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PURPOSE: To test the hypothesis that optical coherence tomography (OCT) choroidal hypertransmission width (CHW) is a prognostic biomarker in idiopathic macular hole (MH) surgery METHODS: Retrospective cohort study of consecutive patients undergoing successful pars plana vitrectomy for idiopathic MH. We collected demographic, clinical, and OCT variables at the preoperative and last available visits. Two investigators assessed the following OCT parameters: MH minimum diameter, base diameter, CHW, ellipsoid zone, and external limiting membrane status (absent vs. present). Delta CHW was calculated as the difference between CHW and MH minimum diameter. Linear models were used to investigate factors associated with postoperative best-corrected visual acuity (BCVA) and BCVA change. RESULTS: Thirty-six eyes (36 patients) with a median (interquartile range (IQR)) follow-up of 9 (8-11) months were included. The median BCVA (IQR) improved from 0.75 (1-0.6) logMAR preoperatively to 0.2 (0.6-0.1) logMAR at the last visit (p < 0.001). Preoperative MH minimum diameter (for a 10-µm increase, estimate (standard error (SE)): 0.009 (0.003) logMAR, p = 0.003), base diameter (for a 10-µm increase, 0.003 (0.001) logMAR, p = 0.032), CHW (for a 10-µm increase, 0.008 (0.002) logMAR, p < 0.001), and delta CHW (for a 10-µm increase, 0.013 (0.005) logMAR, p = 0.009) were significantly associated with postoperative BCVA. The proportion of variance explained was the highest for MH CHW (R2 0.35), followed by minimum MH diameter (R2 0.24), delta CHW (R2 0.19), and MH base diameter (R2 0.14). None of the study variables was associated with delta BCVA. CONCLUSION: Preoperative CHW is associated with postoperative visual acuity in patients undergoing successful idiopathic MH surgery and may be a useful OCT prognostic biomarker.
Assuntos
Corioide , Perfurações Retinianas , Tomografia de Coerência Óptica , Acuidade Visual , Vitrectomia , Humanos , Tomografia de Coerência Óptica/métodos , Perfurações Retinianas/cirurgia , Perfurações Retinianas/diagnóstico , Perfurações Retinianas/fisiopatologia , Estudos Retrospectivos , Masculino , Feminino , Vitrectomia/métodos , Acuidade Visual/fisiologia , Corioide/diagnóstico por imagem , Prognóstico , Idoso , Seguimentos , Pessoa de Meia-Idade , Período Pós-Operatório , BiomarcadoresRESUMO
PURPOSE: Analyze the peripheral vitreoretinal interface with widefield optical coherence tomography. METHODS: Retrospective chart analysis and widefield optical coherence tomography in 120 consecutive cases of rhegmatogenous pathology. RESULTS: There were 166 lesions in 120 eyes, including 106 horseshoe tears, 22 operculated holes, 30 nonoperculated holes, six giant tears, and two peripheral lamellar defects followed for 6.1 ± 1.2 months. Posterior vitreous detachment was present in all eyes (101/101, 100%) with tears and operculated holes, but only in 5/19 eyes (26.3%) with nonoperculated holes ( P < 0.001). Axial vitreous traction was evident at the anterior edge of horseshoe tears (106/106, 100%), but not the posterior border (18/106, 17%, P < 0.001). Operculated holes located posterior to the vitreous base were free from vitreous traction, displaying a morphology similar to the macular hole. Nonoperculated holes were farther anterior with signs of tangential traction in 23/30 (76.7%) cases. Peripheral vitreoschisis was more often associated with nonoperculated holes (25/30, 83.3%), than horseshoe tears (17/106, 16%; P < 0.001). Horseshoe tears and nonoperculated holes were more often associated with retinal detachment (58/106 [54.7%] and 15/30 [50%], respectively) than operculated holes (5/22, 22.7%), P = 0.023. CONCLUSION: Peripheral vitreoretinal interactions are similar to vitreomaculopathies, with axial and vitreoschisis-related tangential traction playing different roles in different rhegmatogenous pathologies. Peripheral optical coherence tomography improves understanding of pathophysiology and risks of retinal detachment.
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Descolamento Retiniano , Perfurações Retinianas , Descolamento do Vítreo , Humanos , Descolamento Retiniano/complicações , Tomografia de Coerência Óptica/métodos , Estudos Retrospectivos , Perfurações Retinianas/diagnóstico , Perfurações Retinianas/complicações , Descolamento do Vítreo/diagnóstico , Descolamento do Vítreo/complicaçõesRESUMO
PURPOSE: To describe macular pucker contraction patterns with en face optical coherence tomography (OCT), to provide a correlation with metamorphopsia scores, and to discuss the protective role of the Henle fiber layer (HFL) against tangential traction. METHODS: Retrospective, institutional, observational, and consecutive case series. Clinical charts, M-charts scores, and structural and en face OCT imaging of patients diagnosed with macular pucker were reviewed. RESULTS: A 120 eyes of 114 consecutive patients diagnosed with macular pucker were included. En face OCT patterns of macular pucker contraction were foveal in 51 of 120 eyes (42.5%) and extrafoveal in 69 of 120 eyes (57.5%). Foveal macular puckers had regular, a concentric, circle morphology in the HFL (46/51 eyes, 90.2%), whereas extrafoveal membranes had irregular, distorted, circular HFL morphology (62/69 eyes, 89.8%; P < 0.001). Foveal contraction morphology and regular HFL pattern, as well as extrafoveal contraction morphology and an irregular HFL pattern, highly correlated one with another (P < 0.001 in both cases). Foveal macular puckers with regular HFL patterns had significantly less vertical and horizontal M-charts scores as compared with extrafoveal membranes with irregular HFL (P < 0.001 in both cases). Ellipsoid zone and external limiting membrane defects were rare in the parafoveal region (5/120 eyes, 4.2%). Visual acuity did not correlate with metamorphopsia scores (P = 0.903). CONCLUSION: En face OCT imaging identifies macular pucker contraction patterns that correlate with metamorphopsia scores and that can be used alongside the current structural OCT staging system to guide clinicians in the surgical decision-making process.
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Tomografia de Coerência Óptica , Transtornos da Visão , Acuidade Visual , Humanos , Tomografia de Coerência Óptica/métodos , Estudos Retrospectivos , Feminino , Masculino , Idoso , Acuidade Visual/fisiologia , Pessoa de Meia-Idade , Transtornos da Visão/fisiopatologia , Transtornos da Visão/diagnóstico , Macula Lutea/diagnóstico por imagem , Macula Lutea/patologia , Idoso de 80 Anos ou mais , Fóvea Central/diagnóstico por imagem , Fóvea Central/patologiaRESUMO
PURPOSE: To describe and report the anatomical and functional outcomes of a novel sutureless peripheral intravascular catheter (PIVC)-assisted scleral fixation of three-piece IOL. METHODS: A retrospective chart review of all patients who underwent scleral fixation surgery performed by a single surgeon was conducted. In all cases, a novel scleral fixation technique of three-piece IOL was performed with the aid of a 24-gauge PIVC cannula. Patients were followed up at postoperative months 1, 3, and 6. RESULTS: Thirteen eyes of 12 patients were included in the analysis. Preoperatively, mean best-corrected visual acuity was 1.26 ± 0.82 LogMar (20/364 Snellen Equivalent), and it improved significantly at all follow-up endpoints being of 0.52 ± 0.25 LogMar at 1 month (20/66 Snellen Equivalent, P = 0.02), 0.4 ± 0.22 LogMar at 3 months (20/50 Snellen Equivalent, P = 0.007) and 0.37 ± 0.2 LogMar (20/47 Snellen Equivalent, P = 0.008) at 6 months postoperatively. No serious intraoperative or postoperative complications were registered. Postoperatively, there were no cases of conjunctival erosions. Over the follow-up period, in all the included cases, the IOL remained centered and stable. CONCLUSION: The PIVC-assisted scleral fixation technique may be a safe and reliable surgical option for secondary IOL placement in cases of insufficient capsular support.
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Implante de Lente Intraocular , Lentes Intraoculares , Humanos , Implante de Lente Intraocular/métodos , Estudos Retrospectivos , Acuidade Visual , Complicações Pós-Operatórias/cirurgia , Esclera/cirurgia , Transtornos da Visão/cirurgia , Catéteres , Técnicas de SuturaRESUMO
PURPOSE: This study aims to describe vessel density differences in tractional versus exudative macular oedema with the aid of novel custom imaging analysis techniques. METHODS: In this retrospective study, patients with exudative and tractional macular oedema were imaged with optical coherence tomography (OCT), en-face OCT, OCT-angiography and fluorescein angiography. A novel image processing algorithm was developed to extrapolate data from the vessel density maps. RESULTS: Forty-one eyes of 36 patients were included. A total of 30 control eyes comprised the control group. At the deep capillary plexus (DCP), exudative eyes presented with a vessel density of 62.12 ± 5.7, significantly higher if compared to both tractional lamellar macular hole (57.6 ± 4.6, p = 0.004) and controls (52.07 ± 2.3, p < 0.001). At the superficial capillary plexus (SCP), there were no differences in vessel density between exudative eyes (51.9 ± 4.4) and both the tractional lamellar hole (54.9 ± 3.1, p = 0.083) and the control (51.72 ± 2.2, p = 0.083) groups. In the exudative subgroup, there was a direct correlation between areas of low flow and those of high flow at both the DCP and SCP (p = 0.001 and p = 0.042, respectively). CONCLUSIONS: Intraretinal expansion of fluid may cause the displacement of the surrounding retinal parenchyma and capillaries.
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Edema Macular , Capilares , Angiofluoresceinografia , Humanos , Edema Macular/diagnóstico , Edema Macular/etiologia , Imagem Multimodal , Vasos Retinianos/diagnóstico por imagem , Estudos Retrospectivos , Tomografia de Coerência ÓpticaRESUMO
PURPOSE: We aimed to investigate non-exudative microcystoid macular abnormalities for visual and anatomical outcome in patients with retinal vein occlusion (RVO) with and without glaucomatous optic neuropathy (GON). METHODS: Medical records of 124 eyes (105 patients) with RVO were reviewed and analyzed. Eyes demonstrating microcystoid macular abnormalities were divided into 2 groups, those with evidence of glaucoma (group A) and those without glaucoma (group B). Best-corrected visual acuity (BCVA), the prevalence and number of microcystoid macular abnormalities, and number of intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections were compared at baseline and follow-up. RESULTS: Seventy-one out of 105 eyes (67.6%) with RVO displayed microcystoid macular abnormalities. Thirty-eight out of 71 eyes (53.5%) presented with concomitant glaucoma (group A), while the remaining 33 eyes (42.6%) had no history of glaucoma (group B). At the end of the follow-up period, mean BCVA was worse in group A versus group B (20/80 versus 20/40, respectively; p = .003). The mean number of anti-VEGF injections was 10.1 ± 9.2 in group A versus 5.9 ± 6.9 in group B (p = .03). CONCLUSION: Eyes with RVO and concomitant glaucoma exhibited a significantly higher number of microcystoid macular abnormalities and worse BCVA versus eyes with RVO without glaucoma.
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Edema Macular , Oclusão da Veia Retiniana , Inibidores da Angiogênese/uso terapêutico , Seguimentos , Humanos , Injeções Intravítreas , Edema Macular/tratamento farmacológico , Retina , Oclusão da Veia Retiniana/complicações , Oclusão da Veia Retiniana/diagnóstico , Oclusão da Veia Retiniana/tratamento farmacológico , Tomografia de Coerência Óptica , Resultado do Tratamento , Acuidade VisualRESUMO
INTRODUCTION: To compare visual outcomes and complication rates of giant retinal tear-associated retinal detachment (GRT-RD) cases treated with short-term perfluorodecalin (PFD) tamponade versus silicone oil (SiO). METHODS: Database analysis of patients with GRT-RD operated on in the period from 1 January 2014 to 31 December 2019. RESULTS: Forty-five patients were operated for GRT-RD using PFD or SiO during this period. Two children, 7 patients receiving gas tamponade, and 2 lost to follow-up were excluded. Eighteen eyes (40%) received PFD and 27 (60%) received SiO. There were 15/18 (83%) macula-sparing cases in the PFD group and 18/27 (67%) in the SiO group (p = 0.13). The mean duration of oil tamponade was 91 days for SiO and 7.6 days for PFD (p < 0.0001). The mean length of follow-up was 274.5 days for PFD and 668.9 days for SiO. The mean BCVA was 6/18 (63.4 ± 26.0 ETDRS letters) for SiO and 6/12 (72.9 ± 12.7 ETDRS letters) for PFD (p = 0.42). Analysing macula-sparing pseudophakic eyes, the BCVA was 6/12 (67.4 ± 25.9 letters, n = 18) for SiO eyes and 6/9 (76.8 ± 9.9 letters, n = 11) for PFD eyes (p = 0.54). The recurrence rate was 22% (6/27) for SiO and 6% (1/18) for PFD (p = 0.12). The rate of cystoid macular oedema (CMO) was 22% for SiO and 22% for PFD. Epiretinal membrane (ERM) was found in 26% of SiO cases and 22% of PFD cases. Loss of vision after oil removal was not observed. Seven eyes (26%) receiving SiO and none receiving PFD developed chronic ocular hypertension (OHT) (p = 0.02). CONCLUSIONS: Short-term tamponade with PFD for GRT-RD appears similar to tamponade with SiO in terms of the visual outcomes and complication rates.
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Descolamento Retiniano , Perfurações Retinianas , Criança , Fluorocarbonos , Seguimentos , Humanos , Descolamento Retiniano/diagnóstico , Descolamento Retiniano/etiologia , Descolamento Retiniano/cirurgia , Óleos de Silicone , Acuidade Visual , VitrectomiaRESUMO
PURPOSE: To evaluate and compare the rate and characteristics of vitreoretinal disorders in fellow eyes of lamellar macular holes (LMH) versus epiretinal membrane foveoschisis (ERMF). METHODS: Included patients in this retrospective study were divided into two groups based on spectral-domain optical coherence tomography (SD-OCT) features of their primary eye: LMH (group A) and ERMF (group B). RESULTS: Ninety-four patients were enrolled: 59 (62.8%) in group A and 35 (37.2%) in group B. Fellow eyes in group A had a higher rate of retinal detachment (8/59 [13.6%] vs. 0/35 [0%], P = 0.024), and full-thickness macular hole (FTMH) (11/59 [18.6%] vs. 2/35 [5.7%], P = 0.079), compared with fellow eyes in group B. In group A, 4/59 patients (6.8%) showed a bilateral LMH while none from group B had a LMH in their fellow eye (0/35 [0%]), P = 0.293. Additionally, epiretinal proliferation was noted in 30/59 (50.8%) fellow eyes in group A versus 3/35 (8.6%) fellow eyes in group B, P < 0.001. Longitudinal data were available for 80/94 patients. Over a mean follow-up of 37.4 ± 29.9 months, 1/48 (2.1%) fellow eyes from group A developed a FTMH and 2/48 (4.2%) developed a LMH, while no FTMH or LMH occurred in fellow eyes of group B. CONCLUSIONS: Fellow eyes of LMH showed a high rate of macular and peripheral vitreoretinal disorders. In addition, epiretinal proliferation was detected in a higher number of fellow eyes of LMH versus ERMF. These findings suggest a bilateral process in eyes of patients with LMH.
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Membrana Epirretiniana , Perfurações Retinianas , Retinosquise , Membrana Epirretiniana/diagnóstico , Seguimentos , Humanos , Perfurações Retinianas/diagnóstico , Perfurações Retinianas/etiologia , Retinosquise/diagnóstico , Estudos Retrospectivos , Tomografia de Coerência Óptica , Acuidade VisualRESUMO
PURPOSE: To investigate whether age-related macular degeneration (AMD) has an influence on the prevalence and anatomical characteristics of lamellar macular holes (LMHs). METHODS: Clinical records and spectral-domain optical coherence tomography images of 756 eyes of 423 consecutive patients diagnosed with AMD were reviewed and analyzed. Spectral-domain optical coherence tomography was used to identify degenerative or tractional LMH subtypes and assess their morphology. The clinical and optical coherence tomography findings of AMD eyes with LMH were compared with those of a control group of eyes with LMH without AMD from a previously published report. RESULTS: Lamellar macular holes were identified in 25 eyes of 23 patients (3.3%; 25 of 756). Seventeen of 25 eyes (68%) presented with degenerative LMH and underlying late neovascular AMD. Mean best-corrected visual acuity was worse in eyes with AMD and LMH eyes than in those with AMD and no LMH (20/230 vs. 20/98; P = 0.02). The mean outer diameter was greater in the group with degenerative LMH with concomitant AMD than in the control group of degenerative LMH without AMD (1,323.9 ± 999.1 µm vs. 905.9 ± 356.8 µm, respectively; P = 0.01). CONCLUSION: The incidence of degenerative LMH increased in advanced forms of AMD, whereas the presence of tractional LMH subtype may be unrelated to AMD evolution.
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Macula Lutea/patologia , Degeneração Macular/complicações , Perfurações Retinianas/etiologia , Tomografia de Coerência Óptica/métodos , Acuidade Visual , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Degeneração Macular/diagnóstico , Masculino , Perfurações Retinianas/diagnóstico , Estudos RetrospectivosRESUMO
PURPOSE: To quantitatively and qualitatively evaluate the microvascular and structural abnormalities associated with inner retinal dimpling after internal limiting membrane peeling for full-thickness macular holes using sequential en face optical coherence tomography (OCT) and OCT angiography. METHODS: Thirteen eyes of 13 patients with idiopathic full-thickness macular holes were enrolled in the study. Patients were treated with pars plana vitrectomy, internal limiting membrane peeling, and gas tamponade. Subjects were evaluated preoperatively and at postoperative Months 1, 3, and 6. At each visit, patients underwent a comprehensive ophthalmologic examination, en face OCT and OCT angiography. The morphology and number and proportionate area of inner retinal dimples were analyzed. Vessel density of the superficial vascular complex at all visits was also measured. RESULTS: Inner retinal dimples were identified 1 month after surgery in all cases. The number and proportionate area of inner retinal dimples significantly increased over the follow-up period (P = 0.05). Preoperative vessel density of the superficial vascular complex was 17.9 ± 1.9 and did not change significantly over the follow-up period (P = 0.15). CONCLUSION: Inner retinal dimples are identified with en face OCT as early as the first month after internal limiting membrane peeling for idiopathic full-thickness macular holes and progressively increase in number and proportionate area in the subsequent 3 to 6 months after surgery. This may be the result of progressive deturgescence of the nerve fiber layer in the postoperative period.
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Membrana Basal/cirurgia , Angiofluoresceinografia/métodos , Macula Lutea/patologia , Células Ganglionares da Retina/patologia , Perfurações Retinianas/cirurgia , Tomografia de Coerência Óptica/métodos , Vitrectomia/métodos , Idoso , Feminino , Seguimentos , Fundo de Olho , Humanos , Masculino , Perfurações Retinianas/diagnóstico , Estudos Retrospectivos , Acuidade VisualRESUMO
PURPOSE: To describe and analyze short-term posterior vitreous abnormalities following intravitreal ocriplasmin in eyes with symptomatic vitreomacular traction syndrome (VMT). METHODS: In this institutional, prospective and interventional study enrolled patients with symptomatic focal VMT syndrome treated with intravitreal ocriplasmin. In all cases, spectral-domain optical coherence tomography scans were quantitatively and qualitatively analyzed preoperatively and at 1 and 4 weeks postoperatively. RESULTS: Twenty-three patients, of which 5 were males and 18 females, with a mean age of 69.5 ± 8.2 years were included in this study. Postoperatively, VMT resolved in 11 of 23 eyes (47.8%). In 9 out of 11 cases (81.8%), VMT resolved by postoperative week 1, whether in the remaining 2 (18.2%) anatomical restoration, was diagnosed at postoperative week 4. At postoperative week 1, a foveolar detachment was detected in 9 out of 23 eyes (39.1%). The foveolar detachment resolved all but one eye by the end of postoperative week 4. At the end of the follow-up period, the presence of subretinal fluid was detected in 7 out of 9 eyes (77.8%), and it was significantly associated with a shrinkage of the posterior vitreous cortex (p < 0.006). At the end of the follow-up period, visual acuity was significantly higher in those eyes with VMT resolution (p < 0.001). CONCLUSION: Intravitreal ocriplasmin is effective for the treatment of patients with VMT. The postoperative presence of posterior hyaloid shrinkage may be associated with higher traction over the foveal area and the appearance of foveolar detachment.
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Fibrinolisina/administração & dosagem , Fragmentos de Peptídeos/administração & dosagem , Perfurações Retinianas/tratamento farmacológico , Tomografia de Coerência Óptica/métodos , Acuidade Visual , Corpo Vítreo/patologia , Descolamento do Vítreo/tratamento farmacológico , Idoso , Feminino , Seguimentos , Humanos , Injeções Intravítreas , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Perfurações Retinianas/diagnóstico , Síndrome , Fatores de Tempo , Resultado do Tratamento , Descolamento do Vítreo/diagnósticoRESUMO
PURPOSE: To describe the functional and anatomical outcomes of pars plana vitrectomy with epiretinal membrane and internal limiting membrane peel in eyes with and without ectopic inner foveal layers (EIFLs). METHODS: In this retrospective multicenter study, patients diagnosed with idiopathic epiretinal membranes who underwent pars plana vitrectomy with epiretinal membrane and internal limiting membrane peel were enrolled, with a minimum follow-up of 12 months. Preoperative and postoperative spectral domain optical coherence tomography scans were qualitatively and quantitatively evaluated. The association of the EIFL and other spectral domain optical coherence tomography parameters with preoperative and postoperative best-corrected visual acuity (BCVA) was analyzed. RESULTS: One hundred eleven eyes of 107 patients were included. Preoperatively, the EIFLs were present in 56 of 111 eyes (50.4%). The presence of EIFL was significantly associated with lower preoperative and postoperative BCVA (P < 0.001). Ectopic inner foveal layer thickness was negatively correlated with preoperative BCVA (r = 0.58, P < 0.001). Postoperatively, the EIFL persisted in 51 of 56 eyes (91%) with Stage 3 and 4 epiretinal membranes. Ectopic inner foveal layer thickness decreased significantly after surgery (P < 0.001), but postoperative EIFL thinning had no direct effect on postoperative change in BCVA. At 12 months from surgery, EIFL thickness maintained a significant negative correlation with BCVA (r = 0.55, P < 0.001). CONCLUSION: The presence of EIFL should be considered a negative prognostic factor for postoperative anatomical and functional recovery.
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Membrana Epirretiniana/fisiopatologia , Fóvea Central/patologia , Recuperação de Função Fisiológica , Segmento Externo das Células Fotorreceptoras da Retina/patologia , Acuidade Visual , Vitrectomia/métodos , Idoso , Idoso de 80 Anos ou mais , Membrana Basal/cirurgia , Membrana Epirretiniana/patologia , Membrana Epirretiniana/cirurgia , Feminino , Seguimentos , Fóvea Central/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Prognóstico , Estudos Retrospectivos , Fatores de Tempo , Tomografia de Coerência Óptica/métodosRESUMO
PURPOSE: Functional and anatomical outcomes of vitrectomy with membrane peeling were compared in tractional lamellar macular holes (LMH)/macular pseudoholes (MPH) versus degenerative LMH. METHODS: This multicenter retrospective study enrolled patients with a minimum follow-up of 6 months. The association of spectral domain optical coherence tomography parameters with preoperative and postoperative best-corrected visual acuity was analyzed. RESULTS: Seventy-seven (74.8%) tractional LMH/MPH and 26 (25.2%) degenerative LMH were included. Preoperative best-corrected visual acuity was better in tractional LMH/MPH (0.39 ± 0.2 logarithm of the minimal angle of resolution, 20/50 Snellen equivalent) than degenerative LMH (0.56 ± 0.2 logarithm of the minimal angle of resolution, 20/66 Snellen equivalent; P < 0.001). Premacular membranes were found in all tractional LMH/MPH, whereas LMH-associated epiretinal proliferation (LHEP) was present in all degenerative LMH. Primary anatomical success was achieved in 97/103 eyes (94.2%), with foveal restoration occurring earlier in degenerative LMH (1.6 ± 2.3 vs. 3.3 ± 3.6 months; P = 0.025). Best-corrected visual acuity improved in both tractional LMH/MPH and degenerative LMH (P < 0.001 and P = 0.012, respectively) but was better in tractional LMH/MPH (P = 0.001). CONCLUSION: The presence of premacular membranes and absence of LMH-associated epiretinal proliferation in all tractional LMH/MPH further distinguishes this from degenerative LMH. Best-corrected visual acuity improved in both subgroups but more so in tractional LMH/MPH. Complete anatomical restoration of foveal microanatomy was rare in degenerative LMH, reflecting significant morphological and pathophysiological differences between the two lesions.
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Retina/patologia , Perfurações Retinianas/cirurgia , Tomografia de Coerência Óptica/métodos , Acuidade Visual , Vitrectomia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Perfurações Retinianas/diagnóstico , Estudos RetrospectivosRESUMO
PURPOSE: Pars plana vitrectomy has been reported to increase the risk of ocular hypertension and open-angle glaucoma. The authors conducted a systematic review of randomized and nonrandomized studies to compare the incidence of open-angle glaucoma and ocular hypertension in vitrectomized versus nonvitrectomized eyes. METHODS: A literature search was performed using MEDLINE and EMBASE until August 2016. Data on ocular hypertension and open-angle glaucoma incidence and mean intraocular pressure after at least 1 year were pooled using random-effects metaanalysis models. Because only nonrandomized studies were retrieved, ROBINS-I tool was used to assess risk of bias in the review. RESULTS: Seven included studies had a paired design to compare the outcomes of vitrectomized versus fellow eyes, with mean follow-up of least 12 months. Four studies (851 patients) provided data on open-angle glaucoma: incidence in vitrectomized versus non-vitrectomized eyes was 7.8% and 4.8%, respectively, yielding a metaanalytic odds ratio of 1.67 (95% CI: 1.08-2.57). Six studies (1,060 patients) reported on the occurrence of ocular hypertension, which was 5.8% in vitrectomized eyes versus 3.1% in fellow eyes (odds ratio: 2.03, 95% CI: 0.97-4.22), without significant differences in the mean postoperative intraocular pressure (mean difference 0.31 mmHg, 95% CI: -0.26 to 0.89). CONCLUSION: Although the review found increased risk of open-angle glaucoma with pars plana vitrectomy, the studies were heterogenous or inconsistent regarding ocular hypertension and intraocular pressure increase. Larger studies should be conducted in homogenous cohorts of patients undergoing macular surgery, excluding complex conditions such as retinal detachment or diabetic retinopathy.
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Glaucoma de Ângulo Aberto/etiologia , Hipertensão Ocular/etiologia , Vitrectomia/efeitos adversos , Glaucoma de Ângulo Aberto/epidemiologia , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Incidência , Pressão Intraocular/fisiologia , Fibras Nervosas/patologia , Hipertensão Ocular/epidemiologia , Hipertensão Ocular/fisiopatologia , Retina/patologiaRESUMO
PURPOSE: To describe the sequential evolution of outer retinal tubulations (ORTs) in patients diagnosed with choroidal neovascularization and/or retinal pigment epithelium atrophy. METHODS: Retrospective evaluation of spectral domain optical coherence tomography of a consecutive cohort of patients with various retinal conditions. RESULTS: We reviewed the clinical findings of 238 eyes of 119 consecutive patients (54 men and 65 women) with a mean age of 76.2 ± 14.2 years (range: 57-90) and a mean follow-up of 3 ± 1.6 years (range 1-7). Over the follow-up period, ORTs were diagnosed in 67 of 238 eyes (28.1%), 9 of which were imaged with sequential, eye-tracked spectral domain optical coherence tomography dating from the beginning of ORT formation. The presence of geographic atrophy and subretinal hyperreflective material at baseline were found to be risk factors for ORT development (P < 0.001 and P < 0.001, respectively). Outer retinal tubulations were divided into forming versus formed morphologies. The latter was comprised open and closed ORTs of which the open subtype was the most common. The formation of ORTs was significantly associated with microcystic macular lesions in the inner nuclear layer and the downward displacement of the outer plexiform layer, referred to as the outer plexiform layer subsidence sign (P < 0.001). CONCLUSION: Outer retinal tubulation is a frequent optical coherence tomography finding in eyes with choroidal neovascularization and geographic atrophy. Open ORTs with progressive scrolled edges and shortened diameter were significantly associated with microcystic macular lesions in the inner nuclear layer and the outer plexiform layer subsidence sign.
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Neovascularização de Coroide/patologia , Degeneração Retiniana/patologia , Epitélio Pigmentado da Retina/patologia , Tomografia de Coerência Óptica/métodos , Idoso , Idoso de 80 Anos ou mais , Neovascularização de Coroide/diagnóstico por imagem , Feminino , Atrofia Geográfica/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Degeneração Retiniana/diagnóstico por imagem , Segmento Externo das Células Fotorreceptoras da Retina/patologia , Estudos Retrospectivos , Acuidade VisualRESUMO
BACKGROUND: This is a pilot study to test a polyethylene glycol-derived polymer used as a retinal patch to seal retinal breaks during pars plana vitrectomy in the treatment of rhegmatogenous retinal detachment in a porcine model. METHODS: Sixteen eyes from eight pigs were assigned to two study groups (12 eyes) and one control group (four eyes). In all study groups, the polymer was used in vivo, during pars plana vitrectomy, to seal the break of a surgically induced rhegmatogenous retinal detachment. Eyes in study groups were filled with balanced saline solution at the end of the surgery. In the control group, the polymer was not used and the eyes underwent standard rhegmatogenous retinal detachment repair with pars plana vitrectomy. All eyes underwent fundus examination at day 3, week 1 and week 2 after surgery. All eyes from all groups were enucleated and processed for qualitative histological evaluation. RESULTS: Intraoperatively, the polymer showed good adherence and compliance to the retina. At week 1, retina was attached in all cases. The polymer was visible with indirect ophthalmoscopy up to week 1. At week 2, the polymer was no longer visible. Histologically, a mild histiocytic reaction was noticed in the retinas of four out of 12 study eyes (33.3%). In the control eyes, non-specific inflammatory signs of retinal inflammation were reported in two out of four eyes (50%). CONCLUSIONS: This study provides initial data to support the use of this polymer as a promising alternative to standard endo-tamponade agents. Its safety and biocompatibility need to be further assessed.
Assuntos
Modelos Animais de Doenças , Tamponamento Interno/métodos , Polietilenoglicóis , Polímeros , Descolamento Retiniano/cirurgia , Perfurações Retinianas/cirurgia , Vitrectomia , Animais , Estudos de Viabilidade , Projetos Piloto , Estudos Prospectivos , SuínosRESUMO
PURPOSE: To investigate the long-term safety and efficacy of microincisional 23-gauge pars plana vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade in the treatment of myopic traction maculopathy. METHODS: A prospective nonrandomized multicenter study was designed. Patients with myopic traction maculopathy without macular hole and retinal detachment were included in the study between January 2009 and May 2012. All patients underwent microincisional 23-gauge pars plana vitrectomy with ILM peeling and 12% C3F8 gas tamponade. In all cases, brilliant blue G staining of the ILM was performed. All patients were prospectively evaluated. The evolution of best-corrected visual acuity (BCVA) and macular thickness were recorded. RESULTS: Myopic traction maculopathy resolved in 28 of the 30 patients (93%) included. Mean follow-up was 33.8 ± 13 months (range, 24-60 months). Mean time of myopic traction maculopathy resolution after surgery was 2.65 ± 1.4 months. At 1 month after surgery, one patient developed a macular hole and another one a rhegmatogenous retinal detachment. After 2 years, another patient developed a retinal detachment. Statistically significant improvements in macular thickness compared with baseline were found at all follow-up visits (P < 0.001, Student's t-test). At final visit, BCVA improved significantly compared with baseline (P = 0.044, Wilcoxon's test). However, a statistically significant improvement in visual acuity was achieved only in eyes with a preoperative Snellen visual acuity ≥ 20/63 (P = 0.027). In contrast, the final BCVA of eyes with worse preoperative visual acuity (<20/63) did not improve significantly (P = 0.41, Wilcoxon's test). CONCLUSION: Microincisional 23-gauge pars plana vitrectomy with ILM peeling and gas tamponade is effective in the treatment of myopic traction maculopathy, with low postoperative complications. Globally, both BCVA and macular thickness improved significantly during the follow-up period. However, greater visual acuity improvements were only seen in eyes with preoperative BCVA equal to or better than 20/63 Snellen equivalent. Some concerns remain about the risk of macular hole formation after ILM peeling. Further studies are necessary to investigate this issue.
Assuntos
Tamponamento Interno , Membrana Epirretiniana/cirurgia , Fluorocarbonos/administração & dosagem , Miopia Degenerativa/cirurgia , Retinosquise/cirurgia , Vitrectomia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Membrana Basal/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Microcirurgia/métodos , Pessoa de Meia-Idade , Miopia Degenerativa/diagnóstico , Miopia Degenerativa/fisiopatologia , Complicações Pós-Operatórias , Estudos Prospectivos , Retinosquise/diagnóstico , Retinosquise/fisiopatologia , Tomografia de Coerência Óptica , Acuidade Visual/fisiologiaRESUMO
PURPOSE: Primarily to assess and compare the prevalence of open-angle glaucoma (OAG) in previously vitrectomized and nonvitrectomized eyes at our institution. Secondarily to assess and compare the prevalence of OAG in eyes those were phakic and pseudophakic/aphakic at the time of vitrectomy. METHODS: A cross-sectional prevalence study was designed. Patients who underwent pars plana vitrectomy at our institution from January 2006 to December 2011 and had not been diagnosed with OAG before the surgical procedure were contacted by phone. Those patients who agreed to participate were invited to the University Hospital of Ourense (Spain) for a comprehensive ophthalmic assessment, including Perkins tonometry, gonioscopy, examination of the optic disk, and a spectral-domain optical coherence tomography scan of the optic nerve head. The definition of OAG was based on standardized criteria, modified versions of the Rotterdam Study, and those published by Foster et al. RESULTS: Among 472 eligible patients, 182 responded and agreed to participate in our study. Of these, 26 were excluded. Finally, 312 eyes of 156 patients were included in the analysis. Fifteen vitrectomized (8.9%) and 3 nonvitrectomized (2%) eyes were diagnosed with OAG. This difference was statistically significant (P = 0.02, chi-square test). Differences in the prevalence of OAG between eyes those were phakic and pseudophakic/aphakic at the time of vitrectomy were not statistically significant (P = 0.48, chi-square test). CONCLUSION: Our study supports the hypothesis of an increased risk of OAG after vitrectomy. Prevalence of OAG in vitrectomized eyes was significantly higher compared with nonvitrectomized ones. However, we were not able to demonstrate significant difference in the prevalence of OAG between eyes those were phakic or aphakic/pseudophakic at the time of vitrectomy.
Assuntos
Glaucoma de Ângulo Aberto/epidemiologia , Vitrectomia/estatística & dados numéricos , Idoso , Estudos Transversais , Feminino , Glaucoma de Ângulo Aberto/diagnóstico , Gonioscopia , Humanos , Pressão Intraocular/fisiologia , Cristalino/fisiologia , Masculino , Prevalência , Pseudofacia/epidemiologia , Espanha/epidemiologia , Tomografia de Coerência Óptica , Tonometria OcularRESUMO
BACKGROUND: Endophthalmitis is a rare but severe complication of vitrectomy. CLINICAL RELEVANCE: Post-surgical endophthalmitis is suspected to be more frequent after microincisional (23- and 25-gauge) compared with standard (20-gauge) vitrectomy. METHODS: We conducted a systematic review of studies that compared microincisional and standard vitrectomy by searching MEDLINE and EMBASE up to November 2012. We used the Bayesian meta-analysis method to compute the odds ratio (OR) of endophthalmitis. We conducted subgroup analyses to compare the effect of different incision types and use of perioperative antibiotics. RESULTS: We identified 3 small randomized and 18 nonrandomized studies that reported 68 cases of endophthalmitis in 148 643 participants. The overall OR of endophthalmitis for microincisional versus standard vitrectomy was 2.3 (95% credible interval [CrI], 0.8-5.8). We found an increased risk of endophthalmitis using a microincisional straight approach compared with standard vitrectomy (OR, 15.1; 95% CrI, 2.01-179), but not for a beveled approach (OR, 0.82; 95% CrI, 0.23-2.28). The OR of studies that reported on mixed microincision was between these 2 values (OR, 4.4; 95% CrI, 1.32-14.3). We estimated that the overall rate of endophthalmitis with 20-gauge vitrectomy was 3 cases in 10 000 procedures, and the probability that a beveled microincision increases the rate of endophthalmitis to more than 6 or 9 events was small (no more than 5% or 1%, respectively). CONCLUSIONS: We did not find an increased risk of endophthalmitis for microincisional vitrectomy compared with standard vitrectomy. The beveled approach seems to be safer than a straight approach, supporting the current recommendation of its adoption in microincisional vitrectomy. However, these findings must be interpreted cautiously because of the small number of endophthalmitis events reported from included studies.
Assuntos
Endoftalmite/etiologia , Microcirurgia/métodos , Complicações Pós-Operatórias , Vitrectomia/métodos , Bases de Dados Factuais , Humanos , Fatores de RiscoRESUMO
PURPOSE: To report a case of presumed sympathetic ophthalmia (SO) following scleral buckling (SB) surgery and to discuss the possible pathogenesis of this condition by reviewing the current evidence on this subject. METHODS: Case report and narrative review of the literature; our case was imaged with spectral-domain optical coherence tomography (SD-OCT) and optical coherence tomography angiography (OCTA), fundus autofluorescence (FAF), fluorescein angiography (FFA) and indocyanine green angiography (ICGA). RESULTS: A 55-year-old man presented with a macula on rhegmatogenous retinal detachment which was treated with 360° SB surgery, subretinal fluid drain (SRFD), cryopexy and pneumoretinopexy. Due to failure of the primary surgery, a second procedure was performed the day after with the explant of the prior buckle and the implant of a wider circumferential element. At three months from surgery, the patient complained of severe bilateral vision loss. Multimodal imaging revealed bilateral, multi-focal exudative retinal detachments and choroidal swelling. A diagnosis of presumed SO was made and the patient was treated with a combination of steroid and immunosuppressive drugs. The clinical picture completely resolved at postoperative month 12. CONCLUSION: SO may be a rare complication of SB surgery. In our case, early recognition and prompt immunosuppressive treatment achieved good long-term clinical results.