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Mete M, Parolini B, Maggio E, Airaghi G, De Santis N, Guerriero M, Pertile G. Use of Heavy Silicon Oil as Intraocular Tamponade for Inferior Retinal Detachment Complicated by Proliferative Vitreoretinopathy: A Multicentric Experience. Ophthalmologica 2023; 246:209-218. [PMID: 37245503 DOI: 10.1159/000531141] [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: 01/23/2023] [Accepted: 05/12/2023] [Indexed: 05/30/2023]
Abstract
INTRODUCTION This is a multicentric study on the use of heavy silicon oil (HSO) as an intraocular tamponade for inferior retinal detachment (RD) complicated by proliferative vitreoretinopathy (PVR). METHODS 139 eyes treated for RD with PVR were included in the study. 10 (7.2%) were affected by primary RD with inferior PVR, while 129 (92.8%) were affected by recurrent RD with inferior PVR. 102 eyes (73.9%) had received a silicon oil (SO) tamponade in a previous intervention prior to receiving HSO. Mean follow-up was 36.5 (standard deviation = 32.3) months. RESULTS The median interval between HSO injection and removal was 4 months (interquartile range: 3). At the time of HSO removal, the retina was attached in 120 eyes (87.6%), whereas in 17 eyes (12.4%), it had re-detached while the HSO was in situ. 32 eyes (23.2%) showed recurrent RD. A subsequent RD relapse was observed in 14.2% of cases with no RD at the time of HSO removal, and in 88.2% if an RD was present at the time of HSO removal. Advancing age showed a positive association with retinal attachment at the end of follow-up, while the risk of RD relapse at the end of the follow-up showed a significant negative association with HSO tamponade duration and with the use of SO rather than air or gas as post-HSO tamponade materials. Mean best corrected visual acuity was 1.1 logarithm of minimum angle of resolution at all follow-up time points. 56 cases (40.3%) needed treatment for elevated intraocular pressure (IOP), with which no clinically relevant variables were associated during follow-up. CONCLUSION HSO represents a safe and effective tamponade in cases of inferior RD with PVR. The presence of RD at the time of HSO removal is a negative prognostic factor for the development of a subsequent RD relapse. According to our findings, in cases of RD at the time of HSO removal, a short-term tamponade should definitely be avoided, in favor of SO. Special attention must be paid to the risk of IOP elevation, and patients should be closely monitored.
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Affiliation(s)
- Maurizio Mete
- Department of Ophthalmology, IRRCS Sacro Cuore-Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | | | - Emilia Maggio
- Department of Ophthalmology, IRRCS Sacro Cuore-Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Giulia Airaghi
- Department of Ophthalmology, ASST Valle Olona, Varese, Italy
| | - Nicoletta De Santis
- Clinic Research Unit, URC, IRRCS Sacro Cuore-Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Massimo Guerriero
- Clinic Research Unit, URC, IRRCS Sacro Cuore-Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Grazia Pertile
- Department of Ophthalmology, IRRCS Sacro Cuore-Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
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Parikh BH, Liu Z, Blakeley P, Lin Q, Singh M, Ong JY, Ho KH, Lai JW, Bogireddi H, Tran KC, Lim JYC, Xue K, Al-Mubaarak A, Yang B, R S, Regha K, Wong DSL, Tan QSW, Zhang Z, Jeyasekharan AD, Barathi VA, Yu W, Cheong KH, Blenkinsop TA, Hunziker W, Lingam G, Loh XJ, Su X. A bio-functional polymer that prevents retinal scarring through modulation of NRF2 signalling pathway. Nat Commun 2022; 13:2796. [PMID: 35589753 PMCID: PMC9119969 DOI: 10.1038/s41467-022-30474-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 04/26/2022] [Indexed: 01/20/2023] Open
Abstract
One common cause of vision loss after retinal detachment surgery is the formation of proliferative and contractile fibrocellular membranes. This aberrant wound healing process is mediated by epithelial-mesenchymal transition (EMT) and hyper-proliferation of retinal pigment epithelial (RPE) cells. Current treatment relies primarily on surgical removal of these membranes. Here, we demonstrate that a bio-functional polymer by itself is able to prevent retinal scarring in an experimental rabbit model of proliferative vitreoretinopathy. This is mediated primarily via clathrin-dependent internalisation of polymeric micelles, downstream suppression of canonical EMT transcription factors, reduction of RPE cell hyper-proliferation and migration. Nuclear factor erythroid 2-related factor 2 signalling pathway was identified in a genome-wide transcriptomic profiling as a key sensor and effector. This study highlights the potential of using synthetic bio-functional polymer to modulate RPE cellular behaviour and offers a potential therapy for retinal scarring prevention.
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Affiliation(s)
- Bhav Harshad Parikh
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Zengping Liu
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Eye Research Institute (SERI), Singapore, Singapore
| | - Paul Blakeley
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Qianyu Lin
- Institute of Materials Research and Engineering (IMRE), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Malay Singh
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Bioinformatics Institute (BII), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Jun Yi Ong
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Kim Han Ho
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Joel Weijia Lai
- Science, Mathematics and Technology Cluster, Singapore University of Technology and Design (SUTD), Singapore, Singapore
| | - Hanumakumar Bogireddi
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kim Chi Tran
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jason Y C Lim
- Institute of Materials Research and Engineering (IMRE), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of Materials Science and Engineering, National University of Singapore, Singapore, Singapore
| | - Kun Xue
- Institute of Materials Research and Engineering (IMRE), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Abdurrahmaan Al-Mubaarak
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Binxia Yang
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Sowmiya R
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Kakkad Regha
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Daniel Soo Lin Wong
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Queenie Shu Woon Tan
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Zhongxing Zhang
- Institute of Materials Research and Engineering (IMRE), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Anand D Jeyasekharan
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Veluchamy Amutha Barathi
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Eye Research Institute (SERI), Singapore, Singapore
- Academic Clinical Program in Ophthalmology, Duke-NUS Medical School, Singapore, Singapore
| | - Weimiao Yu
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Bioinformatics Institute (BII), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Kang Hao Cheong
- Science, Mathematics and Technology Cluster, Singapore University of Technology and Design (SUTD), Singapore, Singapore
| | - Timothy A Blenkinsop
- Department of Cellular, Developmental and Regenerative Biology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Walter Hunziker
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Gopal Lingam
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Eye Research Institute (SERI), Singapore, Singapore
- Department of Ophthalmology, National University Hospital, Singapore, Singapore
| | - Xian Jun Loh
- Institute of Materials Research and Engineering (IMRE), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore.
- Department of Materials Science and Engineering, National University of Singapore, Singapore, Singapore.
| | - Xinyi Su
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore.
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Singapore Eye Research Institute (SERI), Singapore, Singapore.
- Department of Ophthalmology, National University Hospital, Singapore, Singapore.
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SINGLE NUCLEOTIDE POLYMORPHISMS IN RETINAL DETACHMENT PATIENTS WITH AND WITHOUT PROLIFERATIVE VITREORETINOPATHY. Retina 2021; 40:811-818. [PMID: 30807515 DOI: 10.1097/iae.0000000000002477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate differences in genotype distributions of single nucleotide polymorphisms within genes, encoding inflammatory mediators, among patients with rhegmatogenous retinal detachment (RRD) and patients with proliferative vitreoretinopathy (PVR). METHODS A genetic association study was performed on 191 Slovenian patients, divided into 2 groups: 113 RRD patients with PVR and 78 RRD patients without PVR. Genotype distributions were investigated within the following 13 single nucleotide polymorphisms: rs3760396 (CCL2), rs9990554 (FGF2), rs17561 (IL1A), rs2069763 (IL2), rs1800795 (IL6), rs1800871 (IL10), rs3008 (JAK3), rs2229094 (LTA), rs1042522 (TP53), rs7656613 (PDGFRA), rs7226855 (SMAD7), rs1800471 (TGFB1), and rs1800629 (TNF). RESULTS Differences in genotype distributions between patients with RRD with or without PVR were detected in rs1800795 (IL6) (P = 0.04), rs1800871 (in the vicinity of the IL10) (P = 0.034), and rs1800471 (TGFB1) (P = 0.032). After adjustment none of the 13 analyzed single nucleotide polymorphisms showed statistically significant associations in single nucleotide polymorphism genotype distributions between patients with RRD with and without PVR. CONCLUSION Further research is needed, particularly expanded multicentric population-based studies, to clarify the issue of genetic contribution to PVR from different genetic, clinical, and population-based aspects.
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Kouassi AC, Kouassi FX, Kra ANS, Massé H, Lebreton O, Weber M. [Retinal detachment surgery: Evaluation of the anatomical success and functional outcomes in a consecutive series of patients operated between 2011 and 2014 at Nantes University Medical Center]. J Fr Ophtalmol 2018; 41:744-751. [PMID: 30224096 DOI: 10.1016/j.jfo.2018.01.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 12/09/2017] [Accepted: 01/08/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Evaluate the anatomical and functional outcomes of retinal detachment (RD) surgery from January 2011 to November 2014. MATERIALS AND METHODS We conducted a retrospective study of 182 eyes of 175 patients with a minimum follow-up of 6 months, operated for RD at Nantes University Medical Center. It consists of 56 simple RDs and 126 complex RDs treated in first intention by Scleral Buckling (SB), vitrectomy or combined surgery. The analysis is based on anatomic reattachment at the end of a follow-up of at least 6 months after the first surgery and the progression of the best corrected visual acuity (BCVA). RESULTS One hundred and seventy-two vitrectomies, 15 SB and 5 combined surgeries (vitrectomy+SB) were performed. The overall anatomical success rate after a single operation was 131 eyes (72 %). It increased to 163 eyes (90 %) at the end of the follow-up. Depending on the type of RD, anatomic success at 6 months after surgery was achieved for 47 simple RDs (84 %) and 84 complex RDs (67 %). At the end of the follow-up, after one or more operations, these rates increased to 53 simple RDs (95 %) and 110 complex RDs (87 %). For all RDs with an anatomically successful result, we observed a visual improvement≥2 lines in 45 % of cases and a postoperative BCVA≥5/10 in 40 % of cases. CONCLUSION This study confirms the evolution toward vitrectomy surgery for retinal detachment. It finds anatomical and functional results consistent with the literature, with a percentage of approximately 5 % of RDs still not reattached in spite of several operations.
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Affiliation(s)
- A C Kouassi
- CHG de Saint-Nazaire, 11, boulevard Georges-Charpak, 44600 Saint-Nazaire, France.
| | - F X Kouassi
- CHU de Cocody, boulevard de l'université, Abidjan, Côte d'Ivoire
| | - A N S Kra
- CHU de Cocody, boulevard de l'université, Abidjan, Côte d'Ivoire
| | - H Massé
- CHU de Nantes, 5, allée de l'Île-Gloriette, 44093 Nantes, France
| | - O Lebreton
- CHU de Nantes, 5, allée de l'Île-Gloriette, 44093 Nantes, France
| | - M Weber
- CHU de Nantes, 5, allée de l'Île-Gloriette, 44093 Nantes, France
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Schaub F, Hoerster R, Schiller P, Felsch M, Kraus D, Zarrouk M, Kirchhof B, Fauser S. Prophylactic intravitreal 5-fluorouracil and heparin to prevent proliferative vitreoretinopathy in high-risk patients with retinal detachment: study protocol for a randomized controlled trial. Trials 2018; 19:384. [PMID: 30012187 PMCID: PMC6048849 DOI: 10.1186/s13063-018-2761-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 06/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Proliferative vitreoretinopathy (PVR) is the major cause for postoperative failure after vitreo-retinal surgery for primary rhegmatogenous retinal detachment (RRD). Adjunct pharmaceutical therapy was found to be ineffective once PVR is established. Preliminary data suggest that prevention of PVR yields better functional outcome. So far, there is no standard therapy to prevent PVR. METHODS/DESIGN This is a randomized, double-blind, controlled, multicenter, interventional trial with one interim analysis. High-risk patients for PVR with primary RRD will be allocated equally to the following treatment arms: (a) verum: intraoperative adjuvant application of 5-fluorouracil (5-FU) and low-molecular-weight heparin (LMWH) via intraocular infusion during routine pars plana vitrectomy (PPV) and (b) placebo: routinely used intraocular infusion with balanced salt solution during routine PPV. PVR risk is assessed by non-invasive aqueous flare measurement by using laser flare photometry. The primary endpoint of the trial is the occurrence of PVR grade CP (C: full-thickness retinal folds or subretinal strands in clock hours; P: located posterior to equator) 1 or higher within 12 weeks after treatment. Secondary endpoints include PVR grade CA (A: located anterior to equator), best corrected visual acuity, number and extent of surgical procedures to achieve retinal re-attachment, and occurrence of drug-related adverse events within 12 weeks. It is assumed, on the basis of previously published results, that the incidence of PVR grade CP 1 is 35% in the control group and that a reduction by one third would be clinically relevant. Given the sequential design and adjustment for a dropout rate of 5%, a total sample size of 560 patients (280 per group) was calculated to ensure a power of 80% for the confirmatory analysis. DISCUSSION The present trial uses intraoperative intravitreal 5-FU and LMWH as a prophylactic therapy in high-risk patients with primary RRD, aiming to reduce the incidence of PVR in the group that receives the trial drug. Using laser flare photometry to identify high-risk patients for PVR, this trial will test the effectiveness of a simple treatment to prevent PVR. TRIAL REGISTRATION EudraCT no.: 2015-004731-12, registered October 21, 2015; ClinicalTrials.gov Identifier: NCT02834559 , registered July 12, 2016. Protocol version: Version 02. Date: September 18, 2016.
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Affiliation(s)
- Friederike Schaub
- Department of Ophthalmology, University of Cologne, Kerpener Strasse 62, 50924, Cologne, Germany.
| | - Robert Hoerster
- MVZ Augenärztliches Diagnostik- und Therapiecentrum Mönchengladbach/Erkelenz GmbH, Ostpromenade 41, 41812, Erkelenz, Germany
| | - Petra Schiller
- Institute of Medical Statistics and Computational Biology (IMSB), University of Cologne, Bachemer Str. 86, 50931, Cologne, Germany
| | - Moritz Felsch
- Institute of Medical Statistics and Computational Biology (IMSB), University of Cologne, Bachemer Str. 86, 50931, Cologne, Germany
| | - Daria Kraus
- Clinical Trials Center Cologne (CTCC), Gleueler Str. 269D, 50935, Cologne, Germany
| | - Marouan Zarrouk
- Clinical Trials Center Cologne (CTCC), Gleueler Str. 269D, 50935, Cologne, Germany
| | - Bernd Kirchhof
- Department of Ophthalmology, University of Cologne, Kerpener Strasse 62, 50924, Cologne, Germany
| | - Sascha Fauser
- Department of Ophthalmology, University of Cologne, Kerpener Strasse 62, 50924, Cologne, Germany.,F. Hoffmann-La Roche AG, Grenzacherstrasse 124, 4070, Basel, Switzerland
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Rodrigues IA, Sprinkhuizen SM, Barthelmes D, Blumenkranz M, Cheung G, Haller J, Johnston R, Kim R, Klaver C, McKibbin M, Ngah NF, Pershing S, Shankar D, Tamura H, Tufail A, Weng CY, Westborg I, Yelf C, Yoshimura N, Gillies MC. Defining a Minimum Set of Standardized Patient-centered Outcome Measures for Macular Degeneration. Am J Ophthalmol 2016; 168:1-12. [PMID: 27131774 DOI: 10.1016/j.ajo.2016.04.012] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 04/19/2016] [Accepted: 04/20/2016] [Indexed: 11/17/2022]
Abstract
PURPOSE To define a minimum set of outcome measures for tracking, comparing, and improving macular degeneration care. DESIGN Recommendations from a working group of international experts in macular degeneration outcomes registry development and patient advocates, facilitated by the International Consortium for Health Outcomes Measurement (ICHOM). METHODS Modified Delphi technique, supported by structured teleconferences, followed by online surveys to drive consensus decisions. Potential outcomes were identified through literature review of outcomes collected in existing registries and reported in major clinical trials. Outcomes were refined by the working group and selected based on impact on patients, relationship to good clinical care, and feasibility of measurement in routine clinical practice. RESULTS Standardized measurement of the following outcomes is recommended: visual functioning and quality of life (distance visual acuity, mobility and independence, emotional well-being, reading and accessing information); number of treatments; complications of treatment; and disease control. Proposed data collection sources include administrative data, clinical data during routine clinical visits, and patient-reported sources annually. Recording the following clinical characteristics is recommended to enable risk adjustment: age; sex; ethnicity; smoking status; baseline visual acuity in both eyes; type of macular degeneration; presence of geographic atrophy, subretinal fibrosis, or pigment epithelial detachment; previous macular degeneration treatment; ocular comorbidities. CONCLUSIONS The recommended minimum outcomes and pragmatic reporting standards should enable standardized, meaningful assessments and comparisons of macular degeneration treatment outcomes. Adoption could accelerate global improvements in standardized data gathering and reporting of patient-centered outcomes. This can facilitate informed decisions by patients and health care providers, plus allow long-term monitoring of aggregate data, ultimately improving understanding of disease progression and treatment responses.
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Affiliation(s)
- Ian A Rodrigues
- International Consortium for Health Outcomes Measurement, Boston, Massachusetts; Department of Ophthalmology, St Thomas' Hospital, London, United Kingdom
| | - Sara M Sprinkhuizen
- International Consortium for Health Outcomes Measurement, Boston, Massachusetts
| | - Daniel Barthelmes
- Department of Ophthalmology, University Hospital Zurich, and the University of Zurich, Zurich, Switzerland; The Save Sight Institute, The University of Sydney, Sydney, Australia
| | | | | | - Julia Haller
- Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Robert Johnston
- Gloucestershire Hospitals NHS Foundation Trust, Gloucester, United Kingdom
| | | | | | | | | | - Suzann Pershing
- Byers Eye Institute, Stanford University, Palo Alto, California; Veterans Affairs Palo Alto Health Care System, Livermore, California
| | - Dato Shankar
- International Consortium for Health Outcomes Measurement, Boston, Massachusetts
| | - Hiroshi Tamura
- Department of Ophthalmology & Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan; Division of Medical Information Technology & Administration Planning, Kyoto University Hospital, Kyoto, Japan
| | | | | | - Inger Westborg
- Umeå University, Registercenter Syd/EyeNet Sweden, Karlskrona, Sweden
| | | | - Nagahisa Yoshimura
- Department of Ophthalmology & Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Mark C Gillies
- The Save Sight Institute, The University of Sydney, Sydney, Australia.
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Di Lauro S, Castrejón M, Fernández I, Rojas J, Coco RM, Sanabria MR, Rodríguez de la Rua E, Pastor JC. Loss of Visual Acuity after Successful Surgery for Macula-On Rhegmatogenous Retinal Detachment in a Prospective Multicentre Study. J Ophthalmol 2015; 2015:821864. [PMID: 26640704 PMCID: PMC4660023 DOI: 10.1155/2015/821864] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 10/18/2015] [Accepted: 10/22/2015] [Indexed: 11/18/2022] Open
Abstract
Purpose. To quantify the frequency of visual loss after successful retinal detachment (RD) surgery in macula-on patients in a multicentric, prospective series of RD. Methods. Clinical variables from consecutive macula-on RD patients were collected in a prospective multicentric study. Visual loss was defined as at least a reduction in one line in best corrected visual acuity (VA) with Snellen chart. The series were divided into 4 subgroups: (1) all macula-on eyes (n = 357); (2) macula-on patients with visual loss at the third month of follow-up (n = 53) which were further subdivided in (3) phakic eyes (n = 39); and (4) pseudophakic eyes (n = 14). Results. Fifty-three eyes (14.9%) had visual loss three months after surgery (n = 39 phakic eyes; n = 14 pseudophakic eyes). There were no statistically significant differences between them regarding their clinical characteristics. Pars plana vitrectomy (PPV) was used in 67.2% of cases, scleral buckle in 57.7%, and scleral explant in 11.9% (36.1% were combined procedures). Conclusions. Around 15% of macula-on RD eyes lose VA after successful surgery. Development of cataracts may be one cause in phakic eyes, but vision loss in pseudophakic eyes could have other explanations such as the effect of released factors produced by retinal ischemia on the macula area. Further investigations are necessary to elucidate this hypothesis.
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Affiliation(s)
- Salvatore Di Lauro
- IOBA (Eye Institute), University of Valladolid, 47011 Valladolid, Spain
- Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
| | - Melissa Castrejón
- IOBA (Eye Institute), University of Valladolid, 47011 Valladolid, Spain
| | - Itziar Fernández
- IOBA (Eye Institute), University of Valladolid, 47011 Valladolid, Spain
- Ciber-BBN, 47011 Valladolid, Spain
| | - Jimena Rojas
- IOBA (Eye Institute), University of Valladolid, 47011 Valladolid, Spain
| | - Rosa M. Coco
- IOBA (Eye Institute), University of Valladolid, 47011 Valladolid, Spain
| | - María R. Sanabria
- IOBA (Eye Institute), University of Valladolid, 47011 Valladolid, Spain
- Complejo Asistencial de Palencia (CAPA), 34005 Palencia, Spain
| | | | - J. Carlos Pastor
- IOBA (Eye Institute), University of Valladolid, 47011 Valladolid, Spain
- Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
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Pastor JC, Rojas J, Pastor-Idoate S, Di Lauro S, Gonzalez-Buendia L, Delgado-Tirado S. Proliferative vitreoretinopathy: A new concept of disease pathogenesis and practical consequences. Prog Retin Eye Res 2015. [PMID: 26209346 DOI: 10.1016/j.preteyeres.2015.07.005] [Citation(s) in RCA: 217] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
During the last four decades, proliferative vitreoretinopathy (PVR) has defied the efforts of many researchers to prevent its occurrence or development. Thus, PVR is still the major complication following retinal detachment (RD) surgery and a bottle-neck for advances in cell therapy that require intraocular surgery. In this review we tried to combine basic and clinical knowledge, as an example of translational research, providing new and practical information for clinicians. PVR was defined as the proliferation of cells after RD. This idea was used for classifying PVR and also for designing experimental models used for testing many drugs, none of which were successful in humans. We summarize current information regarding the pathogenic events that follow any RD because this information may be the key for understanding and treating the earliest stages of PVR. A major focus is made on the intraretinal changes derived mainly from retinal glial cell reactivity. These responses can lead to intraretinal PVR, an entity that has not been clearly recognized. Inflammation is one of the major components of PVR, and we describe new genetic biomarkers that have the potential to predict its development. New treatment approaches are analyzed, especially those directed towards neuroprotection, which can also be useful for preventing visual loss after any RD. We also summarize the results of different surgical techniques and clinical information that is oriented toward the identification of high risk patients. Finally, we provide some recommendations for future classification of PVR and for designing comparable protocols for testing new drugs or techniques.
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Affiliation(s)
- J Carlos Pastor
- Retina Group, IOBA (Eye Institute), University of Valladolid, Valladolid, Spain; Department of Ophthalmology, Hospital Clinico Universitario de Valladolid, Valladolid, Spain.
| | - Jimena Rojas
- Retina Group, IOBA (Eye Institute), University of Valladolid, Valladolid, Spain; Department of Ophthalmology, Hospital Universitario Austral, Universidad Austral, Buenos Aires, Argentina
| | - Salvador Pastor-Idoate
- Retina Group, IOBA (Eye Institute), University of Valladolid, Valladolid, Spain; Manchester Royal Eye Hospital, Manchester Vision Regeneration (MVR) Lab at NIHR/Wellcome Trust, Manchester, United Kingdom
| | - Salvatore Di Lauro
- Retina Group, IOBA (Eye Institute), University of Valladolid, Valladolid, Spain; Department of Ophthalmology, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | - Lucia Gonzalez-Buendia
- Retina Group, IOBA (Eye Institute), University of Valladolid, Valladolid, Spain; Department of Ophthalmology, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | - Santiago Delgado-Tirado
- Retina Group, IOBA (Eye Institute), University of Valladolid, Valladolid, Spain; Department of Ophthalmology, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
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Rojas J, Fernandez I, Pastor JC, MacLaren RE, Ramkissoon Y, Harsum S, Charteris DG, Van Meurs JC, Amarakoon S, Garcia-Arumi J, Ruiz-Moreno JM, Rocha-Sousa A, Brion M, Carracedo A. Predicting proliferative vitreoretinopathy: temporal and external validation of models based on genetic and clinical variables. Br J Ophthalmol 2014; 99:41-8. [DOI: 10.1136/bjophthalmol-2014-305263] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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