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Grassi P, Charteris D. Macular changes after primary retinectomy for retinal detachment complicated by proliferative vitreoretinopathy. Clin Exp Optom 2024; 107:434-441. [PMID: 37674262 DOI: 10.1080/08164622.2023.2236098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 07/10/2023] [Indexed: 09/08/2023] Open
Abstract
CLINICAL RELEVANCE Primary retinectomy in eyes not previously vitrectomized has been previously rarely performed in a minority of cases, unlike non-primary retinectomies in vitrectomized eyes. BACKGROUND This paper aims to determine anatomical and functional outcomes of primary retinectomy, and to assess structural macular changes among successful cases. METHODS In this retrospective multicentre cohort-study, 35 primary retinectomies in eyes undergoing initial vitrectomy for rhegmatogenous retinal detachment complicated by proliferative vitreoretinopathy C or D between 2014 and 2021 were included. The mean follow-up duration was 48 ± 59.24 months among successes and 46.54 ± 20.99 months among unsuccesses (p = 0.483). RESULTS The anatomical success rate was 48.5% after one retinectomy and 60% after two retinectomies. Mean postoperative best corrected visual acuity (BCVA) was 1.85 ± 0.62 logMAR (6/425 Snellen equivalent). The difference from mean preoperative BCVA was not significant (p = 0.312). Final BCVA ≥ 6/60 was achieved in 17% of cases, and no cases gained ≥6/24. Final mean postoperative BCVA of successes was 1.69 ± 0.60 logMAR (6/294 Snellen equivalent) compared with 2.10 ± 0.57 logMAR (6/756 Snellen equivalent) of unsuccessful cases (p = 0.101). Post-operative macular optical coherence tomography was obtained from 95% of successes. Normal macular profile was found in 10% of cases, and the other cases demonstrated exudative maculopathy (60%), tractional maculopathy (20%) and macular atrophy (10%). Final BCVA was significantly higher in eyes with normal macular status compared to eyes with exudative maculopathy (p = 0.045) and macular atrophy (p = 0.025). CONCLUSION Primary retinectomy may be used for rhegmatogenous retinal detachment complicated with advanced proliferative vitreoretinopathy. Anatomical and functional outcome were inferior than non-primary retinectomies for grade C proliferative vitreoretinopathy. Functional outcome was influenced by macular status. Positive prognostic factors include final anatomical success and normal final macular anatomy.
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Affiliation(s)
- Piergiacomo Grassi
- School of Medical Sciences, the University of Manchester, Manchester, UK
| | - David Charteris
- Vitreoretinal Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
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2
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Estawro R, Abraham N, Fouad Y, Bousquet E, Sarraf D. Cystoid macular edema as a complication of central retinal artery occlusion. Am J Ophthalmol Case Rep 2024; 33:101998. [PMID: 38333032 PMCID: PMC10850887 DOI: 10.1016/j.ajoc.2024.101998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/15/2023] [Accepted: 01/12/2024] [Indexed: 02/10/2024] Open
Abstract
Purpose To describe the development of cystoid macular edema (CME) as a complication of central retinal artery occlusion (CRAO) in 2 cases. Observations The first patient was a 51-year-old female who presented with acute loss of vision in the left eye. Multimodal retinal imaging revealed a CRAO with a perfused cilioretinal artery. CME acutely developed one week after presentation. Cystoid spaces predominantly involved the outer nuclear layer (ONL) on optical coherence tomography (OCT) and completely resolved in two weeks. The second case was a 50-year-old man who presented with acute vision loss in the right eye for 3 weeks. Multimodal retinal imaging illustrated an acute CRAO of the right eye. Four weeks later, visual acuity spontaneously improved to 20/20 and was maintained at 20/20 for more than 2 years. After 28 months, the patient returned with a recurrent drop of vision in the right eye. Cross sectional and en face OCT revealed CME in the right eye without leakage on FA. Cystoid spaces predominantly involved the inner nuclear layer (INL) and resolved with intravitreal anti-VEGF injection combined with carbonic anhydrase inhibitor (CAI) and steroid topical drop therapy. Conclusions and Importance CME can rarely complicate both the acute and chronic phase of CRAO. In the acute phase, cystoid spaces were transient and confined to the ONL on OCT. While in the chronic phase, cystoid spaces were confined to the INL on OCT and angiographically silent on FA. Further studies are needed to identify the incidence, underlying pathophysiology and visual prognosis of CME in cases of CRAO.
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Affiliation(s)
- Rania Estawro
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, CA, United States
- Retina Department, Al-Watany Eye Hospital, Cairo, Egypt
| | - Neda Abraham
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, CA, United States
| | - Yousef Fouad
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, CA, United States
- Department of Ophthalmology, Ain Shams University Hospitals, Cairo, Egypt
| | - Elodie Bousquet
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, CA, United States
- Department of Ophthalmology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris Cité, Paris, France
| | - David Sarraf
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, CA, United States
- Greater Los Angeles VA Healthcare Center, Los Angeles, CA, United States
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Kanzaki Y, Matoba R, Ishihara K, Morita T, Muraoka Y, Kimura S, Koto T, Kawasaki R, Baba T, Okamoto F, Inoue M, Sakamoto T, Tsujikawa A, Morizane Y. Japan-epiretinal membrane (J-ERM) registry: A prospective cohort study protocol investigating the surgical outcome of epiretinal membrane. PLoS One 2024; 19:e0297347. [PMID: 38329968 PMCID: PMC10852224 DOI: 10.1371/journal.pone.0297347] [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: 09/25/2023] [Accepted: 12/21/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Epiretinal membrane (ERM) causes visual impairment such as reduction in visual acuity and metamorphopsia due to retinal traction. With the improvement of optical coherence tomography (OCT) and microincision vitrectomy surgery (MIVS), the surgery of ERM has significantly advanced. However, there have been no large-scale studies on the following: (1) how to evaluate visual impairment in ERM, (2) the relationship between OCT findings and visual function, (3) when is the optimal timing of surgery, and (4) the relationship between the surgical instruments as well as techniques and prognosis. The purpose of this study was to obtain evidence regarding these ERM surgeries. METHODS AND DESIGN This is a prospective, multicenter cohort study of ERM surgery in Japan from March 1, 2023, to March 31, 2027 (UMIN000048472, R-3468-2). Patients who underwent ERM surgery during the study period and agreed to participate in this study will be included. The goal is to have a total of 5,000 eyes surgically treated for ERM. The following data will be collected: age, gender, medical history, subjective symptoms, visual function before and 6 and 12 months after surgery, clinical findings, OCT data, surgical technique, instruments used in surgery, and complications. DISCUSSION The results of this study will support the surgical decisions and procedures in ERM practices.
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Affiliation(s)
- Yuki Kanzaki
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama City, Okayama, Japan
| | - Ryo Matoba
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama City, Okayama, Japan
| | - Kenji Ishihara
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
| | - Tetsuro Morita
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama City, Okayama, Japan
| | - Yuki Muraoka
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
| | - Shuhei Kimura
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama City, Okayama, Japan
| | - Takashi Koto
- Kyorin Eye Center, Department of Ophthalmology, Kyorin University School of Medicine, Mitaka City, Tokyo, Japan
| | - Ryo Kawasaki
- Division of Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita City, Osaka, Japan
| | - Takayuki Baba
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chuo-ku, Chiba, Japan
| | - Fumiki Okamoto
- Department of Ophthalmology, Graduate School of Medicine, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Makoto Inoue
- Kyorin Eye Center, Department of Ophthalmology, Kyorin University School of Medicine, Mitaka City, Tokyo, Japan
| | - Taiji Sakamoto
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima City, Kagoshima, Japan
| | - Akitaka Tsujikawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
| | - Yuki Morizane
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama City, Okayama, Japan
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Garg A, Wahab C, Yan P. Surgical Management of Full-Thickness Macular Holes Spontaneously Arising From Lamellar Macular Holes. JOURNAL OF VITREORETINAL DISEASES 2024; 8:29-33. [PMID: 38223778 PMCID: PMC10786080 DOI: 10.1177/24741264231208493] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Introduction: To review the literature regarding surgical management of full-thickness macular holes (FTMHs) spontaneously arising from lamellar MHs (LMHs). Methods: The literature on surgically managed FTMHs arising from LMHs was reviewed via Ovid MEDLINE and Embase through June 5, 2022. Results: Seventy-six eyes from 16 articles were included. Forty eyes had internal limiting membrane (ILM) peeling, 32 inverted ILM flap techniques, and 4 an unclear surgical technique. The FTMH closure rate was not significantly different between ILM peeling (34/40 [85%]) and the inverted ILM flap techniques (28/32 [88%]) (P = .761). The mean (±SD) logMAR visual acuity improved from 0.64 ± 0.46 to 0.25 ± 0.22 (Snellen 20/87 to 20/36) with ILM peeling (n = 30); similar data were not available for inverted ILM flap techniques. Conclusions: Foveal tissue loss, flat hole edges, and limited retinal hydration may result in inverted ILM flap techniques having outcomes similar to those of ILM peeling in repairing FTMHs from LMHs. Future studies are needed to compare techniques.
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Affiliation(s)
- Anubhav Garg
- Department of Surgery, Division of Ophthalmology, McMaster University, Hamilton, ON, Canada
| | - Charbel Wahab
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
- Kensington Vision and Research Centre, Toronto, ON, Canada
| | - Peng Yan
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
- Kensington Vision and Research Centre, Toronto, ON, Canada
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Al-Sheikh M, Govetto A, Phasukkijwatana N, Matteucci M, Repetto R, Romano MR, Virgili G, Zweifel S, Barthelmes D, Bailey Freund K, Sadda SR, Sarraf D. Myopic macular schisis: Insights into distinct morphological subtypes and novel biomechanical hypothesis. Eur J Ophthalmol 2023; 33:2250-2258. [PMID: 37073079 DOI: 10.1177/11206721231166164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
PURPOSE To analyze the features of myopic macular schisis (MMS) in different retinal layers and to explore the role of Müller cells in the pathophysiology of such condition. METHODS Spectral-domain optical coherence tomography (SD-OCT) images of myopic eyes with staphyloma and macular schisis were reviewed. The morphological features of MMS were analyzed and correlated with their geographical location in the parafoveal and perifoveal region. A biomechanical model was adopted to explain MMS morphological differences. The effect of the different schisis subtypes with best corrected visual acuity (BCVA) was also explored. RESULTS A total of 36 eyes from 26 patients were included in this study. MMS was classified into inner, middle and outer retinal subtypes. The prevalence of middle retinal schisis was significantly lower in the parafovea, within a central 3 mm-diameter circle (p < 0.001) centered at the fovea . The prevalence of inner retinal schisis was significantly higher outside the central 3-mm diameter circle, in the perifoveal region (p < 0.001). No significant differences were noted in the prevalence of outer retinal schisis for these two locations (p = 0.475). The presence of middle retinal schisis within the central 3-mm diameter circle showed a weak association with lower BCVA (p = 0.058). The presence of outer retinal schisis within the central 3-mm diameter circle was significantly related with lower BCVA (p = 0.024). CONCLUSION Three major forms of MMS are distinguished: inner, middle and outer retinal schisis. This classification may have clinical importance as only the outer grade of schisis was associated with vision loss.
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Affiliation(s)
- Mayss Al-Sheikh
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Andrea Govetto
- Ophthalmology Department, Circolo e Fondazione Macchi Hospital, ASST- Sette Laghi, Varese, Italy
| | - Nopasak Phasukkijwatana
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Martina Matteucci
- Ophthalmology Department, Circolo e Fondazione Macchi Hospital, ASST- Sette Laghi, Varese, Italy
| | - Rodolfo Repetto
- Department of Civil, Chemical and Environmental Engineering, University of Genoa, Genoa, Italy
| | - Mario R Romano
- Humanitas University, Eye Unit, Humanitas-Gavazzeni Hospital, Bergamo, Italy
| | - Gianni Virgili
- Ophthalmology Department, Careggi University Hospital, University of Florence, Florence, Italy
| | - Sandrine Zweifel
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Daniel Barthelmes
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Save Sight Insititute, The University of Sydney, Sydney, Australia
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, USA
| | | | - David Sarraf
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California, Los Angeles, California, USA
- Greater Los Angeles VA Healthcare Center, Los Angeles, California, USA
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Liu J, Wang Y, Wang L. Stellate nonheritable idiopathic foveomacular retinoschisis in juveniles: case report. BMC Ophthalmol 2023; 23:389. [PMID: 37752454 PMCID: PMC10521493 DOI: 10.1186/s12886-023-03142-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/13/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Stellate nonhereditary idiopathic foveomacular retinoschisis (SNIFR) is a rare type of retinoschisis with a spoke-like splitting that occurs in the outer plexus layer. We present a case of stellate nonhereditary idiopathic foveomacular retinoschisis in a juvenile, in which two eyes show different development trends and macular retinoschisis could be associated with mechanical force in the Henle fibre layer. The removal of mechanical force can partially restore vision. CASE PRESENTATION A 14-year-old girl with bilateral SNIFR was diagnosed and followed up with spectral-domain optical coherence tomography (SD-OCT). During the two follow-up visits, vitreous adhesion was released in the left eye, and visual acuity improved. Neuroepithelial detachment was aggravated in the right eye, and visual acuity decreased. Therefore, vitrectomy was performed on the right eye. After surgery, the patient's retina was reattached, and her vision was partially restored. CONCLUSIONS We reported a juvenile with bilateral SNIFR. Each of her eyes showed different development trends, so we adopted different treatment methods for each eye. Vitrectomy was performed on the patient to address progressive vision loss, which improved the patient's vision. It was further confirmed that the Henle layer of SNIFR patients was susceptible to posterior vitreous membrane adhesion.
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Affiliation(s)
- Jianan Liu
- Department of Ophthalmology, Hebei Medical University, Shijiazhuag, 050017, Hebei, China
| | | | - Lifei Wang
- Department of Ophthalmology, Hebei Medical University, Shijiazhuag, 050017, Hebei, China.
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Sharma A, Wu L, Bloom S, Stanga P, Figueroa MS, Govetto A, Mirajkar A, Nagpal M, Mehrotra N, Sharma A, Rezaei KA. RWC Update: Intraoperative Fluorescein Angiography, Plasma Rich in Growth Factor as Adjuvant to Vitrectomy in High Myopic Retinal Detachment Associated With Full-Thickness Macular Hole, Giant Tear of the Retinal Pigment Epithelium. Ophthalmic Surg Lasers Imaging Retina 2023; 54:259-264. [PMID: 37184990 DOI: 10.3928/23258160-20230412-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
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Non-Invasive Retinal Imaging Modalities for the Identification of Prognostic Factors in Vitreoretinal Surgery for Full-Thickness Macular Holes. Diagnostics (Basel) 2023; 13:diagnostics13040589. [PMID: 36832078 PMCID: PMC9955111 DOI: 10.3390/diagnostics13040589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/28/2023] [Accepted: 01/30/2023] [Indexed: 02/08/2023] Open
Abstract
In this review, we will focus on different non-invasive retinal imaging techniques that can be used to evaluate morphological and functional features in full-thickness macular holes with a prognostic purpose. Technological innovations and developments in recent years have increased the knowledge of vitreoretinal interface pathologies by identifying potential biomarkers useful for surgical outcomes prediction. Despite a successful surgery of full-thickness macular holes, the visual outcomes are often puzzling, so the study and the identification of prognostic factors is a current topic of interest. Our review aims to provide an overview of the current knowledge on prognostic biomarkers identified in full-thickness macular holes by means of different retinal imaging tools, such as optical coherence tomography, optical coherence tomography angiography, microperimetry, fundus autofluorescence, and adaptive optics.
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Full-Thickness Macular Hole: Are Supra-RPE Granular Deposits Remnants of Photoreceptors Outer Segments? Clinical Implications. Am J Ophthalmol 2023; 245:86-101. [PMID: 36162533 DOI: 10.1016/j.ajo.2022.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/23/2022]
Abstract
PURPOSE To describe the presence of specific morphological characteristics of idiopathic, full-thickness macular hole (MH) potentially influencing postoperative best corrected visual acuity (BCVA) and surgical outcomes. DESIGN Retrospective, multicenter and interventional case series. METHODS Clinical charts and multimodal imaging pictures of 149 eyes of 143 consecutive patients diagnosed with MH, treated surgically and with a minimum follow-up of 12 months, were reviewed. RESULTS Supra-retinal pigment epithelium (RPE) granular deposits were diagnosed in 121 of 149 eyes (81.2%). A smooth morphology was identified in 58 of 149 eyes (38.9%), whereas a bumpy border was present 91 of 149 eyes (61.1%). Photoreceptor disruption was mainly located close to the MH aperture. In 8% of the included cases, preoperative anatomical progression from smooth to bumpy morphology was noted. The presence of supra-RPE granular deposits was a significant predictor of lower postoperative BCVA only in univariate analysis (P < .001). The presence of a bumpy border was significantly correlated with lower postoperative BCVA in both univariate and multivariate analysis (P < .001). BCVA gain was significantly lower in MH with bumpy borders (P < .001). A bumpy border was also significantly associated with poor postoperative anatomical restoration (P < .001). CONCLUSIONS Supra RPE-granular deposits and a bumpy morphology may be indicators of photoreceptor disruption in MH. A bumpy morphology may suggest deeper and potentially irreversible photoreceptor damage, and may negatively influence both functional and anatomical recovery.
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Cristescu IE, Ivanova T, Moussa G, Ferrara M, Patton N, Dhawahir-Scala F, Ch’ng SW, Mitra A, Tyagi AK, Lett KS, Jalil A. Functional and Anatomical Outcomes of Pars Plana Vitrectomy for Epiretinal Membrane in Patients with Uveitis. Diagnostics (Basel) 2022; 12:diagnostics12123044. [PMID: 36553051 PMCID: PMC9777241 DOI: 10.3390/diagnostics12123044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/24/2022] [Accepted: 11/26/2022] [Indexed: 12/12/2022] Open
Abstract
Purpose-To evaluate the anatomical and functional outcomes of vitrectomy and epiretinal membrane (ERM) peeling in patients with uveitis. Secondarily, we evaluated the effect of internal limiting membrane (ILM) peeling on surgical outcomes, and of surgery on uveitis activity and, thus, therapeutic regime. Methods-Bicentre, retrospective, interventional case series of 29 eyes of 29 consecutive patients affected by uveitis and ERM, that had undergone pars plana vitrectomy with ERM peel between 2012 and 2020, with a minimum postoperative follow-up (FU) of six-months. Demographic data, best-corrected visual-acuity (BCVA), clinical findings, intraoperative and postoperative complications, and macular optical-coherence-tomography scans were reviewed. Results-The mean (standard deviation) duration of follow-up was 32 (22) months. At six-month FU, mean central-retinal-thickness (CRT) significantly improved (from 456 (99) to 353 (86) microns; p < 0.001), and mean BCVA improved from 0.73 (0.3) to 0.49 (0.36) logMAR (p < 0.001), with only one (3%) patient experiencing worsening of vision. The rate of concomitant cystoid macular edema decreased from 19 (66%) eyes at presentation to eight (28%) eyes at final-FU (p = 0.003). Comparing eyes in which ILM peeling was performed in addition to ERM peeling only, BCVA or CRT reduction were comparable. Only a minority of six (21%) eyes had a worsening in uveitis activity requiring additional medications, whereas most patients resumed the same treatment (52%) or received less treatment (28%) (p = 0.673). Conclusions-Vitrectomy with ERM peeling led to favourable anatomical and functional outcomes in patients with uveitis regardless of whether the ILM is peeled or not. As in most patients, no activation of the uveitis requiring additional medications was noted, we do not recommend changes in anti-inflammatory/immunosuppressive therapy postoperatively.
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Affiliation(s)
- Irina-Elena Cristescu
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL, UK
| | - Tsveta Ivanova
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL, UK
| | - George Moussa
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL, UK
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham B18 7QH, UK
- Correspondence: ; Tel.: +161-276-1234
| | - Mariantonia Ferrara
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL, UK
| | - Niall Patton
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL, UK
| | - Felipe Dhawahir-Scala
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL, UK
| | - Soon Wai Ch’ng
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham B18 7QH, UK
| | - Arijit Mitra
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham B18 7QH, UK
| | - Ajai K. Tyagi
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham B18 7QH, UK
| | - Kim Son Lett
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham B18 7QH, UK
| | - Assad Jalil
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL, UK
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11
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Update on the utility of en face optical coherence tomography in the assessment of vitreoretinal diseases. J Fr Ophtalmol 2022; 45:1198-1208. [DOI: 10.1016/j.jfo.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/14/2022] [Accepted: 06/20/2022] [Indexed: 11/06/2022]
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12
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Ferrara M, Zheng Y, Romano V. Editorial: Imaging in Ophthalmology. J Clin Med 2022; 11:jcm11185433. [PMID: 36143079 PMCID: PMC9503085 DOI: 10.3390/jcm11185433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
Over the last decade, ophthalmology has significantly benefited from advances in vivo non-invasive ophthalmic imaging techniques that play currently a fundamental role in the clinical assessment, diagnosis, management, and monitoring of a wide variety of conditions involving both the anterior and posterior segment [...]
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Affiliation(s)
| | - Yalin Zheng
- Department of Eye and Vision Science, University of Liverpool, Liverpool L69 3BX, UK
- St Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool L69 3BX, UK
| | - Vito Romano
- Eye Clinic, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, 25121 Brescia, Italy
- ASST Civil Hospital of Brescia, 25123 Brescia, Italy
- Correspondence:
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Non-vasogenic cystoid maculopathies. Prog Retin Eye Res 2022; 91:101092. [PMID: 35927124 DOI: 10.1016/j.preteyeres.2022.101092] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/30/2022] [Accepted: 06/01/2022] [Indexed: 11/23/2022]
Abstract
Besides cystoid macular edema due to a blood-retinal barrier breakdown, another type of macular cystoid spaces referred to as non-vasogenic cystoid maculopathies (NVCM) may be detected on optical coherence tomography but not on fluorescein angiography. Various causes may disrupt retinal cell cohesion or impair retinal pigment epithelium (RPE) and Müller cell functions in the maintenance of retinal dehydration, resulting in cystoid spaces formation. Tractional causes include vitreomacular traction, epiretinal membranes and myopic foveoschisis. Surgical treatment does not always allow cystoid space resorption. In inherited retinal dystrophies, cystoid spaces may be part of the disease as in X-linked retinoschisis or enhanced S-cone syndrome, or occur occasionally as in bestrophinopathies, retinitis pigmentosa and allied diseases, congenital microphthalmia, choroideremia, gyrate atrophy and Bietti crystalline dystrophy. In macular telangiectasia type 2, cystoid spaces and cavitations do not depend on the fluid leakage from telangiectasia. Various causes affecting RPE function may result in NVCM such as chronic central serous chorioretinopathy and paraneoplastic syndromes. Non-exudative age macular degeneration may also be complicated by intraretinal cystoid spaces in the absence of fluorescein leakage. In these diseases, cystoid spaces occur in a context of retinal cell loss. Various causes of optic atrophy, including open-angle glaucoma, result in microcystoid spaces in the inner nuclear layer due to a retrograde transsynaptic degeneration. Lastly, drug toxicity may also induce cystoid maculopathy. Identifying NVCM on multimodal imaging, including fluorescein angiography if needed, allows guiding the diagnosis of the causative disease and choosing adequate treatment when available.
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Savastano MC, Kilian RA, Savastano A, Caporossi T, Molle A, Ripa M, Bacherini D, Rizzo S. Morphological Features of Full-Thickness Macular Holes Using Retromode Scanning Laser Ophthalmoscopy. Ophthalmic Surg Lasers Imaging Retina 2022; 53:368-373. [PMID: 35858228 DOI: 10.3928/23258160-20220614-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Retromode scanning laser ophthalmoscopy (RM-SLO) is a new imaging modality displaying pseudo-3D retinal images. We assessed the correlation between the morphological features of full-thickness macular holes (FTMHs) when using spectral domain-optical coherence tomography (SD-OCT) and when using RM-SLO. MATERIALS AND METHODS This is a prospective observational case series in which patients were examined through SD-OCT and RM-SLO after informed consent was obtained. Intraclass correlation coefficient (ICC) and Pearson correlation coefficient (PCC) were used to assess interobserver agreement and the correlation between the diameters measured with the two techniques. RESULTS We enrolled 20 patients (20 eyes) with an average hole aperture size of 426 μm (140-890 μm) on SD-OCT and 56 pixels (19-102 pixels) on RM-SLO. ICC and PCC were 0.999 and 0.992, respectively. "Standard" and "double-ring" FTMH patterns were described on RM-SLO and related well with SD-OCT findings. CONCLUSIONS RM-SLO is a reliable method for FTMH-diameter evaluation and identifies unique pseudo-3D morphological features consistent with their B-scan counterparts. [Ophthalmic Surg Lasers Imaging Retina 2022; 53:368-373.].
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15
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Clinical features and prognosis in idiopathic epiretinal membranes with different types of intraretinal cystoid spaces. Retina 2022; 42:1874-1882. [DOI: 10.1097/iae.0000000000003537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Gebler M, Pfeiffer S, Callizo J, Hoerauf H, Feltgen N, Bemme S. Incidence and risk factors for macular oedema after primary rhegmatogenous retinal detachment surgery: a prospective single-centre study. Acta Ophthalmol 2022; 100:295-301. [PMID: 34137182 DOI: 10.1111/aos.14940] [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: 03/26/2020] [Accepted: 05/20/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To assess the incidence of cystoid macular oedema (CME) diagnosed by spectral domain optical coherence tomography (SD-OCT) after primary rhegmatogenous retinal detachment (RRD) surgery. METHODS From April 2016 to October 2017, 150 eyes of 150 patients presenting with primary RRD were included consecutively in this prospective single-centre study. Patients with the following characteristics were excluded: previous vitreoretinal surgery, combined cataract surgery, preoperatively presentation with any intraocular or systemic inflammatory condition, visible macular oedema or epiretinal membrane (ERM) on funduscopy. SD-OCT (Spectralis, Heidelberg Engineering) was conducted 3 and 6 weeks after surgery. RESULTS One hundred and twenty-eight of the 150 patients completed the study, of whom 107 (age: 61.7 ± 11.5 years, mean ± SD) showed successful retinal attachment during follow-up visits. The most frequent operation method was scleral buckling (54.2%), followed by vitrectomy (25.2%) and the combination of both techniques (20.6%). Postoperative SD-OCT revealed CME, neurosensory detachment and ERM in 18.7, 31.8 and 32.7% of all cases, respectively. The risk of postoperative CME was significantly elevated in patients with ERM (42.9 versus 6.9%, p < 0.001). In addition, patients with initial detachment of the macula had more postoperative CME (26.5 versus 11.1%, p = 0.044). BCVA improvement was significantly lower in patients with CME compared to patients without 6 weeks after surgery for macula-on RRD. CONCLUSIONS This prospective study confirmed that postoperative CME is a frequent complication after RRD surgery; we identified ERM and macula-off RRD as potential risk factors. As CME potentially delays visual recovery, postoperative follow-ups should include SD-OCT.
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Affiliation(s)
- Marie Gebler
- Department of Ophthalmology University Medical Center Goettingen Goettingen Germany
| | - Sebastian Pfeiffer
- Department of Research, Teaching and Clinical Science University Medical Center Goettingen Goettingen Germany
| | - Josep Callizo
- Department of Ophthalmology University Medical Center Goettingen Goettingen Germany
| | - Hans Hoerauf
- Department of Ophthalmology University Medical Center Goettingen Goettingen Germany
| | - Nicolas Feltgen
- Department of Ophthalmology University Medical Center Goettingen Goettingen Germany
| | - Sebastian Bemme
- Department of Ophthalmology University Medical Center Goettingen Goettingen Germany
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17
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Stino H, Wassermann L, Ristl R, Abela‐Formanek C, Georgopoulos M, Sacu S, Schmidt‐Erfurth U, Pollreisz A. Evaluation of neuroretinal integrity in optical coherence tomography-graded eyes with partial-thickness macular holes. Acta Ophthalmol 2022; 100:e1280-e1286. [PMID: 35403361 DOI: 10.1111/aos.15156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate neuroretinal integrity in different subtypes of optical coherence tomography (OCT)-graded partial-thickness macular holes. METHODS Fovea-centred SD-OCT images (Cirrus, Carl Zeiss Meditec AG; Spectralis, Heidelberg Engineering GmbH) and visual acuity (VA) acquired at every visit were analysed by two retina specialists retrospectively in 71 eyes of 65 patients. Partial-thickness macular holes were classified as lamellar macular hole (LMH), epiretinal membrane foveoschisis (ERMF) or macular pseudohole (MPH). RESULTS Lamellar macular hole, ERMF and MPH were diagnosed in 33 (47%), 31 (43%) and 7 (10%) eyes with a VA of 0.18 ± 0.25, 0.15 ± 0.2, and 0.06 ± 0.08 (p = 0.323), respectively. Median follow-up time was 11 (interquartile range 4-32.5), 10 (interquartile range 5-18) and 19 (interquartile range 8-24) months in LMH, ERMF and MPH. In all subgroups, VA remained stable during the follow-up (p = 0.652, p = 0.915 and p = 1.000). Epiretinal proliferations (EP) were present in 12 LMH and 3 ERMF. At baseline, eyes with EP had significantly worse VA (p < 0.001), wider foveal cavities (p = 0.007) and thinner foveal floors (p < 0.001) compared with eyes without EP. Twelve out of 15 eyes with EP showed exudative cystoid spaces. Among all 71 eyes, 51 remained morphologically and functionally stable during follow-up. CONCLUSION In our study cohort, EP are associated with worse VA and advanced neuroretinal tissue loss presenting with wider foveal cavities and thinner foveal floors. During the follow-up period, VA remained stable in all entities of partial-thickness macular holes.
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Affiliation(s)
- Heiko Stino
- Department of Ophthalmology and Optometry Medical University Vienna Vienna Austria
| | - Lorenz Wassermann
- Department of Ophthalmology and Optometry Medical University Vienna Vienna Austria
| | - Robin Ristl
- Section for Medical Statistics, Center for Medical Statistics, Informatics and Intelligent Systems Medical University Vienna Vienna Austria
| | | | - Michael Georgopoulos
- Department of Ophthalmology and Optometry Medical University Vienna Vienna Austria
| | - Stefan Sacu
- Department of Ophthalmology and Optometry Medical University Vienna Vienna Austria
| | | | - Andreas Pollreisz
- Department of Ophthalmology and Optometry Medical University Vienna Vienna Austria
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18
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Stravalaci M, Ferrara M, Pathak V, Davi F, Bottazzi B, Mantovani A, Medina RJ, Romano MR, Inforzato A. The Long Pentraxin PTX3 as a New Biomarker and Pharmacological Target in Age-Related Macular Degeneration and Diabetic Retinopathy. Front Pharmacol 2022; 12:811344. [PMID: 35069222 PMCID: PMC8776640 DOI: 10.3389/fphar.2021.811344] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 12/20/2021] [Indexed: 12/12/2022] Open
Abstract
Age related macular degeneration (AMD) and diabetic retinopathy (DR) are multifactorial, neurodegenerative and inflammatory diseases of the eye primarily involving cellular and molecular components of the outer and inner blood-retina barriers (BRB), respectively. Largely contributed by genetic factors, particularly polymorphisms in complement genes, AMD is a paradigm of retinal immune dysregulation. DR, a major complication of diabetes mellitus, typically presents with increased vascular permeability and occlusion of the retinal vasculature that leads, in the proliferative form of the disease, to neovascularization, a pathogenic trait shared with advanced AMD. In spite of distinct etiology and clinical manifestations, both pathologies share common drivers, such as chronic inflammation, either of immune (in AMD) or metabolic (in DR) origin, which initiates and propagates degeneration of the neural retina, yet the underlying mechanisms are still unclear. As a soluble pattern recognition molecule with complement regulatory functions and a marker of vascular damage, long pentraxin 3 (PTX3) is emerging as a novel player in ocular homeostasis and a potential pharmacological target in neurodegenerative disorders of the retina. Physiologically present in the human eye and induced in inflammatory conditions, this protein is strategically positioned at the BRB interface, where it acts as a “molecular trap” for complement, and modulates inflammation both in homeostatic and pathological conditions. Here, we discuss current viewpoints on PTX3 and retinal diseases, with a focus on AMD and DR, the roles therein proposed for this pentraxin, and their implications for the development of new therapeutic strategies.
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Affiliation(s)
| | | | - Varun Pathak
- School of Medicine, Dentistry, and Biomedical Sciences, Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, United Kingdom
| | | | | | - Alberto Mantovani
- IRCCS Humanitas Research Hospital, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Rozzano, Italy.,The William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Reinhold J Medina
- School of Medicine, Dentistry, and Biomedical Sciences, Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, United Kingdom
| | - Mario R Romano
- Eye Center, Humanitas Gavazzeni-Castelli, Bergamo, Italy.,Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
| | - Antonio Inforzato
- IRCCS Humanitas Research Hospital, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
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19
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Grassi P, Melville S, Hariprasad AS, Winder S, Ramkissoon Y, Spiteri-Cornish K, Cabrera RG, Subramani S, Chawla A. STRUCTURAL AND FUNCTIONAL MACULAR CHANGES AFTER RETINECTOMY FOR RETINAL DETACHMENT COMPLICATED BY PROLIFERATIVE VITREORETINOPATHY. Retina 2021; 41:2531-2539. [PMID: 34228410 DOI: 10.1097/iae.0000000000003250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To report anatomical and functional outcomes of nonprimary retinectomy for rhegmatogenous retinal detachment with Grade C proliferative vitreoretinopathy, to assess the structural and functional macular changes in successful eyes. METHODS Retrospective single-center cohort study: one hundred-one consecutive retinectomies of 101 eyes affected by rhegmatogenous retinal detachment with C proliferative vitreoretinopathy between January 2014 and February 2020 were included. RESULTS The mean preoperative best-corrected visual acuity (BCVA) was 1.48 ± 0.71 logarithm of the minimal angle of resolution (20/604 Snellen equivalent). The anatomical success rate was 78.2% after one retinectomy and 83.1% after two retinectomies. The final BCVA ≥ 20/200 was achieved in 29% of cases, 8% gained ≥ 20/80. The final mean postoperative BCVA of successes with oil in situ was 1.68 ± 0.59 (20/957 Snellen equivalent) compared with 1.07 ± 0.63 logarithm of the minimal angle of resolution (20/235 Snellen equivalent) of successes after oil removal (P = 0.00005). Postoperative macular optical coherence tomography was obtained from 60/84 successes (71%). The normal macular profile was found in 3%, whereas majority demonstrated exudative maculopathy (51.5%), macular atrophy (22%), tractional maculopathy (21.5%), and macular disciform scar (2%). Bivariate linear relationship between final central foveal thickness and BCVA was statistically significant (P = 0.000013). CONCLUSION Satisfactory anatomical and functional outcome is possible after retinectomy for C proliferative vitreoretinopathy. Positive prognostic factors include the removal of oil without redetachment, normal macular status, and lower central foveal thickness. The functional outcome was influenced by macular changes, as final BCVA and central foveal thickness correlated.
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Affiliation(s)
- Piergiacomo Grassi
- Department of Ophthalmology, Clinical Fellow in Vitreoretinal Surgery, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
- Vitreoretinal Surgery, Vitreoretinal Service, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, University College London, London, United Kingdom
| | - Saffron Melville
- University of Sheffeld Medical School, Sheffield, United Kingdom ; and
| | | | - Stephen Winder
- Department of Ophthalmology, Consultant Ophthalmic and Vitreoretinal Surgeon, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Yashin Ramkissoon
- Department of Ophthalmology, Consultant Ophthalmic and Vitreoretinal Surgeon, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Kurt Spiteri-Cornish
- Department of Ophthalmology, Consultant Ophthalmic and Vitreoretinal Surgeon, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Raquel G Cabrera
- Department of Ophthalmology, Consultant Ophthalmic and Vitreoretinal Surgeon, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Siddharth Subramani
- Department of Ophthalmology, Consultant Ophthalmic and Vitreoretinal Surgeon, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Anand Chawla
- Department of Ophthalmology, Consultant Ophthalmic and Vitreoretinal Surgeon, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
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20
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Bloch E, Flores-Sánchez B, Georgiadis O, Sundaram V, Saihan Z, Mahroo OA, Webster AR, da Cruz L. AN ASSOCIATION BETWEEN STELLATE NONHEREDITARY IDIOPATHIC FOVEOMACULAR RETINOSCHISIS, PERIPHERAL RETINOSCHISIS, AND POSTERIOR HYALOID ATTACHMENT. Retina 2021; 41:2361-2369. [PMID: 33840784 PMCID: PMC7611880 DOI: 10.1097/iae.0000000000003191] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Stellate nonhereditary idiopathic foveomacular retinoschisis is a disorder characterized by splitting of the retina at the macula, without a known underlying mechanical or inherited cause. This study investigates demographic, anatomical, and functional characteristics of subjects with stellate nonhereditary idiopathic foveomacular retinoschisis, to explore potential underlying mechanisms. METHODS In this single-site, retrospective, and cross-sectional, observational study, data were collected from 28 eyes from 24 subjects with stellate nonhereditary idiopathic foveomacular retinoschisis. Descriptive statistics were reported, based on the observed anatomico-functional features. RESULTS The visual acuity remained stable (median 20/20) in all subjects over a median follow-up of 17 months. All cases demonstrated foveomacular retinoschisis within Henle's fiber layer, at the junction of the outer plexiform and outer nuclear layers. This schisis cavity extended beyond the limits of the macular OCT temporally in all eyes. In most affected eyes, there were documented features of peripheral retinoschisis and broad attachment of the posterior hyaloid at the macula. Functional testing in a cross-sectional subset demonstrated normal retinal sensitivity centrally but an absolute scotoma peripherally. CONCLUSION Stellate nonhereditary idiopathic foveomacular retinoschisis seems to be associated with peripheral retinoschisis and anomalous or incomplete posterior hyaloid detachment. Despite chronic manifestation, this does not significantly affect central visual function but can manifest with profound loss of peripheral visual function.
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Affiliation(s)
- Edward Bloch
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Institute of Ophthalmology, University College London, United Kingdom
- Wellcome EPSRC Centre for Interventional and Surgical Sciences, University College London, United Kingdom
| | - Blanca Flores-Sánchez
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Institute of Ophthalmology, University College London, United Kingdom
| | - Odysseas Georgiadis
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Institute of Ophthalmology, University College London, United Kingdom
| | - Venki Sundaram
- Department of Ophthalmology, Luton and Dunstable University Hospital, United Kingdom
| | - Zubin Saihan
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Omar A. Mahroo
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Institute of Ophthalmology, University College London, United Kingdom
| | - Andrew R. Webster
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Institute of Ophthalmology, University College London, United Kingdom
| | - Lyndon da Cruz
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Institute of Ophthalmology, University College London, United Kingdom
- Wellcome EPSRC Centre for Interventional and Surgical Sciences, University College London, United Kingdom
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21
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Machado Nogueira T, de Souza Costa D, Isenberg J, Rezende FA. Stellate nonhereditary idiopathic foveomacular retinoschisis resolution after vitreomacular adhesion release. Am J Ophthalmol Case Rep 2021; 23:101153. [PMID: 34195481 PMCID: PMC8237522 DOI: 10.1016/j.ajoc.2021.101153] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/01/2020] [Accepted: 06/14/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To present a case of stellate nonhereditary idiopathic foveomacular retinoschisis (SNIFR) resolution associated with vitreomacular adherence (VMA) release and propose a potential contributing association between SNIFR and vitreomacular interactions. OBSERVATIONS A 67-year-old female patient was diagnosed and followed for SNIFR in OD with spectral-domain optical coherence tomography (SD-OCT) scans at presentation and subsequent visits at 3, 6, 16 and 22 months. VMA and foveomacular retinoschisis remained unchanged on SD-OCT during the first 6 months of the follow-up. At 16-month follow-up visit, SD-OCT revealed VMA release and an important improvement of the macular schisis. At 22 months of follow-up, SNIFR cavities completely resolved in the presence of posterior hyaloid separation from the macular area without any adjunct treatment. The authors could not identify any other possible cause to justify the resolution of SNIFR other than VMA release in this case. Patient did not undergo any treatment for OD other than phacoemulsification 3 months after initial visit. CONCLUSION The present case illustrates with SD-OCT scans a possible association between SNIFR resolution and VMA release, highlighting a potential tractional component of the posterior vitreous on the internal limiting membrane and consequent glial cells stretching with schisis formation.
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Affiliation(s)
| | | | - Jordan Isenberg
- Department of Ophthalmology, University of Montreal, Montreal, Quebec, Canada
- Department of Pathology, McGill University, Montreal, Quebec, Canada
| | - Flavio A. Rezende
- Department of Ophthalmology, University of Montreal, Montreal, Quebec, Canada
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22
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Vaiano AS, Hoffer KJ, Greco A, Greco A, D'Amico G, Pasqualitto V, Carlevale C, Savini G. Long-term Outcomes and Complications of the New Carlevale Sutureless Scleral Fixation Posterior Chamber IOL. J Refract Surg 2021; 37:126-132. [PMID: 33577699 DOI: 10.3928/1081597x-20201207-02] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 11/17/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the visual outcomes and possible complications of a new foldable sutureless scleral fixation intraocular lens (SSF-IOL), the Carlevale IOL (Soleko). METHODS The SSF-IOL, which has two T-shaped self-blocking plugs on each haptic, was inserted into the posterior chamber. Both haptics was grabbed through two sclerotomies and the two short arms were blocked under the scleral flap, without any suture. A complete clinical evaluation was done preoperatively and at 3, 6, and 12 months postoperatively. RESULTS A total of 54 eyes of 50 consecutive patients were retrospectively analyzed. The mean corrected distance visual acuity was 0.93 ± 0.61 logMAR preoperatively and improved to 0.42 ± 0.34 logMAR at 3 months, 0.42 ± 0.37 logMAR at 6 months, and 0.38 ± 0.38 logMAR at 12 months postoperatively (all P < .0001). The mean corneal endothelial cell density decreased from 1,725.37 ± 528.06 to 1,612.81 ± 522.91 cells/mm2 at 12 months postoperatively (P < .0001). The mean IOL tilt value was 3.1 ± 1.1° at 12 months postoperatively. The authors observed 6 cases (11.1%) of intraoperative rupture of the IOL haptics, 4 cases (7.4%) of early hyphema, 4 cases (7.4%) of macular cystoid edema, 2 cases (3.7%) of haptic exposure under the conjunctiva, and 1 (1.8%) late retinal detachment. CONCLUSIONS This newly introduced surgical technique provided promising results regarding efficacy and safety. Complications occurred in a few cases and were successfully managed. The Carlevale IOL seems to be a surgical solution combining the advantages of an easy and minimally invasive implantation with a good functional recovery with minimal complications. [J Refract Surg. 2021;37(2):126-132.].
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23
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Iuliano L, Cisa di Gresy G, Fogliato G, Corbelli E, Bandello F, Codenotti M. Increased risk of postsurgical macular edema in high stage idiopathic epiretinal membranes. EYE AND VISION (LONDON, ENGLAND) 2021; 8:29. [PMID: 34348801 PMCID: PMC8335864 DOI: 10.1186/s40662-021-00252-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/18/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE To assess the rate of occurrence and the risk factors of postsurgical macular edema (PSME) in eyes with idiopathic epiretinal membrane (iERM) or full-thickness macular hole (FTMH). METHODS Retrospective longitudinal analysis of all subjects scheduled for vitrectomy with or without combined cataract surgery over a 6-month period. Electronic medical charts and imaging data were analyzed preoperatively and at 1, 3 and 6 months after surgery. RESULTS From 101 patients diagnosed with iERM or FTMH, 71 patients were eligible for the study. Forty-nine eyes with iERM (69.0%) and 22 eyes with FTMH (31.0%) underwent vitrectomy either isolated (31.0%) or combined with cataract extraction (69.0%). The overall rate of PSME was 26.7%, without differences between the two groups (P = 0.9479). Combined cataract extraction did not affect the overall occurrence of PSME rate in both groups (P = 0.9255 in FTMH and P = 0.8658 in iERM). If grouped by stage, eyes with stage 4 iERM though disclosed an increased rate of PSME (57.1%) compared to lower (1 to 3) stages (14.3%, P = 0.0021), particularly when combined with cataract surgery (71.4% vs. 15.4% in stages ≤ 3, P = 0.0021). The PSME odds ratio for a stage 4 iERM is 8 (95% CI: 1.933-33.1; P = 0.0041) compared to stages 3 and below. CONCLUSIONS PSME remains a clinically relevant and frequent event after surgery for iERM and FTMH. Patients with stage 4 iERM have an 8-fold higher likelihood of developing PSME in a 6-month postsurgical period compared to iERM in 1-3 stages, especially when combined with cataract extraction.
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Affiliation(s)
- Lorenzo Iuliano
- Department of Ophthalmology, Vita-Salute University, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
| | - Gloria Cisa di Gresy
- Department of Ophthalmology, Vita-Salute University, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Giovanni Fogliato
- Department of Ophthalmology, Vita-Salute University, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Eleonora Corbelli
- Department of Ophthalmology, Vita-Salute University, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, Vita-Salute University, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Marco Codenotti
- Department of Ophthalmology, Vita-Salute University, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
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24
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Govetto A, Mazzotta F, Al-Sheikh M, Mauro A, Romano MR. Macular capillary displacement in exudative and tractional macular oedema: a multimodal imaging study and pathophysiological hypothesis. Graefes Arch Clin Exp Ophthalmol 2021; 259:3675-3685. [PMID: 34236472 DOI: 10.1007/s00417-021-05289-8] [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: 02/28/2021] [Revised: 06/07/2021] [Accepted: 06/15/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE This study aims to describe vessel density differences in tractional versus exudative macular oedema with the aid of novel custom imaging analysis techniques. METHODS In this retrospective study, patients with exudative and tractional macular oedema were imaged with optical coherence tomography (OCT), en-face OCT, OCT-angiography and fluorescein angiography. A novel image processing algorithm was developed to extrapolate data from the vessel density maps. RESULTS Forty-one eyes of 36 patients were included. A total of 30 control eyes comprised the control group. At the deep capillary plexus (DCP), exudative eyes presented with a vessel density of 62.12 ± 5.7, significantly higher if compared to both tractional lamellar macular hole (57.6 ± 4.6, p = 0.004) and controls (52.07 ± 2.3, p < 0.001). At the superficial capillary plexus (SCP), there were no differences in vessel density between exudative eyes (51.9 ± 4.4) and both the tractional lamellar hole (54.9 ± 3.1, p = 0.083) and the control (51.72 ± 2.2, p = 0.083) groups. In the exudative subgroup, there was a direct correlation between areas of low flow and those of high flow at both the DCP and SCP (p = 0.001 and p = 0.042, respectively). CONCLUSIONS Intraretinal expansion of fluid may cause the displacement of the surrounding retinal parenchyma and capillaries.
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Affiliation(s)
- Andrea Govetto
- Ophthalmology Department, Fatebenefratelli and Ophthalmic Hospital, ASSt-Fatebenefratelli-Sacco, Milan, Italy.
| | - Fabiana Mazzotta
- Department of Engineering, University of Naples "Parthenope", Naples, Italy
| | - Mayss Al-Sheikh
- Ophthalmology Department, University of Zurich, Zurich, CH, Switzerland
| | - Alessandro Mauro
- Department of Engineering, University of Naples "Parthenope", Naples, Italy
| | - Mario R Romano
- Ophthalmology Department, Humanitas Gavazzeni, Humanitas University, Bergamo, Italy
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25
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Bringmann A, Karol M, Unterlauft JD, Barth T, Wiedemann R, Kohen L, Rehak M, Wiedemann P. Foveal regeneration after resolution of cystoid macular edema without and with internal limiting membrane detachment: presumed role of glial cells for foveal structure stabilization. Int J Ophthalmol 2021; 14:818-833. [PMID: 34150536 DOI: 10.18240/ijo.2021.06.06] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 03/29/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To document with spectral-domain optical coherence tomography the morphological regeneration of the fovea after resolution of cystoid macular edema (CME) without and with internal limiting membrane (ILM) detachment and to discuss the presumed role of the glial scaffold for foveal structure stabilization. METHODS A retrospective case series of 38 eyes of 35 patients is described. Of these, 17 eyes of 16 patients displayed foveal regeneration after resolution of CME, and 6 eyes of 6 patients displayed CME with ILM detachment. Eleven eyes of 9 patients displayed other kinds of foveal and retinal disorders associated with ILM detachment. RESULTS The pattern of edematous cyst distribution, with or without a large cyst in the foveola and preferred location of cysts in the inner nuclear layer or Henle fiber layer (HFL), may vary between different eyes with CME or in one eye during different CME episodes. Large cysts in the foveola may be associated with a tractional elevation of the inner foveal layers and the formation of a foveoschisis in the HFL. Edematous cysts are usually not formed in the ganglion cell layer. Eyes with CME and ILM detachment display a schisis between the detached ILM and nerve fiber layer (NFL) which is traversed by Müller cell trunks. ILM detachment was also found in single eyes with myopic traction maculopathy, macular pucker, full-thickness macular holes, outer lamellar holes, and glaucomatous parapapillary retinoschisis, and in 3 eyes with Müller cell sheen dystrophy (MCSD). As observed in eyes with MCSD, cellophane maculopathy, and macular pucker, respectively, fundus light reflections can be caused by different highly reflective membranes or layers: the thickened and tightened ILM which may or may not be detached from the NFL, the NFL, or idiopathic epiretinal membranes. In eyes with short single or multiple CME episodes, the central fovea regenerated either completely, which included the disappearance of irregularities of the photoreceptor layer lines and the reformation of a fovea externa, or with remaining irregularities of the photoreceptor layer lines. CONCLUSION The examples of a complete regeneration of the foveal morphology after transient CME show that the fovea may withstand even large tractional deformations and has a conspicuous capacity of structural regeneration as long as no cell degeneration occurs. It is suggested that the regenerative capacity depends on the integrity of the threedimensional glial scaffold for foveal structure stabilization composed of Müller cell and astrocyte processes. The glial scaffold may also maintain the retinal structure after loss of most retinal neurons as in late-stage MCSD.
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Affiliation(s)
- Andreas Bringmann
- Department of Ophthalmology and Eye Hospital, University of Leipzig, Leipzig 04103, Germany
| | | | - Jan Darius Unterlauft
- Department of Ophthalmology and Eye Hospital, University of Leipzig, Leipzig 04103, Germany
| | - Thomas Barth
- Department of Ophthalmology and Eye Hospital, University of Leipzig, Leipzig 04103, Germany
| | - Renate Wiedemann
- Department of Ophthalmology and Eye Hospital, University of Leipzig, Leipzig 04103, Germany
| | - Leon Kohen
- Department of Ophthalmology and Eye Hospital, University of Leipzig, Leipzig 04103, Germany.,Helios Klinikum Aue, Aue 08280, Germany
| | - Matus Rehak
- Department of Ophthalmology and Eye Hospital, University of Leipzig, Leipzig 04103, Germany
| | - Peter Wiedemann
- Department of Ophthalmology and Eye Hospital, University of Leipzig, Leipzig 04103, Germany
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Bringmann A, Unterlauft JD, Barth T, Wiedemann R, Rehak M, Wiedemann P. Müller cells and astrocytes in tractional macular disorders. Prog Retin Eye Res 2021; 86:100977. [PMID: 34102317 DOI: 10.1016/j.preteyeres.2021.100977] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 02/04/2023]
Abstract
Tractional deformations of the fovea mainly arise from an anomalous posterior vitreous detachment and contraction of epiretinal membranes, and also occur in eyes with cystoid macular edema or high myopia. Traction to the fovea may cause partial- and full-thickness macular defects. Partial-thickness defects are foveal pseudocysts, macular pseudoholes, and tractional, degenerative, and outer lamellar holes. The morphology of the foveal defects can be partly explained by the shape of Müller cells and the location of tissue layer interfaces of low mechanical stability. Because Müller cells and astrocytes provide the structural scaffold of the fovea, they are active players in mediating tractional alterations of the fovea, in protecting the fovea from such alterations, and in the regeneration of the foveal structure. Tractional and degenerative lamellar holes are characterized by a disruption of the Müller cell cone in the foveola. After detachment or disruption of the cone, Müller cells of the foveal walls support the structural stability of the foveal center. After tractional elevation of the inner layers of the foveal walls, possibly resulting in foveoschisis, Müller cells transmit tractional forces from the inner to the outer retina leading to central photoreceptor layer defects and a detachment of the neuroretina from the retinal pigment epithelium. This mechanism plays a role in the widening of outer lameller and full-thickness macular holes, and contributes to visual impairment in eyes with macular disorders caused by conractile epiretinal membranes. Müller cells of the foveal walls may seal holes in the outer fovea and mediate the regeneration of the fovea after closure of full-thickness holes. The latter is mediated by the formation of temporary glial scars whereas persistent glial scars impede regular foveal regeneration. Further research is required to improve our understanding of the roles of glial cells in the pathogenesis and healing of tractional macular disorders.
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Affiliation(s)
- Andreas Bringmann
- Department of Ophthalmology and Eye Hospital, University of Leipzig, 04103, Leipzig, Germany.
| | - Jan Darius Unterlauft
- Department of Ophthalmology and Eye Hospital, University of Leipzig, 04103, Leipzig, Germany
| | - Thomas Barth
- Department of Ophthalmology and Eye Hospital, University of Leipzig, 04103, Leipzig, Germany
| | - Renate Wiedemann
- Department of Ophthalmology and Eye Hospital, University of Leipzig, 04103, Leipzig, Germany
| | - Matus Rehak
- Department of Ophthalmology and Eye Hospital, University of Leipzig, 04103, Leipzig, Germany
| | - Peter Wiedemann
- Department of Ophthalmology and Eye Hospital, University of Leipzig, 04103, Leipzig, Germany
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Karti O, Kaya M, Ataş F, Saatci AO. En face optical coherence tomography patterns in patients with angiographically documented uveitic macular edema: a cross-sectional retrospective study. Int Ophthalmol 2021; 41:3303-3312. [PMID: 34014462 DOI: 10.1007/s10792-021-01892-0] [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: 12/04/2020] [Accepted: 05/12/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To elucidate the en face optical coherence tomography (OCT) patterns of macular edema in eyes with angiographically documented uveitic macular edema (UME) and compare visual acuity (VA), OCT and OCT-angiography (OCT-A) parameters among the morphological subgroups. METHODS Thirty-nine eyes of 29 patients with angiographically proven UME were enrolled into the study. All patients underwent comprehensive ophthalmological examination including structural OCT and OCT-A in addition to fluorescein angiography. Eyes with UME were divided into three subgroups (petaloid, sunflower and spoke-wheel pattern) with the help of en face OCT imaging. RESULTS Posterior uveitis was the most common type of uveitis (17 patients; 58.7%), followed by panuveitis (11 patients; 37.9%) and then intermediate uveitis (1 patient; 3.4%). Underlying causes of uveitis were Behçet's disease (13 patients; 44.8%), idiopathic (11 patients; 37.9%), rheumatoid arthritis (2 patients; 6.9%), sarcoidosis (1 patient; 3.4%), inflammatory polyarthritis (1 patient; 3.4%) and psoriatic arthritis (1 patient; 3.4%). The most common en face OCT pattern was petaloid type (25 of 39 eyes; 64.1%). Eleven eyes (28.2%) had sunflower pattern and three (7.7%) spoke-wheel pattern. There were no statistically significant difference among the subgroups regarding the age, VA, central macular thickness and vessel density. CONCLUSION This study reveals three morphological en face OCT patterns in eyes with UME and en face OCT may find a niche in the UME classification with the accumulation of experience among the uveitis experts.
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Affiliation(s)
- Omer Karti
- Department of Ophthalmology, Democracy University, İzmir, Turkey.
| | - Mahmut Kaya
- Department of Ophthalmology, Dokuz Eylul University, İzmir, Turkey
| | - Ferdane Ataş
- Department of Ophthalmology, Dokuz Eylul University, İzmir, Turkey
| | - Ali Osman Saatci
- Department of Ophthalmology, Dokuz Eylul University, İzmir, Turkey
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28
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Lam M, Philippakis E, Gaudric A, Tadayoni R, Couturier A. Postoperative outcomes of idiopathic epiretinal membrane associated with foveoschisis. Br J Ophthalmol 2021; 106:1000-1005. [PMID: 33597194 DOI: 10.1136/bjophthalmol-2020-317982] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/22/2021] [Accepted: 01/26/2021] [Indexed: 11/04/2022]
Abstract
AIMS To analyse the prevalence and postoperative outcomes of a particular form of epiretinal membrane (ERM) with foveoschisis-like stretched hyporeflective spaces in emmetropic eyes. METHODS A retrospective study of all consecutive eyes operated for primary ERM over a 46-month period was conducted. The presence of foveoschisis-like stretched hyporeflective spaces was assessed on the preoperative optical coherence tomography B-scan in all eyes. Highly myopic eyes were excluded. Preoperative and postoperative characteristics of eyes with foveoschisis were compared with those of a control group of 100 consecutive eyes with primary ERM without cystoid spaces. RESULTS Of 544 eyes with primary ERM, 17 had foveoschisis, corresponding to a prevalence of 3.1%. After a mean postoperative follow-up of 17.9±10.9 months, the foveoschisis had completely resolved in 76.5% of eyes (n=13/17). In the four eyes (23.5%) with persistent foveoschisis, the remaining hyporeflective cystoid spaces were located exclusively in the inner nuclear layer. The postoperative visual acuity and central macular thickness did not differ between both groups at the final visit. However, an acute postoperative macular oedema occurred in 24% (n=4/17) of cases (vs 3% in the control group; p=0.0084). CONCLUSION Foveoschisis was found in about 3% of eyes with idiopathic ERM. After peeling, the foveoschisis usually resolves completely with functional outcomes similar to those achieved with other primary ERM. However, this feature was associated with a higher risk of postoperative macular oedema (in 1/4 of cases).
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Affiliation(s)
- Marion Lam
- Université de Paris, Ophthalmology Department, AP-HP, Hôpital Lariboisière, F-75010, Paris, France
| | - Elise Philippakis
- Université de Paris, Ophthalmology Department, AP-HP, Hôpital Lariboisière, F-75010, Paris, France
| | - Alain Gaudric
- Université de Paris, Ophthalmology Department, AP-HP, Hôpital Lariboisière, F-75010, Paris, France
| | - Ramin Tadayoni
- Université de Paris, Ophthalmology Department, AP-HP, Hôpital Lariboisière, F-75010, Paris, France.,Department of ophthalmology, Adolphe de Rothschild Ophthalmologic Foundation, F-75019, Paris, France
| | - Aude Couturier
- Université de Paris, Ophthalmology Department, AP-HP, Hôpital Lariboisière, F-75010, Paris, France
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29
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Gunay BO, Erdogan G. Evaluation of Macular Changes in the Long Term after Pars Plana Vitrectomy with Internal Limiting Membrane Peeling for Diabetic Macular Edema. Ophthalmologica 2021; 244:237-244. [PMID: 33540415 DOI: 10.1159/000514992] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 01/11/2021] [Indexed: 11/19/2022]
Abstract
AIM To evaluate long-term macular changes following pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling for diabetic macular edema (DME). METHODS Forty eligible eyes of 37 patients were included in this retrospective study. Best corrected visual acuity (BCVA), central macular thickness (CMT), and 5-mm macular volume (5-MV) were examined preoperatively, postoperatively after 1, 2, 3, 6, 12, and 24 months, and at a final visit. Response to surgical treatment was considered as recurrence, reincrease, or recovery of DME based on macular changes. RESULTS Mean follow-up time was 51.1 ± 19.0 months after surgery. Recurrence (n = 5) and reincrease (n = 17) of DME was observed in 22 eyes (55%) and additional treatments were applied. Recovery of DME was observed in 18 eyes (45%). Preoperative and final-visit mean BCVA (logMAR) was 1.08 ± 0.37 and 0.93 ± 0.45, respectively (p = 0.02). Preoperative and final-visit mean CMT was 514.74 ± 155.65 and 281.87 ± 112.58 µm, respectively (p < 0.001). The 5-MV significantly decreased following surgery (from 8.18 ± 1.57 to 6.52 ± 1.39 mm3; p < 0.001). DME was present in 12 eyes (30%) at the final visit. CONCLUSION Although PPV with ILM peeling had efficacy in DME management, this effect tended to decrease over time, such that a considerable number of patients required additional treatment.
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Affiliation(s)
- Betul Onal Gunay
- Department of Ophthalmology, University of Health Sciences, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Gurkan Erdogan
- Department of Ophthalmology, University of Health Sciences, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
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30
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dell'Omo R, Filippelli M, De Turris S, Govetto A, Napolitano P, Ermanno dell'Omo, Costagliola C. Multimodal Imaging of Lamellar Macular Holes. J Ophthalmol 2021; 2021:8820444. [PMID: 33604083 PMCID: PMC7868145 DOI: 10.1155/2021/8820444] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/01/2020] [Accepted: 01/11/2021] [Indexed: 01/01/2023] Open
Abstract
Evolution of imaging techniques has renewed interest in the diagnosis of lamellar macular hole (LMH) and greatly implemented the possibilities of gaining more detailed insights into its pathogenesis. Among noninvasive techniques, optical coherence tomography (OCT) is considered the primary examination modality to study LMHs, given its ability to image foveal structure and its widespread availability. OCT also allows to resolve the epiretinal materials associated with LMH, i.e., tractional epiretinal membranes (ERMs) and epiretinal proliferation (EP). En face OCT reconstructions are useful to confirm the foveal abnormalities shown by the eyes with LMH, whereas OCT angiography may reveal alterations of the size and shape of the foveal avascular zone and alterations of the density of the superficial and deep vascular plexuses. On slit-lamp biomicroscopy or fundus camera examination, LMH appears as a round or oval, reddish lesion at the center of the macula, slightly darker than the surrounding retina. The associated tractional ERM, causing wrinkling and glistening of the retinal surface, is usually readily appreciable, whereas EP is hardly apparent on biomicroscopy or fundus photography since the retina surface appears smooth. When imaged with blue fundus autofluorescence (B-FAF) imaging, LMHs are characterized by an increased autofluorescent signal, the intensity of which does not correlate with the thickness of the residual outer retinal tissue. Green reflectance and blue reflectance (BR) images clearly show the increased reflection and wrinkling of the retinal surface caused by tractional ERM associated with LMH. BR and multicolor imaging enable the visualization of EP associated with LMH in the form of a sharply demarcated dark area and in the form of a yellowish area surrounding the hole, respectively. Scarce data regarding invasive imaging techniques, such as fluorescein angiography, for the study of LMH are available in the literature. The aim of this review is to evaluate the contribution that each imaging modality can provide to study the morphologic characteristics of LMH.
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Affiliation(s)
- Roberto dell'Omo
- Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, Via Francesco De Sanctis 1, Campobasso 86100, Italy
| | - Mariaelena Filippelli
- Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, Via Francesco De Sanctis 1, Campobasso 86100, Italy
| | - Serena De Turris
- Eye Clinic, Polytechnic University of Marche, Via Conca 71, Ancona 60121, Italy
| | - Andrea Govetto
- Vitreoretinal Division, Bristol Eye Hospital, Lower Maudlin St., BS1 2LX, Bristol, UK
| | - Pasquale Napolitano
- Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, Via Francesco De Sanctis 1, Campobasso 86100, Italy
| | - Ermanno dell'Omo
- Eye Clinic, Casa di Cura “Villa Maria”, Viale Principe di Piemonte 4, Campobasso 86100, Italy
| | - Ciro Costagliola
- Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, Via Francesco De Sanctis 1, Campobasso 86100, Italy
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31
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Different modes of full-thickness macular hole formation. Exp Eye Res 2020; 202:108393. [PMID: 33301774 DOI: 10.1016/j.exer.2020.108393] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 12/02/2020] [Accepted: 12/05/2020] [Indexed: 02/07/2023]
Abstract
Full-thickness macular holes (FTMH) are an important cause of visual deterioration. However, different modes of FTMH formation are less investigated. It is also not clear whether the development of edematous cysts contributes to FTMH formation. In this retrospective case series of 30 eyes of 30 patients, we describe using spectral-domain optical coherence tomography different modes of FTMH formation. Morphological alterations of established FTMH are shown in 5 eyes of 5 patients. We found in 2 of 30 eyes investigated that anterior hyaloidal traction induced a hyperreflectivity of the inner Müller cell layer of the foveola prior to FTMH formation. In 3 eyes, FTMH were caused by anterior hyaloidal traction which produced foveal pseudocysts that developed to an outer lamellar hole (OLH) characterized by a disruption of the central outer retina. The OLH developed to a FTMH by the disruption of the inner layer of the foveola. FTMH formation from an OLH by hyaloidal traction was observed also in further 7 eyes. In 2 eyes, the OLH, which preceded FTMH formation, was generated by a serous retinal detachment. In 3 eyes, anterior hyaloidal traction caused a detachment of the fovea from the retinal pigment epithelium (RPE); the subsequent disruption of the foveola resulted in a FTMH. Six eyes showed the development of a FTMH from a degenerative lamellar hole (DLH). In 5 eyes with macular pucker, FTMH were formed by traction of epiretinal membranes (ERM) or hyaloidal traction. Two eyes showed the development of a FTMH by anterior or tangential hyaloidal traction likely without a formation of an OLH. FTMH formation from an OLH proceeded with or without an enlargement of cystic cavities in the foveal walls. The formation of FTMH from a DLH, after a detachment of the fovea, and in macular pucker eyes was associated with a formation of cystic cavities in the foveal walls. The best-corrected visual acuity (BCVA) of eyes with an OLH or FTMH was inversely correlated to the base and minimum diameters of the holes, and with the height of the foveal walls; the highest correlation coefficients were found between the BCVA and the base diameter. The data show that FTMH may be formed via different modes by hyaloidal traction and/or traction of ERM, or after a serous retinal detachment. It is suggested that, after FTMH formation, the impaired fluid clearance through the RPE after detachment of the central outer retina causes the development of edematous cysts in the foveal walls which enlarges the FTMH. The BCVA of eyes with an OLH or FTMH mainly depends on the size of the central photoreceptor-free area.
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32
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Preti RC, Zacharias LC, Cunha LP, Monteiro MLR, Sarraf D. Spontaneous macular hole closure after posterior vitreous detachment in an eye with hyperreflective OCT stress line. Am J Ophthalmol Case Rep 2020; 20:100950. [PMID: 33195877 PMCID: PMC7644851 DOI: 10.1016/j.ajoc.2020.100950] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/05/2020] [Accepted: 09/26/2020] [Indexed: 12/01/2022] Open
Abstract
Purpose The aim of this report is to describe a patient who presented with a central hyper-reflective line (HRL) with spectral domain-optical coherence tomography (SD-OCT) after posterior vitreous detachment that evolved to full thickness macular hole (FTMH) with subsequent spontaneous resolution. Observations A 59-year-old patient presented with a history of photopsia and floaters followed by the development of a central scotoma in the right eye (OD). The left eye (OS) was normal. On examination, visual acuity (VA) was 20/20- OD and 20/20 OS. Retinal examination OD was remarkable for a retinal tear, and SD-OCT demonstrated a central HRL. The patient underwent laser retinopexy to barricade the retinal tear. Sequential SD-OCT of the macula was performed and the patient eventually developed a small FTMH 8 months after the baseline presentation. VA was correspondingly reduced to 20/80 OD. Upon return after 4 months, the hole was completely resolved with improvement of VA to 20/20 OD. Conclusion Vitreomacular traction (VMT) may lead to foveal dehiscence. This instability can be detected with SD-OCT as a vertical hyperreflective stress line that is a risk factor for progression to a FTMH. With release of VMT, FTMH can spontaneously close.
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Affiliation(s)
- Rony C Preti
- Division of Ophthalmology, University of São Paulo Medical School, São Paulo, Brazil
| | - Leandro C Zacharias
- Division of Ophthalmology, University of São Paulo Medical School, São Paulo, Brazil
| | - Leonardo P Cunha
- Division of Ophthalmology, University of São Paulo Medical School, São Paulo, Brazil
| | - Mario L R Monteiro
- Division of Ophthalmology, University of São Paulo Medical School, São Paulo, Brazil
| | - David Sarraf
- Retina Disorders and Ophthalmic Genetics, Stein Eye Institute, University of California-Los Angeles, Los Angeles, CA, USA.,Greater Los Angeles VA Healthcare Center, Los Angeles, CA, USA
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33
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Figueroa MS, Mora Cantallops A, Virgili G, Govetto A. Long-term results of autologous plasma as adjuvant to pars plana vitrectomy in the treatment of high myopic full-thickness macular holes. Eur J Ophthalmol 2020; 31:2612-2620. [DOI: 10.1177/1120672120960340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background: To analyse the feasibility and efficacy of a novel autologous plasma rich in growth factor (PRGF) preparation as adjuvant to pars plana vitrectomy and internal limiting membrane peel in high myopic full-thickness macular hole (FTMH). Methods: Single-centre, single-surgeon retrospective chart review of consecutive patients with high myopic FTMH who underwent surgery with a minimum follow-up of 12 months. Patients were divided in group 1 (naïve) and group 2 (persistent). Quantitative and qualitative variables were analysed, compared among groups and correlated with best corrected visual acuity (BCVA). Results: Postoperatively, FTMH resolved in 28/31 eyes in group 1 (90%) and in 10/11 eyes in group 2 (91%), without significant differences ( p = 0.954). None of the preoperative anatomical variables analysed showed significant association with preoperative BCVA. Intraoperatively, no significant complications were registered. Postoperatively, BCVA improved significantly in the studied population ( p < 0.001). Preoperative factors associated with better postoperative BCVA were the presence of intraretinal cystoid spaces ( p = 0.028) and elevated FTMH borders ( p = 0.005). Preoperative dome-shaped macula was associated with significantly worse postoperative BCVA ( p = 0.049). Conclusion: The use of PRGF as adjuvant to vitrectomy showed to be reproducible, straightforward and efficient, with primary anatomical success rate comparable to other surgical approaches and lower risk of complications.
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Affiliation(s)
- Marta S Figueroa
- Retina Division, Ophthalmology Department, Ramon y Cajal University Hospital, Madrid, Spain
- Alcala University, Madrid, Spain
- Vissum, Madrid, Spain
| | - Arnau Mora Cantallops
- Retina Division, Ophthalmology Department, Ramon y Cajal University Hospital, Madrid, Spain
| | - Gianni Virgili
- Ophthalmology Department, Careggi University Hospital, University of Florence, Firenze, Italy
| | - Andrea Govetto
- Ophthalmology Department, Fatebenefratelli-Oftalmico Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
- Vitreoretinal Division, Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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34
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Iovino C, Mastropasqua R, Lupidi M, Bacherini D, Pellegrini M, Bernabei F, Borrelli E, Sacconi R, Carnevali A, D’Aloisio R, Cerquaglia A, Finocchio L, Govetto A, Erba S, Triolo G, Di Zazzo A, Forlini M, Vagge A, Giannaccare G. Intravitreal Dexamethasone Implant as a Sustained Release Drug Delivery Device for the Treatment of Ocular Diseases: A Comprehensive Review of the Literature. Pharmaceutics 2020; 12:pharmaceutics12080703. [PMID: 32722556 PMCID: PMC7466091 DOI: 10.3390/pharmaceutics12080703] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 12/13/2022] Open
Abstract
Drug delivery into the vitreous chamber remains a great challenge in the pharmaceutical industry due to the complex anatomy and physiology of the eye. Intravitreal injection is the mainstream route of drug administration to the posterior segment of the eye. The purpose of this review is to assess the current literature about the widening use of the intravitreal 0.7 mg dexamethasone (Dex) implant, and to provide a comprehensive collection of all the ocular disorders that benefit from Dex administration. Although anti-vascular endothelial growth-factors (VEGFs) have been largely indicated as a first-choice level, the Dex implant represents an important treatment option, especially in selected cases, such as vitrectomized eyes or patients in whom anti-VEGF failed or are contraindicated. In this article, the safety profile as well as the list of the possible complications related to intravitreal Dex injection are also discussed.
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Affiliation(s)
- Claudio Iovino
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, 09124 Cagliari, Italy
- Correspondence: ; Tel.: +39-070-609-2319
| | - Rodolfo Mastropasqua
- Institute of Ophthalmology, University of Modena and Reggio Emilia, 41121 Modena, Italy;
| | - Marco Lupidi
- Department of Surgical and Biomedical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, 06129 Perugia, Italy; (M.L.); (A.C.)
- Fondazione per la Macula Onlus, DINOMGI., University Eye Clinic, 16132 Genova, Italy
- Centre de l’Odéon, 113 Boulevard St Germain, 75006 Paris, France
| | - Daniela Bacherini
- Department of Neurosciences, Psychology, Drug Research and Child Health, Eye Clinic, University of Florence, AOU Careggi, 50139 Florence, Italy; (D.B.); (L.F.)
| | - Marco Pellegrini
- Ophthalmology Unit, S. Orsola-Malpighi University Hospital, University of Bologna, 40138 Bologna, Italy; (M.P.); (F.B.)
| | - Federico Bernabei
- Ophthalmology Unit, S. Orsola-Malpighi University Hospital, University of Bologna, 40138 Bologna, Italy; (M.P.); (F.B.)
| | - Enrico Borrelli
- Department of Ophthalmology, Hospital San Raffaele, University Vita Salute San Raffaele, 20132 Milan, Italy; (E.B.); (R.S.)
| | - Riccardo Sacconi
- Department of Ophthalmology, Hospital San Raffaele, University Vita Salute San Raffaele, 20132 Milan, Italy; (E.B.); (R.S.)
| | - Adriano Carnevali
- Department of Ophthalmology, University “Magna Graecia,” 88100 Catanzaro, Italy; (A.C.); (G.G.)
| | - Rossella D’Aloisio
- Department of Medicine and Science of Ageing, Ophthalmology Clinic, University “G. d’Annunzio” Chieti-Pescara, 66100 Chieti, Italy;
| | - Alessio Cerquaglia
- Department of Surgical and Biomedical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, 06129 Perugia, Italy; (M.L.); (A.C.)
| | - Lucia Finocchio
- Department of Neurosciences, Psychology, Drug Research and Child Health, Eye Clinic, University of Florence, AOU Careggi, 50139 Florence, Italy; (D.B.); (L.F.)
- Moorfields Eye Hospital NHS Foundation Trust, London EC1V2PD, UK
| | - Andrea Govetto
- Fatebenefratelli-Oftalmico Hospital, ASST-Fatebenefratelli-Sacco, 63631 Milan, Italy; (A.G.); (S.E.); (G.T.)
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol BS12LX, UK
| | - Stefano Erba
- Fatebenefratelli-Oftalmico Hospital, ASST-Fatebenefratelli-Sacco, 63631 Milan, Italy; (A.G.); (S.E.); (G.T.)
| | - Giacinto Triolo
- Fatebenefratelli-Oftalmico Hospital, ASST-Fatebenefratelli-Sacco, 63631 Milan, Italy; (A.G.); (S.E.); (G.T.)
| | - Antonio Di Zazzo
- Ophthalmology Complex Operative Unit, Campus Bio Medico University Hospital, 00128, Rome, Italy;
| | | | - Aldo Vagge
- University Eye Clinic, DINOGMI, Polyclinic Hospital San Martino IRCCS, 16132 Genoa, Italy;
| | - Giuseppe Giannaccare
- Department of Ophthalmology, University “Magna Graecia,” 88100 Catanzaro, Italy; (A.C.); (G.G.)
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The Area and Number of Intraretinal Cystoid Spaces Predict the Visual Outcome after Ranibizumab Monotherapy in Diabetic Macular Edema. J Clin Med 2020; 9:jcm9051391. [PMID: 32397232 PMCID: PMC7290842 DOI: 10.3390/jcm9051391] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/03/2020] [Accepted: 05/07/2020] [Indexed: 02/06/2023] Open
Abstract
Visual outcomes in diabetic macular edema (DME) after anti-vascular endothelial growth factor therapy vary across individuals. We retrospectively reviewed the clinical records for 46 treatment-naive eyes of 46 patients with DME who underwent intravitreal ranibizumab (IVR) monotherapy with a pro re nata regimen for 12 months. Overall, mean best-corrected visual acuity (BCVA) improved. Multivariate analyses adjusted for age and baseline BCVA showed that the area ratio, compared with the retinal area, and the number of intraretinal cystoid spaces evaluated on OCT (optical coherence tomography) images at baseline positively correlated with LogMAR BCVA and the extents of ellipsoid zone and external limiting membrane disruption at 12 months, and negatively correlated with central retinal thickness at the time of edema resolution. Therefore, a high area ratio and large number of intraretinal cystoid spaces resulted in a disorganized outer retinal structure at 12 months, a thin and atrophic retina after edema resolution, and a worse visual outcome. The area ratio and number of intraretinal cystoid spaces on initial OCT images were predictors of the visual outcome after IVR therapy in DME irrespective of baseline age and BCVA. The factors were related to retinal neurodegenerative changes in DME and could help in obtaining proper informed consent before treatment.
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