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Upadhyaya A, Kiri H, Natarajan R, Hansraj S, Padhy SK, Takkar B, Padhi TR, Jalali S, Parameswarappa DC. Outcomes of vitreoretinal surgery in eyes with retinitis pigmentosa without retinal detachment. Graefes Arch Clin Exp Ophthalmol 2024; 262:441-448. [PMID: 37861848 DOI: 10.1007/s00417-023-06274-z] [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: 05/29/2023] [Revised: 10/01/2023] [Accepted: 10/07/2023] [Indexed: 10/21/2023] Open
Abstract
PURPOSE Outcomes of retinal detachment (RD) have been discussed in detail in many reports of patients with retinitis pigmentosa (RP). This study tries to understand the outcomes of vitreoretinal (VR) surgery for indications other than RD in the eyes with RP. METHODS This is a retrospective study that includes clinical data from January 2013 to December 2021. Patients with RP who were treated with a VR surgical intervention were included in the study. The primary outcome of the study was to assess the changes in best-corrected visual acuity. RESULTS Forty-four eyes of 40 patients with RP were included in the study. Nearly half of the eyes (43%, 19/44) presented from 1 month to 1 year after the onset of diminished vision, with or without floaters. The mean ± standard deviation (SD) best-corrected visual acuity (BCVA) at presentation was 1.30 ± 0.79 logMAR (20/400 ± 20/125). The major surgical indications were vitreous opacities (43.2%, 19/44) and subluxated/dislocated cataractous lenses (25%, 11/44). The median follow-up duration was 8 months (interquartile range (IQR): 1.5-27). Approximately 77% (34/44) of the eyes had improvement in vision. The mean postoperative BCVA at the last follow-up was 0.95 ± 0.73 logMAR (p-value: 0.03). CONCLUSIONS Most eyes with RP recovered well after VR surgical interventions, with short-term improvements in visual acuity. It may be crucial to address the vitreous opacities and membranes as they hinder the residual central island of vision in RP. However, appropriate counselling is required regarding the progressive nature of retinal neuronal degeneration.
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Affiliation(s)
- Abhishek Upadhyaya
- Srimati Kanuri Santhamma Center for Vitreoretinal Diseases, Anant Bajaj Retina Institute, Kallam Anji Reddy Campus, L V Prasad Eye Institute, L V Prasad Marg, Banjara Hills, Hyderabad, Telangana, 500 034, India
- Standard Chartered - LVPEI Academy for Eye Care Education, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Hardik Kiri
- Srimati Kanuri Santhamma Center for Vitreoretinal Diseases, Anant Bajaj Retina Institute, Kallam Anji Reddy Campus, L V Prasad Eye Institute, L V Prasad Marg, Banjara Hills, Hyderabad, Telangana, 500 034, India
- Standard Chartered - LVPEI Academy for Eye Care Education, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Ramya Natarajan
- Department of Ophthalmic Biophysics, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Saarang Hansraj
- Srimati Kanuri Santhamma Center for Vitreoretinal Diseases, Anant Bajaj Retina Institute, Kallam Anji Reddy Campus, L V Prasad Eye Institute, L V Prasad Marg, Banjara Hills, Hyderabad, Telangana, 500 034, India
- Standard Chartered - LVPEI Academy for Eye Care Education, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Srikanta Kumar Padhy
- Vitreoretina and Uveitis Services, Anant Bajaj Retina Institute, Mithu Tulasi Chanrai Campus, L V Prasad Eye Institute, Bhubaneswar, India
| | - Brijesh Takkar
- Srimati Kanuri Santhamma Center for Vitreoretinal Diseases, Anant Bajaj Retina Institute, Kallam Anji Reddy Campus, L V Prasad Eye Institute, L V Prasad Marg, Banjara Hills, Hyderabad, Telangana, 500 034, India
- Indian Health Outcomes, Public Health, and Economics Research Center, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Tapas Ranjan Padhi
- Vitreoretina and Uveitis Services, Anant Bajaj Retina Institute, Mithu Tulasi Chanrai Campus, L V Prasad Eye Institute, Bhubaneswar, India
| | - Subhadra Jalali
- Srimati Kanuri Santhamma Center for Vitreoretinal Diseases, Anant Bajaj Retina Institute, Kallam Anji Reddy Campus, L V Prasad Eye Institute, L V Prasad Marg, Banjara Hills, Hyderabad, Telangana, 500 034, India
| | - Deepika C Parameswarappa
- Srimati Kanuri Santhamma Center for Vitreoretinal Diseases, Anant Bajaj Retina Institute, Kallam Anji Reddy Campus, L V Prasad Eye Institute, L V Prasad Marg, Banjara Hills, Hyderabad, Telangana, 500 034, India.
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Jayadev C, Gupta A, Gadde SG, Venkatesh R. Toxic posterior segment syndrome with retinal vasculitis likely caused by intraocular cotton fiber after vitreoretinal surgery - a case report. BMC Ophthalmol 2023; 23:464. [PMID: 37974099 PMCID: PMC10655314 DOI: 10.1186/s12886-023-03212-9] [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: 08/31/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Intraocular inflammation is common after anterior or posterior segment surgery. They typically manifest either as non-infectious inflammation of the anterior or posterior segment, known as toxic anterior or posterior segment syndrome (TPSS), or as sterile or infective endophthalmitis. In this report, we describe a rare case of TPSS following vitreoretinal surgery, presenting as hemorrhagic retinal vasculitis. CASE PRESENTATION A 58-year-old male diagnosed with a left eye acute rhegmatogenous retinal detachment underwent an uneventful primary pars plana vitrectomy with silicone oil endotamponade on the same day of presentation. At presentation, there were no signs of intraocular inflammation, and his visual acuity in the affected eye was 20/200. RESULTS The retina was well-attached with silicone oil in place on the first post-operative day. Along the inferior retinal periphery, a hemorrhagic occlusive vasculitis was observed. Clinical examination revealed retained intraocular cotton fiber along the inferotemporal quadrant over the retinal surface. In addition to the standard post-operative medications, a course of systemic steroids (40 mg per day of Prednisolone tablets) was started. At the end of the first post-operative week, clinical signs of hemorrhagic retinal vasculitis were beginning to resolve, and by the end of the fourth post-operative week, they had completely resolved. CONCLUSION This report describes an unusual diagnosis of TPSS after vitreoretinal surgery, most likely due to the presence of an intraocular cotton fiber. This excessive inflammation of the posterior segment usually responds to a course of topical and systemic steroids.
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Affiliation(s)
- Chaitra Jayadev
- Department of Retina and Vitreous, Narayana Nethralaya #121/C, 1st R block, Rajaji Nagar, 560022, Bangalore, India
| | - Aditi Gupta
- Department of Retina and Vitreous, Narayana Nethralaya #121/C, 1st R block, Rajaji Nagar, 560022, Bangalore, India
| | - Santosh Gopikrishna Gadde
- Department of Retina and Vitreous, Narayana Nethralaya #121/C, 1st R block, Rajaji Nagar, 560022, Bangalore, India
| | - Ramesh Venkatesh
- Department of Retina and Vitreous, Narayana Nethralaya #121/C, 1st R block, Rajaji Nagar, 560022, Bangalore, India.
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Ruiz-Moreno JM, García-Zamora M, Ruiz-Medrano J. Retinal phototoxicity after macular hole surgery in a patient under paclitaxel. BMC Ophthalmol 2023; 23:342. [PMID: 37528385 PMCID: PMC10391847 DOI: 10.1186/s12886-023-03086-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 07/15/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND The purpose is to report the second case, to our knowledge, of suspected paclitaxel-induced phototoxic maculopathy following pars plana vitrectomy surgery. CASE PRESENTATION 63-year-old phakic female who underwent an uneventful phaco-vitrectomy to treat a complete macular hole, developing macular phototoxicity in the post-operatively period that could not be explained by the surgery itself and could only be attributed to a possible photosensitization induced by the previous use of paclitaxel. CONCLUSIONS The use of paclitaxel has been widely extended as a chemotherapy drug to treat breast cancer. It works by altering the intracellular microtubular reorganization and, based on this mechanism of action, photosensitivity has been previously described. We report a case of suspected paclitaxel-induced macular phototoxicity following ocular endoillumination during vitrectomy surgery.
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Affiliation(s)
- José M Ruiz-Moreno
- Puerta de Hierro-Majadahonda University Hospital, C/ Manuel de Falla, 1, Majadahonda (Madrid), 28222, Spain.
- Department of Ophthalmology, Castilla La Mancha University, Albacete, Spain.
- Ocular Microsurgery Institute (IMO), Miranza Corporation, Madrid, Spain.
| | - María García-Zamora
- Puerta de Hierro-Majadahonda University Hospital, C/ Manuel de Falla, 1, Majadahonda (Madrid), 28222, Spain
| | - Jorge Ruiz-Medrano
- Puerta de Hierro-Majadahonda University Hospital, C/ Manuel de Falla, 1, Majadahonda (Madrid), 28222, Spain
- Ocular Microsurgery Institute (IMO), Miranza Corporation, Madrid, Spain
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Venkatesh R, Mangla R, Sharief S, Chhablani J. Long-term effects of combined brilliant blue G and xenon light induced retinal toxicity following macular hole repair surgery. BMC Ophthalmol 2023; 23:57. [PMID: 36759787 PMCID: PMC9909863 DOI: 10.1186/s12886-023-02811-w] [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: 11/23/2022] [Accepted: 02/08/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND The purpose of this study was to look at the long-term effects of retinal phototoxicity after macular hole repair surgery using xenon endolight illumination and Brilliant blue G (BBG) dye. CASE PRESENTATION An elderly man in his late seventies underwent para plana vitrectomy with BBG dye to repair an idiopathic full-thickness macular hole (MH) in his right eye. Prior to macular hole surgery, his visual acuity in the right eye was 6/60, N24 at the time of presentation. The MH closed with type 1 closure immediately after surgery, but there was extensive damage to the outer retinal layers and retinal pigment epithelium (RPE) at the macula, resulting in a reduction in visual acuity to 2/60. We presumed that the combination of BBG and xenon light, is the probable reason of retinotoxicity in the current patient. There was a progressive increase in the area of retinal and RPE layer damage and choroidal thinning over a 4-year period. CONCLUSION Due to combined BBG-induced dye and endoilluminator toxicity, a rare case of continuously progressing RPE layer damage with choroidal thinning over a long follow-up interval was described. Such long-term effects of BBG and endolight induced retinotoxicity have not been reported in the literature, to the best of our knowledge.
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Affiliation(s)
- Ramesh Venkatesh
- Narayana Nethralaya, Dept. of Retina and Vitreous, #121/C, Chord Road, 1st R block Rajaji Nagar, 560010, Bangalore, India.
| | - Rubble Mangla
- grid.464939.50000 0004 1803 5324Narayana Nethralaya, Dept. of Retina and Vitreous, #121/C, Chord Road, 1st R block Rajaji Nagar, 560010 Bangalore, India
| | - Shama Sharief
- grid.464939.50000 0004 1803 5324Narayana Nethralaya, Dept. of Retina and Vitreous, #121/C, Chord Road, 1st R block Rajaji Nagar, 560010 Bangalore, India
| | - Jay Chhablani
- grid.21925.3d0000 0004 1936 9000Medical Retina and Vitreoretinal Surgery, University of Pittsburgh School of Medicine, 203 Lothrop Street, Suite 800, 15213 Pittsburg, PA USA
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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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Torres-Villaros H, Louis-Philippe S, Amari F, Giocanti-Aurégan A, Janicot L. Macular toxicity of vital dye after pars plana vitrectomy for idiopathic epiretinal membrane: A case report. Am J Ophthalmol Case Rep 2022; 27:101588. [PMID: 35637750 PMCID: PMC9142655 DOI: 10.1016/j.ajoc.2022.101588] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 12/01/2022] Open
Abstract
Purpose To describe the first reported case of outer retinal damage following the use of Membrane Blue Dual for epiretinal membrane (ERM) surgery. Observations A 74-year-old female underwent pars plana vitrectomy and ERM peeling assisted with Membrane Blue Dual for an idiopathic ERM. Postoperatively, the patient reported a decline in visual acuity with a central scotoma. Fundus examination revealed a well-defined retinal whitening in the peeling area which evolved into pigmentary changes as confirmed by fundus autofluorescence. Optical coherence tomography (OCT) showed loss of outer retinal layers and irregular mottling of the retinal pigment epithelium. Fundus and OCT appearance remained unchanged after 4 months and the central scotoma also persisted. Conclusions and Importance ERM surgery assisted with Membrane Blue Dual can induce major changes in retinal pigment epithelium and outer retinal layers. This adverse event which probably results from combined light and dye toxicity should be considered by all surgeons even though its occurrence is rare.
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Affiliation(s)
- Héloïse Torres-Villaros
- Department of Ophthalmology, Avicenne Hospital, 125, rue de Stalingrad, 93000, Bobigny, France
| | - Steven Louis-Philippe
- Department of Ophthalmology, Avicenne Hospital, 125, rue de Stalingrad, 93000, Bobigny, France
| | - Fatima Amari
- Department of Ophthalmology, Avicenne Hospital, 125, rue de Stalingrad, 93000, Bobigny, France
| | - Audrey Giocanti-Aurégan
- Department of Ophthalmology, Avicenne Hospital, 125, rue de Stalingrad, 93000, Bobigny, France
| | - Lucie Janicot
- Department of Ophthalmology, Avicenne Hospital, 125, rue de Stalingrad, 93000, Bobigny, France
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Malcolm J, Lune Wong CO, Ching J, Saidkasimova S. Paclitaxel may be a risk factor for retinal phototoxicity. Am J Ophthalmol Case Rep 2022; 25:101292. [PMID: 35112024 PMCID: PMC8790282 DOI: 10.1016/j.ajoc.2022.101292] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 08/03/2021] [Accepted: 01/17/2022] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To report the first case, to our knowledge, of suspected paclitaxel induced phototoxic maculopathy following vitrectomy surgery. OBSERVATIONS A 62-year-old phakic female receiving paclitaxel therapy for ovarian carcinoma presented with a best corrected visual acuity (BCVA) of 20/40 OD with an epiretinal membrane (ERM) and lamellar macular hole on spectral domain optical coherence tomography (SD-OCT). The patient underwent an uneventful pars plana vitrectomy with ERM peel using standard illumination and vitrectomy settings. Membrane Blue Dual (DORC, Netherlands) was used to stain the ERM. Two weeks post-operatively, the patient presented with a reduced BCVA of 20/200 in the operated eye. Fluorescein and indocyanine green angiography revealed right sided patchy hypofluorescence and hyperfluorescence secondary to retinal pigment epithelium changes with intact choroidal and retinal vasculature. SD-OCT and fundoscopy showed right sided loss of ellipsoid layer, increased reflectivity within the retinal pigmented epithelium and subretinal fibrosis without cystoid macular edema. Four months post-operatively her vision had stabilized to 20/160; unfortunately, the patient was palliated a month later due to ovarian carcinoma progression. CONCLUSIONS A number of drugs are known to increase photosensitivity to solar and artificial forms of radiation. Paclitaxel use has been widely reported to cause dermatological photosensitivity. We report a case of suspected paclitaxel induced phototoxic maculopathy following endoillumination during vitrectomy surgery.
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Affiliation(s)
| | | | - Jared Ching
- Department of Ophthalmology, Norfolk and Norwich University Hospital, Norwich, UK
- John Van Geest Centre for Brain Repair, University of Cambridge, UK
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Park SJ, Do JR, Shin JP, Park DH. Customized Color Settings of Digitally Assisted Vitreoretinal Surgery to Enable Use of Lower Dye Concentrations During Macular Surgery. Front Med (Lausanne) 2022; 8:810070. [PMID: 35141254 PMCID: PMC8818890 DOI: 10.3389/fmed.2021.810070] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 12/24/2021] [Indexed: 11/13/2022] Open
Abstract
PurposeThis study evaluated the color contrast ratio (CCR) of the internal limiting membrane (ILM) using different color settings of digitally assisted vitreoretinal surgery (DAVS) with different indocyanine green (ICG) concentrations.sMethodsThis is a prospective comparative observational study. Consecutive patients that underwent 25G vitrectomy and ILM peeling using a standard operating microscope (SOM) (25 eyes), DAVS Ver. 1.1 (12 eyes), or DAVS Ver. 1.3 (13 eyes) were enrolled. The SOM and DAVS Ver. 1.1 groups used 0.075% ICG, and the DAVS Ver. 1.3 group used 0.025% ICG. In DAVS Ver. 1.1, macular CCR was compared between four different presets in the red, green, and blue channels: Default (Red (R) 100%, Green (G) 100%, and Blue (B) 100%); Preset 1 (R 20%, G 100%, B 100%); Preset 2 (R 80%, G 80%, B 100%), and Preset 3 (R 85%, G 100%, B 90%). In DAVS Ver. 1.3, macular CCR was evaluated using two different customized settings that modified the hue and saturation: Customized Setting 1 (R 86, G 100, B 100%, Hue +2°, Saturation 90%, Gamma 1.2) and Customized Setting 2 (R 90, G 100, B 100%, Hue +20°, Saturation 100%, Gamma 0.9). All patients underwent ophthalmologic examinations including BCVA at baseline and at 12 months.ResultsIn DAVS Ver. 1.1, macular CCR was highest in Preset 3 (P < 0.01). The CCR of Customized Setting 2 of DAVS Ver. 1.3 using 0.025% ICG did not differ from that of Preset 3 in DAVS Ver. 1.1 using 0.075% ICG. Furthermore, there was no significant difference in BCVA between the Customized Setting 2 of DAVS Ver. 1.3 with 0.025% ICG and the Preset 3 of DAVS Ver. 1.1 with 0.075% ICG groups at baseline and at 12 months (P > 0.05, respectively).ConclusionCustomized DAVS settings enabled surgeons to use a 3-fold lower ICG concentration in ILM peeling.
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Affiliation(s)
- Su Jin Park
- Department of Ophthalmology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Jae Rock Do
- Department of Ophthalmology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Jae Pil Shin
- Department of Ophthalmology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Dong Ho Park
- Department of Ophthalmology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
- Kyungpook National University Bio-Medical Research Institute, Daegu, South Korea
- Kyungpook National University Cell and Matrix Research Institute, Daegu, South Korea
- *Correspondence: Dong Ho Park
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Venkatesh R, Gupta A, Yadav N, Chhablani J. Presumed Combined Brilliant Blue G and Endolight-Induced Macular Damage following Epiretinal Membrane Removal Surgery. J Curr Ophthalmol 2022; 34:267-270. [PMID: 36147266 PMCID: PMC9487014 DOI: 10.4103/joco.joco_46_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 11/05/2022] Open
Abstract
Purpose: To report a rare case of macular outer retinal and retinal pigment epithelium (RPE) damage following brilliant blue G (BBG)-assisted epiretinal membrane (ERM) removal surgery. Methods: Retrospective, observational case report. Results: An 85-year-old lady presented with decreased vision in the left eye and a best-corrected visual acuity of 20/400. The right eye examination was within normal limits. The left eye had a significant cataract, and the fundus examination through the cataractous haze showed an ERM with macular pucker, which was confirmed on an optical coherence tomography (OCT) scan. A combined cataract surgery with intraocular lens implantation and BBG-assisted ERM removal and internal limiting membrane peeling surgery was performed. Over the subsequent visits, a well-defined area of outer retinal and RPE alteration was identified on OCT and fundus autofluorescence without significant improvement in visual acuity. At the last follow-up visit, the visual acuity minimally improved to 20/200. Conclusions: Macular toxicity due to repeated usage of BBG dye and high intensity focal endo-illumination may lead to poor visual outcome following ERM removal or similar macular surgeries. Adequate precautions need to be taken to prevent vision loss.
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Diffuse retinal pigment epithelium atrophy following pars plana vitrectomy for high myopic macular hole assisted by Brilliant Blue G: A case report. Am J Ophthalmol Case Rep 2021; 23:101148. [PMID: 34222716 PMCID: PMC8246242 DOI: 10.1016/j.ajoc.2021.101148] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/25/2020] [Accepted: 06/14/2021] [Indexed: 11/20/2022] Open
Abstract
Purpose To describe a case of diffuse retinal pigment epithelium (RPE) disturbance following 23-gauge pars plana vitrectomy (PPV) with the inverted internal limiting membrane (ILM) technique and Brilliant Blue staining for a high myopic macular hole (MH). Observations A 53-year-old pseudophakic high myopic female was referred to the Vitreoretinal Department with a diagnosis of a full thickness myopic MH of her right eye. Her initial visual acuity was 20/40 of her right eye and 20/20 in the left eye. She underwent routine PPV with inverted ILM flap assisted by repeated brilliant blue staining. Surgery was uneventful without any intraoperative complications. MH closure was obtained within the first days. Three weeks postoperatively, the patient reported a decline in visual acuity of her right eye. Upon examination, her visual acuity decreased to 20/400. Fundus examination showed diffuse pigmentary changes with mottling at the level of the RPE, which later progressed to severe diffuse atrophy, as confirmed by fundus autofluorescence (FAF). After 12 months, visual acuity remained 20/400 with widespread areas of atrophy. Conclusions Uncomplicated routinary PPV assisted with Brilliant Blue, can lead to unexplained atrophy of the RPE. Possible causes include light phototoxicity, dye toxicity or both.
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Soni A, Parameswarappa DC, Tyagi M, Sahoo NK, Dogra A, Pappuru RR, Chhablani J. Brilliant Blue G toxicity in macular hole surgeries: A report on combined phototoxicity and dye-induced macular damage. Semin Ophthalmol 2021; 37:117-122. [PMID: 34010087 DOI: 10.1080/08820538.2021.1928717] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: Vitrectomy with brilliant blue G (BBG) assisted internal limiting membrane (ILM) peeling is the standard operational technique in macular hole surgeries. However, BBG dye, though considered safe and nontoxic, can also occasionally lead to macular toxicity. This study aims to describe the clinical features and characteristics of four eyes who developed macular toxicity after following surgery for macular hole repair.Methods: Retrospective review of four consecutive cases of macular toxicity after conventional BBG assisted ILM peeling. All the cases reviewed, their operative surgical notes were retrieved and analyzed. The ILM was stained twice during surgery with prolonged intraoperative surgical time.Results: All four cases had a prolonged surgical time and the ILM was stained twice during surgery in all cases. The area of macular toxicity was corresponding to the area of ILM peeling which had been exposed to repeated staining by BBG dye. By the end of one month, all four cases had foveal thinning along with choriocapillary atrophy. The mean BCVA was 20/80 before surgery and the final mean visual acuity was <20/800.Conclusion: This report highlights the occurrence of macular and choriocapillary atrophy due to prolonged focal endoillumination and the increased risk of toxicity with repeated dye staining.
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Affiliation(s)
- Aniruddh Soni
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India
| | - Deepika C Parameswarappa
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India
| | - Mudit Tyagi
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India
| | - Niroj K Sahoo
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India
| | - Avantika Dogra
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India
| | - Rajeev Reddy Pappuru
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India
| | - Jay Chhablani
- UPMC Eye Center, University of Pittsburgh, Pittsburgh, USA
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Wallsh J, Asahi MG, Gallemore R. Long-Term Outcomes of Macular Hole Repair with Triamcinolone Acetonide Visualization. Clin Ophthalmol 2021; 15:1607-1619. [PMID: 33888976 PMCID: PMC8057828 DOI: 10.2147/opth.s303890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/12/2021] [Indexed: 01/05/2023] Open
Abstract
Purpose To evaluate the long-term anatomic and visual outcomes of macular hole (MH) repair utilizing triamcinolone acetonide (TA) visualization of the internal limiting membrane (ILM) treated at a tertiary care retina practice. Methods Retrospective chart review of eyes undergoing MH repair with ILM peel utilizing TA visualization followed by gas tamponade and facedown positioning between 2014 and 2020. Pre- and post-operative visual acuity (VA), IOP, and anatomic closure based on optical coherence tomography were documented. Results Seventy-eight eyes were followed for 2.3±0.2 years after primary repair with anatomic closure in 73 (94%) eyes at their final visit and excluding eyes with pathologic myopia, 97%, and for stage 2 and small MHs, 100%. In all eyes, VA significantly improved from 0.97±0.04 (Snellen: 20/187) to 0.66±0.06 (20/91) logMAR (p < 0.0001). There were 16 eyes with 4 years of follow-up, 10 (63%) eyes achieving a VA ≥20/30 at that follow-up visit. Stage 2 and 3 MHs had significantly greater improvements in VA than Stage 4 MHs, −0.46 ± 0.06 versus −0.11 ± 0.11 logMAR (p = 0.021). Of the 13 (17%) eyes with recurrent MHs, 6 (46%) had pathologic myopia and 8 (61.5%) had associated cystoid macular edema. Cataract progression was reported in 52 (96%) phakic eyes and 2 eyes required Ahmed valve placement for management of pre-existing glaucoma. Conclusion Long-term results of MH repair with TA for ILM visualization demonstrate that it is safe and effective. Visual acuity continued to improve throughout the follow-up. Pre-existing glaucoma may progress and recurrence is associated with pathologic myopia and macular edema.
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Affiliation(s)
- Josh Wallsh
- Retina Macula Institute and Research Center, Torrance, CA, USA
| | - Masumi G Asahi
- Retina Macula Institute and Research Center, Torrance, CA, USA
| | - Ron Gallemore
- Retina Macula Institute and Research Center, Torrance, CA, USA
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Avci R, Mavi Yildiz A, Yilmaz S. The Influence of Crescent-Shaped Selective Internal Limiting Membrane Staining on Vital Dye Toxicity in Temporal Inverted Flap Technique. Curr Eye Res 2021; 46:1363-1369. [PMID: 33445962 DOI: 10.1080/02713683.2021.1877312] [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: 10/22/2022]
Abstract
Purpose: To investigate the macular function and morphology after temporal inverted internal limiting membrane (ILM) flap technique with and without staining of the ILM flap in contact with the retinal pigment epithelium (RPE).Materials and Methods: This retrospective study included 30 patients with idiopathic macular hole (MH), who underwent 27 G vitrectomy and temporal inverted ILM flap technique with brillant blue G (BBG) assisted ILM staining. In Group 1 (n = 16), a large bubble of perfluorocarbon liquid (PFCL) measuring approximately 6-disc diameters was used to cover the hole and central part of the ILM flap whereas in Group 2 (n = 14), only a small drop of PFCL to merely cover the MH was used. Complete ophthalmic examination including microperimetry (MP), optical coherence tomography (OCT) was performed preoperatively, 6 months after surgery.Results: MH closure was achieved in all the eyes in both groups. The sizes of ellipsoid zone (EZ) and external limiting membrane (ELM) defect significantly decreased after surgery relative to the baseline width in both groups (p < .05 for all). The mean improvement in visual acuity (p = .896) and retinal sensitivity was similiar between groups (p = .409). Accordingly, the postoperative mean lengths of the EZ (p = .254) and ELM disruption (p = .406) on OCT scans were similiar between groups. However, 3 of the eyes in Group 2 developed cystoid macular edema between postoperative month-1 and month-6.Conclusion: The crescent-shaped selective staining of the ILM flap could prevent prolonged retinal toxicity of vital dyes in inverted ILM flap technique. Further studies involving larger number of patients with longer follow up are needed to determine the impact of this technique in the management of vital dye toxicity.
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Affiliation(s)
- Remzi Avci
- Ophthalmology Department, Bursa Retina Eye Hospital, Bursa, Turkey
| | | | - Sami Yilmaz
- Ophthalmology Department, Bursa Retina Eye Hospital, Bursa, Turkey
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