intravitreal faricimab therapy. Faricimab was well-tolerated, with no significant safety concerns identified, and reduced the overall burden of therapy.</p><p><strong>Conclusion: </strong>Real-world studies corroborate the conclusions drawn from phase-III trials regarding faricimab treatment, demonstrating improvement in both visual and anatomical outcomes. Additionally, no significant safety issues were identified, as the treatment was generally well-tolerated and reduced the overall burden of therapy in the real-world settings.</p>","PeriodicalId":14289,"journal":{"name":"International Journal of Retina and Vitreous","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11245828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141599871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dislocated 4-haptic intraocular lens rescue with Gore-tex suture scleral re-fixation.","authors":"Luke Michaels, George Moussa, Hadi Ziaei, Andrew Davies","doi":"10.1186/s40942-024-00562-4","DOIUrl":"10.1186/s40942-024-00562-4","url":null,"abstract":"<p><strong>Background: </strong>Dislocated IOL exchange conventionally involves manipulation within the anterior chamber which risks secondary injury to anterior chamber structures. We describe and evaluate a 4-haptic IOL rescue technique that avoids entering the anterior chamber and thus minimizes post operative inflammation, astigmatism and recovery time relative to conventional IOL explantation and replacement techniques.</p><p><strong>Methods: </strong>Retrospective, non-randomized, interventional study of all patients undergoing 4-haptic IOL rescue performed by two independent vitreoretinal surgeons at a single UK centre over two years.</p><p><strong>Surgical technique: </strong>A limited peritomy is performed with four 25-gauge scleral ports placed to enable use of two forceps, an infusion and a chandelier. A further four 27-gauge sclerotomies are symmetrically placed on the nasal and temporal sclera at 3 mm from the limbus with a 5 mm vertical separation on either side. A pars plana vitrectomy is performed followed by chandelier illuminated, bimanual cleaning of the dislocated IOL using 27-gauge serrated forceps. Gore-tex sutures are threaded through the IOL islets within the vitreous cavity and externalized through the sclerotomies for scleral re-fixation followed by conjunctival closure.</p><p><strong>Results: </strong>Seven patients underwent IOL recycling with Gore-Tex suture scleral re-fixation. All procedures were successful in repositioning the IOLs, with all patients satisfied with post-operative outcome. Mean (standard deviation) time to IOL dislocation was 13 (3) years. Median visual acuity significantly improved post-operatively from 0.85 logMAR (Interquartile Range [IQR]: 0.2-2.1) to 0.07 (0.02-0.60) logMAR (p = 0.02). No significant post-operative complications were noted apart from persistent cystoid macular oedema in one patient non-compliant with post-operative treatment.</p><p><strong>Conclusions: </strong>Transscleral refixation using Gore-Tex suture is an effective, safe and practical approach in the management of dislocated 4-piece IOLs.</p>","PeriodicalId":14289,"journal":{"name":"International Journal of Retina and Vitreous","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11229232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141554819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tuck-in tenon patch graft for giant full-thickness macular holes.","authors":"Maher Saleh, Chiatse Ellalie Koman","doi":"10.1186/s40942-024-00561-5","DOIUrl":"10.1186/s40942-024-00561-5","url":null,"abstract":"<p><strong>Purpose: </strong>To report the results of using autologous Tenon patch grafts for managing giant full-thickness macular holes (FTMHs) when other alternatives are not applicable.</p><p><strong>Methods: </strong>The same surgical technique was performed in all three cases. Briefly, a small fragment of Tenon's tissue was collected. The graft was introduced through a 23G trocar and released over the macular hole under a bubble of PFCL. The patch is delicately pushed towards the edges of the hole to slide underneath. The PFCL bubble is then actively aspirated next to the optic disc. Tamponade with gas or silicone oil is subsequently injected, with care taken to minimize fluid turbulence during the procedure.</p><p><strong>Results: </strong>The outcomes of autologous Tenon patch grafts in three giant FTMHs are reported. In the first case, silicone oil tamponade was injected, in the second, C2F6 gas was injected. And in the third case, that of a woman with advanced glaucoma, no tamponade was left in the eye. No adverse effects were observed during or after the procedures. Closure of the macular hole and functional improvement were documented during the follow-up period in all three cases.</p><p><strong>Conclusion: </strong>With a follow-up of up to 6 months, the Tenon patch graft appeared to be a promising technique for managing complex cases of FTMH. Additional studies to investigate long-term outcomes and determine the most appropriate indications are warranted.</p>","PeriodicalId":14289,"journal":{"name":"International Journal of Retina and Vitreous","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11218279/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141476621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical trial to test the safety of the EVA Nexus surgical platform.","authors":"Stalmans Peter","doi":"10.1186/s40942-024-00563-3","DOIUrl":"10.1186/s40942-024-00563-3","url":null,"abstract":"<p><strong>Background: </strong>The EVA Nexus system offers several technical improvements over its predecessor. The newly designed Aveta cannula system for vitrectomy surgery avoids the need for removal of the valve from the infusion cannula. The chamfered leading edge of the cannula also reduces the insertion force needed. The new EquiPhaco needles in combination with SmartIOP provide excellent anterior chamber stability during phaco-emulsification surgery, enabling to work at lower infusion pressures, and the multiburst phaco mode allows easier removal of hard cataracts. The system offers a secondary active infusion line for independent control of pressure to the anterior and posterior chambers, monitoring of flow rate/reflux and warning of infusion bottle emptying. This study evaluated whether these technical improvements result in improved surgical safety.</p><p><strong>Methods: </strong>In total, 250 eyes that underwent vitrectomy (53%) or phaco-vitrectomy (47%) using the EVA Nexus system were prospectively included. The occurrence of intraoperative adverse events was compared to that of historically operated eyes using the EVA system.</p><p><strong>Results: </strong>The average age of the patients was 63 years. A total of 33% of the patients were operated on for retinal detachment, 17% for macular pucker, 11% for treating floaters, 9% for removing silicone oil, 8% for macular hole repair and 22% for other diseases. In 75% of surgeries, 23 G instruments were used, and 27 G instruments were used in 25% of cases. Device issues that occurred included priming cycle issues (n = 4), eye pressure stability problems (n = 6) and vitrectome performance issues (n = 1), all of which in the first 100 patients who were included and were fixed with software updates. The frequency of surgical complications in the anterior segment was lower than that in the historically recorded surgical reports. Intraoperative events in the posterior segment included hemorrhage from retinal vessels, choroidal hematoma, iatrogenic retinal damage/tear, and subchoroidal infusion. Again, these events occurred rarely and less frequently than in the historical surgical reports.</p><p><strong>Conclusions: </strong>The EVA Nexus provides a surgical platform that reduces the incidence of intraoperative adverse events and iatrogenic complications in both anterior and posterior segment surgery. This could increase surgical safety during cataract and vitrectomy surgery. TRIAL REGISTRATION NUMBER CLINICALTRIALS.GOV: : NCT05229094 Data 22/5/2021.</p>","PeriodicalId":14289,"journal":{"name":"International Journal of Retina and Vitreous","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11197291/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141446121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}