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Alshaikhsalama AM, Thompson KN, Patrick H, Lee J, Voor TA, Wang AL. Clinical Characteristics and Surgical Outcomes of Patients Undergoing Pars Plana Vitrectomy for Proliferative Diabetic Retinopathy. Ophthalmol Retina 2024:S2468-6530(24)00087-3. [PMID: 38447921 DOI: 10.1016/j.oret.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 02/20/2024] [Accepted: 02/26/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVE To evaluate clinical characteristics impacting surgical outcomes of patients undergoing pars plana vitrectomy (PPV) for complications of proliferative diabetic retinopathy (PDR). DESIGN Retrospective consecutive observational case series of patients at a large county hospital in Dallas, Texas, from 2014 to 2019. SUBJECTS Seven hundred thirty-two patients (933 eyes) undergoing PPV for PDR complications. METHODS Collected data included demographics, surgical indication, adjuvant therapies, intraoperative course, complications, and best corrected visual acuity (BCVA). Patients with < 6 months of follow-up were excluded. Best corrected visual acuity was converted to logarithm of the minimum angle of resolution for analysis. Statistics performed included t test, analysis of variance, and multivariate analyses. MAIN OUTCOME MEASURES Postoperative BCVA, primary anatomic success rate, and postoperative complications. RESULTS Three hundred ninety-three patients were male (509 eyes; 54.5%) with an average age of 52 years. Postoperative BCVA at 6 months was significantly different among surgical indications: 0.79 versus 0.77 versus 1.20 (P < 0.0001) for vitreous hemorrhage (VH), vitreomacular interface abnormalities, and tractional retinal detachment (TRD), respectively. Adjuvant preoperative therapy with panretinal photocoagulation (PRP) versus no PRP (0.95 vs. 1.25; P < 0.001) and insulin versus no insulin (0.99 vs. 1.17; P < 0.01) were associated with improved vision. Iatrogenic breaks were associated with decreased postoperative vision (1.40 vs. 0.88; P < 0.001). The primary anatomic success rate for TRD was 85% (495 eyes). Combined TRD/RRD (tractional and rhegmatogenous retinal detachment) was associated with a lower success rate compared with macula-on/macula-off TRD, with odds ratios of 0.36, 0.46, and 0.53, respectively. Patients experiencing recurrent detachment postsurgery had worse preoperative visual acuity (VA) (1.93 vs. 1.63; P < 0.01) and were younger (47.6 vs. 50.0; P = 0.02). Postoperative complications occurred in 699 eyes (75%), with VH (498 eyes, 53%), cataract (465, 50%), and elevated intraocular pressure (149, 16%) being the most common. Two hundred thirty-six eyes (25%) required a second PPV operation. Endophthalmitis (1 eye; <1%) and choroidal detachment (5 eyes; <1%) were rare. CONCLUSIONS In this retrospective series analyzing surgical outcomes among patients with complications from PDR, vitrectomy led to improved vision on average, with a meaningful proportion of patients receiving additional surgical intervention. Surgical indication, presenting VA, age, and adjuvant therapies appeared to impact outcomes. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
| | | | - Hank Patrick
- The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jessica Lee
- The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Tamara A Voor
- The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Angeline L Wang
- The University of Texas Southwestern Medical Center, Dallas, Texas.
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Xiang W, Fang D, Jiang X, Zhang Z, Xiang C, Huang S, Zhang S, Wei Y. 27‑Gauge vitrectomy vs. 25‑gauge vitrectomy in the management of proliferative diabetic retinopathy with preoperative intravitreal injection of conbercept. Exp Ther Med 2023; 26:472. [PMID: 37664677 PMCID: PMC10469386 DOI: 10.3892/etm.2023.12171] [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: 01/13/2023] [Accepted: 07/14/2023] [Indexed: 09/05/2023] Open
Abstract
Small-gauge vitrectomy has become popular due to its notable advantages, including less trauma, shortened convalescence and improved manoeuvrability. The aim of the present study was to compare the surgical outcomes of 27-gauge (27-G) vitrectomy with those of 25-gauge (25-G) vitrectomy in the management of proliferative diabetic retinopathy (PDR) with preoperative intravitreal injection of conbercept. The data of 48 consecutive patients with PDR (48 eyes) were retrospectively collected. The patients underwent conbercept intravitreal injection and pars plana vitrectomy with a 27-G group (23 eyes) or 25-G group (25 eyes) vitrectomy system. The operating time, suturing rate, endodiathermy rate, postoperative best-corrected visual acuity (BCVA), intraocular pressure (IOP) and complications were recorded. The mean postoperative BCVA at final follow-up was significantly improved compared with that at the baseline in both groups (P<0.001 for both). The differences in the mean BCVA changes between the two groups were not significant (P>0.99), and no differences were observed in the final central foveal thickness (P=0.51) between the two groups. The final IOP remained stable compared with that at the baseline in the 27-G group (P=0.36) and the 25-G group (P=0.05). The suturing rate was significantly decreased in the 27-G group compared with the 25-G group (P=0.04). There were no significant differences between the two groups in terms of the operating time (P=0.18), rate of endodiathermy use (P>0.99), iatrogenic retinal breaks (P=0.42) or postoperative recurrent vitreous haemorrhage (P>0.99). In addition, no case of ocular hypotony was observed in either group. In conclusion, 27-G vitrectomy was as efficient and safe as 25-G vitrectomy in the management of PDR in terms of operating time and complications. With reference to the literature, preoperative conbercept injection appears to assist in decreasing the incidence of intraoperative and postoperative complications.
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Affiliation(s)
- Wu Xiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong 510060, P.R. China
| | - Dong Fang
- Shenzhen Eye Hospital Affiliated to Jinan University, Shenzhen, Guangdong 518040, P.R. China
| | - Xintong Jiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong 510060, P.R. China
| | - Zhaotian Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong 510060, P.R. China
| | - Chuqi Xiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong 510060, P.R. China
| | - Shaofen Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong 510060, P.R. China
| | - Shaochong Zhang
- Shenzhen Eye Hospital Affiliated to Jinan University, Shenzhen, Guangdong 518040, P.R. China
| | - Yantao Wei
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong 510060, P.R. China
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Bouazza M, Razzak A, Amri G, Zadnass M, Rayad R, Oubaaz A. [Medico-surgical management of intravitreal hemorrhage in diabetic patients]. J Fr Ophtalmol 2023; 46:851-856. [PMID: 37598102 DOI: 10.1016/j.jfo.2023.02.022] [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: 11/09/2022] [Revised: 02/04/2023] [Accepted: 02/09/2023] [Indexed: 08/21/2023]
Abstract
Vitreous hemorrhage (VH) is the main complication of proliferative diabetic retinopathy and remains the primary indication for vitrectomy in diabetic patients. The objective of our study is to compare our medical and surgical management of VH with data from the literature and to report the functional results of our series. We studied a series of 284 cases collected over 2 years in two tertiary care centers. In our series, 90.1% of patients had type 2 diabetes, and 70% had glycosylated hemoglobin greater than 7.5%. On fundus examination, 35.2% presented with stage 1 VH, 42.6% with stage 2, 3.6% with stage 3 and 5.2% with stage 4. Ocular ultrasound performed when fundus exam was difficult diagnosed an associated tractional retinal detachment in 8.8% of patients. Medical treatment was sufficient in 77.8% of patients, while 22.2% of our patients underwent vitrectomy, argon laser endophotocoagulation and postoperative anti-VEGF injection. Peeling of tractional fibrovascular membranes and or associated epiretinal membranes was performed in 69.8% of cases. Iatrogenic tears were noted in 11.8% of patients. In this study, 31.5% of patients underwent intraocular gas tamponade, while 23.8% of cases underwent silicone oil tamponade. Postoperative visual acuity improved by at least 2 lines in 60% of our patients, and the VH recurred in 24.2% of cases after surgery.
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Affiliation(s)
- M Bouazza
- Service d'ophtalmologie, Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS), Cheikh-Khalifa International University Hospital, Casablanca, Maroc.
| | - A Razzak
- Service d'ophtalmologie, Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS), Cheikh-Khalifa International University Hospital, Casablanca, Maroc
| | - G Amri
- Service d'ophtalmologie, Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS), Cheikh-Khalifa International University Hospital, Casablanca, Maroc
| | - M Zadnass
- Service d'ophtalmologie, Hassan II University, hôpital 20 Août 1953, Casablanca, Maroc
| | - R Rayad
- Service d'ophtalmologie, Hassan II University, hôpital 20 Août 1953, Casablanca, Maroc
| | - A Oubaaz
- Service d'ophtalmologie, Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS), Cheikh-Khalifa International University Hospital, Casablanca, Maroc
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Venkatesh R, Parmar Y, Mangla R, Sharief S, Yadav NK, Chhablani J. Post-vitrectomy delayed retinal breaks in proliferative diabetic retinopathy. Int J Retina Vitreous 2023; 9:7. [PMID: 36726158 PMCID: PMC9890729 DOI: 10.1186/s40942-023-00444-1] [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: 11/29/2022] [Accepted: 01/21/2023] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To report a series of cases of post-operative new secondary retinal breaks following vitrectomy for proliferative diabetic retinopathy (PDR). METHODS This retrospective case series included data of patients diagnosed with post-operative retinal breaks following uneventful vitrectomy surgery for PDR from January 2018 to December 2021. RESULTS New post-vitrectomy retinal breaks in PDR were seen in 7% of eyes (n = 10/148 eyes; 10 patients). Age of study patients ranged from 45 to 69 years and there were 8 males. Vitreous surgery was performed for vitreous hemorrhage in six eyes, macular tractional retinal detachment in three eyes and epiretinal membrane in one eye. Tractional fibrovascular proliferation near the retinal break prior to its development was noted either pre- or intra-operatively in 8 eyes. Mean time interval between the vitreous surgery and secondary retinal break development was 6.4 months. Residual fibrous tissue post-surgery adjacent to the break was noted in 4 cases. Sclerosed retinal vessel was noted in 4 eyes and associated inner retinal thinning or schisis in 5 eyes. No retinal detachment was noted in any case. Prophylactic barrage was done in 4 eyes. Last follow-up interval ranged from 4 to 53 months and visual acuity ranged from 6/6 to 6/60. No subretinal fluid, traction or break enlargement was noted at the last visit. CONCLUSION Delayed post-operative retinal breaks following vitrectomy are uncommon in PDR eyes. Careful preoperative evaluation of the retinal proliferations, intraoperative dissection of the membranes and regular post-operative reviews are vital in anticipating the development of delayed post-vitrectomy retinal breaks. Observation could be the management strategy for these breaks.
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Affiliation(s)
- Ramesh Venkatesh
- grid.464939.50000 0004 1803 5324Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, 560010 Karnataka India
| | - Yash Parmar
- grid.464939.50000 0004 1803 5324Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, 560010 Karnataka India
| | - Rubble Mangla
- grid.464939.50000 0004 1803 5324Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, 560010 Karnataka India
| | - Shama Sharief
- grid.464939.50000 0004 1803 5324Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, 560010 Karnataka India
| | - Naresh Kumar Yadav
- grid.464939.50000 0004 1803 5324Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, 560010 Karnataka India
| | - Jay Chhablani
- grid.21925.3d0000 0004 1936 9000Medical Retina and Vitreoretinal Surgery, University of Pittsburgh School of Medicine, 203 Lothrop Street, Suite 800, Pittsburg, PA 15213 USA
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Dourandeesh M, Moeini M, Shaye ZA, Shoeibi N, Hosseini SM, Banaee T. Subfoveal choroidal thickness following pars plana vitrectomy in tractional diabetic macular edema. Eur J Ophthalmol 2022; 33:1405-1411. [PMID: 36476066 DOI: 10.1177/11206721221144137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Purpose To evaluate changes in subfoveal choroidal thickness (SCT) in cases of tractional diabetic macular edema (DME) after pars plana vitrectomy (PPV). Methods This prospective study included 31 eyes of 31 patients who underwent PPV for the management of tractional DME. Best-corrected visual acuity (BCVA), SCT, and central macular thickness (CMT) were measured before the operation, as well as one, three, and six months following the surgery in the operated eyes and at baseline, as well as six months in the fellow eyes. Results The SCT decline in eyes with tractional DME was statistically significant six months postoperatively (P = 0.009). A statistically significant decline was observed in the CMT values one, three, and six months postoperatively in eyes with tractional DME (P = 0.02, P < 0.001, and P < 0.001, respectively). There was a statistically significant improvement in the visual acuity of the affected eyes three (P = 0.047) and six months (P = 0.017) postoperatively. Conclusion After PPV for the treatment of tractional DME, a statistically significant decrease in the CMT values is detectable from the first month after surgery, followed by the improvement of BCVA from the third month. It is worth mentioning that a decrease was found in the SCT six months postoperatively.
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Affiliation(s)
- Maryam Dourandeesh
- Eye Research Center, Department of Eye, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Mahdieh Moeini
- Department of Ophthalmology, School of Medicine, Eye Research Center, Khatam Al Anbiya Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Abbasi Shaye
- Akbar clinical research and development unit, Faculty of medicine, University of medical science, Mashhad, Iran
| | - Nasser Shoeibi
- Department of Ophthalmology, School of Medicine, Eye Research Center, Khatam Al Anbiya Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyedeh Maryam Hosseini
- Department of Ophthalmology, School of Medicine, Eye Research Center, Khatam Al Anbiya Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Touka Banaee
- Department of Ophthalmology, University of Texas Medical Branch at Galveston, Galveston, Texas, USA
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Khattab AAA, Ahmed MM, Hammed AH. Pars plana vitrectomy for tractional diabetic macular edema with or without internal limiting membrane peeling. MEDICAL HYPOTHESIS, DISCOVERY & INNOVATION OPHTHALMOLOGY JOURNAL 2022; 11:110-118. [PMID: 37641643 PMCID: PMC10445315 DOI: 10.51329/mehdiophthal1454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/27/2022] [Indexed: 08/31/2023]
Abstract
Background The effectiveness of internal limiting membrane (ILM) peeling in the surgical treatment of tractional diabetic macular edema (DME), although widely examined, remains controversial. This study aimed to assess the efficacy of pars plana vitrectomy (PPV) in the management of tractional DME and to highlight any benefits of additional ILM peeling. Methods This was an open-label, prospective, comparative, and interventional study that enrolled 50 eyes with tractional DME that underwent PPV and allocated each to one of two groups: group A consisted of 25 eyes that had no ILM peeling and group B consisted of 25 eyes that underwent ILM peeling. Postoperative assessments of best-corrected distance visual acuity (BCDVA) in the logarithm of minimal angle of resolution (logMAR) notation and central macular thickness (CMT) were performed at 1, 3, and 6 months postoperatively. Results At baseline, the two groups were comparable in terms of sex ratios, phakic status, insulin use, coexistence of hypertension, and mean (standard deviation [SD]) age, BCDVA, CMT, duration of diabetes mellitus, and glycosylated hemoglobin (HbA1c) levels. In group A, the mean (SD) BCDVA improved significantly from 0.89 (0.12) logMAR preoperatively to 0.64 (0.24) logMAR (P < 0.001), and the mean (SD) CMT declined significantly from 471.28 (80.83) µm to 228.20 (26.45) µm (P < 0.001), at the 6-month postoperative assessment. Likewise, in group B, the mean (SD) BCDVA improved significantly from 0.83 (0.10) logMAR preoperatively to 0.58 (0.24) logMAR (P < 0.001), and the mean (SD) CMT decreased significantly from 496.84 (89.82) µm to 226.20 (18.04) µm (P < 0.001), after 6 months. There were no significant differences between groups A and B in the changes in BCDVA (Delta BCDVA) or CMT (Delta CMT) at 1, 3, and 6 months postoperatively with respect to the baseline values (all P > 0.05). Postoperative complications were comparable between the two groups. A significant negative correlation was detected between the preoperative HbA1c level and BCDVA improvement in all participants (r = - 0.82; P < 0.001). Conclusions PPV is an effective treatment for tractional DME. Additional ILM peeling was not significantly associated with functional and anatomical benefits over a short period. Long-term glycemic control plays a role in vision gain after vitrectomy in patients with diabetes. Further long-term studies are required to verify our findings.
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Raman R, Ramasamy K, Shah U. A Paradigm Shift in the Management Approaches of Proliferative Diabetic Retinopathy: Role of Anti-VEGF Therapy. Clin Ophthalmol 2022; 16:3005-3017. [PMID: 36106093 PMCID: PMC9467443 DOI: 10.2147/opth.s374165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/22/2022] [Indexed: 11/23/2022] Open
Abstract
Diabetic retinopathy (DR) is considered one of the leading causes of vision loss globally. It principally causes upregulation of pro-angiogenic, proinflammatory, and vascular permeability factors such as vascular endothelial growth factor (VEGF), leading to neovascularisation. The advanced stage of DR or proliferative diabetic retinopathy (PDR) is of more concern, as it leads to vitreous haemorrhage and traction retinal detachment. Various risk factors associated with PDR include hyperglycemia, hypertension, neuropathy, dyslipidemia, anaemia, nephropathy, and retinal complications of drugs used for diabetes. Current management approaches for PDR have been stratified and involve pan-retinal photocoagulation, vitrectomy, and anti-VEGF agents. Given the emerging role of anti-VEGF agents as a favourable adjunct or alternative therapy, they have a critical role in the management of PDR. The review emphasises current management approaches for PDR focusing on anti-VEGF therapy. The review also highlights the risk/benefit evaluation of the various approaches employed for PDR management in various clinical scenarios.
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Affiliation(s)
- Rajiv Raman
- Shri Bhagwan Mahavir Vitreoretinal Services, Chennai, Tamil Nadu, India
- Correspondence: Rajiv Raman, Shri Bhagwan Mahavir Vitreoretinal Services, Chennai, Tamil Nadu, India, Tel +91-9444288708, Email
| | - Kim Ramasamy
- Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Utkarsh Shah
- Novartis Healthcare Private Limited, Mumbai, India
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Marashi A, Zazo A. Suprachoroidal injection of triamcinolone acetonide using a custom-made needle to treat diabetic macular edema post pars plana vitrectomy: a case series. J Int Med Res 2022; 50:3000605221089807. [PMID: 35414288 PMCID: PMC9019375 DOI: 10.1177/03000605221089807] [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] [Indexed: 11/25/2022] Open
Abstract
Objective Diabetic macular edema (DME), the most common cause of diabetes-related visual impairment, may occur following pars plana vitrectomy (PPV) to manage proliferative diabetic retinopathy complications. This retrospective single-centre case series evaluated the efficacy and safety of injecting 4 mg/0.1 ml triamcinolone into the suprachoroidal space using a custom-made needle to treat DME post PPV. Methods Data regarding central macular thickness (CMT) using spectral domain-optical coherence tomography and best-corrected visual acuity (by Snellen chart) at baseline (pre-injection), and at 1, 4, and 8 weeks following injection were analysed, along with intraocular pressure (IOP), cataract progression, and ocular safety. Results Eleven eyes in 10 patients received 11 suprachoroidal injections. Vision improvement was noted (0.75 log minimum angle of resolution (MAR) at baseline to 0.40 log MAR after treatment). CMT reduced significantly from 456.45 ± 113.42 μm at baseline to 247.63 ± 53.40 μm at 8 weeks following injection. No rise in IOP, or cataract development in the single treated phakic eye, was observed during 8 weeks of follow-up. Conclusion Suprachoroidal injection of triamcinolone using a custom-made needle to treat DME post PPV shows promising results with acceptable safety outcomes. Large clinical trials with longer follow-up are needed to evaluate this treatment option for countries with limited health-care resources.
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Affiliation(s)
| | - Aya Zazo
- Faculty of Medicine, University of Aleppo, Aleppo, Syria
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Sheth JU, Weng C, Singh R, Khatri M, Saurabh K, Chawla S, Rajendran A, Narayanan R. Vitreoretinal Society of India practice pattern survey 2020: Surgical retina. Indian J Ophthalmol 2021; 69:1442-1449. [PMID: 34011717 PMCID: PMC8302326 DOI: 10.4103/ijo.ijo_2877_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose: To present the outcomes of the Vitreo-retinal Society of India (VRSI) Practice Pattern Survey 2020 in surgical retina. Methods: An online survey of members of VRSI was conducted in April 2020 regarding their practice patterns on varied medical and surgical retina topics concerning imaging and management approach. The results were evaluated by two independent experts in this field and compared with the evidence and other practice patterns in the world. Results: A total of 107 VRSI members participated in the online survey. Responses were obtained on management of wide-ranging surgical retina topics such as diabetic retinopathy, retinal detachments, Macular Hole, and Epiretinal membranes. Participants were also surveyed regarding their attitudes and perceptions about microscopes with the heads-up display system. Each of the survey question responses were then compared to contemporary literature, including evidence-based guidelines, randomized controlled trials, real-world evidence, and analogous international surveys. Comprehensive analysis related to this has been put forward in the article. Conclusion: This survey represents the contemporary practice patterns among vitreoretinal specialists in India. The survey results are vital for fellow practitioners to understand the “standard of care” practice in surgical retina. This will guide them to devise the best possible individualized treatment strategy for most favorable clinical outcomes.
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Affiliation(s)
- Jay U Sheth
- Department of Vitreoretinal Services, Surya Eye Institute and Research Center, Mumbai, Maharashtra, India
| | - Christina Weng
- Associate Professor, Baylor College of Medicine, 1977 Butler Blvd., Houston, TX 77030, USA
| | - Rishi Singh
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Manoj Khatri
- Department of Vitreoretina, Eydox Eye Hospital and Rajan Eye Care Hospital, Chennai, Tamil Nadu, India
| | - Kumar Saurabh
- Department of Vitreo Retina, Kamalnayan Bajaj Sankara Nethralaya, Kolkata, West Bengal, India
| | - Shobhit Chawla
- Medical Director, Prakash Netra Kendr, Lucknow, Uttar Pradeshl Vitreoretinal Society of India, Chennai, Tamil Nadu, India
| | - Anand Rajendran
- Vitreoretinal Society of India; Retina-Vitreous Services, Aravind Eye Hospital, Chennai, Tamil Nadu, India
| | - Raja Narayanan
- Vitreoretinal Society of India, Chennai, Tamil Nadu; Suven Clinical Research Center, LV Prasad Eye Institute, Hyderabad, Telangana, India
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Persistent subretinal fluid following diabetic tractional retinal detachment repair: risk factors, natural history, and management outcomes. Int Ophthalmol 2020; 41:453-464. [PMID: 33037551 DOI: 10.1007/s10792-020-01595-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 09/30/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To study the natural history, anatomical and functional outcomes of persistent subretinal fluid (SRF) after pars plana vitrectomy (PPV) for diabetic tractional retinal detachment (TRD) and combined traction-rhegmatogenous retinal detachment (TRRD). METHODS Retrospective interventional case series of 43 patients (46 eyes) with persistent SRF following PPV for diabetic TRD or combined TRRD from January 2010 to December 2017 at single tertiary institution. Primary outcomes included best corrected visual acuity (BCVA) and central foveal thickness (CFT). RESULTS Thirty-one eyes (67.4%) had macula-off TRD, 5 (10.9%) had fovea-threatening TRD and 10 (21.7%) had combined TRRD. The mean (± SD) duration of decreased vision was 48.0 ± 58.2 weeks. The mean follow-up duration was 21 ± 13.2 months. Residual macular SRF was detected by optical coherence tomography in all eyes at 3 months and in 10 eyes (23.8%) at 12 months after surgery. Only 3 eyes (6.5%) had persistent SRF at final follow up. The mean time to resolution was 10.6 ± 4.1 months [range 6.0-23.0]. Thirteen eyes received additional intervention to address SRF. The mean CFT gradually improved until final follow-up (P-value < 0.001). The mean BCVA improved from 1.62 ± 0.88 LogMAR at presentation to 1.05 ± 0.76 LogMAR at final follow up. No statistically significant difference in final BCVA was found between eyes that had intervention and eyes that were observed (P value = 0.762). CONCLUSION Persistent SRF after diabetic vitrectomy resolves slowly over time with gradual improvement in visual acuity. Additional drainage of persistent SRF may not be necessary.
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Lyssek-Boroń A, Krysik K, Kijonka M, Osuch M, Grabarek BO, Dobrowolski D. Changes in the Density of Corneal Endothelial Cells in Elderly Diabetic Patients After Combined Phacovitrectomy and Ex-PRESS Glaucoma Implants. Curr Pharm Biotechnol 2020; 20:1037-1043. [PMID: 31393242 PMCID: PMC7040517 DOI: 10.2174/1389201020666190808154341] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/19/2019] [Accepted: 08/01/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & OBJECTIVE Corneal endothelial cells (ECD) are characterized by limited regenerative potential, which is additionally impaired in patients with diabetes. This retrospective study included 27 patients aged 58.1±13.6, 16 female and 11 males, who underwent 23-gauge vitrectomy in combination with cataract surgery (phacovitrectomy) and further Ex-PRESS shunt implantation throughout 2013-2017 at St. Barbara Hospital in Sosnowiec, Poland. METHODS In our study, we distinguished 4 periods: initial period; post phacovitrectomy and removal of oil tamponade; and 3 and 12 months post implantation of the Ex-PRESS shunt. Statistical analysis was performed at the level of statistical significance of p<0.05. It included an analysis of variance (ANOVA) and Tukey's post-hoc test in order to determine the differences in the density of ECD cells/mm2 between the periods of observation. The paired-samples t-Student test was also performed to determine whether the differences in visual acuity values before and after PPV and before and after Ex-PRESS shunt were statistically significant. RESULTS The initial count of ECD cells was 2381.1±249, which decreased to 1872.8±350.7 cell/mm2 and finally to 1677.9±327 at the endpoint. Differences in the density of ECD cells/mm2 were observed to be statistically significant between the periods: after PPV vs. initial number of ECD (p = 0.000138); before 3 months after Ex-PRESS shunt vs. initial number of ECD (p = 0.000138); 12 months after Ex- PRESS shunt vs. initial number of ECD (p = 0000138). Analyzing the changes in visual acuity, we observed a deterioration both before and 3 months after Ex-PRESS shunt (p = 0.007944) and before and after PPV (p = 0.060334). In turn, correlation analysis indicated that there is a statistically significant, moderate, positive relationship. The relationship between visual acuity after Ex-PRESS shunt and ECD cells/mm2 density turned out to be statistically significant (r = +0.521381; p < 0.05). CONCLUSION Regardless of the period of observation and the choice of ophthalmic treatment of diabetic complications, we observed a decrease in the number of ECD cells and a deterioration in visual acuity. It is, therefore, reasonable to provide the patient with complete information about the proposed procedures and to consider the risk-benefit balance.
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Affiliation(s)
- Anita Lyssek-Boroń
- Department of Ophthalmology with Pediatric Unit, Santa Barbara Hospital-Trauma Centre, Plac Medykow 1, 42-200 Sosnowiec, Poland
| | - Katarzyna Krysik
- Department of Ophthalmology with Pediatric Unit, Santa Barbara Hospital-Trauma Centre, Plac Medykow 1, 42-200 Sosnowiec, Poland
| | - Magdalena Kijonka
- Department of Ophthalmology with Pediatric Unit, Santa Barbara Hospital-Trauma Centre, Plac Medykow 1, 42-200 Sosnowiec, Poland
| | - Mateusz Osuch
- Department of Ophthalmology with Pediatric Unit, Santa Barbara Hospital-Trauma Centre, Plac Medykow 1, 42-200 Sosnowiec, Poland
| | - Beniamin O Grabarek
- Katowice School of Technology, The University of Science and Art in Katowice, Katowice, Poland.,Center of Oncology, M. Sklodowska-Curie Memorial Institute, Cracow Branch, Gliwice, Poland.,Department of Molecular Biology, School of Pharmacy with Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia, Katowice, Poland
| | - Dariusz Dobrowolski
- Department of Ophthalmology with Pediatric Unit, Santa Barbara Hospital-Trauma Centre, Plac Medykow 1, 42-200 Sosnowiec, Poland.,Chair and Clinical Department of Ophthalmology, School of Medicine with a Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
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12
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Özdemir HB, Hasanreisoğlu M, Yüksel M, Ertop M, Gürelik G, Özdek Ş. Effectiveness of Intravitreal Dexamethasone Implant Treatment for Diabetic Macular Edema in Vitrectomized Eyes. Turk J Ophthalmol 2019; 49:323-327. [PMID: 31893587 PMCID: PMC6961074 DOI: 10.4274/tjo.galenos.2019.95226] [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] [Indexed: 12/03/2022] Open
Abstract
Objectives: To report the effectiveness and long-term outcomes of intravitreal dexamethasone implantation for diabetic macular edema (DME) in vitrectomized eyes Materials and Methods: Medical records of patients were retrospectively reviewed. Time of pars plana vitrectomy (PPV), PPV indications, interval between DEX injection and PPV, other intravitreal treatment prior to DEX application, best corrected visual acuity (BCVA), intraocular pressure (IOP), and central retinal thickness (CRT) measured by optical coherence tomography were recorded. Results: Seventeen eyes of 17 patients were included in the study. The mean follow-up after DEX injection was 21±2.4 months (12-43 months). The female/male ratio was 11/6. Mean age was 60.7 years (46-70 years). Sixteen eyes (94.1%) were pseudophakic at the time of DEX treatment. The most common indication for PPV was tractional retinal detachment (8 eyes, 47.1%). Ten eyes (58.8%) received a single injection and a total of 30 DEX implantations were performed. Mean BCVA was 0.77 logarithm of the minimum angle of resolution (logMAR) units before the first injection and improved to 0.64, 0.68 and 0.66 logMAR after 1, 3 and 6 months, respectively (p<0.01). CRT decreased significantly from 452 µm at baseline to 310, 368±34 and 375 µm after 1, 3 and 6 months, respectively (p<0.04). Mean IOP was 16±1.2 mmHg at baseline and 18.2, 18.8 and 18.5 mmHg after 1, 3, and 6 months (p>0.05). Two eyes (%8) received topical anti-glaucoma medication (IOP≥25 mmHg). Similar results were observed in eyes receiving repeated DEX injections. Conclusion: Intravitreal DEX injection treatment seems to be effective for improving BCVA and decreasing CRT in vitrectomized eyes with DME. This effect seemed to last for 6 months in most eyes, but maximized at 3 months. Patients with repeated injections often require injection before 6 months.
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Affiliation(s)
| | - Murat Hasanreisoğlu
- Gazi University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Murat Yüksel
- Gazi University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Mestan Ertop
- Gazi University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Gökhan Gürelik
- Gazi University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Şengül Özdek
- Gazi University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
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13
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Neroev VV, Zaytseva OV, Okhotsimskaya TD, Fadeeva VA, Verbitskaya VA. [Possibilities of multicolor confocal scanning laser ophthalmoscopy in complex diagnostics of severe proliferative diabetic retinopathy]. Vestn Oftalmol 2019; 135:22-31. [PMID: 31215531 DOI: 10.17116/oftalma201913502122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Multicolor scanning laser ophthalmoscopy (multicolor SLO) is a new informative method of eye fundus visualization. The method is based on synchronously obtaining three separate confocal images with monochromatic laser sources - blue (488 nm), green (515 nm) and infrared (820 nm), which are then combined into one in the Multicolor mode. PURPOSE To evaluate the informative value of multicolor SLO in a complex examination of patients with severe proliferative diabetic retinopathy (PDR). MATERIAL AND METHODS A total of 46 patients (62 eyes) aged 19 to 75 years with severe PDR was examined. All patients had massive growth of proliferative tissue on the eye fundus, which caused traction deformation and/or retinal detachment in the posterior pole. Optical mediums of the eyes were sufficiently transparent to obtain high quality images. All patients underwent color photo-registration of the fundus, fluorescein angiography (FA), optical coherence tomography (OCT) and multicolor SLO under drug-induced mydriasis. RESULTS Pseudo-volumetric images obtained with multicolor SLO allow visualization of of preretinal proliferative membranes and their structure, the degree of their vascularization, the anatomical features of their attachment to retina, and the occluded vessels on fundus periphery. Being an additional option on scanning laser ophthalmoscope, the technique does not require special equipment, which enables several separate examinations, including OCT and FA, to be performed on a single device. CONCLUSION Multicolor SLO is a promising new method of visualizing structures of the eye fundus and can be successfully used in complex diagnostics, monitoring and preoperative preparation of patients with severe PDR.
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Affiliation(s)
- V V Neroev
- Helmholtz Moscow Research Institute of Eye Diseases, 14/19 Sadovaya-Chernogryazskaya St., Moscow, Russian Federation, 105062
| | - O V Zaytseva
- Helmholtz Moscow Research Institute of Eye Diseases, 14/19 Sadovaya-Chernogryazskaya St., Moscow, Russian Federation, 105062
| | - T D Okhotsimskaya
- Helmholtz Moscow Research Institute of Eye Diseases, 14/19 Sadovaya-Chernogryazskaya St., Moscow, Russian Federation, 105062
| | - V A Fadeeva
- Helmholtz Moscow Research Institute of Eye Diseases, 14/19 Sadovaya-Chernogryazskaya St., Moscow, Russian Federation, 105062
| | - V A Verbitskaya
- Helmholtz Moscow Research Institute of Eye Diseases, 14/19 Sadovaya-Chernogryazskaya St., Moscow, Russian Federation, 105062
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14
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Kaidonis G, Hassall MM, Phillips R, Raymond G, Saha N, Wong GH, Gilhotra JS, Liu E, Burdon KP, Henderson T, Newland H, Lake SR, Craig JE. Visual outcomes following vitrectomy for diabetic retinopathy amongst Indigenous and non-Indigenous Australians in South Australia and the Northern Territory. Clin Exp Ophthalmol 2017; 46:417-423. [PMID: 29044997 DOI: 10.1111/ceo.13083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 11/29/2022]
Abstract
IMPORTANCE Visual outcomes following diabetic vitrectomy have not previously been studied in an Australian population. BACKGROUND This analysis aimed to determine the rate of, and factors associated with visual success following diabetic vitrectomy performed for Indigenous and non-Indigenous Australians, and investigate factors predisposing to early progression to diabetic retinopathy (DR) requiring vitrectomy. DESIGN Retrospective, population-based audit. PARTICIPANTS All patients undergoing vitrectomy for the complications of DR in South Australia (SA) and the Northern Territory (NT) between 2007 and 2011. METHODS Medical records were audited and data collected, including demographics, diabetic history, past treatment for DR, indication for vitrectomy and visual acuity pre and postoperatively. MAIN OUTCOME MEASURES Visual success (gain of ≥15 ETDRS letters) at 6 and 12 months, postoperatively. RESULTS A total of 495 diabetic vitrectomies, for 404 eyes of 335 patients were performed in SA and NT between 2007 and 2011. 77 (23%) patients requiring diabetic vitrectomy were Indigenous Australians. 87% of patients undergoing diabetic vitrectomy had stable or improved vision at 1 year, postoperatively. There was no significant difference between indigenous and non-indigenous eyes achieving visual success (P = 0.929). Timely preoperative laser treatment (P = 0.03) and preoperative visual acuity (P = 0.01) were the predominant factors associated with visual success. CONCLUSIONS AND RELEVANCE Indigenous patients are just as likely to have improved vision following diabetic vitrectomy as non-Indigenous Australians. However, the small subset of indigenous patients with blind eyes prior to vitrectomy are significantly less likely to improve from surgery. The underlying factors associated with poor outcomes in this group requires further exploration.
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Affiliation(s)
- Georgia Kaidonis
- Department of Ophthalmology, Flinders University, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Mark M Hassall
- Department of Ophthalmology, University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Russell Phillips
- Department of Ophthalmology, Flinders University, Flinders Medical Centre, Adelaide, South Australia, Australia.,Eyemedics, Wayville, South Australia, Australia
| | - Grant Raymond
- Department of Ophthalmology, University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Niladri Saha
- Department of Ophthalmology, Flinders University, Flinders Medical Centre, Adelaide, South Australia, Australia.,Eyemedics, Wayville, South Australia, Australia
| | - George Hc Wong
- Marion Road Eye Clinic, Adelaide, South Australia, Australia
| | - Jagjit S Gilhotra
- Department of Ophthalmology, University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Department of Ophthalmology, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Ebony Liu
- Department of Ophthalmology, Flinders University, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Kathryn P Burdon
- Department of Ophthalmology, Flinders University, Flinders Medical Centre, Adelaide, South Australia, Australia.,Menzies Research Institute, University of Tasmania, Hobart, Tasmania, Australia
| | - Tim Henderson
- Department of Ophthalmology, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Henry Newland
- Department of Ophthalmology, University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Stewart R Lake
- Department of Ophthalmology, Flinders University, Flinders Medical Centre, Adelaide, South Australia, Australia.,Eyemedics, Wayville, South Australia, Australia
| | - Jamie E Craig
- Department of Ophthalmology, Flinders University, Flinders Medical Centre, Adelaide, South Australia, Australia.,Eyemedics, Wayville, South Australia, Australia
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Lyssek-Boroń A, Wylęgała A, Dobrowolski D, Kowalczyk E, Polanowska K, Wylęgała E. Evaluation of EX-PRESS glaucoma implant in elderly diabetic patients after 23G vitrectomy. Clin Interv Aging 2017; 12:653-658. [PMID: 28435237 PMCID: PMC5391864 DOI: 10.2147/cia.s128618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The most frequent qualifications for pars plana vitrectomy (PPV) in diabetic patients include recurrent hemorrhage into the vitreous body chamber and vitreoretinal proliferation, also with traction retinal detachment. The aim of this study was to evaluate the effectiveness of EX-PRESS implant for the treatment of secondary glaucoma in elderly diabetic patients following PPV 23G with silicon oil or SF6 gas endotamponade. MATERIALS AND METHODS This retrospective analysis comprised 18 patients (19 eyes). We applied EX-PRESS implants in 9 patients with neovascular glaucoma (NVG) and in 10 patients with non-NVG. All patients had earlier history of diabetes and vitrectomy 23G for diabetic complications. Intraocular pressure (IOP) was measured and compared before; 7 days; 1, 3, 6, and 12 months; and a year after the surgery. RESULTS Application of the implant exhibited a lowering effect on IOP. After 1 month, 53% of patients had IOP values beyond 22 mmHg, while 86% after 1 year. CONCLUSION The implant can be used to treat both NVG and non-NVG in diabetic patients following PPV.
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Affiliation(s)
- Anita Lyssek-Boroń
- Department of Ophthalmology with Pediatric Unit, Trauma Center, Santa Barbara Hospital, Sosnowiec
| | - Adam Wylęgała
- Department of Ophthalmology with Pediatric Unit, Trauma Center, Santa Barbara Hospital, Sosnowiec
| | - Dariusz Dobrowolski
- Department of Ophthalmology with Pediatric Unit, Trauma Center, Santa Barbara Hospital, Sosnowiec.,Department of Ophthalmology, Ophthalmology Clinic, Medical University of Silesia, District Railway Hospital, Katowice, Poland
| | - Ewelina Kowalczyk
- Department of Ophthalmology with Pediatric Unit, Trauma Center, Santa Barbara Hospital, Sosnowiec
| | - Katarzyna Polanowska
- Department of Ophthalmology with Pediatric Unit, Trauma Center, Santa Barbara Hospital, Sosnowiec
| | - Edward Wylęgała
- Department of Ophthalmology with Pediatric Unit, Trauma Center, Santa Barbara Hospital, Sosnowiec.,Department of Ophthalmology, Ophthalmology Clinic, Medical University of Silesia, District Railway Hospital, Katowice, Poland
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16
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Mynampati BK, Sambhav K, Grover S, Chalam KV. Inhibition of proliferation of retinal vascular endothelial cells more effectively than choroidal vascular endothelial cell proliferation by bevacizumab. Int J Ophthalmol 2017; 10:15-22. [PMID: 28149771 DOI: 10.18240/ijo.2017.01.03] [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: 08/28/2016] [Accepted: 09/28/2016] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the differential inhibitory effects of bevacizumab on cell proliferation of vascular endothelial growth factor (VEGF)-stimulated choroidal vascular endothelial cells (CVECs) and retinal vascular endothelial cells (RVECs) in vitro. METHODS VEGF (400 ng/mL) enriched CVECs and RVECs were treated with escalating doses of bevacizumab (0.1, 0.5, 1, 1.5 and 2 mg/mL). Cell proliferation changes were analyzed with WST-1 assay and trypan blue exclusion assay at 48, 72h and 1wk. Morphological changes were recorded with bright field microscopy. RESULTS VEGF enriched RVECs showed significantly more decline of cell viability than CVECs after bevacizumab treatment. One week after treatment, RVEC cell proliferation decreased by 29.7%, 37.5%, 52.8%, 35.9% and 45.6% at 0.1, 0.5, 1.0, 1.5 and 2 mg/mL bevacizumab respectively compared to CVEC proliferation decrease of 4.1%, 7.7%, 2.4%, 4.1% and 17.7% (P<0.05) by WST-1 assay. Trypan blue exclusion assay also revealed similar decrease in RVEC proliferation of 20%, 60%, 73.3%, 80% and 93.3% compared to CVEC proliferation decrease of 4%, 12%, 22.9%, 16.7% and 22.2% respectively (P<0.05). The maximum differential effect between the two cell types was observed at bevacizumab doses of 1.0 and 1.5 mg/mL at all time points. RVECs were 22 fold more sensitive (P<0.01) compared to CVECs (52.8% vs 2.4%) at concentration of 1.0 mg/mL, and 8.7 fold more at 1.5 mg/mL (35.9% vs 4.1%) 1wk after treatment (P<0.05 respectively). CONCLUSION VEGF-enriched RVECs are more susceptible to bevacizumab inhibition than CVECs at clinically used dosage of 1.25 mg and this differential sensitivity between two cell types should be taken into consideration in dosage selection.
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Affiliation(s)
- Bharani Krishna Mynampati
- Department of Ophthalmology, University of Florida, College of Medicine, Jacksonville, FL 32209, USA
| | - Kumar Sambhav
- Department of Ophthalmology, University of Florida, College of Medicine, Jacksonville, FL 32209, USA
| | - Sandeep Grover
- Department of Ophthalmology, University of Florida, College of Medicine, Jacksonville, FL 32209, USA
| | - Kakarla V Chalam
- Department of Ophthalmology, University of Florida, College of Medicine, Jacksonville, FL 32209, USA
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17
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Fassbender JM, Ozkok A, Canter H, Schaal S. A Comparison of Immediate and Delayed Vitrectomy for the Management of Vitreous Hemorrhage due to Proliferative Diabetic Retinopathy. Ophthalmic Surg Lasers Imaging Retina 2016; 47:35-41. [PMID: 26731207 DOI: 10.3928/23258160-20151214-05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 10/28/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To compare immediate and delayed vitrectomy for the management of vitreous hemorrhage (VH) due to proliferative diabetic retinopathy (PDR). PATIENTS AND METHODS Retrospective review of 134 eyes receiving vitrectomy for non-clearing, PDR-associated VH. Primary outcome was area under the vision curve (AUC) in patients receiving immediate (< 30 days) versus delayed (> 30 days) vitrectomy with endolaser. RESULTS Forty-six eyes were included, with 17 undergoing immediate (< 30 days) vitrectomy with endolaser and 29 undergoing delayed (> 30 days) vitrectomy with endolaser. Time to vitrectomy was 14.8 days ± 8.26 days compared to 629.6 days ± 894.9 days in the immediate and delayed groups, respectively. AUC was significantly greater for patients undergoing delayed versus immediate vitrectomy (276.1 ± 0.601 logMAR*time versus 165.7 ± 0.761 logMAR*time; P < .0001). There was no difference in AUC postoperatively for delayed versus immediate surgery. Both groups required significantly less postoperative panretinal photocoagulation (P < .05). Preoperative and final visual acuities were equivalent (immediate: 1.86 ± 0.99 and 0.35 ± 0.25; P = .002; delayed: 1.71 ± 1.05 and 0.31 ± 0.34; P < .0001). CONCLUSIONS Immediate vitrectomy with endolaser for PDR-associated VH (< 30 days) decreases time spent with vision loss and the need for adjunctive PRP. Modern vitrectomy is safe and may be considered earlier in VH management.
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18
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Celik E, Sever O, Horozoglu F, Yanyalı A. Segmentation and removal of fibrovascular membranes with high-speed 23 G transconjunctival sutureless vitrectomy, in severe proliferative diabetic retinopathy. Clin Ophthalmol 2016; 10:903-10. [PMID: 27274192 PMCID: PMC4876088 DOI: 10.2147/opth.s95145] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim To evaluate the effectiveness and safety of high-speed (5,000 cuts per minute) 23 G transconjunctival sutureless vitrectomy (TSV) in severe diabetic fibrovascular proliferation (DFVP). Patients and methods In this retrospective consecutive case series, patients who underwent 23 G TSV for severe DFVP between October 2011 and March 2014 at our institution were evaluated. 23 G TSV was performed with a high-speed (5,000 cuts per minute) cutter without a chandelier light. Results The mean follow-up period was 8 months (range: 4–23 months). Of the 27 eyes of 27 patients, 14 eyes (52%) underwent concomitant phacoemulsification with posterior chamber intraocular lens implantation, nine eyes (33%) were pseudophakic, and four eyes were phakic (15%). DFVP was removed with ease in all, and visual acuity was improved in 18 (67%) eyes. Iatrogenic retinal tear was observed in four eyes (15%) and treated successfully during surgery. Suture placement to a single sclerotomy was performed in eight eyes (30%). Postoperative intraocular hemorrhage was observed in five eyes (18%). Cataract formation was observed in two of the four phakic eyes. Three (11%) patients had postoperative intraocular pressure rise. Postoperative hypotony (≤6 mmHg) and endophthalmitis were not observed in any eye. Conclusion The segmentation and removal of fibrovascular membranes with high-speed 23 G TSV seems to be a safe and easy method in severe diabetic eye disease.
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Affiliation(s)
- Erkan Celik
- Sakarya University Medical Education and Research Hospital, Sakarya, Turkey
| | - Ozkan Sever
- Namik Kemal University, School of Medicine, Tekirdag, Turkey
| | - Fatih Horozoglu
- Namik Kemal University, School of Medicine, Tekirdag, Turkey
| | - Ates Yanyalı
- Haydarpasa Numune Medical Education and Research Hospital, Istanbul, Turkey
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19
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Adhi M, Badaro E, Liu JJ, Kraus MF, Baumal CR, Witkin AJ, Hornegger J, Fujimoto JG, Duker JS, Waheed NK. Three-Dimensional Enhanced Imaging of Vitreoretinal Interface in Diabetic Retinopathy Using Swept-Source Optical Coherence Tomography. Am J Ophthalmol 2016; 162:140-149.e1. [PMID: 26548809 DOI: 10.1016/j.ajo.2015.10.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 10/29/2015] [Accepted: 10/29/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To analyze the vitreoretinal interface in diabetic eyes using 3-dimensional wide-field volumes acquired using high-speed, long-wavelength swept-source optical coherence tomography (SSOCT). DESIGN Prospective cross-sectional study. METHODS Fifty-six diabetic patients (88 eyes) and 11 healthy nondiabetic controls (22 eyes) were recruited. Up to 8 SSOCT volumes were acquired for each eye. A registration algorithm removed motion artifacts and merged multiple SSOCT volumes to improve signal. Vitreous visualization was enhanced using vitreous windowing method. RESULTS Of 88 diabetic eyes, 20 eyes had no retinopathy, 21 eyes had nonproliferative diabetic retinopathy (NPDR) without macular edema, 20 eyes had proliferative diabetic retinopathy (PDR) without macular edema, and 27 eyes had diabetic macular edema (DME) with either NPDR or PDR. Thick posterior hyaloid relative to healthy nondiabetic controls was observed in 0 of 20 (0%) diabetic eyes without retinopathy, 4 of 21 (19%) eyes with NPDR, 11 of 20 (55%) eyes with PDR, and 11 of 27 (41%) eyes with DME (P = .0001). Vitreoschisis was observed in 6 of 22 (27%) healthy nondiabetic eyes, 9 of 20 (45%) diabetic eyes without retinopathy, 10 of 21 (48%) eyes with NPDR, 13 of 20 (65%) eyes with PDR, and 17 of 27 (63%) eyes with DME (P = .007). While no healthy nondiabetic controls and diabetic eyes without retinopathy had adhesions/pegs between detached posterior hyaloid and retina, 1 of 21 (4%), 11 of 20 (55%), and 11 of 27 (41%) eyes with NPDR, PDR, and DME, respectively, demonstrated this feature (P = .0001). CONCLUSION SSOCT with motion-correction and vitreous windowing provides wide-field 3-dimensional information of vitreoretinal interface in diabetic eyes. This may be useful in assessing progression of retinopathy, planning diabetic vitreous surgery, and predicting treatment outcomes.
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20
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Yu JG, Ni F, Xiang Y, Feng YF, Wang J, Fu XA. A prospective study on postoperative discomfort after 20-gauge pars plana vitrectomy. Clin Ophthalmol 2015; 9:1379-84. [PMID: 26244010 PMCID: PMC4521668 DOI: 10.2147/opth.s87017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose To evaluate postoperative pain and other irritation symptoms after 20-gauge (20G) pars plana vitrectomy. Materials and methods A total of 110 consecutive patients were enrolled in our studies, and 87 patients who underwent the conventional 20G pars plana vitrectomy were included in the final analysis. All vitrectomies were performed using the same surgical technique by the same surgeon. Patients were examined before surgery and 1 day, 3 days, 7 days, 1 month, and 2 months postoperatively. The main outcome measures include patient age and sex, intraocular pressure (IOP), ocular pain, pain score, pain medication use, and other irritation symptoms comprising itching, foreign body sensation, burning, photophobia, and dryness. The pain was evaluated using the Numerical Rating Scale scored from 0 to 10. Results Postoperative pain was relatively common during the first day after surgery, as it was reported by 43 (49.4%) patients. Then, the prevalence gradually decreased to eleven (12.6%) patients at 2 months. Most patients reported mild or moderate pain, with a pain score of 1–5, but only four patients were given analgesics for ocular pain. A postoperative rise of IOP was noted in 25 patients at day 1. Most of these patients with high IOP reported moderate pain. Other ocular irritation symptoms were varied after surgery. There was still one-quarter of patients that had foreign body sensation and dryness symptoms at month 2 after surgery. Conclusion Mild and moderate ocular pain were relatively common after 20G vitrectomy, which is more often associated with elevated IOP. Other irritation symptoms were also presented after surgery and could affect the life quality of patients. Therefore, the discomforts after 20G pars plana vitrectomy should be of concern, and timely management should be provided as part of routine postoperative care.
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Affiliation(s)
- Ji-Guo Yu
- Department of Ophthalmology, the Central Hospital of Wuhan, Wuhan, Hubei Province, People's Republic of China
| | - Fang Ni
- Department of Ophthalmology, the Central Hospital of Wuhan, Wuhan, Hubei Province, People's Republic of China
| | - Yi Xiang
- Department of Ophthalmology, the Central Hospital of Wuhan, Wuhan, Hubei Province, People's Republic of China
| | - Yi-Fan Feng
- Department of Ophthalmology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Jue Wang
- Department of Ophthalmology, the Central Hospital of Wuhan, Wuhan, Hubei Province, People's Republic of China
| | - Xun-An Fu
- Department of Ophthalmology, the Central Hospital of Wuhan, Wuhan, Hubei Province, People's Republic of China
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