1
|
McElhinney K, McGrath R, Holohan R, Idrees Z. Twelve-month analysis of emergency argon laser retinopexy in an Irish tertiary hospital. Ir J Med Sci 2024; 193:1653-1657. [PMID: 37874504 DOI: 10.1007/s11845-023-03549-6] [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: 06/13/2023] [Accepted: 10/09/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND Retinal tears occur as a result of traction at sites of retinal and vitreous adhesion-this allows retrohyaloid fluid into the subretinal space. Prompt management is required to prevent progression to rhegmatogenous retinal detachment (RRD). AIMS To identify the post-procedural outcomes following treatment of retinal tears with laser retinopexy in an emergency setting. METHODS Retrospective review of all patients who underwent emergency slit-lamp laser retinopexy between January and December 2021 in Cork University Hospital, an Irish tertiary referral centre. RESULTS A total of 87 patients were identified-mean age of 60 ± 12 years and 54% female. Follow-up ranged from 1 week to 11 months. Pre-disposing risk factors were identified-myopia (37%), recent trauma (2%), and RRD family history (5%). All patients had slit-lamp mounted laser-retinopexy performed in the eye-casualty. 63 patients (72%) had a superior break, 66 patients (76%) had a horse-shoe retinal tear, and 21 patients (24%) had a retinal hole. Associated findings included lattice degeneration (26%), sub-retinal fluid (55%), and vitreous haemorrhage (33%). Fourteen patients (16%) required multiple slit-lamp laser retinopexies while 18 patients (21%) required intervention by a vitreo-retinal surgeon including indirect-laser retinopexy (3%), cryotherapy (11%), and pars-plana vitrectomy (6%). At the most recent follow-up, all the patients had anatomically attached retinas. CONCLUSION A notable proportion of patients (21%) undergoing emergency laser retinopexy required further intervention. Patients with anteriorly located retinal tears would benefit from an early discussion with a vitreo-retinal surgeon. Departmental training in laser retinopexy and retinal tear management is recommended as part of ongoing quality improvement.
Collapse
Affiliation(s)
- Kealan McElhinney
- Department of Ophthalmology, Cork University Hospital, Cork, Ireland.
| | - Robert McGrath
- Department of Ophthalmology, Cork University Hospital, Cork, Ireland
| | - Rory Holohan
- Department of Ophthalmology, Cork University Hospital, Cork, Ireland
| | - Zubair Idrees
- Department of Ophthalmology, Cork University Hospital, Cork, Ireland
| |
Collapse
|
2
|
Wang R, Lovenberg C, Hess O, Todorich B. ROLE OF OPTICAL COHERENCE TOMOGRAPHY IN MANAGEMENT OF ACUTE POSTERIOR VITREOUS DETACHMENT AND ITS COMPLICATIONS. Retina 2023; 43:371-378. [PMID: 36728028 DOI: 10.1097/iae.0000000000003741] [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: 02/03/2023]
Abstract
PURPOSE Currently, no consensus exists on the role of optical coherence tomography (OCT) imaging in the setting of acute posterior vitreous detachment (PVD). The authors outline the clinical utility of OCT in the management of acute PVD and its complications. METHODS Literature review of OCT findings in association with acute PVD and report of illustrative cases. RESULTS Optical coherence tomography imaging in the setting of acute PVD can provide details of vitreoretinal interface that are difficult to appreciate on biomicroscopy alone including partial PVDs, focal vitreoretinal adhesions and traction, and subclinical macular changes. The presence of vitreous hyperreflective dots on OCT in the premacular space, especially if severe, is highly correlated with the presence of peripheral retinal breaks and development of epiretinal membrane. Advancements in OCT technology, including enhanced vitreous imaging OCT, swept-source OCT, wide-angle OCT, and widefield OCT, allow for increased resolution and expanded field of imaging of the vitreoretinal interface. CONCLUSION Optical coherence tomography imaging is an emerging standard of care in the setting of patients presenting with new flashes and floaters. The authors highlight the benefits of OCT imaging in patients with acute PVD, which includes recognition of the status of the vitreoretinal interface, assistance in identifying high-risk PVDs, and performance of risk assessment that predict future macular pathologic condition.
Collapse
Affiliation(s)
- Rui Wang
- Department of Ophthalmology, Pennsylvania State College of Medicine, Hershey, Pennsylvania
| | | | - Olivia Hess
- Stanford University School of Medicine, Stanford, California
| | - Bozho Todorich
- Lehigh Eye Specialists, P.C., Allentown, Pennsylvania
- Susquehanna Retina Center, P.C., Lemoyne, Pennsylvania
| |
Collapse
|
3
|
Shaimova VA, Kuchkildina SK, Islamova GR, Arslanov GM, Kravchenko TG, Askaeva AA. [Age-related changes in human vitreous]. Vestn Oftalmol 2023; 139:106-111. [PMID: 37379116 DOI: 10.17116/oftalma2023139031106] [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: 06/30/2023]
Abstract
There are two main age-related changes that can occur in the vitreous body of healthy individuals throughout life: liquefaction (synchesis) and aggregation of collagen fibrils into dense bundles (syneresis). Progressive age-related degradation leads to posterior vitreous detachment (PVD). At present many classifications of PVD exist, in which authors relied either on the morphological features, or on the differences in pathogenesis before and after widespread use of OCT. The course of PVD can be either normal or anomalous. Physiological PVD induced by age-related vitreous changes progresses in specific stages. The review emphasizes that PVD can occur initially not only in the central zone of the retina, but also on the periphery with further spread to the posterior pole. Anomalous PVD can lead to various negative effects on the retina, as well as on the vitreous as a result of traction in the area of vitreoretinal interface.
Collapse
Affiliation(s)
- V A Shaimova
- Academy of Postgraduate Education of the Federal Scientific and Clinical Center of Specialized Types of Medical Care and Medical Technologies, Moscow, Russia
- OOO Center Zreniya, Chelyabinsk, Russia
| | | | | | - G M Arslanov
- Eye Microsurgery Clinic Schastliviy Vzglyad, Saint Petersburg, Russia
| | - T G Kravchenko
- Multiprofile Center for Laser Medicine, Chelyabinsk, Russia
| | | |
Collapse
|
4
|
Patel SN, Lee C, Cui D, Wingert AM, Zhou S, Scott IU. Association of staffing with Incidence of delayed retinal break or detachment after posterior vitreous detachment in a resident urgent care clinic. Graefes Arch Clin Exp Ophthalmol 2021; 260:791-798. [PMID: 34661735 DOI: 10.1007/s00417-021-05437-0] [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: 06/22/2021] [Revised: 08/26/2021] [Accepted: 09/30/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To compare the incidence rate of delayed retinal break or detachment after diagnosis of acute, symptomatic posterior vitreous detachment (PVD) in a resident-run urgent care clinic (UCC) when staffed by a retina attending, non-retina ophthalmology attending, optometrist, or ophthalmology resident only. METHODS Retrospective consecutive case series. Of the 594 patients with acute, symptomatic PVD evaluated in the UCC at Penn State Eye Center between 1/1/2016 and 10/10/2019, 454 were included in the study; 140 were excluded because they were diagnosed with a retinal break or detachment on presentation to the UCC, had media opacity precluding examination, or had no follow-up within one year. Demographics, presenting examination findings, and type of staffing were recorded; subsequent visits up to 1 year were analyzed for presence of delayed retinal break or detachment. RESULTS Among 491 eyes of 454 patients with a mean follow-up of 147 days, ten delayed breaks (10/491, 2.0%) and three delayed detachments (3/491, 0.6%) were discovered. Incidence rates of delayed breaks and detachments were 1.8% (5/282) and 0.7% (2/282), respectively, in the retina attending group, 1.0% (1/105) and 1.0% (1/105) in the non-retina ophthalmology attending group, 4.7% (3/64) and 0% (0/64) in the optometrist group, and 2.5% (1/40) and 0% (0/40) in the ophthalmology resident only group. There was no statistically significant difference in the incidence of delayed break or detachment among the staffing groups (P = 0.7312), but this study was underpowered to detect a statistically significant difference among staffing groups. Patients with a delayed break or detachment were more likely to have lattice degeneration (P = 0.0265) or a history of retinal break in the contralateral eye (P = 0.0014), and most eyes (10 [76.9%]) with a delayed break or detachment were left eyes (P = 0.0466). CONCLUSIONS The overall rate of delayed retinal break or detachment in the current study is similar to previously published rates among retinal physician and retinal fellow examiners. Although no statistically significant difference among staffing groups in the incidence rates of delayed retinal tears or detachments was identified in the study, it is important to note that the optometry and ophthalmology resident only groups had higher incidence rates of delayed retinal breaks than did the retina and non-retina ophthalmology attending groups, and this may be clinically important. Larger cohort studies would be needed in order to have the power to detect statistically significant differences among staffing groups. Varied staffing for acute, symptomatic PVD may assist with resource allocation in similar settings.
Collapse
Affiliation(s)
- Saagar N Patel
- Department of Ophthalmology, Penn State College of Medicine, 500 University Drive, HU19, Hershey, PA, 17033-0850, USA
| | - Charles Lee
- Penn State College of Medicine, Hershey, PA, USA
| | - David Cui
- Penn State College of Medicine, Hershey, PA, USA
| | | | - Shouhao Zhou
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Ingrid U Scott
- Department of Ophthalmology, Penn State College of Medicine, 500 University Drive, HU19, Hershey, PA, 17033-0850, USA. .,Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.
| |
Collapse
|
5
|
Evaluating posterior vitreous detachment by widefield 23-mm swept-source optical coherence tomography imaging in healthy subjects. Sci Rep 2021; 11:19754. [PMID: 34611277 PMCID: PMC8492648 DOI: 10.1038/s41598-021-99372-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 09/23/2021] [Indexed: 11/09/2022] Open
Abstract
Posterior vitreous detachment (PVD) is a separation between the posterior vitreous cortex and internal limiting membrane. Although PVD was historically considered an acute event, recent studies using spectral-domain optical coherence tomography (SD-OCT) revealed a gradual progression of PVD in healthy subjects. Although SD-OCT improved PVD studies, the narrow imaging angle and long examination time were problematic to allow wide angle capture. The Xephilio OCT-S1 (Canon), a swept-source OCT (SS-OCT) device, can obtain up to 23-mm of widefield B-scan images in a single acquisition. We used this widefield SS-OCT to quantitatively evaluate the PVD stage in 214 healthy subjects aged 4–89 years and determine whether PVD stages differ between the bilateral eyes of each patient. Age was significantly positively correlated with the overall PVD stage (ρ = 0.7520, P < 0.001). Interestingly, partial PVD occurred in children as young as 5 years, indicating that initial PVD onset may occur much earlier than previously reported. Furthermore, PVD stages of the bilateral eyes were highly consistent in 183 subjects (85.5%). Widefield 23-mm SS-OCT thus revealed that PVD started earlier than anticipated, and age was correlated with the symmetry of PVD stage. Widefield 23-mm SS-OCT may also be clinically useful for the evaluation of diseased eyes.
Collapse
|
6
|
Hayashi A, Ito Y, Takatsudo Y, Hara N, Gehlbach PL, Mori K. Posterior Vitreous Detachment in Normal Healthy Subjects Younger Than Age Twenty. Invest Ophthalmol Vis Sci 2021; 62:19. [PMID: 34677570 PMCID: PMC8543394 DOI: 10.1167/iovs.62.13.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 09/27/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose To describe the initiation of posterior vitreous detachment (PVD) in the eyes of normal individuals, under 20 years of age, using wide-angle optical coherence tomography (OCT). Methods This is an observational cross-sectional study. Montaged images of horizontal and vertical OCT scans were obtained in 63 healthy eyes of 35 consecutive subjects ranging in age from 4 to 17 years. Results Forty-five eyes (71.4%) had obvious PVD, defined as a contiguous line of posterior cortical vitreous separated from the surface of the retina. Eighteen eyes (28.6%) had no PVD. The mean age of the individuals without PVD was significantly younger than those with PVD (P = 0.008). The spatial distribution of PVD initiation was highest in the superior quadrants, with the nasal, inferior, septum papillomaculae, and temporal quadrants following in descending order of frequency (P < 0.001). PVD was observed to begin anterior to the premacular liquefied lacuna, where the vitreous gel directly adheres to the vitreoretinal interface. In the majority of subjects (80.6%), PVD was initiated anterior to the vascular arcades. Conclusions PVD can be observed by OCT to begin in the first and second decade of life. It begins in the mid-peripheral vitreous, most frequently in the superior quadrants anterior to the vascular arcades. In this study, all PVDs originated outside of the macular liquefied lacunae, where the vitreous gel adheres directly to the retina.
Collapse
Affiliation(s)
- Ayumi Hayashi
- Department of Ophthalmology, International University of Health and Welfare, Nasushiobara-shi, Tochigi, Japan
| | - Yoko Ito
- Department of Ophthalmology, International University of Health and Welfare, Nasushiobara-shi, Tochigi, Japan
| | - Yuki Takatsudo
- Department of Ophthalmology, International University of Health and Welfare, Nasushiobara-shi, Tochigi, Japan
| | - Naoto Hara
- Department of Ophthalmology, International University of Health and Welfare, Nasushiobara-shi, Tochigi, Japan
| | - Peter L. Gehlbach
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Keisuke Mori
- Department of Ophthalmology, International University of Health and Welfare, Nasushiobara-shi, Tochigi, Japan
| |
Collapse
|
7
|
MACULAR HOLE ASSOCIATED WITH AGE-RELATED MACULAR DEGENERATION: Pathogenesis and Surgical Outcomes. Retina 2021; 41:2079-2087. [PMID: 34543242 DOI: 10.1097/iae.0000000000003148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To ascertain the pathogenesis of macular hole (MH) associated with age-related macular degeneration (AMD) and its surgical outcomes. METHODS Patients with full-thickness MH associated with AMD (higher grades than intermediate) were enrolled. The mechanism of MH formation and closure rate after vitrectomy (surgical outcome) were determined using optical coherence tomography imaging. RESULTS The mechanism of MH formation (35 eyes) associated with AMD was classified into four types: vitreomacular traction (42.9%), gradual retinal thinning caused by subretinal drusen or pigment epithelial detachment (22.9%), massive subretinal hemorrhage (20.0%), and combined (14.3%). In the 41 eyes that underwent vitrectomy, the logarithm of the minimum angle of resolution best-corrected visual acuity improved from 0.82 (0.10-2.30) preoperative to 0.69 (0.10-2.30) postoperative (P = 0.001). Successful closure of the MH was achieved in 33 eyes (80.5%) after vitrectomy. No significant association was observed between the closure rate of MH after vitrectomy and mechanism of MH formation (P = 0.083). CONCLUSION The mechanism of MH formation associated with AMD was classified into four types and was not related to its surgical outcome. Considering visual improvement and surgical outcome after vitrectomy in our study, active surgical treatment can be considered for MH associated with AMD.
Collapse
|
8
|
The Effect of the Idiopathic Epiretinal Membrane and Surgically Induced Posterior Vitreous Detachment on the Retinal Nerve Fiber Layer. J Ophthalmol 2021; 2020:5217645. [PMID: 33824761 PMCID: PMC8006755 DOI: 10.1155/2020/5217645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 11/06/2020] [Accepted: 11/06/2020] [Indexed: 12/01/2022] Open
Abstract
Aim To investigate the changes in the retinal nerve fiber layer (RNFL) following pars plana vitrectomy (PPV) with surgically induced posterior vitreous detachment (PVD) and idiopathic epiretinal membrane (ERM) and internal limiting membrane (ILM) peeling. Methods Patients with unilateral ERM with vitreomacular traction were included in this prospective, randomized, and controlled clinical trial. The control group (Group 1) was formed with the nonoperated fellow eyes of the patients, and the study group (Group 2) was formed with the eyes that underwent PPV including idiopathic ERM and ILM peeling. In the preoperative and postoperative periods (1st, 2nd, 3rd, 6th, and 12th months), complete ophthalmological examination of the eyes was performed and RNFL measurements were examined in 4 different quadrants (superior, temporal, inferior, and nasal) with the help of spectral domain optical coherence tomography (OCT). Results There was no statistically significant change in Group 1 during the follow-up period in all quadrants (p > 0.05). The mean RNFL thickness in Group 2 was statistically significantly higher than in Group 1 in superior, inferior, and temporal quadrants (p < 0.01), preoperatively. The mean RNFL in Group 2 was higher in the 1st, 2nd, 3rd, and 6th months and lower in the 12th month in superior, inferior, and temporal quadrants (p < 0.01) when compared to the preoperative period. The mean RNFL thickness in the nasal quadrant in Group 2 was higher in the 1st, 2nd, and 3rd (p < 0.01) months, same in the 6th month (p > 0.05), and lower in the 12th (p < 0.01) month when compared to the preoperative period. Conclusion Idiopathic ERM may cause an increase in RNFL thickness in superior, inferior, and temporal quadrants with possible tractional effect. PPV with PVD induction and ERM and ILM peeling may cause these RNFL changes.
Collapse
|
9
|
Wang MD, Truong C, Mammo Z, Hussnain SA, Chen RWS. Swept Source Optical Coherence Tomography Compared to Ultrasound and Biomicroscopy for Diagnosis of Posterior Vitreous Detachment. Clin Ophthalmol 2021; 15:507-512. [PMID: 33603328 PMCID: PMC7886381 DOI: 10.2147/opth.s297307] [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: 12/17/2020] [Accepted: 01/19/2021] [Indexed: 11/29/2022] Open
Abstract
Background Biomicroscopy, B-scan ultrasound imaging, and SD-OCT are all modalities used to characterize a posterior vitreous detachment (PVD). Our objective is to assess the precision of the diagnosis of PVD by SS-OCT. Methods This prospective observational study examines ninety-five eyes of forty-nine patients with biomicroscopy, B-scan ultrasound, and SS-OCT for the presence or absence of a complete PVD. All SS-OCT images were reviewed by two retina specialists (RWSC, ZM). All three diagnostic methods were evaluated for agreement by Cohen’s kappa statistic. Results The inter-rater reliability between retina specialists reading the SS-OCT images was 97.9% (κ = 0.957). Agreement on PVD status between SS-OCT and biomicroscopy was 85.3% (κ = 0.711). Agreement between SS-OCT and B-scan ultrasound was 83.2% (κ = 0.667). Agreement between B-scan ultrasound and biomicroscopy was 87.4% (κ = 0.743). Conclusion For the diagnosis of complete PVD, SS-OCT allows for high accuracy and agreement between graders.
Collapse
Affiliation(s)
- Marlene D Wang
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Cecile Truong
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Zaid Mammo
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Syed Amal Hussnain
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Royce W S Chen
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, 10032, USA
| |
Collapse
|
10
|
Liao DY, Liu JH, Zheng YP, Shiu HW, Wang JM, Chao HM. OCT proves that vitreomacular adhesion is significantly more likely to develop vision-threatening retinal complications than vitreomacular separation. BMC Ophthalmol 2020; 20:163. [PMID: 32321473 PMCID: PMC7178608 DOI: 10.1186/s12886-020-01416-x] [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: 10/10/2019] [Accepted: 03/31/2020] [Indexed: 11/23/2022] Open
Abstract
Background SD-OCT is becoming commonplace in everyday practice. Vitreomacular adhesions (VMAs) are being more routinely diagnosed. Predictive studies to the natural course of VMA are thus clinically significant. Spectral domain-optical coherence tomography (SD-OCT) was presently utilized to analyze the incidence of floaters, the complete vitreomacular separation or VMA, the VMA complication, the vitreomacular angle (VMAng), and the complication mechanism. Methods Monthly SD-OCT was performed on patients with/without symptomatic floaters. OCT allowed VMA and vitreomacular separation to be compared. The incidence was assessed applying one-tailed Fisher’s exact tests. The VMAngs between the inner retina and posterior hyaloid were measured, and the complication mechanism was studied using OCT image. For macular hole (MH), pre- and/or post-operative best corrected visual acuities (BCVAs; LogMAR), refractions and photoreceptor conditions were also evaluated. Results Totally, 124 eyes were included; there were 116 eyes with VMA and 8 eyes with vitreomacular separation. Considering the percentages over 124 eyes, floaters were present in 14.5% of enrolled eyes (=18/124), consisting of 12.9% of eyes with VMA (16/124) and 1.6% of eyes with vitreomacular separation (2/124). Moreover, there were twelve eyes (9.7%) with VMA-associated vision-threatening complications, including MH (n = 8; 6.5%), retinal detachment (RD; n = 2; 1.6%), vitreomacular traction (VMT; n = 1; 0.8%) and macular pucker (MP; n = 1; 0.8%). Eyes with initial VMA had a significantly greater possibility of complications than eyes with initial vitreomacular separation (p = 0.03). Among these eyes with MH (n = 8), the pre-operative BCVA (LogMAR) was 1.1 ± 0.5, which was insignificantly (p = 0.35) improved to 0.8 ± 0.7 post-operatively. The VMAng of VMA eyes with MHs was 24.2 ± 24.9° (n = 8). The critical VMAng was 13.3°. Conclusions A minority of eyes with VMA or vitreomacular separation had floaters. Moreover, the use of SD-OCT could identify vision-threatening sequelae, namely MH, RD, MP and VMT, and this was significantly more frequent in eyes with VMA than in eyes with complete vitreomacular separation. Therefore, SD-OCT might be a useful way of identifying either identity, and evaluating VMA-associated complications. Whether VMA eyes with MH (n = 8) that have a VMAng greater than critical VMAng have a greater likelihood of tangential traction and subsequent MH needs further investigation.
Collapse
Affiliation(s)
- Ding-Ying Liao
- Department of Ophthalmology, Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jorn-Hon Liu
- Department of Ophthalmology, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Yu-Ping Zheng
- Department of Ophthalmology, Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Huei-Wen Shiu
- Department of Ophthalmology, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Jian-Ming Wang
- Department of Ophthalmology, Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
| | - Hsiao-Ming Chao
- Department of Ophthalmology, Cheng Hsin General Hospital, Taipei, Taiwan. .,Institute of Pharmacology, School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Department of Chinese Medicine, School of Chinese Medicine, China Medical University, Taichung, Taiwan. .,Department of Ophthalmology, Taipei Medical University-Shuang Ho Hospital, Ministry of Health and Welfare, Taipei, Taiwan. .,Department of Ophthalmology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
| |
Collapse
|
11
|
Flaxel CJ, Adelman RA, Bailey ST, Fawzi A, Lim JI, Vemulakonda GA, Ying GS. Posterior Vitreous Detachment, Retinal Breaks, and Lattice Degeneration Preferred Practice Pattern®. Ophthalmology 2019; 127:P146-P181. [PMID: 31757500 DOI: 10.1016/j.ophtha.2019.09.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 09/20/2019] [Indexed: 12/29/2022] 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
| |
Collapse
|
12
|
Tsukahara M, Mori K, Gehlbach PL, Mori K. Posterior Vitreous Detachment as Observed by Wide-Angle OCT Imaging. Ophthalmology 2018; 125:1372-1383. [DOI: 10.1016/j.ophtha.2018.02.039] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 02/12/2018] [Accepted: 02/20/2018] [Indexed: 10/17/2022] Open
|
13
|
|
14
|
Fincham GS, James S, Spickett C, Hollingshead M, Thrasivoulou C, Poulson AV, McNinch A, Richards A, Snead D, Limb GA, Snead MP. Posterior Vitreous Detachment and the Posterior Hyaloid Membrane. Ophthalmology 2018; 125:227-236. [PMID: 28867131 DOI: 10.1016/j.ophtha.2017.08.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 07/11/2017] [Accepted: 08/01/2017] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Despite posterior vitreous detachment being a common ocular event affecting most individuals in an aging population, there is little consensus regarding its precise anatomic definition. We investigated the morphologic appearance and molecular composition of the posterior hyaloid membrane to determine whether the structure clinically observed enveloping the posterior vitreous surface after posterior vitreous detachment is a true basement membrane and to postulate its origin. Understanding the relationship between the vitreous (in both its attached and detached state) and the internal limiting membrane of the retina is essential to understanding the cause of rhegmatogenous retinal detachment and vitreoretinal interface disorders, as well as potential future prophylactic and treatment strategies. DESIGN Clinicohistologic correlation study. PARTICIPANTS Thirty-six human donor globes. METHODS Vitreous bodies identified to have posterior vitreous detachment were examined with phase-contrast microscopy and confocal microscopy after immunohistochemically staining for collagen IV basement membrane markers, in addition to extracellular proteins that characterize the vitreoretinal junction (fibronectin, laminin) and vitreous gel (opticin) markers. The posterior retina similarly was stained to evaluate the internal limiting membrane. Findings were correlated to the clinical appearance of the posterior hyaloid membrane observed during slit-lamp biomicroscopy after posterior vitreous detachment and compared with previously published studies. MAIN OUTCOME MEASURES Morphologic appearance and molecular composition of the posterior hyaloid membrane. RESULTS Phase-contrast microscopy consistently identified a creased and distinct glassy membranous sheet enveloping the posterior vitreous surface, correlating closely with the posterior hyaloid membrane observed during slit-lamp biomicroscopy in patients with posterior vitreous detachment. Immunofluorescent confocal micrographs demonstrated the enveloping membranous structure identified on phase-contrast microscopy to show positive stain results for type IV collagen. Immunofluorescence of the residual intact internal limiting membrane on the retinal surface also showed positive stain results for type IV collagen. CONCLUSIONS The results of this study provide immunohistochemical evidence that the posterior hyaloid membrane is a true basement membrane enveloping the posterior hyaloid surface. Because this membranous structure is observed only after posterior vitreous detachment, the results of this study indicate that it forms part of the internal limiting membrane when the vitreous is in its attached state.
Collapse
Affiliation(s)
- Gregory S Fincham
- Vitreoretinal Service, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Sean James
- Department of Histopathology, Coventry Hospital, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - Carl Spickett
- Department of Pathology, University of Cambridge, Cambridge, United Kingdom
| | | | - Christopher Thrasivoulou
- Research Department of Cell and Developmental Biology, University College London, London, United Kingdom
| | - Arabella V Poulson
- Vitreoretinal Service, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Annie McNinch
- Vitreoretinal Service, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Department of Pathology, University of Cambridge, Cambridge, United Kingdom
| | - Allan Richards
- Department of Pathology, University of Cambridge, Cambridge, United Kingdom; Regional Molecular Genetic Laboratory, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - David Snead
- Department of Histopathology, Coventry Hospital, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - Gloria A Limb
- Institute of Ophthalmology, University College London, London, United Kingdom
| | - Martin P Snead
- Vitreoretinal Service, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Department of Pathology, University of Cambridge, Cambridge, United Kingdom.
| |
Collapse
|
15
|
|
16
|
Storch MW, Hoerauf H. Case report of a secondary macular hole closure after intravitreal bevacizumab therapy in a patient with retinal pigment epithelial detachment. Indian J Ophthalmol 2017; 65:632-633. [PMID: 28724829 PMCID: PMC5549424 DOI: 10.4103/ijo.ijo_818_16] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We describe a case of macular hole (MH) closure after intravitreal bevacizumab therapy for an underlying pigment epithelial detachment (PED) due to exudative age-related macular degeneration (AMD). The 73-year-old Caucasian female presented with reduced visual acuity (20/80) of the left eye and metamorphopsia for approximately 6 months. Spectral domain optical coherence tomography revealed a subfoveal PED due to AMD with an associated MH. To treat the exudative component of the pathology, we started intravitreal bevacizumab therapy, consecutively leading to reduction of the height of PED and allowing closure of the MH. Detachment recurred during further follow-up, but the MH remained closed. MHs and exudative AMD are common diseases, which rarely occur simultaneously. To the best of our knowledge (search via PubMed for “MH,” “PED,” “age-related macular degeneration”), no other case with the persistent closure of an MH associated with PED during intravitreal antivascular endothelial growth factor therapy and despite recurrent PED has been published to date.
Collapse
Affiliation(s)
| | - Hans Hoerauf
- Department of Ophthalmology, University of Göttingen, Göttingen, Germany
| |
Collapse
|
17
|
Soliman MK, Agarwal A, Sarwar S, Hanout M, Sadiq MA, Do DV, Nguyen QD. Pharmacologic Vitreolysis in Vascular Diseases of the Retina. Ophthalmic Surg Lasers Imaging Retina 2016; 47:60-8. [PMID: 26731211 DOI: 10.3928/23258160-20151214-09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 10/22/2015] [Indexed: 11/20/2022]
Abstract
Vascular diseases of the retina such as diabetic retinopathy and vascular occlusions account for a large proportion of visual morbidity and blindness worldwide. The role of vitreous in the pathogenesis of these conditions has been increasingly recognized. Despite advances in the surgical technique of pars plana vitrectomy, the use of intravitreal agents for the lysis of vitreous has received attention, guided largely by promising results from the trials involving patients with non-vascular retinal diseases such as vitreomacular traction. The purpose of this review is to provide a comprehensive summary of the present knowledge on pathophysiologic basis of pharmacologic vitreolysis and its efficacy in vascular diseases of the retina. A review of completed and ongoing clinical trials will be presented, along with insights into future directions of this therapy.
Collapse
|
18
|
Sharma P, Juhn A, Houston SK, Fineman M, Chiang A, Ho A, Regillo C. Efficacy of intravitreal ocriplasmin on vitreomacular traction and full-thickness macular holes. Am J Ophthalmol 2015; 159:861-7.e2. [PMID: 25660387 DOI: 10.1016/j.ajo.2015.01.034] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 01/28/2015] [Accepted: 01/28/2015] [Indexed: 01/29/2023]
Abstract
PURPOSE To analyze a single center's experiences with ocriplasmin on vitreomacular traction (VMT) and the rate of VMT release, full-thickness macular hole (full-thickness MH) closure, and best-corrected visual acuity (BCVA) changes. DESIGN Retrospective interventional case series. METHODS Single-center study of 58 eyes of 56 patients who received intravitreal ocriplasmin for VMT with or without full-thickness MH. VMT release, full-thickness MH closure, visual acuity changes, and anatomic characteristics on spectral-domain optical coherence tomography (SD OCT) were analyzed. RESULTS VMT resolved in 29 of 58 eyes (50%) and nonsurgical closure of full-thickness MH was achieved in 4 of 15 eyes (27%). Mean logMAR BCVA among all treated eyes improved from 0.51 (20/65) at baseline to 0.36 (20/46) at final follow-up (P = .0018) with mean follow-up of 8.7 months. When compared to eyes without VMT release, eyes with successful vitreomacular release had a better pretreatment BCVA (20/48 vs 20/89, P = .004) and final follow-up BCVA (20/31 vs 20/68, P = .0001). Improvement in BCVA was significant in eyes with VMT release (P = .0001). Transient ellipsoid zone changes were noted in 26% of treated eyes (n = 15), of which 14 had successful VMT release. Transient subfoveal fluid accumulation was noted in all these patients with vitreomacular release. Mean time to resolution of ellipsoid zone changes was within 38 days. CONCLUSION In clinical practice, intravitreal injection of ocriplasmin achieved VMT release in approximately one half of treated eyes, with a 27% closure rate for full-thickness MH. Transient ellipsoid changes were evident in 26% of treated eyes, more common in eyes with successful VMT release.
Collapse
|
19
|
|
20
|
Tabibian D, Hoogewoud F, Mavrakanas N, Schutz JS. Misdirected aqueous flow in rhegmatogenous retinal detachment: A pathophysiology update. Surv Ophthalmol 2015; 60:51-9. [DOI: 10.1016/j.survophthal.2014.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Revised: 07/20/2014] [Accepted: 07/23/2014] [Indexed: 11/28/2022]
|
21
|
Stefanini FR, Maia M, Falabella P, Pfister M, Niemeyer M, Kashani AH, Humayun MS, Koss MJ. Profile of ocriplasmin and its potential in the treatment of vitreomacular adhesion. Clin Ophthalmol 2014; 8:847-56. [PMID: 24851038 PMCID: PMC4018320 DOI: 10.2147/opth.s32274] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The recent approval by the US Food and Drug Administration of ocriplasmin for the treatment of symptomatic vitreomacular adhesion (VMA), often associated with vitreomacular traction (VMT) and macular hole (MH), has brought new attention to the field of pharmacologic vitreolysis. The need for an enzyme to split the vitreomacular interface, which is formed by a strong adhesive interaction between the posterior vitreous cortex and the internal limiting membrane, historically stems from pediatric eye surgery. This review summarizes the different anatomic classifications of posterior vitreous detachment or anomalous posterior vitreous detachment and puts these in the context of clinical pathologies commonly observed in clinical practice of the vitreoretinal specialist, such as MH, VMT, age-related macular degeneration, and diabetic macular edema. We revisit the outcome of the Phase II studies that indicated ocriplasmin was a safe and effective treatment for selected cases of symptomatic VMA and MH. Release of VMA at day 28 was achieved by 26.5% of patients in the ocriplasmin group versus 10.1% in the placebo group (P<0.001). Interestingly, for MHs, the numbers were more remarkable. Predictive factors for successful ocriplasmin treatment were identified for VMT (VMA diameter smaller than 1,500 μm) and MH (smaller than 250 μm). In comparison with the highly predictable outcome after vitrectomy, the general success rate of ocriplasmin not under clinical trial conditions has not fully met expectations and needs to be proven in real-world clinical settings. The ocriplasmin data will be compared in the future with observational data on spontaneous VMA release, will help retina specialists make more accurate predictions, and will improve outcome rates.
Collapse
Affiliation(s)
- Francisco R Stefanini
- Retina Division, Department of Ophthalmology and Visual Sciences, Federal University of Sao Paulo, Sao Paulo, Brazil ; Doheny Eye Institute, Los Angeles, CA, USA ; Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Maurício Maia
- Retina Division, Department of Ophthalmology and Visual Sciences, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Paulo Falabella
- Retina Division, Department of Ophthalmology and Visual Sciences, Federal University of Sao Paulo, Sao Paulo, Brazil ; Doheny Eye Institute, Los Angeles, CA, USA ; Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Marcel Pfister
- Doheny Eye Institute, Los Angeles, CA, USA ; Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | | | - Amir H Kashani
- Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Mark S Humayun
- Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Michael J Koss
- Doheny Eye Institute, Los Angeles, CA, USA ; Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA ; Department of Ophthalmology, Goethe University, Frankfurt/Main, Germany
| |
Collapse
|
22
|
A novel spectral-domain optical coherence tomography model to estimate changes in vitreomacular traction syndrome. Graefes Arch Clin Exp Ophthalmol 2014; 252:1729-35. [DOI: 10.1007/s00417-014-2645-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 04/04/2014] [Accepted: 04/09/2014] [Indexed: 02/05/2023] Open
|
23
|
Almeida DRP, Chin EK. Spontaneous resolution of vitreomacular traction in two patients with diabetic macular edema. Case Rep Ophthalmol 2014; 5:66-71. [PMID: 24707275 PMCID: PMC3975209 DOI: 10.1159/000360219] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The nature of the vitreoretinal interface in conditions like diabetic macular edema (DME) remains incompletely understood. Furthermore, it is not clear what the role of pharmacological enzymatic vitreolysis will play in cases of vitreomacular traction (VMT) associated with macular disease like DME. We describe the spontaneous resolution of VMT in 2 patients with DME. As both surgical and pharmacologic interventions have been suggested to treat DME in the setting of VMT, we feel that a clarification of the nomenclature and reporting of these cases of natural history may be useful in more fully understanding the complex decision-making involved when determining whether to treat this subset of patients.
Collapse
Affiliation(s)
- David R P Almeida
- Stephen R. Russell Vitreoretinal Service, Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Eric K Chin
- Stephen R. Russell Vitreoretinal Service, Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| |
Collapse
|
24
|
The International Vitreomacular Traction Study Group classification of vitreomacular adhesion, traction, and macular hole. Ophthalmology 2013; 120:2611-2619. [PMID: 24053995 DOI: 10.1016/j.ophtha.2013.07.042] [Citation(s) in RCA: 727] [Impact Index Per Article: 66.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 07/22/2013] [Accepted: 07/25/2013] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE The International Vitreomacular Traction Study (IVTS) Group was convened to develop an optical coherence tomography (OCT)-based anatomic classification system for diseases of the vitreomacular interface (VMI). DESIGN The IVTS applied their clinical experience, after reviewing the relevant literature, to support the development of a strictly anatomic OCT-based classification system. PARTICIPANTS A panel of vitreoretinal disease experts was the foundation of the International Classification System. METHODS Before the meeting, panel participants were asked to review 11 articles and to complete 3 questionnaires. The articles were preselected based on searches for comprehensive reviews covering diseases of the VMI. Responses to questionnaires and the group's opinions on definitions specified in the literature were used to guide the discussion. MAIN OUTCOME MEASURES Optical coherence tomography-based anatomic definitions and classification of vitreomacular adhesion, vitreomacular traction (VMT), and macular hole. RESULTS Vitreomacular adhesion is defined as perifoveal vitreous separation with remaining vitreomacular attachment and unperturbed foveal morphologic features. It is an OCT finding that is almost always the result of normal vitreous aging, which may lead to pathologic conditions. Vitreomacular traction is characterized by anomalous posterior vitreous detachment accompanied by anatomic distortion of the fovea, which may include pseudocysts, macular schisis, cystoid macular edema, and subretinal fluid. Vitreomacular traction can be subclassified by the diameter of vitreous attachment to the macular surface as measured by OCT, with attachment of 1500 μm or less defined as focal and attachment of more than 1500 μm as broad. When associated with other macular disease, VMT is classified as concurrent. Full-thickness macular hole (FTMH) is defined as a foveal lesion with interruption of all retinal layers from the internal limiting membrane to the retinal pigment epithelium. Full-thickness macular hole is primary if caused by vitreous traction or secondary if directly the result of pathologic characteristics other than VMT. Full-thickness macular hole is subclassified by size of the hole as determined by OCT and the presence or absence of VMT. CONCLUSIONS This classification system will support systematic diagnosis and management by creating a clinically applicable system that is predictive of therapeutic outcomes and is useful for the execution and analysis of clinical studies.
Collapse
|
25
|
de Smet MD, Gad Elkareem AM, Zwinderman AH. The Vitreous, the Retinal Interface in Ocular Health and Disease. Ophthalmologica 2013; 230:165-78. [DOI: 10.1159/000353447] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 04/02/2013] [Indexed: 11/19/2022]
|
26
|
Josso N. Professor Alfred Jost: the builder of modern sex differentiation. Sex Dev 2008; 2:55-63. [PMID: 18577872 DOI: 10.1159/000129690] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2007] [Accepted: 11/09/2007] [Indexed: 11/19/2022] Open
Abstract
Professor Alfred Jost (1916-1991) is famous for his discovery of the Mullerian inhibitor, now called anti-Mullerian hormone (AMH) or Mullerian inhibiting substance (MIS). Alfred Jost resolved the controversy surrounding the mechanism of somatic sex differentiation by proving that male characteristics must be imposed on the fetus by the testicular hormones testosterone and AMH, respectively responsible for the virilization of the Wolffian ducts, urogenital sinus and external genitalia and for the regression of Mullerian ducts. In the absence or inactivity of these hormones, the fetus becomes phenotypically female. Alfred Jost was also a pioneer through his work on testicular differentiation, in collaboration with Solange Magre. He was the first to show that testicular organization is heralded by the development of pre-Sertoli cells, which progressively surround germ cells to form seminiferous tubules. Alfred Jost did not rely only on his brilliant mind. He distrusted theories built on suboptimal experimental data and believed that intelligence was powerless without technical skill. His search for elegant, effective techniques led him to apply surgical methods to fetal endocrinology. He was also a fascinating teacher, particularly for pre-doctoral students. He died aged 75, having retired from the Collège de France, but still active as the Secrétaire Perpétuel of the French Science Academy.
Collapse
Affiliation(s)
- N Josso
- Endocrinologie et Génétique de la Reproduction et du Développement (INSERM), Clamart, France.
| |
Collapse
|