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Celiker H, Çam F, Özkoçak BY. Outcomes of pars plana vitrectomy in the management and diagnosis of patients with infectious, non-infectious, and unidentified uveitis. Graefes Arch Clin Exp Ophthalmol 2024; 262:2237-2246. [PMID: 38363356 PMCID: PMC11222255 DOI: 10.1007/s00417-024-06407-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/22/2024] [Accepted: 02/05/2024] [Indexed: 02/17/2024] Open
Abstract
PURPOSE To present the outcomes of pars plana vitrectomy (PPV) in patients with infectious, non-infectious, and unidentified uveitis, focusing on visual and clinical outcomes, diagnostic yield, and surgery-related complications. METHODS This retrospective, single-center study included patients who underwent 23-gauge PPV for the management of uveitis and had at least 6 months of follow-up. Patients were divided into infectious, non-infectious, and unidentified uveitis groups based on definitive diagnosis after surgery. Etiologies of uveitis, indications for surgery, diagnostic yield, visual outcomes, presence of cystoid macular edema (CME), immunosuppressive drugs, intraoperative and postoperative complications, and repeated vitrectomies were reviewed. RESULTS This study included 62 eyes of 54 patients. Twenty eyes were diagnosed with infectious uveitis, 24 eyes with non-infectious uveitis, and 18 eyes with unidentified uveitis. The diagnostic yield of vitrectomy was 41.7%. Mean BCVA significantly improved at postoperative 1 month compared to baseline and remained stable at following time-points in all groups. The most common early postoperative complication was increased intraocular pressure (17%), and late complication was cataract (36%). Nine eyes underwent re-vitrectomy and the most common cause was retinal detachment with proliferative vitreoretinopathy (PVR). CONCLUSION PPV seems to be effective in diagnosing cases of unknown origin, improving visual acuity, and reducing the need for systemic immunosuppressive drugs. PVR is the most serious complication with poor prognosis that requires repeated surgery in patients with uveitis.
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Affiliation(s)
- Hande Celiker
- Department of Ophthalmology, Marmara University School of Medicine, Istanbul, Turkey.
- Department of Ophthalmology, Marmara University Pendik Education and Research Hospital, Pendik, Istanbul, Turkey.
| | - Furkan Çam
- Department of Ophthalmology, Marmara University School of Medicine, Istanbul, Turkey
| | - Berru Yargı Özkoçak
- Beyoglu Eye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Batistic D, Kreso A, Vrdoljak J, Batistic J, Paladin I, Mizdrak I, Glumac S. An Analysis of Optic Disc Parameters in Patients with Peripheral Retinal Tears Following Acute Posterior Vitreous Detachment: A Cross-Sectional Study. Clin Interv Aging 2024; 19:1153-1162. [PMID: 38952872 PMCID: PMC11216550 DOI: 10.2147/cia.s466511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 06/25/2024] [Indexed: 07/03/2024] Open
Abstract
Background To investigate association between optic disc parameters analyzed by optical coherence tomography (OCT) and occurrence of peripheral retinal tears in patients with symptomatic posterior vitreous detachment (PVD). Methods This cross-sectional study enrolled 75 patients with symptoms of acute PVD, who were allocated into two groups based on whether a peripheral retinal tear occurred or not. Results When comparing the average retinal nerve fiber layer (RNFL) thickness (μm) between retinal tear and control groups, it was shown that patients with a retinal tear have a significantly higher (87.18 [95% confidence interval (CI), 84.47 to 89.9] vs 81.14 [95% CI, 77.81 to 84.46], P = 0.005) average RNFL thickness. Furthermore, we observed a significant difference (0.13, 0.06 to 0.22 vs 0.07, 0.04 to 0.1, P = 0.036, Mann-Whitney U-test) in the size of cup volume (mm3) between the tear and control groups, respectively. Linear regression showed a significant decrease (P = 0.029) in average RNFL thickness with increasing age, but without a significant difference between the two groups. There was no statistically significant difference between the tear and control groups in terms of rim area, disc area, and average cup-to-disc ratio. Conclusion Patients with a higher average RNFL thickness and larger cup volume measured by OCT were more prone to develop a peripheral retinal tear. Increased peripapillary average RNFL thickness due to trauma and subsequent inflammation, possibly related to the more adherent posterior hyaloid membrane to the retina, may also indicate strengthened adhesions in the areas of the peripheral retina where retinal tears occur. OCT analysis of the optic nerve head may be used in everyday clinical practice as a predictor of the development of peripheral retinal tears in patients with symptomatic PVD.
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Affiliation(s)
- Darko Batistic
- Department of Ophthalmology, University Hospital of Split, Split, Croatia
| | - Ante Kreso
- Department of Ophthalmology, University Hospital of Split, Split, Croatia
| | - Josip Vrdoljak
- Department of Pathophysiology, School of Medicine, University of Split, Split, Croatia
| | - Jaksa Batistic
- Department of Urology, University Hospital of Split, Split, Croatia
| | - Ivan Paladin
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Split, Split, Croatia
| | - Ivan Mizdrak
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Split, Split, Croatia
| | - Sandro Glumac
- Department of Anesthesiology and Intensive Care, University Hospital of Split, Split, Croatia
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Shah YS, Abidi M, Ahmed I, Arsiwala-Scheppach LT, Ong SS, Wu D, Handa JT. Risk Factors Associated with Cystoid Macular Edema among Patients Undergoing Primary Repair of Rhegmatogenous Retinal Detachment. Ophthalmol Retina 2024; 8:456-464. [PMID: 38036083 PMCID: PMC11070291 DOI: 10.1016/j.oret.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 11/14/2023] [Accepted: 11/17/2023] [Indexed: 12/02/2023]
Abstract
PURPOSE To investigate predictors of the development and resolution of cystoid macular edema (CME) after rhegmatogenous retinal detachment (RRD) repair. DESIGN Retrospective cross sectional study. SUBJECTS Patients who underwent primary repair of uncomplicated RRD. METHODS Demographics, ophthalmic history, visual acuity, RRD features, time to development/resolution of CME, OCT characteristics of CME/epiretinal membrane (ERM), type of surgery, and treatments were collected. Logistic regressions were used to identify predictors of CME development and resolution. MAIN OUTCOME MEASURES Predictors of CME development and resolution. RESULTS A total of 708 eyes were included, of which 55 (7.8%) developed CME. Factors associated with an increased risk of CME development included total number of retinal detachment surgeries (odds ratio [OR] 1.66 [1.24-2.23], P < 0.001), prior intraocular surgery (OR 4.43 [1.19-16.51], P = 0.03), and presence of ERM after surgery (OR 4.49 [2.30-8.74], P < 0.001). Patients undergoing pars plana vitrectomy (PPV) were more likely to develop CME compared with patients undergoing scleral buckling (SB; OR 3.09 [1.18-8.10], P = 0.02). A longer average time to CME detection was associated with lower CME resolution (OR 0.94 [0.89-0.998], P = 0.04). In patients who developed an ERM postsurgically, those who developed CME after ERM had a lower rate of resolution compared with those who developed CME before ERM (P = 0.03). CONCLUSIONS Cystoid macular edema may be more likely to develop in patients undergoing PPV than SB, those who underwent more surgeries for RRD repair, those who had prior intraocular surgery, or those who developed an ERM after RRD repair. Resolution of CME may be affected by the time to detection of CME and ERM development. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Yesha S Shah
- Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland
| | | | - Ishrat Ahmed
- Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland; Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Lubaina T Arsiwala-Scheppach
- Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland; Wilmer Biostatistics Center, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Sally S Ong
- Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland; Department of Ophthalmology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - David Wu
- Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland; Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts
| | - James T Handa
- Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland.
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Souissi S, Allou V, Trucchi L, Le Mer Y, Tadayoni R, Couturier A. Macular oedema secondary to rhegmatogenous retinal detachment repair: risk factors for resistance to first-line therapy and long-term response to dexamethasone intravitreal implant. Eye (Lond) 2024; 38:1155-1161. [PMID: 38040966 PMCID: PMC11009244 DOI: 10.1038/s41433-023-02852-x] [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: 03/19/2023] [Revised: 11/02/2023] [Accepted: 11/14/2023] [Indexed: 12/03/2023] Open
Abstract
OBJECTIVES To assess the risk factors for resistance to first-line therapy and long-term response to dexamethasone intravitreal implant (Ozurdex®) of patients with macular oedema (MO) secondary to rhegmatogenous retinal detachment repair (RRDR). METHODS This was a retrospective, consecutive cohort study conducted in patients who underwent RRDR between January 2014 and December 2020 in the Rothschild Foundation Hospital and experienced postoperative MO (POMO) with a follow-up of at least 18 months. RESULTS Of the 1152 patients screened, 36 eyes (3.1%) experienced POMO. The mean follow-up duration was 45.2 months (18.0-80.5 months). Twenty-five eyes (69.4%) were resistant to first-line therapy and received at least one Ozurdex® injection (mean number: 2.7 [1-12]). The multivariate analysis showed an increased risk of resistance in patients who underwent perfluorocarbon liquid (PFCL)-assisted drainage (adjusted odds ratio: 8.65; 95% confidence interval: 1.97-15.33; p = 0.01). Significant differences in best-corrected visual acuity and central macular thickness were found between before Ozurdex® injection and the last follow-up visit: from 0.57 ± 0.47 LogMAR to 0.34 ± 0.32 LogMAR (p = 0.02) and from 483.0 ± 124.0 µm to 354.6 ± 96.5 µm (p = 0.001), respectively. The absence of serous retinal detachment and the presence of hyperreflective foci at baseline were associated with a higher resistance and a poorer response to Ozurdex®. Two patients (8%) experienced hypertony, that was well controlled with hypotonic drops. CONCLUSION MO secondary to RRDR is challenging. Ozurdex® could be reasonably proposed as first-line treatment, at least when MO occurs following PFCL-assisted drainage, given the favourable long-term benefit/risk ratio.
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Affiliation(s)
- Soufiane Souissi
- Department of Vitreoretinal Surgery, Rothschild Foundation Hospital, 25-29 rue Manin, 75019, Paris, France.
| | - Violaine Allou
- Department of Vitreoretinal Surgery, Rothschild Foundation Hospital, 25-29 rue Manin, 75019, Paris, France
| | - Laura Trucchi
- Department of Vitreoretinal Surgery, Rothschild Foundation Hospital, 25-29 rue Manin, 75019, Paris, France
| | - Yannick Le Mer
- Department of Vitreoretinal Surgery, Rothschild Foundation Hospital, 25-29 rue Manin, 75019, Paris, France
| | - Ramin Tadayoni
- Department of Vitreoretinal Surgery, Rothschild Foundation Hospital, 25-29 rue Manin, 75019, Paris, France
- Department of Ophthalmology, Lariboisière Hospital, 2 rue Ambroise Paré, 75010, Paris, France
| | - Aude Couturier
- Department of Ophthalmology, Lariboisière Hospital, 2 rue Ambroise Paré, 75010, Paris, France
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Kontou EP, Karakosta C, Kounas K, Iatropoulos I, Tsinopoulos I, Kozobolis V, Stavrakas P. Macular Edema Following Silicone Oil Tamponade for Retinal Detachment: A Literature Review. Cureus 2023; 15:e51233. [PMID: 38283484 PMCID: PMC10821764 DOI: 10.7759/cureus.51233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2023] [Indexed: 01/30/2024] Open
Abstract
Macular edema (ME) is a major cause of reduced vision following intraocular surgery. Although the pathophysiology of ME is not completely understood, inflammatory mediators play a key role. The incidence of ME following pars plana vitrectomy with silicone oil tamponade varies between 13% and 27%. ME usually resolves spontaneously following silicone oil removal, but treatment may be required for resistant cases. In this review, the mechanisms of ME formation after pars plana vitrectomy, its incidence, and its possible therapeutic approaches are discussed.
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Affiliation(s)
- Evgenia P Kontou
- Department of Ophthalmology, General Hospital of Athens "Korgialeneio-Benakio" Hellenic Red Cross, Athens, GRC
- Department of Ophthalmology, School of Medicine, University of Patras, Patras, GRC
| | - Christina Karakosta
- Department of Ophthalmology, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Konstantinos Kounas
- Department of Ophthalmology, School of Medicine, University of Patras, Patras, GRC
| | - Ioannis Iatropoulos
- Department of Ophthalmology, School of Medicine, University of Patras, Patras, GRC
| | - Ioannis Tsinopoulos
- Second Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Vassilios Kozobolis
- Department of Ophthalmology, School of Medicine, University of Patras, Patras, GRC
| | - Panagiotis Stavrakas
- Department of Ophthalmology, School of Medicine, University of Patras, Patras, GRC
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Dean J, McTavish S, Feng Y, Hoyek S, Patel NA. Persistent Inflammation Associated With HLA-B27 After Pars Plana Vitrectomy With Scleral Buckle Placement. JOURNAL OF VITREORETINAL DISEASES 2023; 7:557-561. [PMID: 37974913 PMCID: PMC10649459 DOI: 10.1177/24741264231176143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Purpose: To report 2 cases of persistent inflammation associated with human leukocyte antigen-B27 (HLA-B27) after pars plana vitrectomy (PPV) with scleral buckling. Methods: Two cases were analyzed. Results: A 47-year-old man had pars plana vitrectomy (PPV), scleral buckle (SB) placement, and endolaser for a macula-on rhegmatogenous retinal detachment (RRD). A 61-year-old man also had uneventful PPV, SB placement, and endolaser for a macula-off RRD. Postoperatively, both patients reported eye pain and had persistent intraocular inflammation. Both were found to be HLA-B27 positive despite having no previous signs or symptoms that would warrant HLA-B27 testing. Conclusions: Discovering the source of prolonged postoperative inflammation is critical in initiating the correct treatment and removing suspicion of infection. Although intraocular inflammation associated with HLA-B27 does not often present initially after surgery, HLA-B27 testing should be considered in cases of persistent, unexpected postoperative inflammation.
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Affiliation(s)
- Jordan Dean
- University of Connecticut School of Medicine, Farmington, CT, USA
| | - Sloane McTavish
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Yilin Feng
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Sandra Hoyek
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Nimesh A. Patel
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
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Hsu CR, Hsieh YT, Yang CM, Lin CP. Single-dose Effect of Intravitreal Dexamethasone Implant for Post-vitrectomy Macular Edema under Silicone Oil. Ocul Immunol Inflamm 2023; 31:1587-1593. [PMID: 34477484 DOI: 10.1080/09273948.2021.1970779] [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: 03/04/2021] [Accepted: 08/16/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate the single-dose effect of intravitreal dexamethasone (DEX) implant for patients with post-vitrectomy macular edema (ME) under silicone oil (SO) tamponade. METHODS Twelve eyes diagnosed with ME after undergoing pars plana vitrectomy with SO injections were retrospectively reviewed. Each eye received a single intravitreal DEX implant (0.7-mg, Ozurdex; Allergan Inc) injection as treatment for recalcitrant ME. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) were recorded. RESULTS Compared with baseline (1.24 ± 0.34), the mean LogMAR BCVA improved at 1 (1.14 ± 0.27), 3 (1.13 ± 0.22), and 6 (1.22 ± 0.30) months without statistical significance. Maximal CMT resolution was observed at 1 month after intravitreal injection. The CMT value improved significantly at 1 (P = .008), 3 (P = .006), and 6 (P = .009) months. IOP did not show significant elevation during follow-up. No serious adverse events were observed. CONCLUSION Single-dose treatment of DEX implant may have benefit for recalcitrant post-vitrectomy ME under SO tamponade.
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Affiliation(s)
- Cherng-Ru Hsu
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yi-Ting Hsieh
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Ophthalmology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chung-May Yang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Ophthalmology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chang-Ping Lin
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Ophthalmology, National Taiwan University College of Medicine, Taipei, Taiwan
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Anatychuk L, Zadorozhnyy O, Naumenko V, Maltsev E, Kobylianskyi R, Nazaretyan R, Umanets M, Kustryn T, Nasinnyk I, Korol A, Pasyechnikova N. Vitreoretinal Surgery with Temperature Management: A Preliminary Study in Rabbits. Ther Hypothermia Temp Manag 2023; 13:126-133. [PMID: 36827431 DOI: 10.1089/ther.2022.0044] [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: 02/26/2023] Open
Abstract
The present study aimed to evaluate the structure of the rabbit retina after vitreoretinal surgery using prolonged irrigation with solutions of different temperatures. Thirty-six rabbits (72 eyes) were included in this study and randomly divided into 3 equal groups according to the temperature of the intraocular irrigating fluid they received during vitrectomy. Vitreoretinal surgery was performed with a 5°C irrigation solution in group 1 (12 rabbits, 24 eyes), a 22°C irrigation solution in group 2 (12 rabbits, 24 eyes), and a 36°C irrigation solution in group 3 (12 rabbits, 24 eyes). In each group of animals, the mean irrigation/aspiration time was 30 minutes for left eyes and 60 minutes for right eyes. Histological examination of the retina was performed 1, 7, and 30 days after surgery. During surgery, the temperature in the vitreous cavity of the eyes of rabbits of groups 1, 2, and 3 dropped by 26.0°C, 11.2°C (deep hypothermia), and 1.0°C (mild hypothermia), respectively. The highest rewarming rate was detected in group 1 (0.9°C/min) compared with group 2 (0.7°C/min) and group 3 (0.2°C/min). After 60 minutes of irrigation, retinal structural changes were detected in the animals of groups 1 and 2 (in contrast to the animals of group 3). After surgery with irrigation lasting 30 minutes, no retinal structural changes were observed. This study showed that temperature management, avoidance of intraoperative deep hypothermia, and prevention of rapid uncontrolled rewarming may protect the retinal morphology and increase the safety of prolonged vitreoretinal surgery.
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Affiliation(s)
- Lukyan Anatychuk
- Medical Department, Institute of Thermoelectricity of the National Academy of Sciences of Ukraine and the Ministry of Education and Science of Ukraine, Chernivtsi, Ukraine
- Department of Thermoelectricity, Yuriy Fedkovych Chernivtsi National University, Chernivtsi, Ukraine
| | - Oleg Zadorozhnyy
- Department of Laser Microsurgery of Eye Diseases, State Institution "The Filatov Institute of Eye Diseases and Tissue Therapy of the National Academy of Medical Sciences of Ukraine," Odesa, Ukraine
| | - Volodymyr Naumenko
- Department of Laser Microsurgery of Eye Diseases, State Institution "The Filatov Institute of Eye Diseases and Tissue Therapy of the National Academy of Medical Sciences of Ukraine," Odesa, Ukraine
| | - Eduard Maltsev
- Department of Laser Microsurgery of Eye Diseases, State Institution "The Filatov Institute of Eye Diseases and Tissue Therapy of the National Academy of Medical Sciences of Ukraine," Odesa, Ukraine
| | - Roman Kobylianskyi
- Medical Department, Institute of Thermoelectricity of the National Academy of Sciences of Ukraine and the Ministry of Education and Science of Ukraine, Chernivtsi, Ukraine
- Department of Thermoelectricity, Yuriy Fedkovych Chernivtsi National University, Chernivtsi, Ukraine
| | - Rudolph Nazaretyan
- Department of Laser Microsurgery of Eye Diseases, State Institution "The Filatov Institute of Eye Diseases and Tissue Therapy of the National Academy of Medical Sciences of Ukraine," Odesa, Ukraine
| | - Mykola Umanets
- Department of Laser Microsurgery of Eye Diseases, State Institution "The Filatov Institute of Eye Diseases and Tissue Therapy of the National Academy of Medical Sciences of Ukraine," Odesa, Ukraine
| | - Taras Kustryn
- Department of Laser Microsurgery of Eye Diseases, State Institution "The Filatov Institute of Eye Diseases and Tissue Therapy of the National Academy of Medical Sciences of Ukraine," Odesa, Ukraine
| | - Illia Nasinnyk
- Department of Laser Microsurgery of Eye Diseases, State Institution "The Filatov Institute of Eye Diseases and Tissue Therapy of the National Academy of Medical Sciences of Ukraine," Odesa, Ukraine
| | - Andrii Korol
- Department of Laser Microsurgery of Eye Diseases, State Institution "The Filatov Institute of Eye Diseases and Tissue Therapy of the National Academy of Medical Sciences of Ukraine," Odesa, Ukraine
| | - Nataliya Pasyechnikova
- Department of Laser Microsurgery of Eye Diseases, State Institution "The Filatov Institute of Eye Diseases and Tissue Therapy of the National Academy of Medical Sciences of Ukraine," Odesa, Ukraine
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Optic Capture Without Anterior Vitrectomy in Pediatric Cataract Surgery. Am J Ophthalmol 2023; 247:88-95. [PMID: 36375587 DOI: 10.1016/j.ajo.2022.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 11/13/2022]
Abstract
PURPOSE To compare outcomes of 2 surgical techniques in children undergoing cataract surgery with intraocular lens (IOL) implantation: optic capture of IOL without anterior vitrectomy (AV) or in-the-bag IOL with AV. DESIGN Prospective randomized controlled trial. METHODS Patients were randomized to 2 groups: optic capture without AV (group 1) or in-the-bag implantation with AV (group 2). The following variables were compared: visual axis opacification (VAO), inflammatory deposits on IOL surface, anteroposterior synechia, IOL tilt and decentration, lenticular astigmatism, refractive prediction error, and posterior segment complications. RESULTS Fifty-one eyes of 37 children were investigated with a mean follow-up of 20.1±8.5 months. Group 1 and group 2 had mean ages of 59.2±32.6 and 46.5±21.9 months, respectively (P = .104). Three eyes in group 1 and 2 eyes in group 2 developed VAO (P = .656). Two eyes in group 1 and 5 eyes in group 2 developed anteroposterior synechia (P = .291). Six eyes in group 1 and 11 eyes in group 2 had inflammatory deposits on the IOL (P = .233). Both groups had similar IOL tilt and decentralization (for all meridians, P > .05). The absolute refractive prediction error was 0.55±0.34 diopter (D) and 0.53±0.3 D, respectively (P = .294). Each group had 1 eye with intraocular hypertension (P = .932). CONCLUSION The optic capture method was similar to the conventional technique in the quantitative evaluation of comprehensive data such as visual axis opacification, inflammatory sequelae, refractive outcomes, and IOL stability. The optic capture technique is an appealing option for pediatric cataract surgery because it eliminates the requirement for vitrectomy.
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10
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Du J, Landa G. Impact of prior pars plana vitrectomy on development of cystoid macular edema after uneventful cataract surgery. J Cataract Refract Surg 2023; 49:266-271. [PMID: 36384754 DOI: 10.1097/j.jcrs.0000000000001097] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 11/10/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE To investigate whether a history of prior pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) predisposes to the development of pseudophakic cystoid macular edema (CME). SETTING New York Eye and Ear Infirmary of Mount Sinai, New York, New York. DESIGN Retrospective cohort study. METHODS Records of 365 subjects who underwent PPV for RRD and subsequent cataract surgery between 2017 and 2020 were reviewed. Patients with a history of diabetic retinopathy, inflammatory retinal vascular disease, uveitis, advanced age-related macular degeneration, intraocular infection, myopic maculopathy, or significant intraoperative complications precluding posterior chamber intraocular lens placement were excluded. Age-matched subjects who underwent routine cataract surgery served as controls. Clinical data and macular optical coherence tomography (OCT) findings up to 4 years postoperatively were obtained. RESULTS 54 eyes underwent uneventful cataract surgery by phacoemulsification and had a history of PPV with gas tamponade. 55 eyes underwent uneventful cataract surgery only. The average follow-up time after cataract surgery was 39.1 months. In eyes with a history of PPV, the incidence of OCT-detected CME was 27.8% (15/54) compared with 3.8% (2/55) in the control group ( P < .001) and the incidence of clinically significant CME was 18.5% (10/54) compared with 1.8% (1/55) in the control group ( P = .004). 80% (12/15) of CME cases were treated with topical therapy, and none required intravitreal injection. CONCLUSIONS Prior PPV for RRD is associated with an increased incidence of pseudophakic CME after uneventful cataract surgery. Prophylactic or prolonged postoperative anti-inflammatory topical therapy may be prudent to consider in these patients.
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Affiliation(s)
- Jeanette Du
- From the Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York (Du, Landa); Icahn School of Medicine at Mount Sinai, New York, New York (Landa)
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11
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Motta L, Frisina R, Ripa M, Gius I, Greggio A, Tozzi L, De Salvo G, Meduri A. Postoperative complications after successful primary rhegmatogenous retinal detachment repair. BMC Ophthalmol 2023; 23:77. [PMID: 36829144 PMCID: PMC9960660 DOI: 10.1186/s12886-023-02824-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 02/17/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND To evaluate the incidence and risk factors for cystoid macular edema (CME) and epiretinal membrane (ERM) development after surgery for primary rhegmatogenous retinal detachment (RRD). METHODS Retrospective observational cohort study involving 62 consecutive patients with primary RRD who underwent RRD repair with either scleral buckling (SB) or pars plana vitrectomy (PPV). SB was used in young phakic patients without posterior vitreous detachment (PVD), high myopic patients, and RRD associated with either anterior or inferior retinal tears. PPV was preferred over SB in pseudophakic patients or those with media opacity and posterior breaks that precluded the SB approach. After surgery, the macular changes, including CME and ERM development, were evaluated 3 and 6 months postoperatively. Phacoemulsification and intraocular lens (IOL) implantation were performed in phakic patients where media opacity or lens bulging did not allow the surgeon to perform surgical maneuvers. The inner limiting membrane (ILM) peeling was randomly performed in the macula-off and the macula-on RRD "pending foveal detachment" subgroup. RESULTS Sixty-two eyes affected by RRD who underwent SB or PPV were enrolled. CME occurred in 33.3% of the PPV group regardless of the ERM formation. No CME cases were found in the SB group. Macula-off RRD increased the risk of CME by odds ratio (OR) = 4.3 times compared to macula-on RRD regardless of the surgical procedure (p = 0.04). Macula-off status increased the risk of CME of OR = 1.73 times compared to macula-on in the PPV subgroup (p = 0.4). Combined cataract surgery and PPV increased the risk of CME by OR = 3.3 times (p = 0.16) compared to PPV alone, and ILM peeling increased the risk of postoperative CME by OR = 1.8 times (p = 0.37). ERM occurred in 28% of patients who did not undergo ILM peeling, and 29.42% of those who underwent ILM peeling developed ERM (p = 0.6). CONCLUSIONS The risk of postoperative CME was higher in patients with macula-off than in macula-on RRD and in those with macula-off RRD who underwent PPV. The SB would be advisable in patients with RRD sparing the macula. Furthermore, despite having several advantages, the combined phacoemulsification plus IOL implantation and PPV highly increased the risk of postoperative CME.
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Affiliation(s)
- Lorenzo Motta
- grid.417122.30000 0004 0398 7998Department of Ophthalmology, William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford, UK
| | - Rino Frisina
- grid.413861.9Department of Guglielmo da Saliceto Hospital, Ophthalmology Unit of Surgery, Piacenza, Italy
| | - Matteo Ripa
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy. .,Catholic University "Sacro Cuore", Rome, Italy.
| | - Irene Gius
- grid.5608.b0000 0004 1757 3470Ophthalmology Department, University of Padova, Padova, Italy
| | - Angelo Greggio
- grid.5608.b0000 0004 1757 3470Ophthalmology Department, University of Padova, Padova, Italy
| | - Luigi Tozzi
- grid.410345.70000 0004 1756 7871Ophthalmology department, San Martino Hospital, Belluno, Italy
| | - Gabriella De Salvo
- grid.430506.40000 0004 0465 4079Eye Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Alessandro Meduri
- grid.10438.3e0000 0001 2178 8421Department of Biomedical Sciences, Eye Clinic, University of Messina, Messina, Italy
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Intravitreal Dexamethasone Implant at the Time of Silicon Oil Removal to Treat Persistent Macular Edema after Rhegmatogenous Retinal Detachment Repair. J Clin Med 2023; 12:jcm12041697. [PMID: 36836233 PMCID: PMC9962319 DOI: 10.3390/jcm12041697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/16/2023] [Accepted: 02/19/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND An intravitreal dexamethasone implant (DEX-I) was found to be effective and safe for the treatment of cystoid macular edema (CME) after vitrectomy for rhegmatogenous retinal detachment (RRD) and in silicone oil (SO)-filled eyes. We aimed to investigate the efficacy and safety of DEX-I at the time of SO removal for the treatment of recalcitrant CME after successful RRD repair. METHODS A retrospective review of the medical records was performed on 24 consecutive patients (24 eyes) with recalcitrant CME after RRD repair who were treated with a single 0.7-mg DEX-I at the time of SO removal. The main outcome measures were changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT). A regression model was performed to assess the relationship between BCVA and CMT at 6 months and independent variables. RESULTS In all 24 patients, CME occurred after RRD repair and remained despite topical therapy. The mean time of CME onset was 27.4 ± 7.7 days after vitrectomy. The mean time between vitrectomy and DEX-I was 106.8 ± 10.1 days. The mean CMT was significantly decreased from 429.6 ± 59.1 µm at baseline to 294 ± 46.4 µm at month 6 (p < 0.0001). The mean BCVA significantly improved from 0.99 ± 0.3 at baseline to 0.60 ± 0.3 at month 6 (p < 0.0001). An elevation of intraocular pressure was observed in one (4.1%) eye, which was medically managed. A univariate regression model revealed a relationship between month-6 BCVA after DEX-I and gender (β = -0.27; p = 0.03) and macular status (β = -0.45; p = 0.001) when RRD occurred. No relationship between month-6 CMT and independent variables was found. CONCLUSIONS DEX-I at the time of SO removal had an acceptable safety profile and achieved favorable outcomes in eyes affected by recalcitrant CME that occurred after RRD repair. RRD-related macular status is significantly associated with visual acuity after DEX-I.
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Lazzara F, Conti F, Ferrara M, Lippera M, Coppola M, Rossi S, Drago F, Bucolo C, Romano MR. Safety Profile of Lutein- Versus Triamcinolone Acetonide-Based Vitreous Staining. Transl Vis Sci Technol 2023; 12:5. [PMID: 36598459 PMCID: PMC9832719 DOI: 10.1167/tvst.12.1.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Purpose To assess the safety profile of a new lutein-based vitreous dye (LB-VD) formulation compared with various triamcinolone acetonide (TA) formulations with and without subsequent exposure to perfluorodecalin (PFD) in vitro. Methods Human adult retinal pigment epithelial cells (ARPE-19) were treated with the following formulations: undiluted preserved TA (TA-BA), diluted preserved TA (D-TA-BA), preservative-free TA (TA-PF), and LB-VD. First, cell tolerability was evaluated with MTT, LDH, and ATPlite assays after 1, 5, and 30 minutes of exposure to each tested formulation. Then, cells were sequentially exposed to formulations and PFD. After 24 hours of exposure to PFD, cell tolerability was evaluated through MTT and ATPlite assays. Results Among the formulations tested, LB-VD showed the highest levels of cell viability, cell metabolism, and cell proliferation and induced the lowest release of LDH, whereas the TA-based formulations demonstrated a cytotoxic effect on ARPE-19 cells in vitro. After subsequent 24-hour exposure to PFD, a greater reduction of cell viability was noted for all the formulations; however, this reduction was not significant only for the combination LB-VD-PFD, which was the best tolerated condition. Conclusions LB-VD showed a better safety profile compared with all TA-based formulations, even when used in combination with PFD. Translational Relevance In surgical practice, LB-VD may be preferred to TA-based formulations for vitreous staining in the light of its more favorable safety profile.
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Affiliation(s)
- Francesca Lazzara
- Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, Catania, Italy
| | - Federica Conti
- Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, Catania, Italy
| | - Mariantonia Ferrara
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Myrta Lippera
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Michele Coppola
- Department of Ophthalmology, San Gerardo Hospital, Monza, Italy
| | - Settimio Rossi
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Filippo Drago
- Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, Catania, Italy,Center for Research in Ocular Pharmacology–CERFO, University of Catania, Catania, Italy
| | - Claudio Bucolo
- Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, Catania, Italy,Center for Research in Ocular Pharmacology–CERFO, University of Catania, Catania, Italy
| | - Mario R. Romano
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy,Eye Center, Humanitas Gavazzeni-Castelli, Bergamo, Italy
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14
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Cristescu IE, Ivanova T, Moussa G, Ferrara M, Patton N, Dhawahir-Scala F, Ch’ng SW, Mitra A, Tyagi AK, Lett KS, Jalil A. Functional and Anatomical Outcomes of Pars Plana Vitrectomy for Epiretinal Membrane in Patients with Uveitis. Diagnostics (Basel) 2022; 12:diagnostics12123044. [PMID: 36553051 PMCID: PMC9777241 DOI: 10.3390/diagnostics12123044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/24/2022] [Accepted: 11/26/2022] [Indexed: 12/12/2022] Open
Abstract
Purpose-To evaluate the anatomical and functional outcomes of vitrectomy and epiretinal membrane (ERM) peeling in patients with uveitis. Secondarily, we evaluated the effect of internal limiting membrane (ILM) peeling on surgical outcomes, and of surgery on uveitis activity and, thus, therapeutic regime. Methods-Bicentre, retrospective, interventional case series of 29 eyes of 29 consecutive patients affected by uveitis and ERM, that had undergone pars plana vitrectomy with ERM peel between 2012 and 2020, with a minimum postoperative follow-up (FU) of six-months. Demographic data, best-corrected visual-acuity (BCVA), clinical findings, intraoperative and postoperative complications, and macular optical-coherence-tomography scans were reviewed. Results-The mean (standard deviation) duration of follow-up was 32 (22) months. At six-month FU, mean central-retinal-thickness (CRT) significantly improved (from 456 (99) to 353 (86) microns; p < 0.001), and mean BCVA improved from 0.73 (0.3) to 0.49 (0.36) logMAR (p < 0.001), with only one (3%) patient experiencing worsening of vision. The rate of concomitant cystoid macular edema decreased from 19 (66%) eyes at presentation to eight (28%) eyes at final-FU (p = 0.003). Comparing eyes in which ILM peeling was performed in addition to ERM peeling only, BCVA or CRT reduction were comparable. Only a minority of six (21%) eyes had a worsening in uveitis activity requiring additional medications, whereas most patients resumed the same treatment (52%) or received less treatment (28%) (p = 0.673). Conclusions-Vitrectomy with ERM peeling led to favourable anatomical and functional outcomes in patients with uveitis regardless of whether the ILM is peeled or not. As in most patients, no activation of the uveitis requiring additional medications was noted, we do not recommend changes in anti-inflammatory/immunosuppressive therapy postoperatively.
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Affiliation(s)
- Irina-Elena Cristescu
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL, UK
| | - Tsveta Ivanova
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL, UK
| | - George Moussa
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL, UK
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham B18 7QH, UK
- Correspondence: ; Tel.: +161-276-1234
| | - Mariantonia Ferrara
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL, UK
| | - Niall Patton
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL, UK
| | - Felipe Dhawahir-Scala
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL, UK
| | - Soon Wai Ch’ng
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham B18 7QH, UK
| | - Arijit Mitra
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham B18 7QH, UK
| | - Ajai K. Tyagi
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham B18 7QH, UK
| | - Kim Son Lett
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham B18 7QH, UK
| | - Assad Jalil
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL, UK
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15
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Ferrara M, Zheng Y, Romano V. Editorial: Imaging in Ophthalmology. J Clin Med 2022; 11:jcm11185433. [PMID: 36143079 PMCID: PMC9503085 DOI: 10.3390/jcm11185433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
Over the last decade, ophthalmology has significantly benefited from advances in vivo non-invasive ophthalmic imaging techniques that play currently a fundamental role in the clinical assessment, diagnosis, management, and monitoring of a wide variety of conditions involving both the anterior and posterior segment [...]
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Affiliation(s)
| | - Yalin Zheng
- Department of Eye and Vision Science, University of Liverpool, Liverpool L69 3BX, UK
- St Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool L69 3BX, UK
| | - Vito Romano
- Eye Clinic, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, 25121 Brescia, Italy
- ASST Civil Hospital of Brescia, 25123 Brescia, Italy
- Correspondence:
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16
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Retinal and Corneal Changes Associated with Intraocular Silicone Oil Tamponade. J Clin Med 2022; 11:jcm11175234. [PMID: 36079165 PMCID: PMC9457190 DOI: 10.3390/jcm11175234] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/13/2022] [Accepted: 09/01/2022] [Indexed: 12/22/2022] Open
Abstract
Silicone oils (SO) are used as long-term intraocular tamponades and have an irreplaceable role in vitreoretinal surgery. They can, however, be associated with multiple and potentially severe complications, involving different ocular tissues, in particular retina and cornea. Recent advances in ophthalmic imaging have allowed the precise characterization of retinal and corneal microstructural changes, at a subclinical level. This detailed analysis of SO-related retinal and corneal changes has improved our understanding of their pathogenesis and offer the potential for optimized monitoring and management of patients with SO-filled eyes. This review aims to provide clinicians and ophthalmic scientists with an updated and comprehensive overview of the corneal and retinal changes associated with SO tamponade.
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17
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Chronopoulos A, Chronopoulos P, Hattenbach LO, Ashurov A, Schutz JS, Pfeiffer N, Korb C. Intravitreal fluocinolone acetonide implant for chronic postoperative cystoid macular edema - two years results. Eur J Ophthalmol 2022; 33:11206721221124688. [PMID: 36062617 DOI: 10.1177/11206721221124688] [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: 11/15/2022]
Abstract
PURPOSE We report visual and anatomical outcomes of chronic postoperative macular edema treated with a fluocinolone acetonide intravitreal implant. METHOD Retrospective study of chronic, post-surgical CME treated with a fluocinolone acetonide intravitreal implant. Best registered visual acuity (BRVA), central retinal thickness (CRT), and Goldmann tonometry intraocular pressure (IOP) were assessed over 24 months. The need for IOP lowering treatment, top-up therapy during follow-up, and complications were also assessed. RESULTS We analyzed 16 consecutive eyes of 16 patients with chronic, post-surgical CME treated with fluocinolone acetonide intravitreal implant. Surgical indications included cataract surgery, vitrectomy plus membrane peeling and combined phaco-vitrectomy. Baseline mean BRVA of 0.8 ± 0.65 logMAR improved to 0.60 ± 0.4 logMAR (p = 0.02) at 12 months and to 0.7 ± 0.5 logMAR (p = 0.32) at 24 months. At month 12, BRVA improved in 11 eyes, stabilized in 4 eyes, and decreased in 1 eye. At month 24, VA remained improved in 5 eyes, remained stabilized in 5 eyes, and decreased in 1 eye. Mean CRT decreased from 524 ± 132 μm at baseline to 389 μm at month 3, 347 μm at month 6, 355 ± 106 μm (p = 0.0003) at month 12, and 313 ± 83 μm (p = 0.0001) at month 24. At 12 months, CRT improved in 13 eyes and remained unchanged in 2 eyes. At 24 months, CRT improved further in 8 eyes, and stabilized in 3 eyes. Increased IOP (≥21 mmHg) was observed only in 4 eyes, all successfully managed with topical medication. No further side effects were observed in any patient. CONCLUSION Visual and anatomic improvements were achieved by a single fluocinolone acetonide implant with few side effects up to 24 months in CME eyes with a long and heavy prior treatment history.
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Affiliation(s)
- Argyrios Chronopoulos
- Department of Ophthalmology, 9209Ludwigshafen Hospital, Ludwigshafen am Rhein, Germany
| | - Panagiotis Chronopoulos
- Department of Ophthalmology, 39068University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - L O Hattenbach
- Department of Ophthalmology, 9209Ludwigshafen Hospital, Ludwigshafen am Rhein, Germany
| | - Agharza Ashurov
- Department of Ophthalmology, 9209Ludwigshafen Hospital, Ludwigshafen am Rhein, Germany
| | - James S Schutz
- Department of Ophthalmology, 9209Ludwigshafen Hospital, Ludwigshafen am Rhein, Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, 39068University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Christina Korb
- Department of Ophthalmology, 39068University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
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Merad M, Vérité F, Baudin F, Ghezala IB, Meillon C, Bron AM, Arnould L, Eid P, Creuzot-Garcher C, Gabrielle PH. Cystoid Macular Edema after Rhegmatogenous Retinal Detachment Repair with Pars Plana Vitrectomy: Rate, Risk Factors, and Outcomes. J Clin Med 2022; 11:jcm11164914. [PMID: 36013153 PMCID: PMC9410086 DOI: 10.3390/jcm11164914] [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: 07/01/2022] [Revised: 08/18/2022] [Accepted: 08/19/2022] [Indexed: 11/26/2022] Open
Abstract
(1) Background: The aim was to describe the rate and outcomes of cystoid macular edema (CME) after pars plana vitrectomy (PPV) for primary rhegmatogenous retinal detachment (RRD) and to identify risk factors and imaging characteristics. (2) Methods: A retrospective consecutive case study was conducted over a 5-year period among adult patients who underwent PPV for primary RRD repair. The main outcome measure was the rate of CME at 12 months following PPV. (3) Results: Overall, 493 eyes were included. The CME rate was 28% (93 patients) at 12 months. In multivariate analysis, eyes with worse presenting visual acuity (VA) (odds ratio [OR], 1.55; 95% CI, 1.07–2.25; p = 0.02) and grade C proliferative vitreoretinopathy (PVR) (OR, 2.88; 95% CI, 1.04–8.16; p = 0.04) were more at risk of developing CME 1 year after PPV. Endolaser retinopexy was associated with a greater risk of CME than cryotherapy retinopexy (OR, 3.06; 95% CI, 1.33–7.84; p = 0.01). Eyes undergoing cataract surgery within 6 months of the initial RRD repair were more likely to develop CME at 12 months (OR, 1.96; 95% CI, 1.06–3.63; p = 0.03). (4) Conclusions: CME is a common complication after PPV for primary RRD repair. Eyes with worse presenting VA, severe PVR at initial presentation, endolaser retinopexy, and cataract surgery within 6 months of initial RRD repair were risk factors for postoperative CME at 12 months.
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Affiliation(s)
- Malik Merad
- Department of Ophthalmology, Dijon University Hospital, 21000 Dijon, France
| | - Fabien Vérité
- Agathe Group INSERM U 1150, UMR 7222 CNRS, ISIR (Institute of Intelligent Systems and Robotics), Sorbonne Université, 75005 Paris, France
| | - Florian Baudin
- Department of Ophthalmology, Dijon University Hospital, 21000 Dijon, France
| | - Inès Ben Ghezala
- Department of Ophthalmology, Dijon University Hospital, 21000 Dijon, France
| | - Cyril Meillon
- Department of Ophthalmology, Dijon University Hospital, 21000 Dijon, France
| | - Alain Marie Bron
- Department of Ophthalmology, Dijon University Hospital, 21000 Dijon, France
- Eye and Nutrition Research Group, Centre des Sciences du Goût et de l’Alimentation, AgroSup Dijon, CNRS, INRAE, Université de Bourgogne Franche-Comté, 21000 Dijon, France
| | - Louis Arnould
- Department of Ophthalmology, Dijon University Hospital, 21000 Dijon, France
| | - Pétra Eid
- Department of Ophthalmology, Dijon University Hospital, 21000 Dijon, France
| | - Catherine Creuzot-Garcher
- Department of Ophthalmology, Dijon University Hospital, 21000 Dijon, France
- Eye and Nutrition Research Group, Centre des Sciences du Goût et de l’Alimentation, AgroSup Dijon, CNRS, INRAE, Université de Bourgogne Franche-Comté, 21000 Dijon, France
| | - Pierre-Henry Gabrielle
- Department of Ophthalmology, Dijon University Hospital, 21000 Dijon, France
- Eye and Nutrition Research Group, Centre des Sciences du Goût et de l’Alimentation, AgroSup Dijon, CNRS, INRAE, Université de Bourgogne Franche-Comté, 21000 Dijon, France
- Correspondence: ; Tel.: +33-380-293-031
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Pessoa B, Heitor J, Coelho C, Leander M, Menéres P, Figueira J, Meireles A, Beirão M. Systemic and vitreous biomarkers - new insights in diabetic retinopathy. Graefes Arch Clin Exp Ophthalmol 2022; 260:2449-2460. [PMID: 35325286 DOI: 10.1007/s00417-022-05624-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/17/2022] [Accepted: 03/05/2022] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Diabetic retinopathy (DR) is a microvascular inflammatory and neurodegenerative disease. The purpose of this study was to analyze the relationship between DR severity and the levels of potential biomarkers in the serum and/or vitreous. METHODS A prospective, consecutive, controlled, observational study was performed between June 2018 and January 2020. Blood and vitreous samples were collected on the day of vitrectomy in patients without diabetes and in patients with diabetes with epiretinal membrane, macular edema, and indication for vitrectomy. RESULTS Transthyretin (TTR) was the only blood biomarker with levels statistically higher in patients with diabetes (p = 0.037). However, no correlation with DR severity was observed. Erythropoietin (EPO) was the only blood biomarker whose levels were associated with DR severity (p = 0.036). In vitreous samples, levels of EPO (p = 0.011), interleukin (IL)-6 (p < 0.001), IL-8 (p < 0.001), IL-17 (p = 0.022), monokine induced by interferon-γ (MIG) (p < 0.001), and interferon gamma-induced protein 10 (IP-10) (p = 0.005) were significantly higher in patients with diabetes. Additionally, in vitreous, IL-6, IL-8, MIG, and IPL-10 levels were also higher in more severe DR cases (p < 0.05). CONCLUSIONS Among the studied biomarkers, vitreous IL-6, IL-8, MIG, and IP-10 were the ones whose levels had the strongest coherent relationship with DR severity prediction and, thus, have the best potential post-vitrectomy prognostic value.
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Affiliation(s)
- Bernardete Pessoa
- Departamento de Oftalmologia, Hospital de Santo António, Centro Hospitalar Universitário Do Porto, Largo Prof. Abel Salazar-Edifício Neoclássico, 4099-001, Porto, Portugal.
- Unit for Multidisciplinary Investigations in Biomedicine (UMIB/ICBAS/UP), Porto, Portugal.
- Laboratory of Cytometry, Unit for Diagnosis in Hematology, Clinical Hematology Department, Centro Hospitalar Universitário Do Porto, Porto, Portugal.
| | - João Heitor
- Departamento de Oftalmologia, Hospital de Santo António, Centro Hospitalar Universitário Do Porto, Largo Prof. Abel Salazar-Edifício Neoclássico, 4099-001, Porto, Portugal
- Laboratory of Cytometry, Unit for Diagnosis in Hematology, Clinical Hematology Department, Centro Hospitalar Universitário Do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade Do Porto, Porto, Portugal
| | - Constança Coelho
- Laboratory of Cytometry, Unit for Diagnosis in Hematology, Clinical Hematology Department, Centro Hospitalar Universitário Do Porto, Porto, Portugal
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Magdalena Leander
- Unit for Multidisciplinary Investigations in Biomedicine (UMIB/ICBAS/UP), Porto, Portugal
- Laboratory of Cytometry, Unit for Diagnosis in Hematology, Clinical Hematology Department, Centro Hospitalar Universitário Do Porto, Porto, Portugal
| | - Pedro Menéres
- Departamento de Oftalmologia, Hospital de Santo António, Centro Hospitalar Universitário Do Porto, Largo Prof. Abel Salazar-Edifício Neoclássico, 4099-001, Porto, Portugal
- Laboratory of Cytometry, Unit for Diagnosis in Hematology, Clinical Hematology Department, Centro Hospitalar Universitário Do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade Do Porto, Porto, Portugal
| | - João Figueira
- Laboratory of Cytometry, Unit for Diagnosis in Hematology, Clinical Hematology Department, Centro Hospitalar Universitário Do Porto, Porto, Portugal
- Centro Hospitalar E Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Association for Innovation and Biomedical Research On Light and Image, Coimbra, Portugal
| | - Angelina Meireles
- Departamento de Oftalmologia, Hospital de Santo António, Centro Hospitalar Universitário Do Porto, Largo Prof. Abel Salazar-Edifício Neoclássico, 4099-001, Porto, Portugal
- Laboratory of Cytometry, Unit for Diagnosis in Hematology, Clinical Hematology Department, Centro Hospitalar Universitário Do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade Do Porto, Porto, Portugal
| | - Melo Beirão
- Departamento de Oftalmologia, Hospital de Santo António, Centro Hospitalar Universitário Do Porto, Largo Prof. Abel Salazar-Edifício Neoclássico, 4099-001, Porto, Portugal
- Unit for Multidisciplinary Investigations in Biomedicine (UMIB/ICBAS/UP), Porto, Portugal
- Laboratory of Cytometry, Unit for Diagnosis in Hematology, Clinical Hematology Department, Centro Hospitalar Universitário Do Porto, Porto, Portugal
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Sborgia G, Niro A, Pastore V, Favale RA, Sborgia A, Gigliola S, Giuliani G, Grassi MO, Coassin M, Aiello F, Iaculli C, Reibaldi M, Boscia F, Alessio G. Mid-term safety and effectiveness of intravitreal dexamethasone implant to treat persistent cystoid macular edema in vitrectomized eyes for bacterial endophthalmitis. Graefes Arch Clin Exp Ophthalmol 2022; 260:2703-2710. [PMID: 35254512 DOI: 10.1007/s00417-022-05615-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 02/22/2022] [Accepted: 03/01/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To evaluate the mid-term safety and effectiveness of intravitreal dexamethasone implant (DEX-i) for treating unresponsive to medical therapy cystoid macular edema (CME) in vitrectomized eyes for endophthalmitis. METHODS Retrospective and interventional case series study conducted on vitrectomized eyes for endophthalmitis that developed a CME that did not adequately respond to medical therapy, who underwent 0.7-mg DEX-i. Main outcome measures were changes in central retinal thickness (CRT) and best corrected visual acuity (BCVA). RESULTS Eleven eyes were included in the study. Microbiological findings of vitreous biopsies were 7 (63.6%) staphylococcus epidermidis; 3 (27.3%) Pseudomonas aeruginosa; and 1 (9.1%) Propionibacterium acnes. Median (interquartile range, IqR) duration of CME was 4.0 (3.0-4.0) months. Median (IqR) time between vitrectomy and DEX-i was 9.0 (9.0-11.0) months. Median CRT was significantly decreased from 548.0 (412.8-572.5) µm at baseline to 308.0 (281.3-365.5) µm at month 6 (p = 0.0009, Friedman test). Median BCVA significantly improved from 38.0 (30.5-44.8) letters at baseline to 50.0 (46.8-53.0) letters at month 6 (p < 0.0001, Friedman), with 9 (81.8%) eyes gaining ≥ 10 letters. Elevation of intraocular pressure was observed in one (9.1%) eye, which was successfully controlled with medical therapy. No recurrence of endophthalmitis or other complications was observed. Eight (72.7%) eyes required an additional DEX-i, while 3 (27.3%) were successfully controlled with only one DEX-i. CME recurrence occurred in 5 (62.5%) Gram-positive and 3 (100.0%) Gram-negative bacteria (p = 0.2357). CONCLUSION In vitrectomized eyes for endophthalmitis affected by CME unresponsive to medical therapy, DEX-i had an acceptable safety profile and achieved favorable outcomes. The possibility of suppressing mechanisms for infection control should be taken into account, although correct management of endophthalmitis and long time without reactivation before DEX-i reduce the risk.
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Affiliation(s)
- Giancarlo Sborgia
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, 70124, Bari, Italy
| | - Alfredo Niro
- Eye Clinic, Hospital "SS Annunziata", ASL Taranto, Via F. Bruno, 1, 74010, Taranto, Italy.
| | - Valentina Pastore
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, 70124, Bari, Italy
| | - Rosa Anna Favale
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, 70124, Bari, Italy
| | - Alessandra Sborgia
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, 70124, Bari, Italy
| | - Samuele Gigliola
- Eye Clinic, Hospital "SS Annunziata", ASL Taranto, Via F. Bruno, 1, 74010, Taranto, Italy
| | - Gianluigi Giuliani
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, 70124, Bari, Italy
| | - Maria Oliva Grassi
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, 70124, Bari, Italy
| | - Marco Coassin
- Ophthalmology, University Campus Bio Medico of Rome, 00128, Rome, Italy
| | - Francesco Aiello
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome "Tor Vergata", 00133, Rome, Italy
| | - Cristiana Iaculli
- Department of Ophthalmology, Policlinico Riuniti Di Foggia, University of Foggia, 71122, Foggia, Italy
| | - Michele Reibaldi
- Department of Surgical Sciences, University of Torino, 10126, Turin, Italy
| | - Francesco Boscia
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, 70124, Bari, Italy
| | - Giovanni Alessio
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, 70124, Bari, Italy
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21
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Etten PG, Overdam KA, Manning S, Faridpooya K, Wubbels RJ, Meurs JC, Verhoekx JS. Pseudophakic vitrectomy or phacovitrectomy for idiopathic epiretinal membranes and the risk of postoperative macular oedema. Acta Ophthalmol 2021; 100:e1352-e1353. [PMID: 34913273 DOI: 10.1111/aos.15083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 11/19/2021] [Accepted: 12/07/2021] [Indexed: 11/26/2022]
Affiliation(s)
| | | | - Sonia Manning
- The Rotterdam Eye Hospital Rotterdam The Netherlands
| | | | - René J. Wubbels
- The Rotterdam Ophthalmic Institute Rotterdam The Netherlands
| | - Jan C. Meurs
- The Rotterdam Eye Hospital Rotterdam The Netherlands
- Erasmus MC Rotterdam Rotterdam The Netherlands
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22
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Starr MR, Cai L, Obeid A, Ryan EH, Eliott D, Ryan C, Forbes NJ, Ammar M, Patel LG, Capone A, Emerson GG, Joseph DP, Gupta OP, Regillo CD, Hsu J, Yonekawa Y. Risk Factors for Presence of Cystoid Macular Edema following Rhegmatogenous Retinal Detachment Surgery. Curr Eye Res 2021; 46:1867-1875. [PMID: 33979556 DOI: 10.1080/02713683.2021.1929330] [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: 10/21/2022]
Abstract
Purpose: Cystoid macular edema (CME) following cataract surgery is a well-known entity. Less is known regarding the risk factors of developing CME following repair of rhegmatogenous retinal detachments (RRD).Methods: This was a multi-institutional study of primary RRD surgeries from 1/1/2015 through 12/31/2015. The primary outcome was the development of postoperative CME following RRD surgery. Post-operative optical coherence tomography imaging and 3 months of follow-up following RRD repair were required.Results: There were 1,466 eyes that met the inclusion criteria, and 140 (9.6%) developed postoperative CME following primary RRD repair. On multivariate analysis, the statistically significant metrics were older patient age (OR 1.03 per year, 95% CI 1.01 to 1.05), pre-operative proliferative vitreoretinopathy (PVR, OR 1.74, 95% 1.03 to 2.95), and cataract surgery following RRD repair (OR 2.18, 95% CI 1.47 to 3.25). Single surgery success was protective against CME (OR 0.20 (95% CI 0.14-0.30). Seventy-six (9.0%) of the phakic eyes and 60 (9.9%) of the pseudophakic eyes developed post-operative CME. Multivariate analysis showed that cataract surgery following RRD repair (p < .0001) for phakic eyes and older age (p = .0075) for pseudophakic eyes were risk factors. In eyes that underwent successful retinal reattachment with one surgery, post-operative cataract surgery (p = .0005) and pre-operative PVR (p = .0011) were risk factors for CME in this subgroup.Conclusion: CME occurred in nearly 10% of the eyes following RRD repair. The biggest risk factors were recurrent RRD, preexisting PVR, older age, and cataract surgery following RRD repair.
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Affiliation(s)
- Matthew R Starr
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Louis Cai
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Anthony Obeid
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Edwin H Ryan
- VitreoRetinal Surgery, Minneapolis, Minnesota, USA
| | - Dean Eliott
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Claire Ryan
- VitreoRetinal Surgery, Minneapolis, Minnesota, USA
| | | | - Michael Ammar
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Luv G Patel
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Antonio Capone
- Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | | | | | - Omesh P Gupta
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Carl D Regillo
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jason Hsu
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Yoshihiro Yonekawa
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Hu L, Chen Q, Du Z, Wang W, Zhao G. Evaluation of vitrectomy combined preoperative intravitreal ranibizumab and postoperative intravitreal triamcinolone acetonide for proliferative diabetic retinopathy. Int Ophthalmol 2021; 41:1635-1642. [PMID: 33538931 DOI: 10.1007/s10792-021-01703-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 01/08/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND To explore the treatment efficacy of the combination of preoperative intravitreal ranibizumab (IVR) and postoperative intravitreal triamcinolone acetonide (IVTA) in patients undergoing pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR). METHODS A retrospective comparative study was performed on 128 eyes of 128 patients who had PDR and underwent PPV. Patients who received a single PPV were assigned to Group A. Those who received PPV with preoperative IVR were assigned to Group B. Patients in Group C underwent PPV combined preoperative IVR and postoperative IVTA. Intraoperative findings, changes in mean best-corrected visual acuity (BCVA) and postoperative adverse events, were retrospectively evaluated at 6-month follow-up. RESULTS The incidences of iatrogenic breaks, severe intraoperative bleeding, using long-term internal tamponade agents, recurrent vitreous hemorrhage (VH), and duration of surgery were statistically significantly less in Group B and Group C than in Group A. The postoperative BCVA was statistically significantly better in Groups B and Group C than in Group A, respectively, at 1 month after surgery. The mean 3-month postoperative visual acuity was better in Group C. The incidence of high intraocular pressure (IOP) was significantly higher in Group C at the first postoperative week. There were no statistically significant differences in the incidence of exudative retinal detachment and choroidal detachment among the three groups. CONCLUSION In patients undergoing PPV for PDR, preoperative IVR significantly reduced the occurrence of intraoperative and postoperative complications, and the combination of preoperative IVR and postoperative IVTA can better improve the postoperative visual outcome.
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Affiliation(s)
- Liting Hu
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, Shandong Province, China
| | - Qiulu Chen
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, Shandong Province, China
| | - Zhaodong Du
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, Shandong Province, China.
| | - Wenying Wang
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, Shandong Province, China
| | - Guiqiu Zhao
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, Shandong Province, China
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Pole C, Chehaibou I, Govetto A, Garrity S, Schwartz SD, Hubschman JP. Macular edema after rhegmatogenous retinal detachment repair: risk factors, OCT analysis, and treatment responses. Int J Retina Vitreous 2021; 7:9. [PMID: 33494835 PMCID: PMC7831177 DOI: 10.1186/s40942-020-00254-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 10/28/2020] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To investigate risk factors, imaging characteristics, and treatment responses of cystoid macular edema (CME) after rhegmatogenous retinal detachment (RRD) repair. METHODS Consecutive, retrospective case-control series of patients who underwent pars plana vitrectomy (PPV) and/or scleral buckling (SB) for RRD, with at least six months of follow-up. Clinical and surgical parameters of patients with and without CME (nCME), based on spectral-domain optical coherence tomography (OCT), were compared. RESULTS Of 99 eyes enrolled, 25 had CME while 74 had nCME. Patients with CME underwent greater numbers of surgeries (P < 0.0001). After adjusting for number of surgeries, macula-off RRD (P = 0.06), proliferative vitreoretinopathy (PVR) (P = 0.09), surgical approach (PPV and/or SB, P = 0.21), and tamponade type (P = 0.10) were not statistically significant, although they all achieved significance on univariate analysis (P = 0.001 or less). Intraoperative retinectomy (P = 0.009) and postoperative pseudophakia or aphakia (P = 0.008) were more frequent in the CME group, even after adjustment. Characteristics of cCME on OCT included diffuse distribution, confluent cysts, and absence of subretinal fluid or intraretinal hyperreflective foci. Macular thickness improved significantly with intravitreal triamcinolone (P = 0.016), but not with anti-vascular endothelial growth factor agents (P = 0.828) or dexamethasone implant (P = 0.125). After adjusting for number of surgeries and macular detachment, final visual acuities remained significantly lower in the CME vs nCME group (P = 0.012). CONCLUSION Risk factors of CME include complex retinal detachment repairs requiring multiple surgeries, and pseudophakic or aphakic lens status. Although this cCME was associated with poor therapeutic response, corticosteroids were the most effective studied treatments.
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Affiliation(s)
- Cameron Pole
- Retina Division, Stein Eye Institute, University of California Los Angeles, 100 Stein Plaza, Los Angeles, CA, 90095-7002, USA
| | - Ismael Chehaibou
- Retina Division, Stein Eye Institute, University of California Los Angeles, 100 Stein Plaza, Los Angeles, CA, 90095-7002, USA.,Ophthalmology Department, AP-HP, Hôpital Lariboisière, Université de Paris, 75010, Paris, France
| | - Andrea Govetto
- Ophthalmology Department, Fatebenefratelli-Oftalmico Hospital, ASST-Fatebenefratelli-Sacco, Milan, Italy
| | - Sean Garrity
- Tufts Medical Center/New England Eye Center, Ophthalmic Consultants of Boston, Boston, MA, USA
| | - Steven D Schwartz
- Retina Division, Stein Eye Institute, University of California Los Angeles, 100 Stein Plaza, Los Angeles, CA, 90095-7002, USA
| | - Jean-Pierre Hubschman
- Retina Division, Stein Eye Institute, University of California Los Angeles, 100 Stein Plaza, Los Angeles, CA, 90095-7002, USA.
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25
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Anatychuk L, Pasyechnikova N, Naumenko V, Kobylianskyi R, Nazaretyan R, Zadorozhnyy O. Prospects of Temperature Management in Vitreoretinal Surgery. Ther Hypothermia Temp Manag 2020; 11:117-121. [PMID: 32679001 DOI: 10.1089/ther.2020.0019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Currently, there are no clear recommendations about the safety of certain temperature conditions for intraocular structures during vitreoretinal surgery; instructions on the safe rate of rewarming of the vitreous cavity; and the advisability of monitoring ocular temperature in the postoperative period. The purpose was to study the dynamics of epibulbar and intraocular temperature during vitreoretinal surgery. This study included 20 patients with rhegmatogenous retinal detachment (10 eyes) and retinal detachment associated with proliferative diabetic retinopathy (10 eyes). All patients underwent vitreoretinal surgery. In all cases, the ambient temperature, the patient's body temperature, the temperature of the irrigating solution, and temperature in the anterior, mid-, and posterior vitreous were recorded during surgery. Pre- and postoperative thermometry was also performed on the outer ocular surface. During vitreoretinal surgery with room temperature irrigation solution, a decrease in temperature (p < 0.001) versus the initial one was found in all segments of the vitreous cavity. In the absence of continuous irrigation, a rapid rewarming of the vitreous cavity was noted (an average of 0.18°C/min). Our study also demonstrated the presence of regional hyperthermia of the operated eye in a number of patients (25%) in the postoperative period. Current research shows that vitreoretinal surgery is performed under conditions of uncontrolled local ocular hypothermia and is characterized by a rapid uncontrolled rewarming of the vitreous cavity after cessation of cooling, and in the postoperative period local hyperthermia of the operated eye is observed in a number of patients.
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Affiliation(s)
- Lukyan Anatychuk
- Medical Department, Institute of Thermoelectricity of the National Academy of Sciences of Ukraine and the Ministry of Education and Science of Ukraine, Chernivtsi, Ukraine.,Department of Thermoelectricity and Medical Physics, Yuriy Fedkovych Chernivtsi National University, Chernivtsi, Ukraine
| | - Nataliya Pasyechnikova
- Department of Laser Microsurgery of Eye Diseases, State Institution "The Filatov Institute of Eye Diseases and Tissue Therapy of the National Academy of Medical Sciences of Ukraine," Odesa, Ukraine
| | - Volodimir Naumenko
- Department of Laser Microsurgery of Eye Diseases, State Institution "The Filatov Institute of Eye Diseases and Tissue Therapy of the National Academy of Medical Sciences of Ukraine," Odesa, Ukraine
| | - Roman Kobylianskyi
- Medical Department, Institute of Thermoelectricity of the National Academy of Sciences of Ukraine and the Ministry of Education and Science of Ukraine, Chernivtsi, Ukraine.,Department of Thermoelectricity and Medical Physics, Yuriy Fedkovych Chernivtsi National University, Chernivtsi, Ukraine
| | - Rudolf Nazaretyan
- Department of Laser Microsurgery of Eye Diseases, State Institution "The Filatov Institute of Eye Diseases and Tissue Therapy of the National Academy of Medical Sciences of Ukraine," Odesa, Ukraine
| | - Oleg Zadorozhnyy
- Department of Laser Microsurgery of Eye Diseases, State Institution "The Filatov Institute of Eye Diseases and Tissue Therapy of the National Academy of Medical Sciences of Ukraine," Odesa, Ukraine
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26
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Rate of hypotony and intraocular pressure fluctuation immediately after intravitreal dexamethasone implantation in vitrectomized eyes. J Fr Ophtalmol 2020; 43:103-110. [DOI: 10.1016/j.jfo.2019.07.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/05/2019] [Accepted: 07/10/2019] [Indexed: 11/18/2022]
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Chatziralli I, Dimitriou E, Theodossiadis G, Kazantzis D, Alonistiotis D, Theodossiadis P. Efficacy of intravitreal dexamethasone implant for the treatment of macular oedema after pars plana vitrectomy for rhegmatogenous retinal detachment: long-term outcomes. Cutan Ocul Toxicol 2019; 39:25-30. [PMID: 31691630 DOI: 10.1080/15569527.2019.1684315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: To investigate the efficacy and safety of intravitreal dexamethasone implant as initial and only treatment for macular oedema after pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD).Methods: This study included 14 patients, who were diagnosed with macular oedema after PPV for RRD and who were treated with intravitreal dexamethasone implant. Patients were examined at the time of macular oedema diagnosis (baseline) and 1, 6 and 12 months after treatment, using best corrected visual acuity (BCVA) measurement and optical coherence tomography (OCT).Results: The mean BCVA at baseline was 0.72 ± 0.29 logMAR and improved significantly to 0.37 ± 0.21, 0.42 ± 0.19 and 0.35 ± 0.22 logMAR at month 1, 6 and 12 after treatment with dexamethasone implant. The mean central retinal thickness (CRT) was 623 ± 142 μm at baseline and decreased significantly to 339 ± 163 μm, 428 ± 131 μm and 356 ± 147 μm at month 1, 6 and 12 after treatment. Total resolution of macular oedema was observed in 10 out of 14 patients (71.4%) at month 12. Ellipsoid zone was intact in 71.4% of patients at the end of the follow-up, while 71.4% of patients received only one implant until the end of the 12-month follow-up. No adverse events were observed.Conclusions: Intravitreal dexamethasone implant was found to be effective and safe as initial treatment for macular oedema after PPV for RRD.
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Affiliation(s)
- Irini Chatziralli
- 2nd Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Dimitriou
- 2nd Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
| | - George Theodossiadis
- 2nd Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Kazantzis
- 2nd Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Alonistiotis
- 2nd Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
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Chatziralli I, Theodossiadis G, Dimitriou E, Kazantzis D, Theodossiadis P. Macular Edema after Successful Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment: Factors Affecting Edema Development and Considerations for Treatment. Ocul Immunol Inflamm 2019; 29:187-192. [PMID: 31577459 DOI: 10.1080/09273948.2019.1652330] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: To investigate the incidence of macular edema after pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) repair, the factors affecting its development and the efficacy of intravitreal dexamethasone implant for its treatment.Methods: Participants in this study 86 patients with RRD. All patients were examined postoperatively and those with macular edema were treated with intravitreal dexamethasone implant and were followed-up for 12 months.Results: 14 out of 86 patients presented macular edema post PPV for RRD repair. Patients with preoperative macula off RRD, duration of RRD >1 week and proliferative vitreoretinopathy were more prone to develop macular edema. There was a statistically significant improvement in best corrected visual acuity and central retinal thickness at month 12 post intravitreal dexamethasone implant compared to baseline.Conclusions: The incidence of macular edema post PPV for RRD repair was found to be 16.3%. Intravitreal dexamethasone implant seemed to be safe and effective in cases with post-PPV macular edema after RRD repair.
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Affiliation(s)
- Irini Chatziralli
- 2nd Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
| | - George Theodossiadis
- 2 Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Dimitriou
- 2 Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Kazantzis
- 2 Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
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Coussa RG, Antaki F, Zaguia F, Vila N, Kapusta MA. Prognostic factors of postoperative intraretinal cystoid spaces after primary pars plana vitrectomy for vitreomacular traction. J Curr Ophthalmol 2019; 31:399-405. [PMID: 31844790 PMCID: PMC6896453 DOI: 10.1016/j.joco.2019.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/17/2019] [Accepted: 05/31/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose To study the anatomical and surgical prognostic factors related to developing postoperative intraretinal cystoid spaces (ICS) six months after 25-gauge pars plana vitrectomy (PPV) for vitreomacular traction (VMT). Methods The study is a retrospective case series of patients presenting with VMT treated primarily with PPV. All patients underwent 25-gauge PPV by the same retina surgeon. Intra-operative parameters were all recorded. Postoperative visual acuity (VA), foveal thickness, and ICS were collected over six months of follow-up. ICS were defined as hyporeflective cysts divided by hyperreflective septa on optical coherence tomography (OCT). Patients with ICS persistence 3 months postoperatively received topical treatment extension. The primary outcome measure was odds of preoperative ICS in patients with postoperative ICS compared to controls. Secondary outcome measures were odds of presence of an attached hyaloid to the optic disc, presence of pseudophakia, the use of intra-operative air, and the use of more than one intra-operative indocyanine green (ICG) injections in patients with postoperative ICS compared to controls. Results Two hundred and eighty treatment-naïve patients with preoperative diagnosis of epiretinal membrane (ERM) were reviewed. Thirty patients with VMT, confirmed both preoperatively on OCT and intra-operatively, were included. Postoperatively, 40% (n = 12) presented with ICS at 6 months. Among these, 83% (n = 10) had ICS prior to PPV. Patients presenting with preoperative ICS were significantly more at risk of having persistent ICS postoperatively (P < 0.05). The following factors did not statistically affect ICS occurrence: optic disc hyaloid attachment status, phakia/pseudophakia, intra-operative air vs. sulfur hexafluoride (SF6), and the number of intra-operative ICG injections. Conclusions Our data demonstrate a predictive relationship between the occurrence/persistence of ICS post-PPV for VMT and the initial foveal status. Specifically, having preoperative ICS is a major risk factor for its persistence postoperatively. Our data highlight the pathophysiological importance of the vitreous phase and its effect on visual prognosis.
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Affiliation(s)
- Razek Georges Coussa
- Department of Ophthalmology, Jewish General Hospital, McGill University Health Center, Montreal, Canada
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
- Corresponding author. Cole Eye Institute, Cleveland Clinic Main Campus, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
| | - Fares Antaki
- Department of Ophthalmology, Jewish General Hospital, McGill University Health Center, Montreal, Canada
- Department of Ophthalmology, Université de Montréal, Montreal, Canada
| | - Fatma Zaguia
- Department of Ophthalmology, Jewish General Hospital, McGill University Health Center, Montreal, Canada
| | - Natalia Vila
- Department of Ophthalmology, Jewish General Hospital, McGill University Health Center, Montreal, Canada
| | - Michael Alton Kapusta
- Department of Ophthalmology, Jewish General Hospital, McGill University Health Center, Montreal, Canada
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30
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Inner Retinal Layer and Outer Retinal Layer Findings after Macular Hole Surgery Assessed by means of Optical Coherence Tomography. J Ophthalmol 2019; 2019:3821479. [PMID: 31061725 PMCID: PMC6466935 DOI: 10.1155/2019/3821479] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 02/24/2019] [Indexed: 11/18/2022] Open
Abstract
Aim To summarize the spectrum of optical coherence tomography (OCT) and OCT angiography (OCTA) features after full-thickness macular hole (MH) repair surgery. Methods A PubMed engine search was carried out using the terms "Macular Hole," "Optical Coherence Tomography," and "Optical Coherence Tomography Angiography." All reports published in English up to October 2018, irrespective of their publication status, were included. Tomographic signs analyzed were divided according to the involved portion of the retina in "inner retinal layers" and "external retinal layers." Despite predominantly involving the inner retinal layers, cystoid macular edema (CME) has been treated as a separate entity. Finally, report on vessel density (VD) changes and the foveal avascular zone (FAZ) area modifications have been included. Results Different clinical findings can be observed on OCT of patients who underwent MH repair surgery. There is general consent that retinal thinning involving primarily the retinal nerve fiber layer and the ganglion cell layer takes place after surgery. In the postoperative period, the outermost retinal layers get progressively restored. Persistent defects in the ellipsoid zone or in the external limiting membrane correlate with worse postoperative visual outcome. OCTA has globally demonstrated that eyes after MH closure show a reduction in macular and paramacular VD and smaller FAZ areas, compared with control or fellow eyes. Conclusion Clinicians should be aware of the most common tomographic findings to properly manage each condition. In addition, significant advantages for the postoperative application of OCT and OCTA include noninvasiveness, rapid and simple execution, repeatability, and precise measurements.
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Bastakis GG, Dimopoulos D, Stavrakakis A, Pappas G. Long-term efficacy and duration of action of dexamethasone implant, in vitrectomised and non-vitrectomised eyes with persistent diabetic macular oedema. Eye (Lond) 2018; 33:411-418. [PMID: 30302004 DOI: 10.1038/s41433-018-0219-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 08/04/2018] [Accepted: 08/16/2018] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To evaluate the efficacy and duration of action of an intravitreal (dexamethasone (Ozurdex)) implant in vitrectomised and non-vitrectomised eyes with persistent diabetic macular oedema (DMO). METHODS We retrospectively analysed the records for 18 eyes that had or had not been vitrectomised but required an intravitreal dexamethasone implant for DMO after a poor response to anti-vascular endothelial growth factor. Optical coherence tomography and visual acuity (VA) examinations were performed before and 1, 3 and 6 months after implantation. The six months following implantation constituted one treatment round; up to three rounds were studied. RESULTS Ten of 18 eyes had undergone vitrectomy. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) were significantly improved by months 1-3 after implantation of the Ozurdex device in all rounds of treatment. The BCVA and CMT deteriorated gradually after month 3 through to month 6 post implantation. There were no statistically significant differences between the vitrectomised and non-vitrectomised groups at any time point. When the implantation interval was <6 weeks from the end of each treatment round, the improvement in BCVA and CMT was obvious even after 18 months of treatment. CONCLUSIONS Vitrectomy did not have a negative effect on the duration of action or efficacy of the Ozurdex implant in patients with persistent DMO. The implant started working from the first month after implantation regardless of whether vitrectomy had or had not been performed. The maximum functional and anatomic improvement was achieved in the first 3 months post implantation in all treatment rounds.
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Affiliation(s)
- George G Bastakis
- Ophthalmology Clinic, Medical Retina & Vitreoretinal Surgery Department, Venizeleio Hospital of Crete, Knossos avenue 44, Crete, 71409,, Heraklion, Greece
| | - Dimitris Dimopoulos
- Ophthalmology Clinic, Medical Retina & Vitreoretinal Surgery Department, Venizeleio Hospital of Crete, Knossos avenue 44, Crete, 71409,, Heraklion, Greece
| | - Anastasios Stavrakakis
- Ophthalmology Clinic, Medical Retina & Vitreoretinal Surgery Department, Venizeleio Hospital of Crete, Knossos avenue 44, Crete, 71409,, Heraklion, Greece
| | - George Pappas
- Ophthalmology Clinic, Medical Retina & Vitreoretinal Surgery Department, Venizeleio Hospital of Crete, Knossos avenue 44, Crete, 71409,, Heraklion, Greece.
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Thanos A, Todorich B, Yonekawa Y, Papakostas TD, Khundkar T, Eliott D, Dass AB, Williams GA, Capone A, Faia LJ, Wolfe JD, Hassan TS, Ruby AJ. DEXAMETHASONE INTRAVITREAL IMPLANT FOR THE TREATMENT OF RECALCITRANT MACULAR EDEMA AFTER RHEGMATOGENOUS RETINAL DETACHMENT REPAIR. Retina 2018. [PMID: 28622270 DOI: 10.1097/iae.0000000000001720] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the efficacy of the intravitreal dexamethasone implant as the treatment for recalcitrant macular edema after successful rhegmatogenous retinal detachment repair. METHODS A retrospective review of the medical records was performed on 17 consecutive patients (17 eyes) with recalcitrant macular edema associated with rhegmatogenous retinal detachment repair who were treated with a single or multiple injections of an intravitreal dexamethasone 0.7-mg implant (Ozurdex; Allergan Inc) at two centers. Main outcomes of the study were change in logarithm of the minimum angle of resolution visual acuity, measurement of central foveal thickness, and macular cube volume as measured by spectral domain optical coherence tomography and frequency of complications. RESULTS The mean age was 67 years (range, 51-78 years). All 17 patients received previous topical therapy and 12 of them had previous administration of intravitreal triamcinolone with persistence of macular edema. Baseline mean best-corrected visual acuity was 20/100 (logarithm of the minimum angle of resolution 0.75; range, 0.18-1.3 ±0.37) in the affected eyes. There was a statistically significant improvement in best-corrected visual acuity at 1 month (P < 0.001) and 3 months (P = 0.01). Mean baseline central foveal thickness was 505 μm, and mean macular cube volume was 10.62 mm. There was a statistically significant decrease in central foveal thickness and macular cube volume at 1 month (505-290 μm, P = 0.013 and 10.62-9.13 mm, P < 0.0001) and 3 months (P = 0.01). All patients developed recurrence of macular edema at 3 months, which required retreatment. The average number of implants was 4 (range, 1-14). No adverse effects such as retinal detachment or endophthalmitis occurred. Two patients experienced an increase in intraocular pressure that was controlled with topical therapy. CONCLUSION Macular edema that occurs in eyes after successful repair of rhegmatogenous retinal detachment can be chronic and recalcitrant, and may be successfully and safely treated with the dexamethasone intravitreal implant.
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Affiliation(s)
- Aristomenis Thanos
- Associated Retinal Consultants, William Beaumont Hospital, Royal Oak, Michigan
| | - Bozho Todorich
- Associated Retinal Consultants, William Beaumont Hospital, Royal Oak, Michigan
| | - Yoshihiro Yonekawa
- Retina Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Thanos D Papakostas
- Retina Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Tahsin Khundkar
- Oakland University, William Beaumont School of Medicine, Rochester, Michigan
| | - Dean Eliott
- Retina Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Ashvani B Dass
- Associated Retinal Consultants, William Beaumont Hospital, Royal Oak, Michigan
| | - George A Williams
- Associated Retinal Consultants, William Beaumont Hospital, Royal Oak, Michigan
| | - Antonio Capone
- Associated Retinal Consultants, William Beaumont Hospital, Royal Oak, Michigan
| | - Lisa J Faia
- Associated Retinal Consultants, William Beaumont Hospital, Royal Oak, Michigan
| | - Jeremy D Wolfe
- Associated Retinal Consultants, William Beaumont Hospital, Royal Oak, Michigan
| | - Tarek S Hassan
- Associated Retinal Consultants, William Beaumont Hospital, Royal Oak, Michigan
| | - Alan J Ruby
- Associated Retinal Consultants, William Beaumont Hospital, Royal Oak, Michigan
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Alfaqawi F, Sarmad A, Ayesh K, Mitra A, Sharma A. Intravitreal Fluocinolone Acetonide (ILUVIEN) Implant for the Treatment of Refractory Cystoid Macular Oedema After Retinal Detachment Repair. Turk J Ophthalmol 2018; 48:155-157. [PMID: 29988755 PMCID: PMC6032957 DOI: 10.4274/tjo.34966] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 01/24/2018] [Indexed: 12/01/2022] Open
Abstract
Cystoid macular oedema (CMO) is one of the most frequent postoperative macular complications to cause partial visual recovery after successful retinal detachment (RD) repair. Refractory CMO is difficult to treat and many strategies have been employed with varying degrees of success. We report for the first time the use of ILUVIEN implant to treat refractory CMO after successful RD repair. A 65-year-old female presented with right eye full-thickness macular hole and underwent pars plana vitrectomy, internal limiting membrane peeling and cryotherapy with gas tamponade with 12% C3F8. She subsequently developed right eye macula-on RD and proliferative vitreoretinopathy and required multiple procedures for successful retinal reattachment. Later, she developed CMO that responded to intravitreal triamcinolone injections and intravitreal dexamethasone 0.7-mg implants but recurrence of CMO continued to be a problem. After receiving ILUVIEN intravitreal implant, her visual acuity improved and CMO resolved without recurrence for 13 months. Refractory CMO after RD repair is difficult to treat and in a quarter of cases will not improve without treatment. Our case shows that a single ILUVIEN implant maintained anatomical dry fovea and improved vision. This also demonstrates that ILUVIEN is an effective management strategy to reduce the need for repeated treatments.
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Affiliation(s)
- Fadi Alfaqawi
- City Hospital, Birmingham and Midland Eye Centre, Ophthalmology Clinic, Birmingham, United Kingdom
| | - Ambreen Sarmad
- City Hospital, Birmingham and Midland Eye Centre, Ophthalmology Clinic, Birmingham, United Kingdom
| | - Kholoud Ayesh
- Alquds University Faculty of Medicine, Department of Ophthalmology, Abu Dis, Palestine
| | - Arijit Mitra
- City Hospital, Birmingham and Midland Eye Centre, Ophthalmology Clinic, Birmingham, United Kingdom
| | - Ash Sharma
- City Hospital, Birmingham and Midland Eye Centre, Ophthalmology Clinic, Birmingham, United Kingdom
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Therapeutic Effects of Methanol Extract from Euphorbia kansui Radix on Imiquimod-Induced Psoriasis. J Immunol Res 2017; 2017:7052560. [PMID: 28761880 PMCID: PMC5518522 DOI: 10.1155/2017/7052560] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 04/22/2017] [Accepted: 05/07/2017] [Indexed: 01/07/2023] Open
Abstract
The roots of Euphorbia kansui, which belong to the family Euphorbiaceae, have been used as a traditional medicine for the treatment of various diseases such as diabetes, ascites, and leukemia. Recently, it was reported that the methylene chloride fraction of E. kansui radix (EKC) regulated the differentiation of Th17 cells and alleviated the symptoms of Th17-related inflammatory bowel disease. Imiquimod (IMQ), a TLR7/8 agonist, has been used to induce psoriasis in a mouse model. In this study, we evaluated the effect of EKC in an IMQ-induced psoriasis model. EKC effectively inhibited the production of interleukin-17A and interferon-γ in vitro. On this basis, EKC was administered to an animal model of psoriasis. Acanthosis and the infiltration of inflammatory cells into the dermis were significantly reduced by EKC. EKC also inhibited the expression of IL-17A, IL-22, IL-23, IL-12, and RAR-related orphan receptor gamma t (RORγt) in the spleen, skin-draining lymph nodes, and the skin. Additionally, EKC inhibited the activity of dendritic cells but not that of keratinocytes. In conclusion, EKC ameliorated the symptoms of psoriasis through inhibition of Th17 differentiation and activation of dendritic cells. These effects are expected to be beneficial in the treatment and prevention of psoriasis.
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Controversies over the role of internal limiting membrane peeling during vitrectomy in macular hole surgery. Surv Ophthalmol 2017; 62:58-69. [DOI: 10.1016/j.survophthal.2016.07.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 07/18/2016] [Accepted: 07/22/2016] [Indexed: 02/02/2023]
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Twelve-Month Results of a Single or Multiple Dexamethasone Intravitreal Implant for Macular Edema following Uncomplicated Phacoemulsification. BIOMED RESEARCH INTERNATIONAL 2015; 2015:362564. [PMID: 26509151 PMCID: PMC4609771 DOI: 10.1155/2015/362564] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 02/17/2015] [Indexed: 11/18/2022]
Abstract
The clinical efficacy of one or two intravitreal injections of a continued deliverance dexamethasone 700 μg implant in ten patients with persistent macular edema following uncomplicated phacoemulsification was evaluated. Complete ophthalmological examination and spectral domain optical coherence tomography were carried out. Follow-up was at day 7 and months 1, 2, 4, 6, 8, and 12. At baseline mean best corrected visual acuity was 62 Early Treatment Diabetic Retinopathy Study Chart letters, which showed statistically significant improvement at each follow-up, except at month 6, to reach 79 letters at month 12 (P = 0.018). Prior to treatment mean central foveal thickness was 622 μm, which showed statistically significant improvement at each follow-up to reach a mean value of 282 μm (P = 0.012) at month 12. Five patients received a second dexamethasone implant at month 7. Two patients were excluded from the study at months 4 and 8. Intraocular pressure remained stable during the study period with the exception of mild increase in two patients requiring topical therapy. In conclusion there was statistically significant improvement of best corrected visual acuity and mean central foveal thickness with one or two intravitreal dexamethasone implants over 12 months.
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Watanabe A, Tsuzuki A, Arai K, Gekka T, Kohzaki K, Tsuneoka H. Efficacy of Intravitreal Triamcinolone Acetonide for Diabetic Macular Edema After Vitrectomy. J Ocul Pharmacol Ther 2015; 32:38-43. [PMID: 26325253 DOI: 10.1089/jop.2015.0045] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
PURPOSE To compare the efficacy of intravitreal injection of triamcinolone acetonide (IVTA) for diabetic macular edema (DME) in vitrectomized eyes with DME without vitrectomy eyes. METHODS This retrospective comparative study evaluated the efficacy of IVTA treatment of DME in 26 consecutive eyes (23 patients). Changes in mean best-corrected visual acuity (VA) and mean central retinal thickness (CRT) were retrospectively evaluated before IVTA and during the 6-month period after IVTA. RESULTS Subjects were divided into 2 groups: 13 consecutive eyes (11 patients) with proliferative diabetic retinopathy or DME that underwent vitrectomy (vitrectomized group), and 13 consecutive eyes (12 patients) with DME who received IVTA, but did not undergo vitrectomy (nonvitrectomized group). In the vitrectomized group, there was a significantly decreased CRT for up to 4 months as compared to the thicknesses before IVTA. In the nonvitrectomized group, there was a significantly decreased CRT for up to 5 months after IVTA. In both groups, there was significant improvement in the VA for up to 4 months after IVTA. CONCLUSION IVTA may represent a valid treatment option for DME, even in vitrectomized eyes.
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Affiliation(s)
- Akira Watanabe
- Department of Ophthalmology, The Jikei University School of Medicine , Tokyo, Japan
| | - Akane Tsuzuki
- Department of Ophthalmology, The Jikei University School of Medicine , Tokyo, Japan
| | - Kota Arai
- Department of Ophthalmology, The Jikei University School of Medicine , Tokyo, Japan
| | - Tamaki Gekka
- Department of Ophthalmology, The Jikei University School of Medicine , Tokyo, Japan
| | - Kenichi Kohzaki
- Department of Ophthalmology, The Jikei University School of Medicine , Tokyo, Japan
| | - Hiroshi Tsuneoka
- Department of Ophthalmology, The Jikei University School of Medicine , Tokyo, Japan
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