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Brown DM, Laswell SM, Rahman EZ, Fan KC, Shah A, Patel SB, Wykoff CC. CLINICALLY RELEVANT POSTERIOR VITREOUS DETACHMENT STAGING USING CIRCUMPAPILLARY AND MACULAR VOLUME OPTICAL COHERENCE TOMOGRAPHY. Retina 2024; 44:1441-1448. [PMID: 39047131 PMCID: PMC11280448 DOI: 10.1097/iae.0000000000004115] [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] [Indexed: 07/27/2024]
Abstract
PURPOSE This study was designed to investigate retinal nerve fiber layer circumpapillary optical coherence tomography to determine posterior vitreous detachment (PVD) status and to develop a clinically relevant PVD grading scale based on retinal nerve fiber layer circumpapillary optical coherence tomography to determine the incidence of PVD by age and association with vitreomacular traction disorders. METHODS Ophthalmic images and medical records of patients with retinal diseases were retrospectively analyzed by three masked graders using retinal nerve fiber layer circumpapillary optical coherence tomography and macular optical coherence tomography. Based on PVD status, eyes were categorized into five newly defined PVD stages. RESULTS Among 2002 eyes, PVD stages were as follows: A) 25 (1.25%); B) 725 (36.21%); C-) 248 (12.39%); C+) 151 (7.54%); D) 851 (42.51%); X) 2 (0.1%). Posterior vitreous detachment was correlated with advanced age (P < 0.0001). Limited separation or partial separation between lamella within the posterior vitreous cortex (Stage B) was noted early (68% of eyes <18 years). Overall, 34% of eyes >70 years did not exhibit complete PVD. Of 75 eyes with tractional vitreoretinal disorders, 64 (85.3%) were Stage C-/C+, identifying Stage C as the high-risk "complication" stage. CONCLUSION Imaging analyses using retinal nerve fiber layer circumpapillary optical coherence tomography and macular optical coherence tomography scans in conjunction allow rapid assessment of the PVD stage. These techniques can assist clinicians and surgeons in counseling patients and planning surgical approaches. Observations confirmed the progression of PVD through predictable stages and the progression of PVD with age.
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Affiliation(s)
- David M. Brown
- Retina Consultants of Texas, Retina Consultants of America, Houston, Texas
- Blanton Eye Institute, Houston Methodist Hospital, Weill Cornell Medical College, Houston, Texas; and
| | - Stephen M. Laswell
- Retina Consultants of Texas, Retina Consultants of America, Houston, Texas
- Paul L. Foster School of Medicine, El Paso, Texas
| | - Effie Z. Rahman
- Retina Consultants of Texas, Retina Consultants of America, Houston, Texas
| | - Kenneth C. Fan
- Retina Consultants of Texas, Retina Consultants of America, Houston, Texas
| | - Ankoor Shah
- Retina Consultants of Texas, Retina Consultants of America, Houston, Texas
| | - Sagar B. Patel
- Retina Consultants of Texas, Retina Consultants of America, Houston, Texas
| | - Charles C. Wykoff
- Retina Consultants of Texas, Retina Consultants of America, Houston, Texas
- Blanton Eye Institute, Houston Methodist Hospital, Weill Cornell Medical College, Houston, Texas; and
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Venkatesh R, Mangla R, Handa A, Chitturi SP, Parmar Y, Sangoram R, Yadav NK, Chhablani J. Vitreomacular interface abnormalities in type 2 macular telangiectasia (MacTel). Graefes Arch Clin Exp Ophthalmol 2024; 262:1455-1463. [PMID: 38108907 DOI: 10.1007/s00417-023-06330-8] [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: 02/20/2023] [Revised: 11/20/2023] [Accepted: 12/01/2023] [Indexed: 12/19/2023] Open
Abstract
PURPOSE To describe the different types of vitreomacular interface abnormalities (VMIA) seen on optical coherence tomography (OCT) in type 2 macular telangiectasia (MacTel) and explain the possible reasons for its development. METHODS In this retrospective cross-sectional study, type 2 MacTel eyes with macular volumetric OCT imaging protocol were included to identify different types of VMIA such as abnormal PVD, vitreomacular traction (VMT), ERM, and lamellar and full-thickness macular hole. The VMIA findings were then correlated with different MacTel disease stages and visual acuity. RESULTS One thousand forty-three OCTs of 332 type 2 MacTel eyes from 169 patients at different visits were examined. VMIA was detected in 709 (68%) of those OCT scans in 216 (65%) eyes. There were 273 (39%), 31 (4%), 89 (13%), 7 (1%), and 381 (54%) OCT scans with vitreomacular adhesion, VMT, ERM, and inner and outer lamellar macular holes discovered respectively. VMIA eyes had a high frequency of abnormal PVD (p = 0.001) and retinal pigment clumps (RPCs) [p = 0.032]. Eyes with abnormal PVD (p = 0.034) and RPC (p = 0.000) had a higher rate of ERM development. RPC was linked to an increased risk of developing ERM (odd ratio 2.472; 95% CI 1.488-4.052). RPC and ERM contributed significantly to poor visual acuity (0.661 ± 0.416, 20/92). CONCLUSION OCT reveals a high frequency of VMIA in advanced type 2 MacTel eyes. RPC could be responsible for the development of anomalous PVD, as well as subsequent VMIAs and ERM. Additional work is required to examine the long-term changes and surgical outcomes of these eyes.
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Affiliation(s)
- Ramesh Venkatesh
- Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1stR Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, Karnataka, India.
| | - Rubble Mangla
- Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1stR Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, Karnataka, India
| | - Ashit Handa
- Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1stR Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, Karnataka, India
| | - Sai Prashanti Chitturi
- Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1stR Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, Karnataka, India
| | - Yash Parmar
- Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1stR Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, Karnataka, India
| | - Rohini Sangoram
- Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1stR Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, Karnataka, India
| | - Naresh Kumar Yadav
- Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1stR Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, Karnataka, India
| | - Jay Chhablani
- University of Pittsburgh School of Medicine, Medical Retina and Vitreoretinal Surgery, 203 Lothrop Street, Suite 800, Pittsburgh, PA, 15213, USA
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A New Pharmacological Vitreolysis through the Supplement of Mixed Fruit Enzymes for Patients with Ocular Floaters or Vitreous Hemorrhage-Induced Floaters. J Clin Med 2022; 11:jcm11226710. [PMID: 36431188 PMCID: PMC9695351 DOI: 10.3390/jcm11226710] [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: 11/01/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose: Ocular floaters caused by vitreous degeneration or blood clots may interfere with various visual functions. Our study investigated the pharmacologic effects of oral supplementation of mixed fruit enzymes (MFEs) for treating spontaneous symptomatic vitreous opacities (SVOs) and those secondary to vitreous hemorrhage (VH). Methods: 224 patients with monocular symptomatic vitreous opacities (SVOs) were recruited between September and December 2017 and received oral supplementation of MFEs (190 mg bromelain, 95 mg papain, and 95 mg ficin) for 3 months in a double-blind clinical trial. Participants were divided according to the etiology of the SVOs, spontaneous (experiment 1) versus VH (experiment 2), and then randomly assigned into four treatments groups: one group received oral vitamin C, as a placebo; and the other 3 groups received 1 capsule per day (low dose), 2 capsules per day (middle dose), or 3 capsules per day (high dose) of MFEs. The number of SVOs was determined at baseline and then 1, 2, and 3 months after initiating treatment. Further, in cases secondary to VH, the changes in corrected distance visual acuity (CDVA) were assessed after 3 months. Second, we compared the free radical scavenging capabilities of each substance: vitamin C, bromelain, papain, ficin, and MFEs (combination of bromelain, papain, and ficin) by DDPH assay. Finally, SVOs-related symptoms and satisfaction with the treatments were evaluated at the last follow-up visit Results: In experiment 1, the disappearance rate of SVOs was 55%, 62.5%, and 70% after taking 1, 2, and 3 capsules daily, respectively (total p < 0.001), in a dose-dependent manner. In experiment 2, the disappearance rate of VH-induced SVOs was 18%, 25%, and 56% (p < 0.001) after 1, 2, and 3 capsules of the supplement daily, respectively. Additionally, the patients’ vision elevated from 0.63LogMAR to 0.19LogMAR (p = 0.008). Conclusions: A pharmacological approach using a high dose of oral supplementation with MFEs (bromelain, papain, and ficin) was effective in reducing vitreous opacities, even after intraocular hemorrhage. Furthermore, pharmacologic vitreolysis with MFEs supplementation showed high patient satisfaction, and also improved CDVA in patients with vitreous hemorrhage-induced floaters
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Jothi Balaji J, Raman R, Lakshminarayanan V. Relationship Between Posterior Vitreous Detachment and Macular Dimensions in Myopic Eyes. Clin Ophthalmol 2022; 16:593-602. [PMID: 35256841 PMCID: PMC8898068 DOI: 10.2147/opth.s349531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/21/2022] [Indexed: 12/01/2022] Open
Abstract
Background Posterior vitreous detachment (PVD) can result in serious pathologic events at the vitreoretinal interface. This study aims to assess the relationship between PVD, macular thickness (MT), and the foveal avascular zone (FAZ) in myopic eyes. Methods This retrospective study evaluated 63 myopic subjects’ data who were examined between January 1 and June 30, 2019. The myopes were grouped on a severity scale, namely mild, moderate, high, and very high using their spherical equivalent (SE). The PVD classification was based on OCT images. The status of the PVD and MT were evaluated with the Macular Cube 200×200 images, the FAZ with an OCTA Angioplex, and the dimensions were calculated using a customized algorithm. Results The study population (114 eyes) had a median (range) age was 26.00 (22.00–28.00) years and the females constituted 62.3% of the dataset. In this population, 10 eyes had no PVD in any quadrant, and 73 eyes had incomplete PVD in all four quadrants. The inferior quadrant had the maximum rate of PVD occurrences and the nasal quadrant had the least number of occurrences. High myopic eyes exhibited significantly increased low foveal volume (p = <0.01). The inferior part of the para- and perimacular area showed a significant thinning in very high myopic eyes (p = <0.050). The very high myopic eyes showed a significant alteration of FAZ’s circularity index (p = 0.002). Conclusion In high and very high myopic eyes, an increasing trend of partial PVD is seen, most commonly in the inferior quadrant. A significant alteration in foveal volume and circularity index of the FAZ is seen in high and very high myopic eyes.
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Affiliation(s)
- Janarthanam Jothi Balaji
- Department of Optometry, Medical Research Foundation, Chennai, Tamil Nadu, 600006, India
- Correspondence: Janarthanam Jothi Balaji, Department of Optometry, Medical Research Foundation, 18, College Road, Nungambakkam, Chennai, Tamil Nadu, 600006, India, Tel +91 44-42271500, Email
| | - Rajiv Raman
- Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Chennai, Tamil Nadu, 600006, India
| | - Vasudevan Lakshminarayanan
- Theoretical and Experimental Epistemology Lab, School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada
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Turkseven Kumral E, Imamoglu S, Yildiz HE, Ercalik NY, Sevim MS, Guneri B, Bardak YK, Bardak H. Changes in higher-order aberrations after vitrectomy for vitreomacular interface diseases. Int Ophthalmol 2022; 42:1623-1629. [DOI: 10.1007/s10792-021-02156-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 12/18/2021] [Indexed: 11/28/2022]
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6
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Stankiewicz A, Marciniak T, Dabrowski A, Stopa M, Marciniak E, Obara B. Segmentation of Preretinal Space in Optical Coherence Tomography Images Using Deep Neural Networks. SENSORS 2021; 21:s21227521. [PMID: 34833597 PMCID: PMC8623441 DOI: 10.3390/s21227521] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 02/01/2023]
Abstract
This paper proposes an efficient segmentation of the preretinal area between the inner limiting membrane (ILM) and posterior cortical vitreous (PCV) of the human eye in an image obtained with the use of optical coherence tomography (OCT). The research was carried out using a database of three-dimensional OCT imaging scans obtained with the Optovue RTVue XR Avanti device. Various types of neural networks (UNet, Attention UNet, ReLayNet, LFUNet) were tested for semantic segmentation, their effectiveness was assessed using the Dice coefficient and compared to the graph theory techniques. Improvement in segmentation efficiency was achieved through the use of relative distance maps. We also show that selecting a larger kernel size for convolutional layers can improve segmentation quality depending on the neural network model. In the case of PVC, we obtain the effectiveness reaching up to 96.35%. The proposed solution can be widely used to diagnose vitreomacular traction changes, which is not yet available in scientific or commercial OCT imaging solutions.
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Affiliation(s)
- Agnieszka Stankiewicz
- Division of Electronic Systems and Signal Processing, Institute of Automatic Control and Robotics, Poznan University of Technology, 60-965 Poznan, Poland; (A.S.); (A.D.)
| | - Tomasz Marciniak
- Division of Electronic Systems and Signal Processing, Institute of Automatic Control and Robotics, Poznan University of Technology, 60-965 Poznan, Poland; (A.S.); (A.D.)
- Correspondence:
| | - Adam Dabrowski
- Division of Electronic Systems and Signal Processing, Institute of Automatic Control and Robotics, Poznan University of Technology, 60-965 Poznan, Poland; (A.S.); (A.D.)
| | - Marcin Stopa
- Department of Ophthalmology, Chair of Ophthalmology and Optometry, Heliodor Swiecicki University Hospital, Poznan University of Medical Sciences, 60-780 Poznan, Poland; (M.S.); (E.M.)
| | - Elzbieta Marciniak
- Department of Ophthalmology, Chair of Ophthalmology and Optometry, Heliodor Swiecicki University Hospital, Poznan University of Medical Sciences, 60-780 Poznan, Poland; (M.S.); (E.M.)
| | - Boguslaw Obara
- School of Computing, Newcastle University, Newcastle upon Tyne NE4 5TG, UK;
- Biosciences Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
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7
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Ghasemi Falavarjani K, Anvari P, Dehghan Niri M, Molaei S, Abdi F, Shad E, Kazemi P, Sadda SR. The effect of intravitreal recombinant tissue plasminogen activator injection on diabetic tractional fibrovascular membranes: Proposed criteria using optical coherence tomography. Eur J Ophthalmol 2021; 32:424-428. [PMID: 33653173 DOI: 10.1177/1120672121998224] [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: 11/16/2022]
Abstract
PURPOSE To evaluate the effect of intravitreal recombinant tissue plasminogen activator (tPA) on diabetic tractional fibrovascular membranes (FVM) using proposed optical coherence tomography (OCT) criteria. METHODS This prospective, interventional case series enrolled eyes with tractional retinal detachment who were candidates for pars plana vitrectomy. OCT images were obtained to evaluate the border of the attached-detached retina and overlying FVP at baseline and 1 week post-intravitreal tPA injection using the follow-up scan acquisition protocol. Two independent graders assessed retinal detachment (RD) height, FVM height, and retinal thickness at the site of membrane attachment. RESULTS Thirteen eyes from 13 individuals were included. Assessment of RD height, FVM height, and retinal thickness at membrane attachment point were feasible at both visits in 10/13 (77%), 10/13 (77%), and 8/13 (62%) of eyes, respectively. There was excellent agreement between the two graders for all measurements (all ICC > 0.94). Release of the retina-membrane attachment point was not observed in any eyes. No statistically significant change was found in any of the measured parameters. CONCLUSIONS Excellent agreement was achieved between the graders for quantitative assessment of diabetic FVM using our proposed OCT criteria. We did not observe a significant change in the FVM measurements, 1-week after intravitreal tPA injection.
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Affiliation(s)
- Khalil Ghasemi Falavarjani
- Eye Research Center, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran.,Stem Cell and Regenerative Medicine Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Pasha Anvari
- Eye Research Center, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
| | | | - Saber Molaei
- Eye Research Center, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Fateme Abdi
- Eye Research Center, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Esrafil Shad
- Eye Research Center, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Pegah Kazemi
- Eye Research Center, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
| | - SriniVas R Sadda
- Stein Eye Institute, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA.,Doheny Eye Institute, Los Angeles, CA, USA
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8
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Joondeph BC, Willems P, Raber T, Duchateau L, Markoff J. Prognostic Factors Associated with Ocriplasmin Efficacy for the Treatment of Symptomatic Vitreomacular Adhesion and Full-thickness Macular Hole: Analysis from Four Studies. J Ophthalmic Vis Res 2021; 16:42-55. [PMID: 33520127 PMCID: PMC7841271 DOI: 10.18502/jovr.v16i1.8250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 10/23/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To assess the effect of patient baseline characteristics on the efficacy of ocriplasmin treatment for symptomatic vitreomacular adhesion (VMA) with full-thickness macular hole (FTMH) from phase 3/4 studies. Methods Patients with symptomatic VMA and FTMH at baseline and receiving ocriplasmin treatment 125 μg were pooled from the MIVI-TRUST, OASIS, and ORBIT studies. Multivariable logistic regression analysis was used to evaluate whether patient baseline characteristics were predictors of having VMA resolution by Day 28 and FTMH closure by Month 6. Results Two hundred and seventy-four patients receiving ocriplasmin treatment were assessed. Overall, 22.6% (62/274) of the patients experienced both VMA resolution by Day 28 and non-surgical FTMH closure by Month 6. Patients with FTMH ≤250 µm at baseline had a significantly higher success rate compared to those with FTMH >400 µm (29.9% [41/137] vs 2.2% [1/48]; P = 0.009). In patients with VMA resolution by Day 28, both small FTMH size (P = 0.001) and FTMH width at RPE (P = 0.012) were significantly associated with a higher FTMH closure rate. Patients with VMA resolution had higher rates of FTMH closure. Previously identified baseline predictive factors, including age, lens status, or presence of epiretinal membrane (ERM) were not found to be predictive of both VMA release and FTMH closure. Conclusion The analysis revealed that FMTH ≤250 µm was the only factor predictive for achieving both pharmacological VMA resolution by Day 28 and nonsurgical FTMH closure by Month 6; neither lens status or presence of ERM, previously identified baseline characteristics favoring VMA resolution, showed statistically significant predictive power for both outcomes.
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Affiliation(s)
| | | | | | - Luc Duchateau
- Biometrics Research Group, Ghent University, Gent, Belgium
| | - Joseph Markoff
- Wills Eye Hospital, Philadelphia, Pennsylvania, USA.,Thomas Jefferson Medical College, Philadelphia, Pennsylvania, USA
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9
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Gabriel RS, Boisvert CJ, Mehta MC. Review of Vitreopapillary Traction Syndrome. Neuroophthalmology 2020; 44:213-218. [PMID: 33012906 DOI: 10.1080/01658107.2020.1725063] [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: 10/24/2022] Open
Abstract
Vitreopapillary traction (VPT) syndrome is a potentially visually significant disorder of the vitreopapillary interface characterised by an incomplete posterior vitreous detachment with the persistently adherent vitreous exerting tractional pull on the optic disc and resulting in morphologic alterations and a consequent decline of visual function. It is most commonly unilateral but bilateral reports have also been described. The cause of the condition may be unknown or idiopathic, although the histology of traction shows proliferation of fibrous astrocytes, myofibroblasts, fibrocytes, and retinal pigment epithelial cells. It is theorised that VPT may induce a congested optic disc with neuronal dysfunction as well as decreased prelaminar flow. The present study reviews and summarises the features, diagnosis, and management of VPT.
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Affiliation(s)
- Rami S Gabriel
- School of Medicine, University of California, Irvine, California, USA
| | - Chantal J Boisvert
- Department of Ophthalmology, Duke Eye Center and Duke University Medical Center, Durham, North Carolina, USA
| | - Mitul C Mehta
- Gavin Herbert Eye Institute, University of California, Irvine, California, USA
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10
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Schuster AK, Kluck A, Korb CA, Stoffelns B, Nickels S, Schulz A, Münzel T, Wild PS, Beutel ME, Schmidtmann I, Lackner KJ, Peto T, Pfeiffer N. Characteristics and pathologies of the vitreo-macular interface-results from the Gutenberg Health Study. Acta Ophthalmol 2020; 98:e273-e281. [PMID: 31680456 DOI: 10.1111/aos.14285] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 10/01/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE We aimed to determine the prevalence of characteristics and pathologies of the vitreo-macular interface within the general population. METHODS The Gutenberg Health Study is a population-based study in Germany, including an ophthalmological examination with refraction, biometry and optical coherence tomography (OCT) imaging. Characteristics of the vitreo-macular interface were graded on volume scans including visibility of an epiretinal membrane, full-thickness macular hole, lamellar hole and pseudohole. Overall and age-specific prevalences including 95% confidence intervals [95%-CI] were calculated. Association analyses were conducted to determine systemic and ocular factors that are associated with epiretinal membranes (the most common pathology) using multivariable logistic regression. RESULTS A total of 1890 people aged 40-80 years were included in the study. Of these, 4.7% (95%-CI: 3.8%-5.8%) had an epiretinal membrane in at least one eye, 0.1% a full-thickness macular hole, 0.6% a lamellar hole and 0.6% a pseudohole. The presence of an epiretinal membrane was associated with higher age, myopic refractive error and prior retinal laser therapy, but not with gender, body height, body weight, smoking, prior cataract surgery or intraocular pressure. CONCLUSIONS Epiretinal membranes are more frequent in older and myopic subjects and in those with prior retinal laser therapy.
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Affiliation(s)
| | - Anne‐Kristin Kluck
- Department of Ophthalmology University Medical Center of the Johannes Gutenberg‐University Mainz Mainz Germany
| | - Christina A. Korb
- Department of Ophthalmology University Medical Center of the Johannes Gutenberg‐University Mainz Mainz Germany
| | - Bernhard Stoffelns
- Department of Ophthalmology University Medical Center of the Johannes Gutenberg‐University Mainz Mainz Germany
| | - Stefan Nickels
- Department of Ophthalmology University Medical Center of the Johannes Gutenberg‐University Mainz Mainz Germany
| | - Andreas Schulz
- Preventive Cardiology and Preventive Medicine Center for Cardiology University Medical Center of the Johannes Gutenberg‐University Mainz Mainz Germany
| | - Thomas Münzel
- Center for Cardiology I University Medical Center Mainz Mainz Germany
| | - Philipp S. Wild
- Preventive Cardiology and Preventive Medicine Center for Cardiology University Medical Center of the Johannes Gutenberg‐University Mainz Mainz Germany
- Center for Thrombosis and Hemostasis University Medical Center of the Johannes Gutenberg‐University Mainz Mainz Germany
- DZHK (German Center for Cardiovascular Research), partner site Rhine‐Main Mainz Germany
| | - Manfred E. Beutel
- Department of Psychosomatic Medicine and Psychotherapy University Medical Center Mainz Mainz Germany
| | - Irene Schmidtmann
- Institute for Medical Biostatistics, Epidemiology and Informatics University Medical Center of the Johannes Gutenberg‐University Mainz Mainz Germany
| | - Karl J. Lackner
- Institute of Clinical Chemistry and Laboratory Medicine University Medical Center Mainz Mainz Germany
| | - Tunde Peto
- Centre for Public Health Queen's University Belfast Northern Ireland UK
| | - Norbert Pfeiffer
- Department of Ophthalmology University Medical Center of the Johannes Gutenberg‐University Mainz Mainz Germany
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Quinn NB, Steel DH, Chakravarthy U, Peto T, Hamill B, Muldrew A, Graham K, Elliott D, Hennessy R, Cruise S, McGuinness B, Young IS, Kee F, Hogg RE. Assessment of the Vitreomacular Interface Using High-Resolution OCT in a Population-Based Cohort Study of Older Adults. Ophthalmol Retina 2020; 4:801-813. [PMID: 32335034 DOI: 10.1016/j.oret.2020.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 02/20/2020] [Accepted: 02/20/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To describe the prevalence of vitreomacular interface (VMI) features and their associated risk factors in the Northern Ireland Cohort for the Longitudinal Study of Ageing (NICOLA) Study. DESIGN Cross-sectional population-based study. PARTICIPANTS Noninstitutionalized Northern Irish adults 40 years of age or older. METHODS Using geographic stratification, a representative sample of people in Northern Ireland was invited to participate in the NICOLA Study. SD OCT images of participants were graded for vitreomacular traction (VMT), macular hole (MH), and epiretinal membrane (ERM) according to the International Vitreomacular Traction Study Group. A subsample was graded in more detail to estimate the prevalence of VMA and VMA area detailing size and location of VMA. Descriptive analysis and risk factors for each VMI feature were determined using generalized estimating equations. Results were standardized to the Northern Ireland population census (2011). MAIN OUTCOME MEASURES Cohort profile, standardized prevalence, and risk factor associations of each VMI feature. RESULTS Three thousand three hundred fifty-one NICOLA participants had gradable SD OCT images available for at least 1 eye. The prevalence of VMT was 0.5% (CI, 0.31%-0.70%), that for MH was 0.3% (CI, 0.23%-0.52%), and that for ERM was 7.6% (CI, 7.0%-8.3%). A detailed VMA analysis was performed on a subsample consisting of the first 1481 participants. The prevalence of VMA was 22.6% (CI, 21.1-24.2), and VMA area ranged from 0.25 to 42.7 mm2 (mean, 12.53 mm2; standard deviation, 6.90 mm2). In multivariate analyses, increased age was associated with an increased odds ratio (OR) of VMT, MH, and ERM. VMA area was positively associated with younger age and normal blood pressure. ERM and MH were present more often in more myopic eyes, associated with an increase in levels of high-density lipoprotein (HDL) cholesterol and triglycerides. CONCLUSIONS The epidemiologic characteristics of VMI features indicated that VMI interactions throughout life are age dependent. Vitreous separation reduced to a greater extent in the horizontal meridians compared with the vertical, differing from previous studies. Future longitudinal studies of the evolution of these VMI changes over time would be of great interest.
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Affiliation(s)
- Nicola B Quinn
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - David H Steel
- Sunderland Eye Infirmary, Sunderland, United Kingdom, and Institute of Genetic Medicine, Newcastle University, Newcastle-Upon-Tyne, United Kingdom
| | - Usha Chakravarthy
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Tunde Peto
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Barbra Hamill
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Alyson Muldrew
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Katie Graham
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - David Elliott
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Riona Hennessy
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Sharon Cruise
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | | | - Ian S Young
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Frank Kee
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Ruth E Hogg
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom.
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Savastano MC, Savastano A, Rizzo S. Pharmacological Adjuncts to Vitrectomy Surgery. Curr Pharm Des 2019; 24:4843-4852. [PMID: 30706802 DOI: 10.2174/1381612825666190130125136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 01/24/2019] [Indexed: 11/22/2022]
Abstract
Pharmacological adjuncts to vitrectomy surgery are useful tools to better deal with surgery. Their introduction has enriched the therapeutic choice before, during and after operations. Although several classifications could be made to frame adjuncts to vitrectomy, we preferred to divide the pharmacological adjuncts to vitrectomy surgery for therapeutic use in the pre-operatory procedure (neo-adjuvant), for intraoperative use and for post-operatory practice (adjuvant). This type of classification allowed us to explore all the adjuncts based on the timing of their use. The actual interest in vitrectomy surgery is giving rise to considerable interest in new molecules with and without the pharmacological effect that will soon be available for the aid of vitreoretinal surgery.
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Willekens K, Abegão Pinto L, Lemmens S, Bataillie S, Somers A, Vandewalle E, Stalmans P, Stalmans I. The vitreopapillary interface in healthy and glaucoma: posterior vitreous detachment in the vitreopapillary interface study. Acta Ophthalmol 2018; 96:573-581. [PMID: 30280516 DOI: 10.1111/aos.13818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 04/13/2018] [Indexed: 01/26/2023]
Abstract
PURPOSE To investigate the vitreopapillary interface (VPI) in health and glaucoma according to the different stages of posterior vitreous detachment (PVD) formation. METHODS Prospective single centre study including healthy subjects and glaucoma patients. PVD staging was performed with spectral domain optical coherence tomography. Gender, age, lens status and refractive error were assessed in both groups. Glaucoma patients additionally had a comprehensive ophthalmological investigation including intraocular pressure measurement, visual field testing and confocal imaging of the optic nerve head. RESULTS Data on 523 subjects (993 eyes) were included from the VPI study (clinicaltrials.gov NCT02290795) database (493 eyes of 258 healthy subjects and 500 eyes of 265 glaucoma patients). Healthy subjects were significantly younger than primary open angle glaucoma patients (59.7 ± 14.81 versus 70.0 ± 10.78 years, p < 0.001), but were otherwise matched for refractive error and gender. Significantly more glaucomatous eyes were pseudophakic (26.6% versus 5.1%). Including only phakic nonoperated eyes from subjects between 50 and 80 years old decreased the age difference between healthy and open angle glaucoma (64.1 ± 8.0 versus 65.9 ± 6.7 years, p = 0.051). Comparing these subgroups rendered similar average ages for PVD stages 0 and 4, in contrast to the significant older age for the glaucoma subgroup in stage 1 (64.1 ± 6.01 versus 61.4 ± 8.38 years, p < 0.001) and a trend towards significance in stage 3 (70.8 ± 69.8 versus 67.5 ± 5.92 years, p = 0.051). CONCLUSION The VPI study is a large clinical trial investigating the VPI in health and glaucoma. A subset of glaucoma patients seems to experience stages 1-3 of PVD formation at older age compared to healthy subjects.
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Affiliation(s)
- Koen Willekens
- Department of Ophthalmology; University Hospitals Leuven; Leuven Belgium
- Department of Ophthalmology Neurosciences; Laboratory of Ophthalmology; KU Leuven; Leuven Belgium
| | - Luìs Abegão Pinto
- Department of Ophthalmology; Centro Hospitalar Lisboa Norte; Lisbon Portugal
| | - Sophie Lemmens
- Department of Ophthalmology; University Hospitals Leuven; Leuven Belgium
- Department of Ophthalmology Neurosciences; Laboratory of Ophthalmology; KU Leuven; Leuven Belgium
| | - Sophie Bataillie
- Department of Ophthalmology; University Hospitals Leuven; Leuven Belgium
| | - Alix Somers
- Department of Ophthalmology; University Hospitals Leuven; Leuven Belgium
- Department of Ophthalmology Neurosciences; Laboratory of Ophthalmology; KU Leuven; Leuven Belgium
| | - Evelien Vandewalle
- Department of Ophthalmology; University Hospitals Leuven; Leuven Belgium
- Department of Ophthalmology Neurosciences; Laboratory of Ophthalmology; KU Leuven; Leuven Belgium
| | - Peter Stalmans
- Department of Ophthalmology; University Hospitals Leuven; Leuven Belgium
| | - Ingeborg Stalmans
- Department of Ophthalmology; University Hospitals Leuven; Leuven Belgium
- Department of Ophthalmology Neurosciences; Laboratory of Ophthalmology; KU Leuven; Leuven Belgium
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Barca F, Mucciolo DP, Caporossi T, Virgili G, Tartaro R, Rizzo S. Italian real-life experience on the use of ocriplasmin. BMJ Open Ophthalmol 2018; 3:e000110. [PMID: 30123843 PMCID: PMC6093221 DOI: 10.1136/bmjophth-2017-000110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 12/28/2017] [Accepted: 03/02/2018] [Indexed: 11/03/2022] Open
Abstract
Objective To evaluate the success of an intravitreal injection of ocriplasmin to release symptomatic vitreomacular traction (VMT) and close a full-thickness macular hole. Methods and analysis An observational retrospective multicentre study conducted in Italy. Patients with symptomatic distortion and loss of vision secondary to VMT were included in the study. The patients received a single injection of ocriplasmin and were followed up for 1, 3 and 6 months. Best-corrected visual acuity (BCVA) and spectral domani OCT (SD-OCT) were performed for patient assessment, and adverse events were recorded and analysed. Results 74 patients (74 eyes) were included in the study. 44 of 74 eyes (59.5%) experienced complete release of the VMT. Macular hole closure was obtained in eight eyes (40%). BCVA improved about three lines after 3 months of follow-up in the patients with VMT resolution in comparison with the patients who did not have VMT resolution (p<0.0001). In 55/74 eyes of 55 patients (74.3%), no adverse events were reported, and most of them were transitory (17/19; 89.5%). The mean time to resolve VMT was 27.4±21.9 days. No cases of retinal tear, retinal detachment or lens destabilisation were observed. Conclusion Ocriplasmin is a potential alternative treatment for patients with symptomatic VMT and has a good safety profile. A more careful selection of patients, in clinical practice, may increase the success rate.
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Affiliation(s)
- Francesco Barca
- Department of Surgical and Translational Medicine, Ophthalmology, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Dario Pasquale Mucciolo
- Department of Surgical and Translational Medicine, Ophthalmology, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Tomaso Caporossi
- Department of Surgical and Translational Medicine, Ophthalmology, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Gianni Virgili
- Department of Surgical and Translational Medicine, Ophthalmology, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Ruggero Tartaro
- Department of Surgical and Translational Medicine, Ophthalmology, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Stanislao Rizzo
- Department of Surgical and Translational Medicine, Ophthalmology, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
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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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McKibbin M, Farragher TM, Shickle D. Monocular and binocular visual impairment in the UK Biobank study: prevalence, associations and diagnoses. BMJ Open Ophthalmol 2018; 3:e000076. [PMID: 29657974 PMCID: PMC5895967 DOI: 10.1136/bmjophth-2017-000076] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 09/04/2017] [Accepted: 01/04/2018] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To determine the prevalence of, associations with and diagnoses leading to mild visual impairment or worse (logMAR >0.3) in middle-aged adults in the UK Biobank study. METHODS AND ANALYSIS Prevalence estimates for monocular and binocular visual impairment were determined for the UK Biobank participants with fundus photographs and spectral domain optical coherence tomography images. Associations with socioeconomic, biometric, lifestyle and medical variables were investigated for cases with visual impairment and matched controls, using multinomial logistic regression models. Self-reported eye history and image grading results were used to identify the primary diagnoses leading to visual impairment for a sample of 25% of cases. RESULTS For the 65 033 UK Biobank participants, aged 40-69 years and with fundus images, 6682 (10.3%) and 1677 (2.6%) had mild visual impairment or worse in one or both eyes, respectively. Increasing deprivation, age and ethnicity were independently associated with both monocular and binocular visual impairment. No primary diagnosis for the recorded level of visual impairment could be identified for 49.8% of eyes. The most common identifiable diagnoses leading to visual impairment were cataract, amblyopia, uncorrected refractive error and vitreoretinal interface abnormalities. CONCLUSIONS The prevalence of visual impairment in the UK Biobank study cohort is lower than for population-based studies from other industrialised countries. Monocular and binocular visual impairment are associated with increasing deprivation, age and ethnicity. The UK Biobank dataset does not allow confident identification of the causes of visual impairment, and the results may not be applicable to the wider UK population.
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Affiliation(s)
| | | | - Darren Shickle
- Academic Unit of Public Health, University of Leeds, Leeds, UK
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Manousaridis K, Peter-Reichart S, Mennel S. Pharmacologic vitreolysis for vitreomacular traction syndrome and macular hole. SPEKTRUM DER AUGENHEILKUNDE 2017. [DOI: 10.1007/s00717-017-0385-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pierro L, Rabiolo A, Iuliano L, Gagliardi M, Panico D, Bandello F. Vascular Density of Retinal Capillary Plexuses in Different Subtypes of Macular Hole. Ophthalmic Surg Lasers Imaging Retina 2017; 48:648-654. [PMID: 28810040 DOI: 10.3928/23258160-20170802-07] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 03/01/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To compare vessel density and the foveal avascular zone (FAZ) area among eyes with full-thickness macular hole (FTMH), lamellar macular hole (LMH), and macular pseudohole (MPH) using optical coherence tomography angiography (OCTA). PATIENTS AND METHODS Cross-sectional study involving 10 eyes with idiopathic FTMH, 10 eyes with LMH, 10 eyes with MPH, 17 unaffected fellow eyes, and 10 healthy controls. All patients underwent 3 mm × 3 mm OCTA centered on the macula. Vessel density and FAZ area were calculated. RESULTS In the deep capillary plexus, FTMHs disclosed the highest vessel density (82.7% ± 16.8%), superior to LMHs (63.7% ± 5.9%; P = .0092), MPHs (37.8% ± 2.5%; P = .0011), and controls (53.0% ± 12.2%; P < .0001). In the superficial capillary plexus (SCP), MPHs had the lowest vascular density. Fellow eyes had reduced vascular density at SCP compared to control eyes. CONCLUSIONS Microvascular changes are evident in different subtypes of macular holes. Unaffected fellow eyes exhibit early involvement of SCP. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:648-654.].
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Abstract
PURPOSE To assess the posterior vitreous release rates following a single, office-based intravitreal injection of expansile gas in treating vitreomacular traction. METHODS Thirty eyes of 29 consecutive patients with symptomatic vitreomacular traction received a single, office-based intravitreal injection of up to 0.3 mL of 100% perfluoropropane (C3F8). RESULTS Overall, vitreomacular traction release occurred in 25 of 30 eyes by the final follow-up visit (83% final release rate); furthermore, 90% (9 of 10 eyes) with diabetes mellitus released, 83% (5 of 6 eyes) with concurrent epiretinal membrane released, and 83% (5 of 6 eyes) previously treated with ocriplasmin released. Vitreomacular traction release occurred overnight in some patients and was documented on spectral domain optical coherence tomography at an average of 13 days (range, 1-62 days). The phakic release rate was 89% (16 of 18 eyes) versus a 75% pseudophakic release rate (9 of 12 eyes) (P = 0.3173). Ellipsoid zone changes on spectral domain optical coherence tomography occurred in 1 of 30 gas-treated eyes. One patient developed pupillary block. CONCLUSION Office-based intravitreal injection of C3F8 offers an inexpensive and effective treatment for vitreomacular traction, including for patients who underwent previous ocriplasmin administration and in patients with diabetes mellitus or epiretinal membrane.
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Schumann RG, Langer J, Compera D, Luedtke K, Schaumberger MM, Kreutzer T, Mayer WJ, Wolf A, Priglinger SG. Assessment of intravitreal ocriplasmin treatment for vitreomacular traction in clinical practice. Graefes Arch Clin Exp Ophthalmol 2017; 255:2081-2089. [PMID: 28755165 DOI: 10.1007/s00417-017-3747-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 06/29/2017] [Accepted: 07/05/2017] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To assess treatment effects following intravitreal injection of ocriplasmin for vitreomacular traction (VMT), with or without full-thickness macular hole (FTMH), in real-life setting. METHODS This is a monocentric, retrospective, consecutive series of 82 eyes from 82 patients who underwent ocriplasmin treatment between July 2013 and December 2016. We included 57 eyes with pure VMT, 17 eyes with small FTMHs, and eight eyes with medium FTMHs. Primary outcome measures were VMT release and MH closure rates. Secondary outcomes were visual acuity (VA), morphological changes, and subjective visual impairment after 1, 3, and 6 months and at last follow-up. RESULTS After a median follow-up of 10 months, VMT release was achieved by pharmacologic vitreolysis in 57% of all eyes, whereas the macular hole closure rate was 32%. In those presenting with five or more positive prognostic factors (PPF), eyes with pure VMT showed nonsurgical traction release in 88%, and FTMHs were released in 93%, with a closure rate of 20%. Small FTMHs closed in 41% and medium FTMHs in 13%. The mean change in VA (LogMAR) was -0.07 ± 0.24 (median - 0.10) in all eyes. Subretinal fluid accumulation and ellipsoid zone changes were seen in 31% and 37% of all eyes, respectively. They were more frequent in eyes with traction release, but were self-limited. CONCLUSIONS In a real-life setting, release of VMT by ocriplasmin injection can be achieved in the majority of eyes, relying on a strict patient selection. Closure of FTMHs rather correlates with hole diameter than with presence of PPF, and remains a rare finding in medium FTMHs.
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Affiliation(s)
- Ricarda G Schumann
- Department of Ophthalmology, Ludwig-Maximilians-University, Mathildenstrasse 8, 80336, Munich, Germany.
| | - Julian Langer
- Department of Ophthalmology, Ludwig-Maximilians-University, Mathildenstrasse 8, 80336, Munich, Germany
| | - Denise Compera
- Department of Ophthalmology, Ludwig-Maximilians-University, Mathildenstrasse 8, 80336, Munich, Germany
| | - Katharina Luedtke
- Department of Ophthalmology, Ludwig-Maximilians-University, Mathildenstrasse 8, 80336, Munich, Germany
| | - Markus M Schaumberger
- Department of Ophthalmology, Ludwig-Maximilians-University, Mathildenstrasse 8, 80336, Munich, Germany
| | - Thomas Kreutzer
- Department of Ophthalmology, Ludwig-Maximilians-University, Mathildenstrasse 8, 80336, Munich, Germany
| | - Wolfgang J Mayer
- Department of Ophthalmology, Ludwig-Maximilians-University, Mathildenstrasse 8, 80336, Munich, Germany
| | - Armin Wolf
- Department of Ophthalmology, Ludwig-Maximilians-University, Mathildenstrasse 8, 80336, Munich, Germany
| | - Siegfried G Priglinger
- Department of Ophthalmology, Ludwig-Maximilians-University, Mathildenstrasse 8, 80336, Munich, Germany
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McKibbin M, Farragher T, Shickle D. Vitreoretinal interface abnormalities in middle-aged adults with visual impairment in the UK Biobank study: prevalence, impact on visual acuity and associations. BMJ Open Ophthalmol 2017; 1:e000057. [PMID: 29354705 PMCID: PMC5721636 DOI: 10.1136/bmjophth-2016-000057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 04/03/2017] [Accepted: 04/11/2017] [Indexed: 11/18/2022] Open
Abstract
Objective The aim of this study was to determine the prevalence of vitreoretinal interface abnormalities (VRIA), the degree of visual impairment and associations with VRIA among adults, aged 40–69 years, in the UK Biobank study. Methods and analysis Colour fundus photographs and spectral domain optical coherence tomography images were graded for 25% of the 8359 UK Biobank participants with mild visual impairment or worse (LogMAR >0.3 or Snellen <6/12) in at least one eye. The prevalence and contribution of VRIA to visual impairment was determined and multinomial logistic regression models were used to investigate association with known risk factors and other predetermined socioeconomic, biometric, lifestyle and medical variables for cases and matched controls. Results The minimum prevalence of any VRIA was 17.6% and 8.1% in the eyes with and without visual impairment, respectively. VRIA were identified as the primary cause of visual impairment in 3.6% of eyes. Although epiretinal membrane and vitreomacular traction were the most common VRIA, the degree of visual impairment was typically milder with these than with other VRIA. Visual impairment with a VRIA was positively associated with increasing age (relative risk ratio (RRR) 1.22 (95% CI 1.07 to 1.40)), female gender (RRR 1.28; 1.08 to 1.52) and Asian or Asian British ethnicity (RRR 1.60; 1.10 to 2.32). Conclusions VRIA are common in middle-aged adults in the UK Biobank study, especially in eyes with visual impairment. VRIA were considered to be the primary cause of visual impairment in 3.6% of all eyes with visual impairment, although there was variation in the degree of visual impairment for each type of VRIA.
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Affiliation(s)
- Martin McKibbin
- Department of Ophthalmology, Eye Clinic, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Darren Shickle
- Academic Unit of Public Health, University of Leeds, Leeds, UK
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Xie P, Zheng X, Yu Y, Ye X, Hu Z, Yuan D, Liu Q. Vitreomacular adhesion or vitreomacular traction may affect antivascular endothelium growth factor treatment for neovascular age-related macular degeneration. Br J Ophthalmol 2017; 101:1003-1010. [PMID: 28596285 DOI: 10.1136/bjophthalmol-2017-310155] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 04/19/2017] [Accepted: 04/23/2017] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The aim of this review is to determine whether vitreomacular adhesion (VMA) or vitreomacular traction (VMT) has an influence on the outcomes of antivascular endothelium growth factor (anti-VEGF) treatment neovascular age-related macular degeneration (nAMD). METHODS A systematic literature search was performed in Pubmed.gov, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang, SinoMed and ClinicalTrials.gov up to 30 June 2016 to identify eligible studies. RESULTS Nine studies and 2212 participants were finally identified. At month 6, the mean improvement in best-corrected visual acuity (BCVA) and mean decline in central retinal thickness (CRT) of the VMA/VMT(+) group was less than that of the VMA/VMT(-) group (95% CI -3.05 to -0.96 letters, p=0.0002; 15.53 to 32.98 μm, p<0.00001; respectively); at month 12, there was a small or only marginally significant difference (-0.01 to 2.00 letters, p=0.05; 0.17 to 23.7 μm, p=0.05; respectively) between the groups. During the 12 months, however, the VMA/VMT(+) group required more injections ((0.25 to 0.95), p=0.0008). CONCLUSIONS In using anti-VEGF drugs to treat nAMD, clinicians should take into account the fact that concurrent VMA or VMT might antagonise the efficacy of anti-VEGF drugs during the early stage of treatment.
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Affiliation(s)
- Ping Xie
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xinhua Zheng
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.,Department of Ophthalmology, Wuxi Children's Hospital, Wuxi, Jiangsu, China
| | - Yingqing Yu
- Department of Ophthalmology, Wuxi Children's Hospital, Wuxi, Jiangsu, China
| | - Xiaojian Ye
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Zizhong Hu
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Dongqing Yuan
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Qinghuai Liu
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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Abstract
PURPOSE To quantify the changes in vitreomacular interactions that occur with normal aging in normal eyes. METHODS Spectral domain optical coherence tomography (SD-OCT, Spectralis; Heidelberg Engineering, Heidelberg, Germany) foveal scans of subjects with best corrected visual acuity better than 20/40 and no ocular pathology were included in the study. Each scan was analyzed to determine the status of vitreoretinal interface: complete vitreous adhesion, partial posterior vitreous detachment (PVD) with persistent vitreomacular adhesion (VMA), or complete PVD. Area of VMA was delineated using the Spectralis drawing tool and calculated in mm for each scan. Subjects, aged 10 years to 97 years, were divided into 9 age groups according to decade of life. RESULTS Five hundred and sixty-six SD-OCT scans were analyzed. Area of VMA (mm) decreased sigmoidally (R = 0.99) with each decade of life. With aging, percentage of PVD increased while percentage of complete adhesion decreased. Males were found to have significantly larger area of VMA (mm) compared with females in the fifth through eighth decades of life, P < 0.05. CONCLUSION Vitreomacular interface interactions throughout life are age and gender dependent. This adds to our current understanding of the normal aging process undergone by the vitreous, thereby providing assistance in the clinical differentiation between normal and pathologic vitreomacular interactions.
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Spectral versus time-domain OCT in detecting preoperative epiretinal membranes that accompany macular holes. Eur J Ophthalmol 2017; 27:185-189. [PMID: 27646327 DOI: 10.5301/ejo.5000862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare the sensitivities of spectral-domain optical coherence tomography (SD-OCT) versus time-domain OCT (TD-OCT) in identifying epiretinal membranes (ERM) preoperatively in patients who underwent surgery for full-thickness macular holes (FTMH). METHODS This is an interventional retrospective case series of 59 eyes diagnosed with FTMHs who underwent 25-G pars plana vitrectomy with internal limiting membrane peeling between 2009 and 2015. Preoperative OCTs were obtained by SD-OCT (Spectralis, Heidelberg, Germany) or TD-OCT (Stratus, Carl Zeiss Meditec, Dublin, CA, USA). Volume scans were reviewed for ERM accompanying the FTMH. This was compared to indocyanine green-negative staining and intraoperative findings of ERM as the gold standard. RESULTS Baseline characteristics between the SD-OCT and TD-OCT groups were comparable. Mean duration of postoperative follow-up was 41.4 weeks (±49.0). Of 59 eyes, 33 (55.9%) exhibited an ERM intraoperatively. Four ERMs (SD-OCT group) compared to 12 (TD-OCT group) were not visualized on preoperative OCT (p = 0.003). Sensitivity and specificity of SD-OCT in ERM detection was 79% and 100% compared to 14% and 91% for TD-OCT. Visual acuity improved in both arms (0.5 and 0.3 logMAR units in SD-OCT and TD-OCT, respectively (p = 0.002, 0.0002). CONCLUSIONS We found that SD-OCT was superior to TD-OCT in identifying the presence of ERM preoperatively in patients who underwent macular hole surgery. Since ERMs may decrease the chance of successful pharmacologic vitreolysis, we recommend using SD-OCT over TD-OCT in the evaluation of patients with FTMH to more accurately identify ERMs and allow more comprehensive treatment decisions (pharmacologic versus surgical).
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VITRECTOMY FOR PERSISTENT MACULAR HOLES FOLLOWING OCRIPLASMIN INJECTION: A Comparative Multicenter Study. Retina 2017; 37:2295-2303. [PMID: 28098729 DOI: 10.1097/iae.0000000000001473] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine functional and anatomical outcomes of pars plana vitrectomy for persistent full-thickness macular hole (MH) after intravitreal injection of ocriplasmin. METHODS This is a multicenter retrospective interventional study of 37 eyes of 37 patients who underwent pars plana vitrectomy with internal limiting membrane peeling for persistent MH after ocriplasmin treatment between December 2013 and December 2015 and comparison with 35 eyes of 35 patients who were offered ocriplasmin injection but underwent pars plana vitrectomy alone without pharmacologic vitreolysis before surgery. In addition, 24 matched pairs (MH diameter at baseline ±5 µm) were analyzed. Clinical data such as visual acuity, intraoperative characteristics, and spectral domain optical coherence tomography images were reviewed. Main outcome measures were visual acuity and MH closure rate. RESULTS After a mean follow-up period of 9 months, postoperative mean visual acuity showed no significant differences between ocriplasmin-treated eyes (logarithm of minimum angle of resolution 0.37 ± 0.26, Snellen 20/47) and eyes without ocriplasmin treatment (logarithm of minimum angle of resolution 0.39 ± 0.25; Snellen 20/49) (P > 0.9). After ocriplasmin injection, mean MH diameter enlarged from 217 ± 102 µm to 384 ± 239 µm (P < 0.001). Matched-pair analysis revealed no difference in gain of visual acuity between the first visit and the last follow-up (P = 0.29). Macular hole closure was observed in similar proportion in ocriplasmin-treated eyes (97%) and vitrectomy-only eyes (94%) (P > 0.5). CONLCUSION Eyes with persistent MH after ocriplasmin injection showed significant visual improvement after pars plana vitrectomy. Matched-pair analysis revealed no statistical differences in functional and anatomical postoperative results comparing with eyes of similar MH diameter that proceeded directly to surgery without ocriplasmin pretreatment.
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Kim YC, Harasawa M, Siringo FS, Quiroz-Mercado H. Assessment of posterior vitreous detachment on enhanced high density line optical coherence tomography. Int J Ophthalmol 2017; 10:165-167. [PMID: 28149795 DOI: 10.18240/ijo.2017.01.27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 05/20/2016] [Indexed: 01/30/2023] Open
Affiliation(s)
- Yu Cheol Kim
- Department of Ophthalmology, University of Colorado School of Medicine, Rocky Mountains Lions Eye Institute, Aurora 80045, USA; Department of Ophthalmology, University of Colorado School of Medicine, Denver Health Medical Center, Denver80204, USA; Department of Ophthalmology, Keimyung University School of Medicine, Dongsan Medical Center, Daegu 41931, Korea
| | - Mariana Harasawa
- Department of Ophthalmology, University of Colorado School of Medicine, Denver Health Medical Center, Denver80204, USA
| | - Frank S Siringo
- Department of Ophthalmology, University of Colorado School of Medicine, Rocky Mountains Lions Eye Institute, Aurora 80045, USA; Department of Ophthalmology, University of Colorado School of Medicine, Denver Health Medical Center, Denver80204, USA
| | - Hugo Quiroz-Mercado
- Department of Ophthalmology, University of Colorado School of Medicine, Rocky Mountains Lions Eye Institute, Aurora 80045, USA; Department of Ophthalmology, University of Colorado School of Medicine, Denver Health Medical Center, Denver80204, USA
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Phadikar P, Saxena S, Ruia S, Lai TYY, Meyer CH, Eliott D. The potential of spectral domain optical coherence tomography imaging based retinal biomarkers. Int J Retina Vitreous 2017; 3:1. [PMID: 28078103 PMCID: PMC5220620 DOI: 10.1186/s40942-016-0054-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 12/07/2016] [Indexed: 01/01/2023] Open
Abstract
Background Biomarker”, a merged word of “biological marker”, refers to a broad subcategory of medical signs that objectively indicate the state of health, and well-being of an individual. Biomarkers hold great promise for personalized medicine as information gained from diagnostic or progression markers can be used to tailor treatment to the individual for highly effective intervention in the disease process. Optical coherence tomography (OCT) has proved useful in identifying various biomarkers in ocular and systemic diseases. Main body Spectral domain optical coherence tomography imaging-based biomarkers provide a valuable tool for detecting the earlier stages of the disease, tracking progression, and monitoring treatment response. The aim of this review article is to analyze various OCT based imaging biomarkers and their potential to be considered as surrogate endpoints for diabetic retinopathy, age related macular degeneration, retinitis pigmentosa and vitreomacular interface disorder. These OCT based surrogate markers have been classified as retinal structural alterations (macular central subfield thickness and cube average thickness); retinal ultrastructural alterations (disruption of external limiting membrane and ellipsoid zone, thinning of retinal nerve fiber layer and ganglion cell layer); intraretinal microangiopathic changes; choroidal surrogate endpoints; and vitreoretinal interface endpoints. Conclusion OCT technology is changing very quickly and throughout this review there are some of the multiple possibilities that OCT based imaging biomarkers will be more useful in the near future for diagnosis, prognosticating disease progression and as endpoint in clinical trials.
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Affiliation(s)
- Prateep Phadikar
- Department of Ophthalmology, King George's Medical University, Lucknow, U.P. 226003 India
| | - Sandeep Saxena
- Department of Ophthalmology, King George's Medical University, Lucknow, U.P. 226003 India
| | - Surabhi Ruia
- Department of Ophthalmology, King George's Medical University, Lucknow, U.P. 226003 India
| | - Timothy Y Y Lai
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Carsten H Meyer
- Department of Ophthalmology, Pallas Klinik, Aarau, Switzerland
| | - Dean Eliott
- Harvard Medical School, Massachusetts Eye and Ear, Boston, MA USA
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Chatziralli I, Theodossiadis G, Xanthopoulou P, Miligkos M, Sivaprasad S, Theodossiadis P. Ocriplasmin use for vitreomacular traction and macular hole: A meta-analysis and comprehensive review on predictive factors for vitreous release and potential complications. Graefes Arch Clin Exp Ophthalmol 2016; 254:1247-56. [DOI: 10.1007/s00417-016-3363-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 03/20/2016] [Accepted: 04/19/2016] [Indexed: 02/04/2023] Open
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Vielmuth F, Schumann RG, Spindler V, Wolf A, Scheler R, Mayer WJ, Henrich PB, Haritoglou C. Biomechanical Properties of the Internal Limiting Membrane after Intravitreal Ocriplasmin Treatment. Ophthalmologica 2016; 235:233-40. [DOI: 10.1159/000444508] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 02/03/2016] [Indexed: 11/19/2022]
Abstract
Purpose: To assess the stiffness of the human internal limiting membrane (ILM) and evaluate potential changes of mechanical properties following intravitreal ocriplasmin injection for vitreomacular traction. Methods: This is an interventional comparative case series of 12 surgically excised ILM specimens consecutively obtained from 9 eyes of 9 patients after unsuccessful pharmacologic vitreolysis with ocriplasmin. During the same time period, 16 specimens from 13 other eyes without ocriplasmin treatment were harvested during vitrectomy and served as controls. All patients presented with macular holes or vitreomacular traction and underwent vitrectomy with ILM peeling either with or without brilliant blue (BB) staining. All specimens were analyzed using atomic force microscopy with scan regions of 25 × 25 μm. In all specimens, both the retinal side and vitreal side of the ILM were analyzed. Results: Atomic force microscopy revealed no significant differences in elasticity of ILM specimens removed from eyes with or without ocriplasmin treatment. Undulated areas of the retinal side presented stiffer than the vitreal side of the ILM. Topographical mapping of both the vitreal and retinal side of the ILM showed no apparent alteration of the morphology in ocriplasmin-treated eyes compared to untreated eyes. Staining with BB resulted in an increase of tissue stiffness. Conclusions: Intravitreal injection of ocriplasmin does not change biomechanical properties of the human ILM. There is no evidence of a potential enzymatic effect of ocriplasmin interfering with the stiffness of this basement membrane.
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Pierro L, Iuliano L, Bandello F. OCT Angiography Features of a Case of Bilateral Full-Thickness Macular Hole at Different Stages. Ophthalmic Surg Lasers Imaging Retina 2016; 47:388-9. [PMID: 27065383 DOI: 10.3928/23258160-20160324-16] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 02/23/2016] [Indexed: 11/20/2022]
Abstract
The authors present the optical coherence tomography angiography features of the deep vascular plexus in a case of bilateral full-thickness macular hole. The right eye is a newly diagnosed, small, full-thickness macular hole, and the left eye is a longstanding, large macular hole.
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Prospero Ponce CM, Stevenson W, Gelman R, Agarwal DR, Christoforidis JB. Ocriplasmin: who is the best candidate? Clin Ophthalmol 2016; 10:485-95. [PMID: 27051270 PMCID: PMC4803238 DOI: 10.2147/opth.s97947] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Enzymatic vitreolysis is currently the focus of attention around the world for treating vitreomacular traction and full-thickness macular hole. Induction of posterior vitreous detachment is an active area of developmental clinical and basic research. Despite exerting an incompletely elucidated physiological effect, ocriplasmin (also known as microplasmin) has been recognized to serve as a well-tolerated intravitreal injection for the treatment of vitreomacular traction and full-thickness macular hole. There are several unexplored areas of intervention where enzymatic vitreolysis could potentially be used (ie, diabetic macular edema). Recent promising studies have included combinations of enzymatic approaches and new synthetic molecules that induce complete posterior vitreous detachment as well as antiangiogenesis. Although no guidelines have been proposed for the use of ocriplasmin, this review attempts to aid physicians in answering the most important question, "Who is the best candidate?"
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Affiliation(s)
- Claudia M Prospero Ponce
- Retina Division, Department of Ophthalmology, University of Arizona Medical Center, Tucson, AZ, USA
| | - William Stevenson
- Retina Division, Department of Ophthalmology, University of Arizona Medical Center, Tucson, AZ, USA
| | - Rachel Gelman
- Retina Division, Department of Ophthalmology, University of Arizona Medical Center, Tucson, AZ, USA
| | - Daniel R Agarwal
- Retina Division, Department of Ophthalmology, University of Arizona Medical Center, Tucson, AZ, USA
| | - John B Christoforidis
- Retina Division, Department of Ophthalmology, University of Arizona Medical Center, Tucson, AZ, USA
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A retrospective cohort study in patients with tractional diseases of the vitreomacular interface (ReCoVit). Graefes Arch Clin Exp Ophthalmol 2016; 254:617-28. [PMID: 26899900 PMCID: PMC4799804 DOI: 10.1007/s00417-016-3294-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 10/08/2015] [Accepted: 12/17/2015] [Indexed: 02/05/2023] Open
Abstract
Purpose To assess how vitreomacular adhesion (VMA), vitreomacular traction (VMT), and macular holes (MH) evolve, and to assess visual acuity outcomes associated with different management strategies for each subgroup. Methods Retrospective, single-center, observational study of 400 patients (556 eyes) who presented with optical coherence tomography (OCT) findings related to tractional diseases of the vitreomacular interface (187 with bilateral disease). The outcomes measured include prevalence of symptoms, rates of disease stabilization, spontaneous resolution, and disease progression necessitating surgical intervention. Size of VMA/VMT was not measured. Results Vision loss and metamorphopsia were the leading causes for referral. Patients were followed for a mean of 10.9 months (median 6.9 months). Spontaneous resolution occurred in 22.7 % (46/203) of eyes with VMT and in 7.3 % (9/124) of eyes with VMA (P < .001). In the former group, 34.1 % (14 eyes) showed improved visual acuity (P = .001). During follow-up, 11.3 % (14/124) of eyes with VMA showed disease progression; six (4.8 %) developed a macular hole. Eleven of the 203 eyes with VMT (5.4 %) developed a macular hole; 52 of 203 eyes with VMT (25.6 %) had disease progression that resulted in patients opting for pars plana vitrectomy (PPV). Of the eyes with VMA, 4.8 % (6/124) had disease progression resulting in patients opting for PPV. Conclusions Better visual acuity outcomes were found in eyes with spontaneous resolution compared to the other groups. Spontaneous resolution of VMT and VMA was rare, whereas disease progression resulting in PPV was more common.
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Flores-Moreno I, Arias-Barquet L, Vidal-Martí M, Muñoz-Blanco A, Rubio-Caso MJ, Ruiz-Moreno JM, Duker JS, Caminal JM. The Prevalence of Vitreomacular Interface Pathology in a Spanish Tertiary Hospital. Ophthalmologica 2016; 235:179-83. [PMID: 26886685 DOI: 10.1159/000443937] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 01/05/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE To determine the prevalence of vitreomacular interface (VMI) pathology, using spectral-domain optical coherence tomography (SD-OCT). METHODS VMI status was classified into macular posterior vitreous detachment (PVD), focal vitreomacular adhesion (VMA; ≤1,500 μm), broad VMA (>1,500 μm), focal vitreomacular traction (VMT; ≤1,500 μm), broad VMT (>1,500 μm), full-thickness macular hole (FTMH) with the presence of VMT, and FTMH without the presence of VMT. RESULTS A total of 1,976 eyes were included. A nonpathologic VMI was observed in 1,875 eyes (94.8%), including 1,050 (53.1%) with PVD, 120 (6.1%) with focal VMA and 705 (35.6%) with broad VMA. A pathologic state of the VMI was diagnosed in 101 eyes (5.1%). Thirty-three eyes (1.7%) were classified as focal VMT, 29 (1.4%) as broad VMT, 39 (1.9%) as FTMH, resulting in 6 small, 12 medium and 21 large FTMHs, six eyes had VMT associated to FTMH. CONCLUSIONS Even in a tertiary care, retinal referral practice, VMI pathology is a relatively rare condition. There was a higher prevalence in a tertiary hospital study compared to population-based studies.
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Affiliation(s)
- Ignacio Flores-Moreno
- Department of Ophthalmology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
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Kang HM, Lee SJ, Kim CG, Chung EJ, Koh HJ. Gas-mediated vitreomacular adhesion release with intravitral ranibizumab injections for exudative age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2016; 254:1681-92. [PMID: 26743753 DOI: 10.1007/s00417-015-3257-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 11/09/2015] [Accepted: 12/24/2015] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To evaluate the efficiency of gas-assisted vitreomacular adhesion (VMA) release combined with intravitreal ranibizumab injections for exudative age-related macular degeneration (AMD) patients. MATERIALS AND METHODS This prospective, interventional case series included a total of 23 eyes of 22 patients. The eyes were treated with intravitreal injection of 0.3 mL of perfluoropropane (C3F8) gas and concomitant intravitreal ranibizumab injection to stimulate VMA release. After three initial loading injections, additional intravitreal ranibizumab injections were performed pro re nata. Over a 12-month period, monthly examinations were performed for best-corrected visual acuity (BCVA, logMAR; logarithm of the minimum angle resolution), optical coherence tomography, and dilated fundus examinations. RESULTS After gas injection, 22 eyes (95.7 %) showed complete VMA release at 1 week. Complete VMA was achieved in all eyes at 2 months after VMA release, without serious ocular adverse events except one patient who developed a retinal tear. Mean BCVA was 0.61 ± 0.37 logMAR (20/81 Snellen equivalents) at baseline and 0.46 ± 0.30 logMAR (20/57 Snellen equivalents) at 12 months (P = 0.135). Mean central macular thickness was 357.9 ± 128.6 μm at baseline and 245.6 ± 60.0 μm at 12 months (P = 0.188). Mean numbers of intravitreal ranibizumab injections were 4.8 ± 2.4 times during 12 months (4 to 8 injections). CONCLUSION Gas-assisted VMA release can be used as an efficient alternative for exudative AMD patients with obvious VMA.
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Affiliation(s)
- Hae Min Kang
- Department of Ophthalmology, Catholic Kwandong University, International St. Mary's Hospital, Incheon, Republic of Korea
- Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemoon-gu, Seoul, 120-752, Republic of Korea
| | - Sung Jun Lee
- Yonsei Bon Ophthalmology clinic, Seoul, Republic of Korea
| | - Chul Gu Kim
- Department of Ophthalmology, Myung-Gok Eye Research Institute, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Republic of Korea
| | - Eun Jee Chung
- Department of Ophthalmology, National Health Insurance Corporation Ilsan Hospital, Goyang, Republic of Korea
| | - Hyoung Jun Koh
- Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemoon-gu, Seoul, 120-752, Republic of Korea.
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Mukherjee C, Mitra A, Kumar NA, Elsherbiny S, Lip PL. Macular Hole Formation After Intravitreal Ranibizumab Injection in Wet Age-Related Macular Degeneration. Open Ophthalmol J 2015; 9:177-80. [PMID: 26962382 PMCID: PMC4763958 DOI: 10.2174/1874364101509010177] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 09/07/2015] [Accepted: 09/07/2015] [Indexed: 11/22/2022] Open
Abstract
Ranibizumab is a monoclonal antibody fragment that inhibits angiogenesis by inhibiting vascular endothelial growth factor A, used as a treatment for patients with wet aged-related macular degeneration (ARMD). Adverse effects from intravitreal Ranibizumab injections are well recognised. Macular hole formation following Ranibizumab injection is a complication that has been recently reported in few case reports. We present a larger case series of five patients, who developed full thickness macular holes (FTMH) after intravitreal Ranibizumab injections for treatment of wet ARMD that we were aware of between 2009 and 2013.
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Affiliation(s)
- Chandoshi Mukherjee
- The Birmingham and Midland Eye Centre, City Hospital Dudley Road Birmingham, West Midlands B18 7QH, UK
| | - Arijit Mitra
- The Birmingham and Midland Eye Centre, City Hospital Dudley Road Birmingham, West Midlands B18 7QH, UK
| | - N Ajith Kumar
- The Birmingham and Midland Eye Centre, City Hospital Dudley Road Birmingham, West Midlands B18 7QH, UK
| | - Samer Elsherbiny
- The Birmingham and Midland Eye Centre, City Hospital Dudley Road Birmingham, West Midlands B18 7QH, UK
| | - Peck Lin Lip
- The Birmingham and Midland Eye Centre, City Hospital Dudley Road Birmingham, West Midlands B18 7QH, UK
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Lee KH, Chin HS, Kim NR, Moon YS. Effects of Vitreomacular Traction on Ranibizumab Treatment Response in Eyes with Neovascular Age-related Macular Degeneration. KOREAN JOURNAL OF OPHTHALMOLOGY 2015; 29:396-403. [PMID: 26635456 PMCID: PMC4668255 DOI: 10.3341/kjo.2015.29.6.396] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 05/07/2015] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To investigate the effects of vitreomacular traction (VMT) on ranibizumab treatment response for neovascular age-related macular degeneration (AMD). METHODS A retrospective review of 85 eyes of 85 patients newly diagnosed with neovascular AMD was conducted. Patients were eligible if they had received more than three consecutive monthly ranibizumab (0.50 mg) treatments and ophthalmic evaluations. Patients were classified into a VMT (+) group or VMT (-) group according to optical coherence tomography imaging. Best corrected visual acuity and central retinal thickness (CRT) measurements were obtained at three and six months after initial injection. RESULTS One month after the third injection, mean visual acuity (VA) increases of 6.36 and 9.87 letters were observed in the VMT (+) and VMT (-) groups, respectively. The corresponding mean CRT values decreased by 70.29 µm and 121.68 µm, respectively. A total 41 eyes were identified as eligible for a subsequent fourth injection; 71.1% of patients (27 eyes) in the VMT (+) group but only 29.8% of patients in the VMT (-) group needed a subsequent fourth injection. Follow-up was extended to six months for 42 of the 85 enrolled patients (49.4%). The trends in VA and optical coherence tomography were found to be maintained at six-month follow-up. CONCLUSIONS VA and CRT appeared to be more improved after ranibizumab treatment in the VMT (-) group compared to the VMT (+) group. VMT might antagonize the effect of ranibizumab treatment in a subpopulation of AMD patients.
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Affiliation(s)
- Kang Hoon Lee
- Department of Ophthalmology and Inha Vision Science Laboratory, Inha University School of Medicine, Incheon, Korea. ; Graduate School of Medical Sciences and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea
| | - Hee Seung Chin
- Department of Ophthalmology and Inha Vision Science Laboratory, Inha University School of Medicine, Incheon, Korea
| | - Na Rae Kim
- Department of Ophthalmology and Inha Vision Science Laboratory, Inha University School of Medicine, Incheon, Korea
| | - Yeon Sung Moon
- Department of Ophthalmology and Inha Vision Science Laboratory, Inha University School of Medicine, Incheon, Korea
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Abstract
PURPOSE To report on total number, distribution, and type of cells at the vitreomacular interface in small full-thickness macular holes. METHODS Internal limiting membrane specimens were removed from 20 consecutive patients with macular holes <250 μm at times when pharmacologic vitreolysis was not available. Specimens were flat mounted and investigated by phase contrast and interference microscopy and immunocytochemistry. Clinical data were documented including optical coherence tomography analysis using the caliper function. Thirteen antibodies were used for glial cells, hyalocytes, macrophages, retinal pigment epithelial cells, different types of collagen, alpha-smooth muscle actin, and proliferating cells. RESULTS There was a positive correlation between macular hole size and cell density at the internal limiting membrane (Spearman's Rho: r = 0.519, P = 0.019). Mostly, single glial cells were found on the internal limiting membrane. In five patients, cell clusters were present. There was a strong immunoreactivity for glial cell markers. Immunoreactivity of hyalocyte markers, alpha-smooth muscle actin, and Ki-67 was found in cell clusters but otherwise sparse. CONCLUSION Single cells of glial origin without signs of proliferation or contraction are present in eyes with small full-thickness macular holes. In some eyes, however, clusters of cells can be seen, capable of proliferation and exerting tangential traction. Our findings emphasize the need for better visualization of the vitreoretinal pathology by optical coherence tomography, especially to distinguish between single cells and cell clusters.
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Association between anatomical resolution and functional outcomes in the mivi-trust studies using ocriplasmin to treat symptomatic vitreomacular adhesion/vitreomacular traction, including when associated with macular hole. Retina 2015; 35:1151-7. [PMID: 25741816 DOI: 10.1097/iae.0000000000000508] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate visual function in patients with symptomatic vitreomacular adhesion (VMA)/vitreomacular traction including when associated with macular hole after ocriplasmin treatment, and the association between resolution of the underlying condition and improvement in visual function. METHODS Six hundred and fifty-two patients from 2 Phase 3 trials received a single intravitreal injection of ocriplasmin 125 μg (n = 464) or placebo (n = 188). Mean and categorical changes from baseline in best-corrected visual acuity and 25-item Visual Function Questionnaire scores were used to evaluate visual function. Subgroups with VMA resolution and full-thickness macular hole closure were compared. RESULTS Overall, 42% of patients who achieved VMA resolution at Day 28 had a ≥2-line improvement in best-corrected visual acuity at Month 6, and 20% had a ≥3-line improvement. Likewise, 69% of patients with nonsurgical full-thickness macular hole closure at Day 28 had a ≥2-line improvement at Month 6, and 48% had a ≥3-line best-corrected visual acuity improvement. Mean improvements in 25-item Visual Function Questionnaire scores were associated with achieving VMA resolution and nonsurgical full-thickness macular hole closure. CONCLUSION In patients with symptomatic VMA/vitreomacular traction, VMA resolution and nonsurgical full-thickness macular hole closure were each associated with improvements in visual function. Resolving the underlying anatomical condition in symptomatic VMA/vitreomacular traction will increase the probability of achieving a clinically meaningful improvement in visual function.
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Schumann RG, Wolf A, Mayer WJ, Compera D, Hagenau F, Ziada J, Kampik A, Haritoglou C. Pathology of Internal Limiting Membrane Specimens Following Intravitreal Injection of Ocriplasmin. Am J Ophthalmol 2015; 160:767-78. [PMID: 26133247 DOI: 10.1016/j.ajo.2015.06.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 06/18/2015] [Accepted: 06/20/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To describe ultrastructure and immunocytochemistry of internal limiting membrane peelings after unsuccessful treatment with ocriplasmin, to compare with untreated eyes, and to correlate with clinical imaging data. DESIGN Interventional comparative case series. METHODS Internal limiting membrane specimens were removed from 10 eyes with small macular holes and vitreomacular traction during vitrectomy after intravitreal ocriplasmin injection without release of traction or closure of macular holes during follow-up. Based on optical coherence tomography analysis, specimens from 10 other eyes without ocriplasmin treatment served as controls. All specimens were processed as flat mounts for phase-contrast microscopy followed by immunolabeling for fluorescence microscopy and embedding in epoxy resin with serial sectioning for transmission electron microscopy. RESULTS Despite the absence of contractive epiretinal membranes on optical coherence tomography, we found epiretinal cells and vitreous collagen fibrils on the internal limiting membrane in specimens removed from eyes with and without previous pharmacologic vitreolysis. Immunolabeling revealed glial cells and hyalocytes in macular holes, whereas myofibroblasts were predominant in vitreomacular traction. There was no apparent damage of the vitreoretinal interface after unsuccessful pharmacologic vitreolysis compared to untreated controls. CONCLUSIONS Epiretinal cell proliferation and vitreous collagen fibrils with close adhesions to the internal limiting membrane are not always detectable by optical coherence tomography or may not have been recognized. Since they are associated with unsuccessful ocriplasmin treatment, presence and topography of epiretinal cells and vitreous collagen remnants on the internal limiting membrane should be further elucidated in order to refine criteria and indications for case selection in pharmacologic vitreolysis.
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Lee GD, Taney LS, Rogers AH, Shah CP, Duker JS, Baumal CR. Surgical Outcomes for Persistent Macular Hole After Ocriplasmin. Ophthalmic Surg Lasers Imaging Retina 2015; 46:732-6. [PMID: 26247454 DOI: 10.3928/23258160-20150730-07] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 06/03/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To report surgical and visual acuity outcomes in eyes with unresolved full-thickness macular hole (FTMH) after treatment with ocriplasmin who subsequently underwent vitrectomy. PATIENTS AND METHODS Retrospective case series of four eyes. Vision and anatomy via optical coherence tomography (OCT) were assessed before and after intravitreal ocriplasmin as well as 6 months after subsequent vitrectomy. RESULTS Initial visual acuity ranged from 20/70 to 20/200. OCT showed focal vitreomacular traction (VMT) with FTMH ranging from 136 to 311 µm in diameter. Following ocriplasmin, VMT released in all four eyes without closure of the FTMH. All FTMHs enlarged over follow-up after ocriplasmin (mean increase 133 µm). Subsequent vitrectomy led to anatomic FTMH closure in all eyes. Final vision improved in all eyes (20/30 to 20/70). CONCLUSION Initial ocriplasmin treatment of FTMH in this series of patients did not reduce the effectiveness of vitrectomy, which was required for definitive FTMH repair.
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Dugel PU, Regillo C, Eliott D. Characterization of Anatomic and Visual Function Outcomes in Patients With Full-Thickness Macular Hole in Ocriplasmin Phase 3 Trials. Am J Ophthalmol 2015; 160:94-9.e1. [PMID: 25818925 DOI: 10.1016/j.ajo.2015.03.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 03/19/2015] [Accepted: 03/20/2015] [Indexed: 01/29/2023]
Abstract
PURPOSE To characterize anatomic and visual outcomes in patients with full-thickness macular hole (FTMH) at baseline in ocriplasmin phase 3 clinical trials, focusing on the relationship between resolution of vitreomacular adhesion and FTMH closure. DESIGN Two multicenter, randomized, double-masked clinical trials. METHODS Pharmacologic FTMH closure was one of multiple secondary endpoints. OCT scans were obtained at baseline and at all postinjection visits, and for patients with baseline FTMH, evaluated for FTMH width, vitreomacular adhesion, and epiretinal membrane. RESULTS FTMH closure was observed in a greater proportion of ocriplasmin- vs vehicle-injected patients with baseline FTMH width ≤250 μm (58.3% vs 16.0%, P < .001) and >250 to ≤400 μm (36.8% vs 5.3%, P = .009). Among FTMH patients in the ocriplasmin group, ≥2-line visual acuity gains at month 6 were achieved by a greater percentage of those who achieved hole closure at day 28 vs those who did not achieve this outcome (72.1% vs 25.4%). CONCLUSIONS Ocriplasmin demonstrated efficacy in closure of small and medium FTMH, and in FTMH without epiretinal membrane at baseline. Visual acuity gains occurred more frequently when hole closure was achieved after ocriplasmin treatment compared to when this outcome did not occur. Ocriplasmin treatment is an additional option for the management of patients with FTMH and vitreomacular adhesion.
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IMPROVED EFFICACY OF OCRIPLASMIN FOR VITREOMACULAR TRACTION RELEASE AND TRANSIENT CHANGES IN OPTIC DISK MORPHOLOGY. Retina 2015; 35:1135-43. [DOI: 10.1097/iae.0000000000000507] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Real-life experience after intravitreal ocriplasmin for vitreomacular traction and macular hole: a spectral-domain optical coherence tomography prospective study. Graefes Arch Clin Exp Ophthalmol 2015; 254:223-33. [DOI: 10.1007/s00417-015-3031-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 04/14/2015] [Accepted: 04/20/2015] [Indexed: 02/02/2023] Open
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Reply: To PMID 23881226. Retina 2015; 35:e28-9. [PMID: 25807179 DOI: 10.1097/iae.0000000000000597] [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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Movement of the inner retina complex during the development of primary full-thickness macular holes: implications for hypotheses of pathogenesis. Graefes Arch Clin Exp Ophthalmol 2015; 253:2103-9. [PMID: 25673252 DOI: 10.1007/s00417-015-2951-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 01/19/2015] [Accepted: 01/26/2015] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND The inner retinal complex is a well-defined layer in spectral-domain OCT scans of the retina. The central edge of this layer at the fovea provides anatomical landmarks that can be observed in serial OCT scans of developing full-thickness macular holes (FTMH). Measurement of the movement of these points may clarify the mechanism of FTMH formation. METHOD This is a retrospective study of primary FTMH that had a sequence of two OCT scans showing progression of the hole. Measurements were made of the dimensions of the hole, including measurements using the central edge of the inner retinal complex (CEIRC) as markers. The inner retinal separation (distance between the CEIRC across the centre of the fovea) and the Height-IRS (average height of CEIRC above the retinal pigment epithelium) were measured. RESULTS Eighteen cases were identified in 17 patients. The average increase in the base diameter (368 microns) and the average increase in minimum linear dimension (187 microns) were much larger than the average increase in the inner retinal separation (73 microns). The average increase in Height-IRS was 103 microns. CONCLUSION The tangential separation of the outer retina to produce the macular hole is much larger than the tangential separation of the inner retinal layers. A model based on the histology of the Muller cells at the fovea is proposed to explain the findings of this study.
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Die vitreoretinale Grenzfläche und ihre Rolle in der Pathogenese vitreomakulärer Erkrankungen. Ophthalmologe 2015; 112:10-9. [DOI: 10.1007/s00347-014-3048-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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