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Borkenstein AF, Borkenstein EM, Langenbucher A. VIVEX: A Formula for Calculating Individual Vitreous Volume: A New Approach Towards Tailored Patient Dosing Regime in Intravitreal Therapy. Ophthalmol Ther 2024; 13:205-219. [PMID: 37938450 PMCID: PMC10776541 DOI: 10.1007/s40123-023-00838-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/17/2023] [Indexed: 11/09/2023] Open
Abstract
INTRODUCTION Personalized medicine and patient-tailored drug dosing have been substantiated through thousands of clinical studies, demonstrating their safety and efficacy. The principle: "as much as necessary, as little as possible" is widely spread. Quantities and doses are therefore adjusted individually. This is not the case for intravitreal injections in the context of retinal diseases. Intravitreal injections are not adjusted in relation to the vitreous volume. The vitreous body is described as "approx. 4 cm3" in the literature. METHODS In this retrospective observational study, we included 72 eyes of patients who had undergone magnetic resonance imaging (MRI) of the orbit and biometry measurements of the anterior chamber depth (ACD) and axial length. After segmentation of the volume data, the vitreous volume was extracted by voxel integration, and a simple prediction model was derived to determine the vitreous volume from the axial length (AL) measurement with AL3·π/6·(0.76 + 0.012·(AL-24). This is the volume of a sphere AL3·π/6 and a correction term 0.76 + 0.012·(AL-24) to account for the portion of the vitreous in the entire globe and the proportional increase of the vitreous portion for long (myopic) eyes. RESULTS Emmetropic eyes with an axial length of 22.50-23.50 mm had a vitreous volume of around 4.5-5.5 cm3. Myopic eyes with an axial length of 30.00 mm had a calculated vitreous volume of 9.0-10.0 cm3. Hypermetropic eyes with an axial length of 20.00 mm showed a vitreous volume of 3.0-4.0 cm3. CONCLUSIONS By implementing the new calculation formula on the IOLCON website, it will be easy to get the exact individual vitreous volume. The data could be used by retinal surgeons prior to surgery. The knowledge of anatomical dimensions and exact individual vitreous volume seems to be important for gas and silicone oil fillings. With the newly derived knowledge, multicentric studies can evaluate the impact of the dose in intravitreal therapies. Patient-tailored dosing could prevent side effects and improve effectiveness.
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Affiliation(s)
- Andreas F Borkenstein
- Borkenstein and Borkenstein Private Practice, Privatklinik der Kreuzschwestern Graz, Kreuzgasse 35, 8010, Graz, Austria.
| | - Eva-Maria Borkenstein
- Borkenstein and Borkenstein Private Practice, Privatklinik der Kreuzschwestern Graz, Kreuzgasse 35, 8010, Graz, Austria
| | - Achim Langenbucher
- Institut für Experimentelle Ophthalmologie, Universität des Saarlandes, 66424, Homburg/Saar, Germany
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Wakabayashi T, Tsuboi K, Oshima Y, Ishida Y, Baba K, Shiraki N, Yamamoto Y, Fukuyama H, Abe K, Otsuka Y, Hashimoto R, Shiraki A, Hara C, Venkatesh R, Chhablani J, Gomi F, Kamei M, Maeno T, Yonekawa Y, Ikuno Y. Efficacy of Vitrectomy With Tamponade Versus No Tamponade for Myopic Traction Maculopathy: A Multicenter Study (SCHISIS Report No.1). Am J Ophthalmol 2023; 254:182-192. [PMID: 37343740 DOI: 10.1016/j.ajo.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 06/05/2023] [Accepted: 06/08/2023] [Indexed: 06/23/2023]
Abstract
PURPOSE To evaluate the influence of tamponade on the visual and anatomic outcomes of pars plana vitrectomy for myopic traction maculopathy (MTM). DESIGN Multicenter, retrospective clinical cohort study. METHODS Consecutive eyes that underwent vitrectomy for advanced MTM with tamponade of air, sulfur hexafluoride (SF6), or perfluoropropane (C3F8) or without tamponade with a minimum follow-up of 12 months were included. Main outcome measures included postoperative visual acuity (VA) at 12 months in eyes with vs without tamponade. RESULTS We included a total of 193 eyes (193 patients) in this study; 136 eyes (70%) treated with tamponade were compared with 57 eyes (30%) treated without tamponade. Baseline characteristics did not differ significantly between the groups. Both groups showed significant visual improvement at 12 months (both P < .001). However, postoperative visual acuity and visual improvement at 12 months were significantly better (P = .003 and P = .028, respectively) in eyes without tamponade, although the MTM in these eyes without tamponade took longer to resolve (P = .039). Retinal thickness and the ellipsoid zone were more preserved in eyes without tamponade (P < .001 and P = .001, respectively). Complications such as macular holes did not differ between the groups. A novel imaging finding of "schisis bending (accordioning)" was identified during MTM resolution. CONCLUSIONS Vitrectomy either with or without tamponade for MTM was effective in improving vision in this study. However, eyes without tamponade experienced even better visual improvement and preserved retinal anatomy, despite a longer schisis resolution time. Surgery without tamponade may achieve better visual outcomes.
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Affiliation(s)
- Taku Wakabayashi
- From the Wills Eye Hospital (T.W., Y.Y.), Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA; Department of Ophthalmology (T.W., N.S., AS., C.H.), Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
| | - Kotaro Tsuboi
- Department of Ophthalmology (K.T., Y.I., K.B., M.K.), Aichi Medical University, Nagakute, Aichi, Japan; Casey Eye Institute (K.T.), Oregon Health & Science University, Portland, Oregon, USA
| | - Yusuke Oshima
- Oshima Eye Clinic (Y.O.), Seiyukai Medical Corporation, Takatsuki, Osaka, Japan
| | - Yuichiro Ishida
- Department of Ophthalmology (K.T., Y.I., K.B., M.K.), Aichi Medical University, Nagakute, Aichi, Japan
| | - Keita Baba
- Department of Ophthalmology (K.T., Y.I., K.B., M.K.), Aichi Medical University, Nagakute, Aichi, Japan
| | - Nobuhiko Shiraki
- Department of Ophthalmology (T.W., N.S., AS., C.H.), Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yuki Yamamoto
- Department of Ophthalmology (Y.Y., H.F. F.G.), Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Hisashi Fukuyama
- Department of Ophthalmology (Y.Y., H.F. F.G.), Hyogo College of Medicine, Nishinomiya, Hyogo, Japan; Department of Ophthalmology (H.F.), Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Kentaro Abe
- Department of Ophthalmology (K.A., Y.O., R.H., T.M.), Toho University Sakura Medical Center, Sakura, Japan
| | - Yuki Otsuka
- Department of Ophthalmology (K.A., Y.O., R.H., T.M.), Toho University Sakura Medical Center, Sakura, Japan
| | - Ryuya Hashimoto
- Department of Ophthalmology (K.A., Y.O., R.H., T.M.), Toho University Sakura Medical Center, Sakura, Japan
| | - Akihiko Shiraki
- Department of Ophthalmology (T.W., N.S., AS., C.H.), Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Chikako Hara
- Department of Ophthalmology (T.W., N.S., AS., C.H.), Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Ramesh Venkatesh
- Department of Retina and Vitreous (R.V.), Narayana Nethralaya, Rajaji Nagar, Bengaluru, Karnataka, India
| | - Jay Chhablani
- Department of Ophthalmology (J.C.), University of Pittsburgh Eye Center, Pittsburg, Pennsylvania, USA
| | - Fumi Gomi
- Department of Ophthalmology (Y.Y., H.F. F.G.), Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Motohiro Kamei
- Department of Ophthalmology (K.T., Y.I., K.B., M.K.), Aichi Medical University, Nagakute, Aichi, Japan
| | - Takatoshi Maeno
- Department of Ophthalmology (K.A., Y.O., R.H., T.M.), Toho University Sakura Medical Center, Sakura, Japan
| | - Yoshihiro Yonekawa
- From the Wills Eye Hospital (T.W., Y.Y.), Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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de Santana JM, Cordeiro GG, Soares DTC, Costa MR, Paashaus da Costa Pinto A, Lira RPC. Use of axial length to estimate the vitreous chamber volume in pseudophakic. Graefes Arch Clin Exp Ophthalmol 2020; 259:1471-1475. [PMID: 33141255 DOI: 10.1007/s00417-020-04991-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/28/2020] [Accepted: 10/22/2020] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To develop an equation for estimating the vitreous chamber volume in pseudophakic patients based on the axial length of the eye. METHODS A consecutive series of patients who underwent vitrectomy surgery for a macular hole or an epiretinal membrane were enrolled. The inclusion criteria were as follows: having pseudophakia, being older than 50 years, and having eyes with axial length ranging from 21 to 26 mm. Before the surgery, the axial length was measured using optical biometry. Pars plan vitrectomy was performed, and, after the fluid-air exchange, the vitreous chamber was filled with Brilliant Blue G (0.005%). The infused volume of each eye was recorded. Then, epiretinal membrane peeling or internal limiting membrane peeling and a new fluid-air exchange were performed. Main outcomes and measures were the vitreous chamber volume and axial length. RESULTS The sample consisted of 112 patients. The mean [standard deviation (SD), range] age was 71 years (7, 53-90). Sixty-five individuals (58%) were women. In 58 (51.8%) patients, surgery was performed on the right eye. The mean (SD; range) axial length was 23.78 mm (0.93; 21.55-25.26), and the mean (SD; range) vitreous chamber volume was 4.96 mL (0.69; 3.60-6.40). Pearson's correlation coefficient (r = 0.950; p < 0.01) was positive, and the coefficient of determination (R2) was 0.902. The estimated regression equation was Y = 0.71X - 11.84, where Y was the vitreous chamber volume, X was the axial length of the eye, the linear coefficient for the straight line was - 11.83, and the angular coefficient was 0.71 (p < 0.01). CONCLUSION These data suggest that the vitreous chamber volume is significantly correlated with the axial length and the former could probably be calculated using biometry. New studies with larger samples will be required to confirm these observations and will allow the development of an algorithm (perhaps non-linear) that includes extreme axial length values and that takes into account other factors such as the status of the lens and sex.
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