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Fazel F, Rezaeian-Ramsheh A, Fazel M, Ahmadieh H. CLOSURE OF IDIOPATHIC FULL-THICKNESS MACULAR HOLE AFTER INTRAVITREAL C3F8 INJECTION WITHOUT VITREOMACULAR TRACTION RELEASE: A CASE REPORT AND REVIEW OF LITERATURE. Retin Cases Brief Rep 2024; 18:77-79. [PMID: 35993722 DOI: 10.1097/icb.0000000000001314] [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: 06/15/2023]
Abstract
BACKGROUND The purpose of this study was to describe a successful closure of macular hole without release of vitreomacular traction after intravitreal perfluoropropane (C3F8) gas injection. CASE PRESENTATION A 54-year-old woman was referred to our clinic with the history of declined vision after a period of distorted vision in her right eye. After dilated fundus examination and performing optical coherence tomography, a V-shaped vitreomacular traction complicated by full-thickness macular hole was diagnosed and she underwent pneumatic vitreolysis using intravitreal C3F8 gas injection. After 12 weeks, her visual acuity was significantly improved and fundus examination and optical coherence tomography revealed that the macular hole was completely resolved despite persisted vitreomacular traction. CONCLUSION Intravitreal gas injection would be a promising option to manage idiopathic macular holes not only by releasing the vitreous traction on the macula but also through some not proven or even unknown mechanisms.
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Affiliation(s)
- Farhad Fazel
- Department of Ophthalmology, Isfahan Eye Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; and
| | - Abdolreza Rezaeian-Ramsheh
- Department of Ophthalmology, Isfahan Eye Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; and
| | - Mohammadreza Fazel
- Department of Ophthalmology, Isfahan Eye Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; and
| | - Hamid Ahmadieh
- Department of Ophthalmology, Isfahan Eye Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; and
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Boral SK, Agarwal D. Role of Small-Gauge Proportionate Reflux-Assisted Hydrodissection In Elevated Symptomatic Vitreofoveal Traction. Retina 2023; 43:1620-1625. [PMID: 33840788 DOI: 10.1097/iae.0000000000003178] [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: 10/21/2022]
Abstract
BACKGROUND/PURPOSE To describe a new technique to release the elevated symptomatic vitreofoveal traction. METHODS This was a retrospective, interventional case series where a new technique of hydrodissection by proportionate reflux property of small-gauge vitrectomy cutter was used in cases of elevated symptomatic vitreofoveal traction as evident on optical coherence tomography. After vitrectomy, an opening was made in the taut posterior hyaloid face around the foveal elevation. Then, the cutter tip was insinuated inside the hyaloid opening, and the port opening was directed toward the tip of the fovea at its hyaloid attachment. The proportionate reflux property of the cutter was then used to cause reflux of cassette fluid. The hydrostatic force thus generated separates the vitreofoveal attachment. End point was separation of vitreofoveal traction. RESULTS Seven eyes of seven patients were operated by 27-gauge (n = 3) or 25-gauge (n = 4) vitrectomy system. Mean preoperative and postoperative BCVA were LogMAR 0.44 (20/55) ± 0.14 and LogMAR 0.27 (20/37) ± 0.11, respectively ( P = 0.23). Mean preoperative foveal elevation was 560.86 ± 196.57 μ m, which significantly decreased postoperatively to 251 ± 79.13 μ m ( P < 0.01). VMTs were successfully released in all cases. Mean follow-up was 184.00 ± 80.32 days. CONCLUSION Small-gauge proportionate reflux-assisted hydrodissection is an innovative technique for management of elevated symptomatic cases of vitreofoveal traction.
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Affiliation(s)
- Subhendu K Boral
- Department of Vitreoretina, Disha Eye Hospitals Pvt Ltd, Barrackpore, Kolkata, West Bengal, India
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3
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Quiroz-Reyes MA, Quiroz-Gonzalez EA, Quiroz-Gonzalez MA, Lima-Gomez V. Pneumatic vitreolysis versus vitrectomy for the treatment of vitreomacular traction syndrome and macular holes: complication analysis and systematic review with meta-analysis of functional outcomes. Int J Retina Vitreous 2023; 9:33. [PMID: 37316932 DOI: 10.1186/s40942-023-00472-x] [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: 03/15/2023] [Accepted: 05/10/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND We conducted a systematic review to compare the effects of pneumatic vitreolysis (PV), enzymatic vitreolysis (EVL) with ocriplasmin, and pars plana vitrectomy (PPV) on vitreomacular traction (VMT) syndrome and macular holes (MHs) to assess their efficacy as treatment options. METHODS Databases, including PubMed, ClinicalTrials.gov ( www. CLINICALTRIALS gov ), the Cochrane Central Register of Controlled Trials (CENTRAL)-including the Cochrane Eyes and Vision Group Trials Register (The Cochrane Library 2013, Issue 2)-, Ovid MEDLINE, and EMBASE (January 2000-October 2022), were searched to identify studies comparing the outcomes of PV versus PPV, PPV versus ocriplasmin and ocriplasmin versus PV. RevMan 5.1 was used for the meta-analysis of the studies. RESULTS Among the 89 studies, 79 were considered eligible for qualitative analysis, and 10 quantitative studies were subjected to meta-analysis. PPV resulted in better postoperative visual acuity improvement than ocriplasmin (standardized mean deviation (SMD) = 0.38, 95% CI 0.03-0.73, p = 0.0003). PV resulted in no significant difference in visual improvement compared with PPV (SMD = - 0.15, 95% CI - 0.47 to 0.16, p = 0.35). PPV was significantly more effective in terms of the VMT release rate (risk ratio = 0.48, 95% CI 0.38-0.62, p = 0.00001) and MH closure rate (risk ratio = 0.49, 95% CI 0.30-0.81, p = 0.006) than ocriplasmin. PV was more effective than ocriplasmin in terms of the VMT release rate (risk ratio = 0.49, 95% CI 0.35-0.70, p = 0.0001). Qualitative analysis showed MH closure rates of 46%, 47.8%, and 95% and VMT releases rates of 46%, 68% and 100% after ocriplasmin, PV, and PPV treatments, respectively. Adverse events and postoperative complications occurring after treatment have also been documented in these studies. CONCLUSION PPV appears to be the most promising option for MH closure and VMT release, with fewer serious complications than EVL or PV. However, given the limited number of studies comparing these treatments, further research is needed to establish the superiority of PPV over the other options.
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Affiliation(s)
- Miguel A Quiroz-Reyes
- Retina Department of Oftalmologia Integral ABC (Nonprofit Medical and Surgical Organization), Which is Affiliated with the Postgraduate Studies Division of the National Autonomous University of Mexico, Av. Paseo de las Palmas 735 Suite 303, Lomas de Chapultepec, 11000, Mexico City, Mexico.
| | - Erick A Quiroz-Gonzalez
- Retina Department of Oftalmologia Integral ABC (Nonprofit Medical and Surgical Organization), Which is Affiliated with the Postgraduate Studies Division of the National Autonomous University of Mexico, Av. Paseo de las Palmas 735 Suite 303, Lomas de Chapultepec, 11000, Mexico City, Mexico
- Institute of Ophthalmology, Fundacion Conde de Valenciana, (Nonprofit Organization), Which is Affiliated with the Postgraduate Studies Division of the National Autonomous University of Mexico, Av. Chimalpopoca 14. Col. Obrera, 06800, Mexico City, Mexico
| | - Miguel A Quiroz-Gonzalez
- Retina Department of Oftalmologia Integral ABC (Nonprofit Medical and Surgical Organization), Which is Affiliated with the Postgraduate Studies Division of the National Autonomous University of Mexico, Av. Paseo de las Palmas 735 Suite 303, Lomas de Chapultepec, 11000, Mexico City, Mexico
| | - Virgilio Lima-Gomez
- Juarez Hospital, Public Assistance Institution (Nonprofit Organization), Av. Politecnico Nacional 5160, Colonia Magdalena de las Salinas, 07760, Mexico City, Mexico
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Fouad AN, Eissa IM, Nassar GA, Leila M, Fathy AM. Effect of pneumatic vitreolysis in management of patients with symptomatic focal vitreomacular traction. Int J Retina Vitreous 2022; 8:22. [PMID: 35346391 PMCID: PMC8962114 DOI: 10.1186/s40942-022-00376-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/20/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To evaluate the efficacy of single intravitreal injection of an expansile concentration of sulphur hexafluoride gas (SF6) in treating patients with symptomatic focal vitreomacular traction (VMT) documented by spectral domain optical coherence tomography (SD-OCT) preoperatively. METHODS This is a prospective interventional case series including 30 eyes of 29 patients with symptomatic focal VMT evident on SD-OCT. Pre-operatively, mean best corrected visual acuity (BCVA) was 20/125 (range 20/400-20/40). Mean central foveal thickness (CFT) was 382 μm (range 149-576 μm; SD ± 91.88). All eyes received single intravitreal injection of 0.3 mL of 100% SF6 gas. Postoperatively, we performed SD-OCT at one week, one month, and three months for all eyes. Primary outcome measure was release of VMT. Secondary outcome measures were changes in postoperative BCVA andCFT. RESULTS Overall, VMT release occurred in 24 of 30 eyes by the final follow-up visit (80% final release rate); furthermore, 76.9% of eyes with diabetic maculopathy and 25% of eyes with concurrent epiretinal membrane (ERM) had successful VMT release. VMT release was documented on SD-OCT at an average of 3 weeks (range, 1-12 weeks). The rate of release in phakic eyes was 90% (18 of 20 eyes) versus 60% in pseudophakic eyes (6 of 10 eyes). One patient developed a retinal break at upper nasal retina after two weeks of injection. CONCLUSION Pneumatic vitreolysis (PVL) with limited face-down position is a viable option for treating focal VMT with few adverse events. Further studies are needed to evaluate its indications, benefits, and risks.
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Affiliation(s)
- Ahmed N Fouad
- Retina Department, Research Institute of Ophthalmology, 2 Al Ahram st., Giza, Egypt.
| | - Iman M Eissa
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ghada A Nassar
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mahmoud Leila
- Retina Department, Research Institute of Ophthalmology, 2 Al Ahram st., Giza, Egypt
| | - Adel M Fathy
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
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5
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Pneumatic Vitreolysis vs Pars Plana Vitrectomy in focal symptomatic Vitreomacular Traction Syndrome. Retina 2022; 42:1277-1283. [DOI: 10.1097/iae.0000000000003456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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6
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Baumann C, Sabatino F, Zheng Y, Johannigmann-Malek N, Maier M, Kaye SB, Patton N. Anatomical and functional outcomes of pneumatic vitreolysis for treatment of vitreomacular traction with and without macular holes. Graefes Arch Clin Exp Ophthalmol 2022; 260:2209-2215. [PMID: 35122133 PMCID: PMC9203395 DOI: 10.1007/s00417-022-05568-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/06/2022] [Accepted: 01/14/2022] [Indexed: 01/15/2023] Open
Abstract
PURPOSE To evaluate the outcome of pneumatic vitreolysis (PVL) for vitreomacular traction (VMT) with or without full thickness macular hole (MH) < 400 µm. METHODS Forty-seven eyes of 47 patients were included who had undergone PVL for VMT with or without MH. Main outcome measures were release of VMT, MH closure, best-corrected visual acuity (BCVA) and adverse events. RESULTS Thirty-three patients had isolated VMT and 14 patients VMT with a MH. Four weeks after PVL, the overall VMT release rate was 35/47 (74.5%): 25/37 (67.6%) in phakic and 10/10 (100%) in pseudophakic eyes (p = 0.03). Four of 14 MH (28.6%) were closed. Twenty-two of 47 (46.8%) eyes required a subsequent PPV: 12/33 (36.4%) in the VMT only group and 10/14 (71.4%) in the VMT with MH group. Mean BCVA improved from 0.48 (± 0.24) to 0.34 (± 0.23) logMAR at 6 months in patients with VMT alone (p < 0.001), and from 0.57 (± 0.27) to 0.41 (± 0.28) logMAR in patients with VMT and MH (p = 0.008). Adverse events included new formation of a large MH in 4/33 (12.1%) eyes, failure of MH closure in 10/14 (71.4%) eyes, progression of mean minimum linear diameter (MLD) MH size from baseline 139 (± 67) to 396 (± 130) µm (p < 0.001) and development of a retinal detachment in 4/47 (8.5%) eyes. CONCLUSION While PVL leads to a high VMT release rate particularly in pseudophakic eyes, it is associated with a relatively high incidence of MH formation, MH size progression and retinal detachment.
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Affiliation(s)
- Carmen Baumann
- Ophthalmology Department, Hospital rechts der Isar, Technical University of Munich (TUM), Ismaninger Str. 22, 81675 Munich, Germany
| | | | - Yalin Zheng
- University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool, L7 8TX UK
| | - Navid Johannigmann-Malek
- Ophthalmology Department, Hospital rechts der Isar, Technical University of Munich (TUM), Ismaninger Str. 22, 81675 Munich, Germany
| | - Mathias Maier
- Ophthalmology Department, Hospital rechts der Isar, Technical University of Munich (TUM), Ismaninger Str. 22, 81675 Munich, Germany
| | - Stephen B. Kaye
- University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool, L7 8TX UK
| | - Niall Patton
- Manchester Royal Eye Hospital, Oxford Road, Manchester, M13 9WL UK
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7
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Chan CK, Mein CE, Glassman AR, Beaulieu WT, Calhoun CT, Jaffe GJ, Jampol LM, MacCumber MW, Maguire MG, Maturi RK, Salehi-Had H, Rofagha S, Sun JK, Martin DF. Pneumatic Vitreolysis with Perfluoropropane for Vitreomacular Traction with and without Macular Hole: DRCR Retina Network Protocols AG and AH. Ophthalmology 2021; 128:1592-1603. [PMID: 33989683 PMCID: PMC8545749 DOI: 10.1016/j.ophtha.2021.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To evaluate pneumatic vitreolysis (PVL) in eyes with vitreomacular traction (VMT) with and without full-thickness macular hole (FTMH). DESIGN Two multicenter (28 sites) studies: a randomized clinical trial comparing PVL with observation (sham injection) for VMT without FTMH (Protocol AG) and a single-arm study assessing PVL for FTMH (Protocol AH). PARTICIPANTS Participants were adults with central VMT (vitreomacular adhesion was ≤3000 μm). In Protocol AG, visual acuity (VA) was 20/32 to 20/400. In Protocol AH, eyes had a FTMH (≤250 μm at the narrowest point) and VA of 20/25 to 20/400. METHODS Pneumatic vitreolysis using perfluoropropane (C3F8) gas. MAIN OUTCOME MEASURES Central VMT release at 24 weeks (Protocol AG) and FTMH closure at 8 weeks (Protocol AH). RESULTS From October 2018 through February 2020, 46 participants were enrolled in Protocol AG, and 35 were enrolled in Protocol AH. Higher than expected rates of retinal detachment and tear resulted in early termination of both protocols. Combining studies, 7 of 59 eyes (12% [95% CI, 6%-23%]; 2 eyes in Protocol AG, 5 eyes in Protocol AH) that received PVL developed rhegmatogenous retinal detachment (n = 6) or retinal tear (n = 1). At 24 weeks in Protocol AG, 18 of 23 eyes in the PVL group (78%) versus 2 of 22 eyes in the sham group (9%) achieved central VMT release without rescue vitrectomy (adjusted risk difference, 66% [95% CI, 44%-88%]; P< 0.001). The mean change in VA from baseline at 24 weeks was 6.7 letters in the PVL group and 6.1 letters in the sham group (adjusted difference, -0.8 [95% CI, -6.1 to 4.5]; P = 0.77). In Protocol AH, 10 of 35 eyes (29% [95% CI, 16%-45%]) achieved FTMH closure without rescue vitrectomy at 8 weeks. The mean change in VA from baseline at 8 weeks was -1.5 letters (95% CI, -10.3 to 7.3 letters). CONCLUSIONS In most eyes with VMT, PVL induced hyaloid release. In eyes with FTMH, PVL resulted in hole closure in approximately one third of eyes. These studies were terminated early because of safety concerns related to retinal detachments and retinal tears.
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Affiliation(s)
- Clement K Chan
- Southern California Desert Retina Consultants, Palm Desert, California
| | - Calvin E Mein
- Retinal Consultants of San Antonio, San Antonio, Texas
| | | | | | | | - Glenn J Jaffe
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Lee M Jampol
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Maureen G Maguire
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Hani Salehi-Had
- Retina Associates of Southern California, Huntington Beach, California
| | - Soraya Rofagha
- East Bay Retina Consultants, Oakland, California, and Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Jennifer K Sun
- Joslin Diabetes Center, Beetham Eye Institute, Department of Ophthalmology, Harvard University, Boston, Massachusetts
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8
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Indications and outcomes for intravitreal injection of C 3F 8 gas for symptomatic vitreomacular traction. Sci Rep 2021; 11:18089. [PMID: 34508148 PMCID: PMC8433203 DOI: 10.1038/s41598-021-97639-z] [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: 04/13/2021] [Accepted: 08/27/2021] [Indexed: 11/08/2022] Open
Abstract
To evaluate the indications and outcomes of perfluoropropane (C3F8) gas injection for symptomatic vitreomacular traction (VMT). A retrospective analysis of eyes with VMT treated with 0.3 mL of C3F8 gas was performed. Patients were not asked to posture after gas injection. In phakic patients, cataract surgery was performed simultaneously. Patients were examined after one week and one month postoperatively. Twenty-nine consecutive eyes of 26 patients with symptomatic VMT who underwent pneumatic vitreolysis were included. A complete posterior vitreous detachment was achieved in 18 eyes (62.1%) after a single gas injection at the final visit. The rate of posterior vitreous detachment was reduced significantly with the presence of epiretinal membrane (ERM) (p = 0.003). Three eyes formed a macular hole (MH) postoperatively and another eye developed a retinal detachment. Mean visual acuity increased significantly after one month (p < 0.008). Pneumatic vitreolysis is a viable option for treating VMT with few adverse events. Patient with concomitant ERM had a significantly lower success rate.
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9
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[Biomarkers in full-thickness and lamellar defects of the macula]. Ophthalmologe 2021; 118:321-336. [PMID: 33646383 DOI: 10.1007/s00347-021-01340-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Biomarkers are characteristic biological measurable signs and objective parameters to detect the state of health. Besides functional and temporal factors, imaging biomarkers play an increasingly important role. In full-thickness and lamellar defects of the macula numerous imaging parameters have been described. This knowledge resulted in new classifications for both clinical pictures, which are based on important biomarkers of these clinical pictures and characteristic features of described subtypes. METHODS Imaging biomarkers for full-thickness and lamellar macular defects are described with respect to the classification and their functional prognostic importance. The importance of these biomarkers is presented. RESULTS The current classification of full-thickness and lamellar macular defects is based on structural biomarkers. Biomarkers are important for prognostic and therapeutic evaluation and they have an impact on the surgical strategy. There are various surgical strategies for treatment of full-thickness macular holes depending on the size of the foramen and other biomarkers. The inverted ILM flap technique improves the closure rate of large macular holes. In lamellar macular holes showing signs of progression an early surgical intervention results in a good anatomical and functional prognosis. CONCLUSION Multimodal diagnostics provide important preoperative, intraoperative, and postoperative features for macular holes and lamellar macular holes, which are essential biomarkers for the exact classification, the therapeutic strategy and for assessment of the prognosis.
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10
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Seamone ME, Rubin U, Grewal PS, Greve M. Pneumatic Vitreolysis With Intravitreal Air for Focal Vitreomacular Traction. JOURNAL OF VITREORETINAL DISEASES 2020; 5:348-353. [PMID: 37007599 PMCID: PMC9976235 DOI: 10.1177/2474126420962649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To determine whether pneumatic vitreolysis with intravitreal air is effective for focal vitreomacular traction (VMT). Methods: We conducted a retrospective consecutive case series of 20 eyes from 19 individuals with focal VMT who underwent pneumatic vitreolysis with intravitreal air (January 2017 to November 2018). We analyzed patients via spectral-domain optical coherence tomography before intravitreal air injection and at 1 month. The primary outcome measure was release of VMT. Results: We observed release of VMT in 55% of individuals. An analysis limited to phakic eyes demonstrated release of VMT in 69%, and 65% developed improved best-corrected visual acuity. Individuals with persistent VMT and visual improvement had a significant reduction in angle of vitreoretinal insertion ( P < .01), area under VMT ( P < .05), and subfoveal cyst area ( P < .05). Conclusions: Intravitreal air is an effective treatment for focal VMT. In individuals with persistent VMT, visual-acuity improvement was associated with a reduction in overall VMT.
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Affiliation(s)
- Mark E. Seamone
- Department of Ophthalmology & Visual Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Uriel Rubin
- Department of Ophthalmology & Visual Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Parampal S. Grewal
- Department of Ophthalmology & Visual Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Mark Greve
- Department of Ophthalmology & Visual Sciences, University of Alberta, Edmonton, Alberta, Canada
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11
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Mehta N, Gupta L, Jansen M, Rosen R, Lee J. Immediate Release of Vitreomacular Traction After Pneumatic Vitreolysis Followed by the Drinking Bird Technique. JOURNAL OF VITREORETINAL DISEASES 2020; 4:320-324. [PMID: 37009183 PMCID: PMC9976107 DOI: 10.1177/2474126419888591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To report a case of release of vitreomacular traction (VMT) in a patient with a full thickness macular hole (FTMH) immediately following pneumatic vitreolysis (PV) combined with head bobbing movements. Methods: A 71-year-old female with VMT and an FTMH presented with blurred vision for 2 months to the level of 20/400. At her 1-month follow-up visit, PV was performed using C3F8 gas and she was instructed to perform the drinking bird technique for ten minutes. Results: Optical coherence tomography performed ten minutes after PV with head bobbing showed VMT release and a smaller FTMH. Visual acuity improved to 20/150 immediately afterwards and to 20/80 two months later. Conclusions: Using the drinking bird technique for a continuous period of time immediately following PV may encourage rapid VMT release. PV may be a feasible option for patients with VMT and FTMH who do not want surgery.
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Affiliation(s)
- Neesurg Mehta
- Department of Ophthalmology, New York Eye and Ear Infirmary, New York, NY, USA
| | - Lalita Gupta
- Department of Ophthalmology and Visual Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Michael Jansen
- Department of Ophthalmology, New York Eye and Ear Infirmary, New York, NY, USA
| | - Richard Rosen
- Department of Ophthalmology, New York Eye and Ear Infirmary, New York, NY, USA
| | - Jessica Lee
- Department of Ophthalmology, New York Eye and Ear Infirmary, New York, NY, USA
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Abstract
PURPOSE To compare the effect of intravitreal injections of air with gas on vitreomacular traction (VMT) release and attempt to analyze predictive factors for success. METHODS The medical records of patients with symptomatic VMT undergoing intravitreal injections (0.3 mL) of either octafluoropropane (C3F8) or air were retrospectively reviewed. The VMT release (primary end point) and the best-corrected visual acuity (secondary end point) were noted 1 month after injection. At baseline and 1 month after the injection, a macular optical coherence tomography was performed. RESULTS Twenty-four eyes of 22 patients were included. Vitreomacular traction was released in 10 cases, 7 among 11 C3F8-injected eyes (63%) and 3 among 13 air-injected eyes (23%) (P = 0.045). In eyes with released VMT, ETDRS improved from 61 ± 35 (0-100) to 65 ± 37 (0-100) 1 month after the injection (P = 0.03). All patients with VMT release had a horizontal vitreomacular adhesion of less than 600 µm. Five eyes (23%) underwent vitrectomy after the injection of gas or air. CONCLUSION Posterior vitreous detachment in VMT can be observed with both air and gas injection with a low complication rate. The occurrence of VMT release observed with air seemed to be less frequent than that observed with gas.
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13
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Anderson MF, Magal I, Ells A, Fielden M, Mahsin M, Kherani A, Williams RG. Intravitreal gas injection for the treatment of full-thickness macular holes. Can J Ophthalmol 2019; 55:e13-e18. [PMID: 31712036 DOI: 10.1016/j.jcjo.2019.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/23/2019] [Accepted: 04/29/2019] [Indexed: 10/26/2022]
Affiliation(s)
| | | | - Anna Ells
- University of Calgary, Calgary, Alberta
| | | | - Md Mahsin
- University of Calgary, Calgary, Alberta
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Flaxel CJ, Adelman RA, Bailey ST, Fawzi A, Lim JI, Vemulakonda GA, Ying GS. Idiopathic Epiretinal Membrane and Vitreomacular Traction Preferred Practice Pattern®. Ophthalmology 2019; 127:P145-P183. [PMID: 31757497 DOI: 10.1016/j.ophtha.2019.09.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 09/20/2019] [Indexed: 12/16/2022] Open
Affiliation(s)
| | | | - Steven T Bailey
- Casey Eye Institute, Oregon Health & Science University, Portland, OR
| | - Amani Fawzi
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | - G Atma Vemulakonda
- Department of Ophthalmology, Palo Alto Medical Foundation, Palo Alto, CA
| | - Gui-Shuang Ying
- Center for Preventative Ophthalmology and Biostatistics, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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15
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Özdemir HB, Özdek Ş, Hasanreisoğlu M. Pneumatic Vitreolysis for the Treatment of Vitreomacular Traction Syndrome. Turk J Ophthalmol 2019; 49:201-208. [PMID: 31486607 PMCID: PMC6761384 DOI: 10.4274/tjo.galenos.2019.00400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objectives: To evaluate the posterior vitreous release rates after a single injection of expansile gas in patients with vitreomacular traction (VMT) syndrome with or without associated full-thickness macular hole (FTMH). Materials and Methods: Thirteen eyes of 12 consecutive patients with VMT (11 eyes) or VMT+FTMH (2 eyes) were reviewed retrospectively. Intravitreal injection of 0.3 mL of pure sulfur hexafluoride (SF6) (9 eyes) or perfluoropropane (C3F8) (4 eyes) was performed. Bobbing the head forward and backward similar to ‘drinking bird’ head movements was instructed until VMT release. Full ophthalmic examination and optical coherence tomography was performed at each visit. Results: VMT was released in all patients (100%) and mean release time was 5.2 days (1-19 days). Macular hole closure was not achieved in either of the two eyes with FTMH. Mean central subfield thickness decreased significantly from 361 μm to 263 μm (p=0.007). The mean pretreatment visual acuity was 0.44 LogMAR, which significantly improved to 0.25 LogMAR at the last visit (p=0.003). One of 13 eyes had retinal tear after the procedure which was successfully treated with laser retinopexy. Gas migration to the anterior chamber occurred in one patient. No other complications were observed. Conclusion: Pneumatic vitreolysis with C3F8 and SF6 gases is a relatively safe, low-cost, and minimally invasive treatment modality for VMT. However, FTMH closure could not be achieved with pneumatic vitreolysis.
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Affiliation(s)
- Hüseyin Baran Özdemir
- University of Health Sciences, Ulucanlar Eye Training and Research Hospital, Ophthalmology Clinic, Ankara, Turkey
| | - Şengül Özdek
- Gazi University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Murat Hasanreisoğlu
- Gazi University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
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16
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Crosson JN, Thomley ME, Chan CK, Mein CE. Loculated subretinal fluid after pneumatic vitreolysis. Am J Ophthalmol Case Rep 2019; 15:100462. [PMID: 31467998 PMCID: PMC6711859 DOI: 10.1016/j.ajoc.2019.100462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 01/16/2019] [Accepted: 05/06/2019] [Indexed: 11/30/2022] Open
Abstract
Purpose To present, to the authors’ knowledge, the first reported case of loculated subretinal fluid associated with pneumatic vitreolysis (PVL). Observations A 74 year old female was followed for 9 months with vitreomacular traction (VMT) and 20/20 visual acuity in her right eye. Her visual acuity decreased at 9 months to 20/50 and she was treated with PVL. VMT release was successful on day 7. An isolated shallow pocket of loculated subretinal fluid developed inferotemporal to the fovea at one month after PVL and persisted for 14 months. The subretinal fluid eventually resolved at 14 months after PVL, and visual acuity improved to 20/30, and there were no electroretinographic abnormalities. Conclusion and Importance Localized subretinal fluid is an unusual complication of PVL. No adverse visual outcome developed despite the persistent extrafoveal subretinal fluid in this case, and the subretinal fluid eventually resolved over a year after PVL.
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Affiliation(s)
- Jason N Crosson
- Retina Consultants of Alabama, The University of Alabama at Birmingham, 700 18th St. S #707, Birmingham, AL, 35294, USA
| | - Meredith E Thomley
- Retina Consultants of Alabama, The University of Alabama at Birmingham, 700 18th St. S #707, Birmingham, AL, 35294, USA.,The University of Alabama at Birmingham, 1760 University Blvd., Birmingham, AL, 35233, USA
| | - Clement K Chan
- Southern California Desert Retina Consultants, 36949 Cook St., Palm Desert, CA, 92211, USA.,Department of Ophthalmology, Loma Linda University, Suite 1800, Faculty Medical Offices, Loma Linda, CA, 92354, USA
| | - Calvin E Mein
- Retinal Consultants of San Antonio, 9480 Huebner Rd, San Antonio, TX, 78240, USA.,University of Texas Health Science Center, 7000 Fannin St., San Antonio, TX, 77030, USA
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17
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Jandeck C. [Vitreomacular Interface Diseases: Vitreomacular Adhesion, Vitreomacular Traction, Epiretinal Membranes, and Macular Hole]. Klin Monbl Augenheilkd 2019; 236:e56-e79. [PMID: 31416094 DOI: 10.1055/a-0988-4428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Posterior vitreous detachment (PVD) is a common phenomenon in the aging eye. This review presents the sequence of events due to complicated persistent symptomatic vitreomacular adhesions that exert tractional forces on the macula (vitreomacular traction, VMT; macular hole, MH; epiretinal membrane). Pathologic aspects, clinical features, diagnostic implications, and current management strategies are described. Observation, pharmacologic vitreolysis with Ocriplasmin, and surgical treatment are positioned as treatment options for different diseases.
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18
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Qi J, Hu X, Dong X, Lu Y, Lu H, Zhao W, Wu W. Towards more accurate bioimaging of drug nanocarriers: turning aggregation-caused quenching into a useful tool. Adv Drug Deliv Rev 2019; 143:206-225. [PMID: 31158405 DOI: 10.1016/j.addr.2019.05.009] [Citation(s) in RCA: 137] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 05/04/2019] [Accepted: 05/29/2019] [Indexed: 01/12/2023]
Abstract
One of the current challenges in the monitoring of drug nanocarriers lies in the difficulties in discriminating the carrier-bound signals from the bulk signals of probes. Environment-responsive probes that enable signal switching are making steps towards a solution to this problem. Aggregation-caused quenching (ACQ), a phenomenon generally regarded as unfavorable in bioimaging, has turned out to be a promising characteristic for achieving environment-responsiveness and eliminating free-probe interference. So-called ACQ probes emit fluorescence when dispersed molecularly within the carrier matrix but quench immediately and absolutely once they are released into the ambient aqueous environment upon the degradation of the nanocarriers. Therefore, the fluorescence observed represents integral nanocarriers. Based on this rationale, the in vivo fates of various nanocarriers have been explored using live imaging equipment, with very interesting findings revealing the role of the particles. The current applications are however restricted to nanocarriers with highly hydrophobic matrices (lipid or polyester nanoparticles) or with a hydrophobic core-hydrophilic shell structure (micelles). The ACQ-based bioimaging strategy is emerging as a promising tool to achieve more accurate bioimaging of drug nanocarriers. This review article provides an overview of the ACQ phenomenon and the rationale for and examples of applications, as well as the limitations of the ACQ-based strategy, with a focus on improving the accuracy of bioimaging of nanoparticles.
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19
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Menzler J, Neubauer AS, Haritoglou C, Jackson TL. Incidence and prevalence of vitreomacular traction with and without macular hole in Germany. Clin Ophthalmol 2019; 13:177-188. [PMID: 30697035 PMCID: PMC6339449 DOI: 10.2147/opth.s188704] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Symptomatic vitreomacular adhesion (sVMA) comprises vitreomacular traction (VMT) and stage 1 and 2 full-thickness macular holes (MHs) associated with vitreomacular adhesion (VMA). We aimed to estimate the incidence and prevalence of sVMA in Germany. MATERIALS AND METHODS A systematic literature review was conducted to identify the incidence and prevalence of sVMA based on international epidemiologic studies, weighted for study size and then averaged across eligible studies. A second systematic review aimed to estimate the proportion of vitrectomy undertaken for sVMA in Germany. This was combined with the reported number of vitrectomies in Germany in 2016 to estimate the number of patients undergoing vitrectomy for sVMA. RESULTS The prevalence of sVMA is 1,365 per 100,000 population, with an incidence of 6.96 per 100,000 per year. For Germany, this translates to 1,119,300 cases, with 5,700 new cases reported annually. Analyzing the national hospital statistics, ~2,300 patients undergo vitrectomy due to sVMA in Germany each year, of which about 1,700 patients have VMT. CONCLUSION Incidence figures, driven by patients presenting to clinic, are much lower than expected based on population-based studies, suggesting that many patients with sVMA exist outside of the clinic system.
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Affiliation(s)
- Jacob Menzler
- Institute for Health- and Pharmacoeconomics/Neubauer Consult, Munich, Germany,
| | - Aljoscha Steffen Neubauer
- Institute for Health- and Pharmacoeconomics/Neubauer Consult, Munich, Germany,
- Private practice, Munich, Germany
| | | | - Timothy L Jackson
- Department of Ophthalmology, Faculty of Life Course Sciences and Medicine, King's College London, London, UK
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20
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Veith M, Penčák M, Ernest A, Straňák Z. Treatment of Vitreomacular Traction with Intravitreal Injection of Perfluoropropane. CESKÁ A SLOVENSKÁ OFTALMOLOGIE : CASOPIS CESKÉ OFTALMOLOGICKÉ SPOLECNOSTI A SLOVENSKÉ OFTALMOLOGICKÉ SPOLECNOSTI 2019; 75:182-187. [PMID: 32397720 DOI: 10.31348/2019/4/2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the effect of one intravitreal injection of expansile gas in the treatment of vitreomacular traction (VMT). METHODS A retrospective review of eyes with VMT treated with singl injection of 0,3 ml of 100% C3F8 gas was performed. The procedure was performed on an outpatient basis under topical anesthesia. RESULTS Twelve consecutive patient (14 eyes) with symptomatic VMT underwent pneumatic vitreolysis. Mean extend of vitreomacular adhesion was 490,5 µm (408-751). A posterior vitreous detachment developed in 13 eyes (92,9 %) after a single gas injection, in 11 eyes (84,6 %) during the first month of follow-up, in 2 eyes within two month of injection. Mean baseline and last BCVA were 0,5 (0,16-0,18) and 0,67 (0,2-1,0) respectively (p.
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21
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Dhoot DS, Hariprasad SM, Steinle NC. Current Treatment Options for the Management of Vitreomacular Traction. Ophthalmic Surg Lasers Imaging Retina 2018; 48:374-377. [PMID: 28499047 DOI: 10.3928/23258160-20170428-02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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22
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Paul C, Krug P, Müller HH, Wachtlin J, Mennel S, Müller S, Schmitz-Valckenberg S, Bertelmann T, Schumann RG. Comparison of the horizontal diameter to a modeled area of traction in eyes with vitreomacular traction: is the diameter close enough to the truth? Graefes Arch Clin Exp Ophthalmol 2018; 256:1817-1822. [PMID: 29955972 DOI: 10.1007/s00417-018-4055-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 06/17/2018] [Accepted: 06/21/2018] [Indexed: 11/29/2022] Open
Abstract
PURPOSE In daily practice, vitreomacular traction (VMT) is described by the horizontal diameter of its attachment site implying a regular round shape of VMT. We investigated the deviation from this circular area of vitreous traction in patients with VMT. METHODS A retrospective analysis of optical coherence tomography (OCT) scans was performed. The area of vitreomacular attachment was determined using six radial OCT scans (Ameasured). The assumed circular area of traction was calculated based on measuring the maximal horizontal diameter for comparison (Acircular). RESULTS Thirty-seven eyes of 37 patients with pure VMT were included. Patients' mean age was 72.8 ± 8.2 years. Mean horizontal VMT diameter was 400.8 ± 230.5 μm (median 361 μm; range 44-991 μm). While there was no difference between mean areas of traction for Acircular and Ameasured (P = 0.93), the individual difference (|Acircular - Ameasured|) was 0.042 (± 0.044) mm2 in mean or relative 73.0% (± 135.8%). A difference of ≥ 30% of Ameasured to Acircular was found in 16 eyes (43.2%) and ≥ 100% in 7 eyes (18.9%), respectively. CONCLUSION Vitreous attachment sites possess an irregular non-circular shape in a significant number of eyes with VMT. Consequently, the area of traction appears inaccurately described by its horizontal VMT diameter alone. As the area of traction is important for therapeutic recommendation, our results emphasize the need for a more precise description of the area of traction in eyes with VMT.
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Affiliation(s)
- Christoph Paul
- Department of Ophthalmology, Philipps-University Marburg, Baldingerstraße, 35043, Marburg, Germany.
| | - P Krug
- Department of Ophthalmology, University Medical Center Goettingen, Goettingen, Germany
| | - H H Müller
- Institute of Medical Biometry and Epidemiology, Philipps-University Marburg, Marburg, Germany
| | - J Wachtlin
- Department of Ophthalmology, Sankt Gertrauden-Krankenhaus, Berlin, Germany.,The Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - S Mennel
- Department of Ophthalmology, Feldkirch State Hospital, Feldkirch, Austria
| | - S Müller
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | | | - T Bertelmann
- Department of Ophthalmology, University Medical Center Goettingen, Goettingen, Germany.,ARTEMIS Eye Clinic, Dillenburg, Germany
| | - R G Schumann
- Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany
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23
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Čokl N, Globočnik Petrovič M. Intravitreal Injection of Perfluoropropane is More Efficacious than Sulfur Hexafluoride In Releasing Vitreomacular Traction. Acta Clin Croat 2018; 57:327-334. [PMID: 30431727 PMCID: PMC6532010 DOI: 10.20471/acc.2018.57.02.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
SUMMARY – The aim was to compare the efficacy of a single intravitreal injection of perfluoropropane (C3F8) and sulfur hexafluoride (SF6) in releasing vitreomacular traction (VMT). This prospective study included two groups of patients with symptomatic VMT confirmed by spectral-domain optical coherence tomography (SD-OCT). Patients from both groups received a single intravitreal injection of expansile gas. One group (29 eyes) received 0.3 mL of 100% C3F8, and the other group (28 eyes) received 0.3 mL of 100% SF6. Eyes without VMT release one month after SF6 injection were secondarily injected with C3F8. The primary outcome was the ratio of eyes in each group with complete VMT release on OCT one month following primary treatment. The secondary outcome was the ratio of reinjected eyes with complete VMT release on OCT one month following second injection. Additional outcome was the ratio of VMT release in eyes with specific clinical characteristics. One month after the application, complete release of VMT on OCT was recorded in 18 out of 29 eyes (62%) in the C3F8 group, in 6 out of 28 eyes (21.4%) in the SF6 group, and in 7 out of 14 (50%) reinjected eyes. There was no statistically significant difference in age, width of vitreomacular attachment (WVMAT), central retinal thickness and presence of additional features between the two groups. In eyes with WVMAT <500 microns, there was no statistically significant difference between the two gases in releasing VMT. In eyes with WVMAT >500 microns, C3F8 was more efficacious (p=0.001). According to the results of our study, intravitreal C3F8 injection seems to be more efficacious in releasing VMT than SF6 in eyes with WVMAT larger than 500 microns.
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Affiliation(s)
| | - Mojca Globočnik Petrovič
- Eye Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University Ljubljana, Ljubljana, Slovenia
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24
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Benarous A, Le Mer Y. Long-Term Results of Vitrectomy for Macular Holes after Failure of Vitreolysis. Ophthalmologica 2018; 240:14-22. [PMID: 29566375 DOI: 10.1159/000481893] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 10/02/2017] [Indexed: 11/19/2022]
Abstract
PURPOSE Ocriplasmin injection may close some small-to-medium macular holes associated with vitreoretinal traction. If the treatment fails, does vitrectomy and gas injection yield the same results as primary surgery? MATERIAL AND METHODS We report a retrospective case series study of 3 eyes of 3 consecutive patients operated on a few months after initial intravitreal injection of ocriplasmin and enlargement of the macular hole. The minimal follow-up period after surgery was 18 months. RESULTS Surgery was uneventful in all cases. Vitrectomy, internal limiting membrane peeling, and gas injection allowed closing of the 3 macular holes with a progressive improvement in visual acuity over time. Before ocriplasmin injection, visual acuity ranged from 20/60 to 20/32, after failed ocriplasmin injection from 20/80 to 20/40, and at the final follow-up after 18 months from 20/32 to 20/25. CONCLUSION Vitrectomy with internal limiting membrane peeling leads to closure of macular holes even in cases of prior failure to close them by ocriplasmin injection.
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25
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Abstract
Pneumatic vitreolysis with C3F8 gas is effective in releasing focal vitreomacular traction in a high percentage of eyes with few adverse events, especially with limited vitreomacular traction (within 1 disk area), lack of thick cellophane membranes, no diabetes mellitus, younger age (mean age of 69.1 years vs. 78.1 years), better baseline best spectacle–corrected visual acuity (mean of 20/50 vs. 20/66), small Stage 2 macular hole, and female gender. Purpose: To evaluate the outcome of perfluoropropane (C3F8) gas injection for symptomatic vitreomacular traction (VMT) with or without Stage 2 macular hole (MH). Methods: A retrospective review of eyes with VMT treated with 0.3 mL of C3F8 gas was performed. Patients avoided the supine position until gas resolution. Patients with small MH maintained partial face-down positioning. Results: Forty-nine consecutive patients (50 eyes) with symptomatic VMT underwent pneumatic vitreolysis between 2010 and 2016. A posterior vitreous detachment developed in 43 eyes (86.0%) after a single gas injection, at a median of 3.0 weeks. Twenty-eight of 35 eyes (80.0%) with VMT only and all 15 eyes (100%) with a small Stage 2 MH developed a posterior vitreous detachment, with MH closure in 10 of 15 eyes (66.7%). Median baseline and last best spectacle–corrected visual acuities were 20/50 and 20/40, respectively (P < 0.001). Mean follow-up time was 11.1 ± 9.9 months. Rate of posterior vitreous detachment was reduced with presence of diabetes mellitus (25%) and with thick cellophane membrane (50%). Univariate analysis showed increased VMT release for eyes with VMT extent within 1 disk area (χ2 = 13.1, P = 0.002), eyes with absence of diabetes mellitus (χ2 = 8.8, P = 0.007), and eyes with Stage 2 MH (χ2 = 5.47, P = 0.019); there was a trend between success and lack of thick cellophane membrane (χ2 = 3.32, P = 0.068). Results using logistic regression also showed younger age (P = 0.012), followed by better baseline best spectacle–corrected visual acuity (P = 0.044), lack of diabetes mellitus (P = 0.077), and female gender (P = 0.045) to be predictors of increased VMT release. One VMT-only eye formed a MH and another VMT-only eye developed a retinal detachment. Both eyes responded to vitrectomy. Conclusion: Pneumatic vitreolysis with limited face-down position is a viable option for treating VMT with few adverse events. More studies are needed to elucidate its indications, benefits, and risks.
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26
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Haas AM, Mayer C, Haas A, Wackernagel W. Effect of intravitreal C 3F 8 gas in patients with vitreomacular traction: A retrospective case series. SPEKTRUM DER AUGENHEILKUNDE 2017; 32:228-238. [PMID: 30595622 PMCID: PMC6280806 DOI: 10.1007/s00717-017-0382-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 11/14/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND We aimed to assess the efficacy of a single intravitreal perfluoropropane (C3F8) gas injection for the treatment of vitreomacular traction with or without a macular hole. METHODS In this retrospective case series, seven eyes of six patients with symptomatic vitreomacular traction documented on optical coherence tomography, one with a macular hole additionally, received a single intravitreal C3F8 gas injection of up to 0.3 ml. The primary endpoint was vitreomacular traction release at 1 month after injection. Secondary endpoints included resolution of vitreomacular adhesion within 6 months, nonsurgical closure of macular holes, and change in central foveal thickness and best-corrected visual acuity. RESULTS Overall, on optical coherence tomography, six of seven eyes (85.7%) had release of vitreomacular traction during the entire study duration: three within 1 month of injection and the other three within 6 months. Of the latter group, two of the three eyes showed a concurrent epiretinal membrane and one concurrent diabetic retino- and maculopathy. The patient with a macular hole had resolution of vitreomacular traction within 1 month but had to undergo vitrectomy because of nonclosure of the macular hole. Associated adverse events were macular edema with a consequent lamellar hole after injection in one patient, and another patient developed retinal detachment. CONCLUSION Intravitreal C3F8gas injection is an inexpensive and promising minimally invasive option for the treatment of symptomatic and persistent vitreomacular traction with or without a macular hole. Further larger studies, especially comparing C3F8 gas injection with other treatment options, are needed.
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Affiliation(s)
- Anna-Maria Haas
- Department of Ophthalmology, Medical University of Graz, Auenbruggerplatz 4, 8036 Graz, Austria
| | - Christoph Mayer
- Department of Ophthalmology, Medical University of Graz, Auenbruggerplatz 4, 8036 Graz, Austria
| | - Anton Haas
- Department of Ophthalmology, Medical University of Graz, Auenbruggerplatz 4, 8036 Graz, Austria
| | - Werner Wackernagel
- Department of Ophthalmology, Medical University of Graz, Auenbruggerplatz 4, 8036 Graz, Austria
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27
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Chan CK, Mein CE, Crosson JN. Pneumatic Vitreolysis for Management of Symptomatic Focal Vitreomacular Traction. J Ophthalmic Vis Res 2017; 12:419-423. [PMID: 29090053 PMCID: PMC5644410 DOI: 10.4103/jovr.jovr_146_17] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 08/03/2017] [Indexed: 11/06/2022] Open
Abstract
Pneumatic vitreolysis (PVL) is the intravitreal injection of a small quantity of expansile gas for the purpose of achieving focal vitreomacular traction (VMT) release for eyes with symptomatic VMT, or inducing VMT release and closure of the macular defect for eyes with a small stage-2 macular hole (MH). Initially, there was limited interest in this technique upon its introduction for clinical treatment in human eyes in 1993. With the advent of optical coherence tomography allowing detailed observation of vitreomacular interface changes and rising importance of medical economics in recent years, there has been increasing interest in PVL, a low-cost procedure for managing symptomatic VMT. The success rates of VMT release in the literature have ranged from 60% to 100% and the rates of closure of small macular holes have ranged from 50% to 80% following PVL. In a recent retrospective consecutive series of 56 eyes in two centers undergoing C3F8 gas injection, Chan and Mein reported an overall success of 86% in VMT release and 60% closure of small macular holes with few adverse events (7% with retinal breaks, retinal detachment, or progression of VMT). Multiple recent studies have shown superior outcome utilizing C3F8 gas compared with SF6 gas for PVL. In conclusion, PVL is a promising, low-cost therapeutic option, with the potential for managing symptomatic focal VMT on a global scale.
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Affiliation(s)
- Clement K. Chan
- Southern California Desert Retina Consultants, Palm Desert, CA, USA
- Department of Ophthalmology, Loma Linda University, Loma Linda, CA, USA
| | - Calvin E. Mein
- Retinal Consultants of San Antonio, San Antonio, TX, USA
- Department of ophthalmology, University of Texas Health, San Antonio, TX, USA
| | - Jason N. Crosson
- Retina Consultants of Alabama, Department of Ophthalmology, the University of Alabama at Birmingham, Birmingham, AL, USA
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Mennel S, Bechrakis NE, Binder S, Haas A. State of the art und Zukunft der Vitrektomie – Techniken und Instrumente. SPEKTRUM DER AUGENHEILKUNDE 2017. [DOI: 10.1007/s00717-017-0367-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Zusammenfassung
Hintergrund
Durch die Einführung der Pars plana Vitrektomie ist eine Vielzahl von vitreoretinalen Erkrankungen behandelbar geworden. Kontinuierliche Verbesserungen der Geräte, Instrumente und zusätzliche Hilfsmittel sowie neue Techniken kennzeichnen den enormen Fortschritt der vitreoretinalen Chirurgie.
Methoden
In einer Literaturübersicht werden die Operationstechniken verschiedenster vitreoretinaler Eingriffe analysiert. Sofern aufgrund aktueller Entwicklungen verschiedene Optionen in der Operationstechnik bestehen, werden Experten auf dem Gebiet der vitreoretinalen Chirurgie über ihre Erfahrung und ihre Empfehlung befragt.
Ergebnisse
Die 20 Gauge Pars plana Vitrektomie wurde größtenteils durch die Verwendung von Trokaren (23, 25 und 27 Gauge) mit entsprechenden Instrumenten mit kleinerem Durchmesser abgelöst. Die Pars plana Vitrektomie ist nahtlos möglich, trotzdem kann es notwendig sein, eine zusätzliche Sicherung der Wunde mit einer Naht durchzuführen, um Leckage und Hypotonie zu vermeiden. Die Visualisierung des Glaskörpers erfolgt zunehmend mit Triamcinolon, epiretinale Gliosen und die Membrana limitans interna werden routinemäßig mit Vitalfarbstoffen dargestellt. Bei der Operationstechnik beim Makulaforamen und bei der Ablatio retinae zeigen sich sowohl bei aktuellen Publikationen als auch unter den Experten Variationen.
Schlussfolgerungen
Die Pars plana Vitrektomie hat sich aufgrund der Weiterentwicklung speziell im Bereich der Trokar Systeme, Vitrektome, der Weitwinkel-Beobachtungssysteme sowie dank neuer Techniken zu einer essentiellen OP-Methode für ein weites Indikationsspektrum entwickelt. Dies ist die Basis der Behandlung verschiedenster vitreoretinaler Erkrankungen mit immer weniger Operationstrauma, weniger intraoperativen und postoperativen Komplikationen und gutem Therapieerfolg. Unterschiedliche Operationsvarianten, neue Techniken und die Weiterentwicklung der Geräte und Instrumente sind die Basis für einen auch zukünftigen Fortschritt der Pars plana Vitrektomie.
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29
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Manousaridis K, Peter-Reichart S, Mennel S. Ocriplasmin treatment for vitreomacular traction in real life: can the indication spectrum be expanded? Graefes Arch Clin Exp Ophthalmol 2017; 255:1907-1916. [PMID: 28681138 DOI: 10.1007/s00417-017-3731-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 06/13/2017] [Accepted: 06/20/2017] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To evaluate the efficacy of intravitreal ocriplasmin for the resolution of vitreomacular traction (VMT) with or without a full thickness macular hole (FTMH) in the clinical setting and to assess whether the indication spectrum of this treatment modality can be expanded beyond that of the MIVI-TRUST trials. METHODS The records of patients with VMT with or without FTMH, who were treated with intravitreal ocriplasmin were reviewed. Patients were divided in two groups. In the first group, VMT with or without FTMH was present without any other macular pathology. In the second group, VMT with or without FTMH occurred alongside of other macular disease including age-related macular degeneration, diabetic maculopathy and post-operative pseudophakic cystoid macular edema. RESULTS Release of the VMT was achieved in 12/20 patients (12/20 eyes) of the first group. 16 eyes in this group met 3 or more criteria known to be associated with favorable prognosis after intravitreal ocriplasmin treatment. No cases of release of the VMT were observed in the second group, which included 15 patients (15 eyes). Significant improvement of visual acuity and reduction of the central macular thickness was observed only in the subgroup of eyes which responded to treatment. CONCLUSIONS Concomitant macular pathology was a significant factor for treatment failure and we suggest that ocriplasmin should be regarded with caution in these cases. Careful patient selection for treatment with ocriplasmin using specific criteria in the clinical setting can provide superior results to those reported in the MIVI-TRUST trials.
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Affiliation(s)
- Kleanthis Manousaridis
- Ophthalmology Department, State Hospital Feldkirch, Academic Teaching Hospital, Carinagasse 47, 6800, Feldkirch, Austria.
| | - Silvia Peter-Reichart
- Ophthalmology Department, State Hospital Feldkirch, Academic Teaching Hospital, Carinagasse 47, 6800, Feldkirch, Austria
| | - Stefan Mennel
- Ophthalmology Department, State Hospital Feldkirch, Academic Teaching Hospital, Carinagasse 47, 6800, Feldkirch, Austria
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