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PURPOSE: To analyze the single surgery success rate and anterior segment complications related to phacoemulsification and intraocular lens implantation in a series of patients undergoing phacovitrectomy for all types of primary rhegmatogenous retinal detachment. METHODS: We performed a retrospective interventional case series on 302 eyes undergoing phacovitrectomy for primary rhegmatogenous retinal detachment repair between November 1, 2016, and February 2, 2019, in Edmonton, Canada. Primary outcomes included single surgery retinal reattachment rate and anterior segment complications. Secondary outcomes included the effects of proliferative vitreoretinopathy and macula and/or peripheral internal limiting membrane peeling on the rate of surgical success. RESULTS: The single surgery success rate of phacovitrectomy for all types of primary rhegmatogenous retinal detachment was 85.1%. The presence of proliferative vitreoretinopathy was associated with lower surgical success (odds ratio, 0.33; P = 0.01). Macular internal limiting membrane peeling was associated with higher surgical success (odds ratio, 2.4; P = 0.05). Anterior segment complications included posterior capsular opacification (28.8%), posterior synechiae (10.9%), and posterior capsular rupture (2.3%). CONCLUSION: Phacovitrectomy is a safe and effective treatment option for the primary repair of rhegmatogenous retinal detachments. This study provides evidence to support the safe incorporation of phacoemulsification and intraocular lens implantation with retinal surgery.
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Implante de Lente Intraocular , Facoemulsificação , Descolamento Retiniano/cirurgia , Vitrectomia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pseudofacia/fisiopatologia , Descolamento Retiniano/fisiopatologia , Estudos Retrospectivos , Resultado do Tratamento , Acuidade Visual , Vitreorretinopatia Proliferativa/complicações , Vitreorretinopatia Proliferativa/fisiopatologia , Adulto JovemRESUMO
BACKGROUND: Exogenous endophthalmitis is a potential complication of intraocular surgery and frequently results in visual impairment. Current treatment involves administration of intravitreal (IVT) antibiotics with or without vitrectomy surgery. Evidence for the use of adjunctive anti-inflammatory agents is conflicting. We set out to determine if bevacizumab, a humanized monoclonal IgG1 antibody targeted against vascular endothelial growth factor (VEGF), has anti-inflammatory properties in experimental models of Gram-positive and Gram-negative inflammation. METHODS: BALB/c mice were subjected to lipopolysaccharide- (LPS) or peptidoglycan- (PGN) induced ocular inflammation and treated with IVT bevacizumab. Iris microvasculature was imaged 6 hours following irritant/treatment using intravital microscopy (IVM) before the mice were euthanized and the eyes were enucleated immediately post-mortem. Following enucleation, levels of VEGF and 23 cytokines and chemokines (IL-1α, IL-1ß, IL-2, IL-3, IL-4, IL-5, IL-6, IL-10, IL-12 (p40), IL-12 (p70), IL-13, IL-17, TNF, KC, G-CSF, GM-CSF, Eotaxin, INF-γ, MCP-1, MIP-1α, MIP-1ß, RANTES) were quantified using a multiplex assay. RESULTS: Levels of VEGF were significantly increased during the inflammatory response, triggered by either PGN or LPS. Both the adherence of leukocytes to the iris vascular endothelium and the levels of pro-inflammatory cytokines and chemokines were significantly increased following administration of either irritant. Treatment with bevacizumab decreased levels of leukocyte adherence in LPS-treated eyes, however, not in PGN-treated eyes. Conversely, bevacizumab treatment decreased levels of cytokines and chemokines (TNF, IL-6, MCP-1, MIP-1α, MIP-1ß, RANTES, KC) in PGN-treated eyes, however, not in LPS-treated eyes. CONCLUSIONS: Within a 6-hour window bevacizumab had anti-inflammatory actions that were distinct in both Gram-positive (PIU) and Gram-negative (EIU) models, respectively. Given our findings, this would suggest that bevacizumab may have utility as an adjunctive therapy to IVT antibiotics and vitrectomy in the management of exogenous endophthalmitis.
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Inibidores da Angiogênese/uso terapêutico , Bevacizumab/uso terapêutico , Infecções Oculares Bacterianas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Uveíte/tratamento farmacológico , Animais , Citocinas/metabolismo , Modelos Animais de Doenças , Infecções Oculares Bacterianas/etiologia , Infecções Oculares Bacterianas/metabolismo , Infecções por Bactérias Gram-Negativas/etiologia , Infecções por Bactérias Gram-Negativas/metabolismo , Infecções por Bactérias Gram-Positivas/etiologia , Infecções por Bactérias Gram-Positivas/metabolismo , Inflamação/tratamento farmacológico , Inflamação/metabolismo , Inflamação/microbiologia , Injeções Intravítreas , Lipopolissacarídeos , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Peptidoglicano , Fatores de Tempo , Uveíte/metabolismo , Uveíte/microbiologia , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Fator A de Crescimento do Endotélio Vascular/metabolismoAssuntos
Branquioma/patologia , Neoplasias da Mama/patologia , Neoplasias de Cabeça e Pescoço/patologia , Síndromes Paraneoplásicas Oculares/diagnóstico , Esclera/irrigação sanguínea , Transtornos da Visão/diagnóstico , Branquioma/cirurgia , Neoplasias da Mama/cirurgia , Angiografia por Tomografia Computadorizada , Feminino , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Excisão de Linfonodo , Mastectomia Segmentar , Pessoa de Meia-Idade , Órbita/irrigação sanguínea , Veias/fisiopatologia , Acuidade Visual/fisiologiaRESUMO
Susac syndrome is characterized by encephalopathy, sensorineural hearing loss, and branch retinal artery occlusion. Additional ocular findings include arteriolar wall hyperfluorescence and Gass plaques. We present a 51-year-old Caucasian woman with ophthalmologic findings indicative of Susac syndrome in the setting of tinnitus and migraine with aura.
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Enxaqueca com Aura/complicações , Síndrome de Susac/diagnóstico , Zumbido/complicações , Feminino , Angiofluoresceinografia , Humanos , Pessoa de Meia-Idade , Síndrome de Susac/complicaçõesRESUMO
Since the introduction of artificial intelligence (AI) in 1956 by John McCarthy, the field has propelled medicine, optimized efficiency, and led to technological breakthroughs in clinical care. As an important frontier in healthcare, AI has implications on every subspecialty within medicine. This review highlights the applications of AI in ophthalmology: a specialty that lends itself well to the integration of computer algorithms due to the high volume of digital imaging, data, and objective metrics such as central retinal thickness. The focus of this review is the use of AI in retina, cornea, anterior segment, and pediatrics.
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Inteligência Artificial , Oftalmologia , Humanos , Criança , Oftalmologia/métodos , Aprendizado de Máquina , Algoritmos , Atenção à Saúde/métodosRESUMO
Purpose: To determine the anatomic and visual outcomes of pars plana vitrectomy for uncomplicated, primary macula-off rhegmatogenous retinal detachment (RRD) with and without internal limiting membrane (ILM) peeling. Methods: This retrospective chart review comprised 129 patients with uncomplicated, primary macula-off RRD presenting between January 1, 2016, and May 31, 2021. Thirty-six patients (27.9%) had ILM peeling and 93 (72.0%) did not. The primary outcome was the rate of recurrent RRD. Secondary outcomes included preoperative and postoperative best-corrected visual acuity (BCVA), epiretinal membrane (ERM) formation, and macular thickness. Results: No significant difference was found in the risk for recurrent RRD between patients who had ILM peeling and those who did not (2.8% [1/36] and 5.4% [5/93], respectively) (P = 1.00). The final postoperative BCVA was better in eyes that did not have ILM peeling (P< .001). No ERM occurred in the group with ILM peeling, whereas ERM occurred in 27 patients (29.0%) who did not have ILM peeling. The temporal macular retina was thinner in eyes in which ILM peeling was performed. Conclusions: The risk for recurrent RRD was not statistically lower in eyes having ILM peeling of the macula in uncomplicated, primary macula-off RRD. Despite a reduction in postoperative ERM formation, eyes having macular ILM peeling had worse postoperative VA.
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Introduction: To evaluate the effect of antivascular endothelial growth factor (anti-VEGF)-related endophthalmitis on intravitreal injection (IVI) frequency in patients with neovascular age-related macular degeneration (nAMD). Methods: A retrospective chart review was performed of all cases of post IVI endophthalmitis that occurred in Edmonton, Alberta, Canada, between 2012 and 2019. Contralateral eyes affected by nAMD but without endophthalmitis served as a control group. The main outcome measures were the frequency of anti-VEGF injections, visual acuity, and activity of choroidal neovascularization before and after endophthalmitis. Results: Seventeen eyes met the inclusion criteria, 2 (12%) of which never resumed IVI after endophthalmitis because of the quiescence of disease. Post-endophthalmitis eyes received IVI less frequently in the 1 year after endophthalmitis (mean 0.52 ± 0.42 IVI/month) than those that received IVI 1 year before endophthalmitis (1.09 ± 0.36 IVI/month) (P = .001). The 17 contralateral eyes also received anti-VEGF injections less frequently after endophthalmitis than before (P = .001). There was no significant change in optical coherence tomography markers of disease activity in cases or controls. Conclusions: In patients with nAMD, endophthalmitis resolution is associated with a decrease in anti-VEGF injection frequency. The same decrease in anti-VEGF injection frequency is also seen in contralateral eyes unaffected by endophthalmitis. Markers of disease activity remain unchanged in both eyes, suggesting disease quiescence despite reduced IVI frequency.
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PURPOSE: To present a surgical technique and case presentation of internal chandelier-assisted macular buckling for myopic foveoschisis. METHODS: Review of patient clinical features, visual acuity, and optical coherence tomography results after internal chandelier-assisted macular buckling for myopic foveoschisis. RESULTS: A 48-year-old highly myopic woman (axial length 29.85 mm) underwent internal chandelier-assisted macular buckling for myopic foveoschisis with macular detachment. The best-corrected visual acuity improved from 20/150 to 20/40. Postoperative optical coherence tomography confirmed central buckle positioning and demonstrated resolved foveoschisis and macular detachment. There were no complications. CONCLUSION: Internal chandelier-assisted macular buckling is a valuable tool to optimize buckle position and patient outcomes.
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Miopia Degenerativa , Miopia , Perfurações Retinianas , Retinosquise , Feminino , Humanos , Pessoa de Meia-Idade , Miopia/cirurgia , Miopia Degenerativa/complicações , Perfurações Retinianas/etiologia , Retinosquise/complicações , Retinosquise/diagnóstico , Retinosquise/cirurgia , Estudos Retrospectivos , Tomografia de Coerência Óptica , Acuidade Visual , Vitrectomia/efeitos adversosRESUMO
BACKGROUND & AIMS: Clostridium difficile-associated disease (CDAD) is the leading cause of nosocomial diarrhea in the United States. C difficile toxins TcdA and TcdB breach the intestinal barrier and trigger mucosal inflammation and intestinal damage. The inflammasome is an intracellular danger sensor of the innate immune system. In the present study, we hypothesize that TcdA and TcdB trigger inflammasome-dependent interleukin (IL)-1beta production, which contributes to the pathogenesis of CDAD. METHODS: Macrophages exposed to TcdA and TcdB were assessed for IL-1beta production, an indication of inflammasome activation. Macrophages deficient in components of the inflammasome were also assessed. Truncated/mutated forms of TcdB were assessed for their ability to activate the inflammasome. The role of inflammasome signaling in vivo was assessed in ASC-deficient and IL-1 receptor antagonist-treated mice. RESULTS: TcdA and TcdB triggered inflammasome activation and IL-1beta secretion in macrophages and human mucosal biopsy specimens. Deletion of Nlrp3 decreased, whereas deletion of ASC completely abolished, toxin-induced IL-1beta release. TcdB-induced IL-1beta release required recognition of the full-length toxin but not its enzymatic function. In vivo, deletion of ASC significantly reduced toxin-induced inflammation and damage, an effect that was mimicked by pretreatment with the IL-1 receptor antagonist anakinra. CONCLUSIONS: TcdA and TcdB trigger IL-1beta release by activating an ASC-containing inflammasome, a response that contributes to toxin-induced inflammation and damage in vivo. Pretreating mice with the IL-1 receptor antagonist anakinra afforded the same level of protection that was observed in ASC-/- mice. These data suggest that targeting inflammasome or IL-1beta signaling may represent new therapeutic targets in the treatment of CDAD.
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Clostridioides difficile/patogenicidade , Ileíte/imunologia , Íleo/imunologia , Imunidade Inata , Mediadores da Inflamação/metabolismo , Interleucina-1beta/metabolismo , Macrófagos/imunologia , Animais , Proteínas Reguladoras de Apoptose , Proteínas de Bactérias/genética , Toxinas Bacterianas/genética , Biópsia , Proteínas Adaptadoras de Sinalização CARD , Proteínas de Transporte/genética , Proteínas de Transporte/metabolismo , Caspase 1/metabolismo , Linhagem Celular , Clostridioides difficile/genética , Proteínas do Citoesqueleto/deficiência , Proteínas do Citoesqueleto/genética , Modelos Animais de Doenças , Endocitose , Endossomos/imunologia , Endossomos/microbiologia , Enterotoxinas/genética , Humanos , Ileíte/microbiologia , Ileíte/patologia , Ileíte/prevenção & controle , Íleo/efeitos dos fármacos , Íleo/microbiologia , Íleo/patologia , Imunidade Inata/efeitos dos fármacos , Proteína Antagonista do Receptor de Interleucina 1/farmacologia , Macrófagos/efeitos dos fármacos , Macrófagos/microbiologia , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos C57BL , Camundongos Knockout , Mutação , Proteína 3 que Contém Domínio de Pirina da Família NLRRESUMO
Inflammation significantly contributes to the progression of chronic kidney disease (CKD). Inflammasome-dependent cytokines, such as IL-1ß and IL-18, play a role in CKD, but their regulation during renal injury is unknown. Here, we analyzed the processing of caspase-1, IL-1ß, and IL-18 after unilateral ureteral obstruction (UUO) in mice, which suggested activation of the Nlrp3 inflammasome during renal injury. Compared with wild-type mice, Nlrp3(-/-) mice had less tubular injury, inflammation, and fibrosis after UUO, associated with a reduction in caspase-1 activation and maturation of IL-1ß and IL-18; these data confirm that the Nlrp3 inflammasome upregulates these cytokines in the kidney during injury. Bone marrow chimeras revealed that Nlrp3 mediates the injurious/inflammatory processes in both hematopoietic and nonhematopoietic cellular compartments. In tissue from human renal biopsies, a wide variety of nondiabetic kidney diseases exhibited increased expression of NLRP3 mRNA, which correlated with renal function. Taken together, these results strongly support a role for NLRP3 in renal injury and identify the inflammasome as a possible therapeutic target in the treatment of patients with progressive CKD.
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Proteínas de Transporte/metabolismo , Nefrite/metabolismo , Insuficiência Renal Crônica/metabolismo , Obstrução Ureteral/metabolismo , Animais , Proteínas de Transporte/genética , Células Cultivadas , Fibrose , Humanos , Rim/patologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Proteína 3 que Contém Domínio de Pirina da Família NLR , RNA Mensageiro/metabolismo , Obstrução Ureteral/patologiaRESUMO
Purpose: To determine whether pneumatic vitreolysis with intravitreal air is effective for focal vitreomacular traction (VMT). Methods: We conducted a retrospective consecutive case series of 20 eyes from 19 individuals with focal VMT who underwent pneumatic vitreolysis with intravitreal air (January 2017 to November 2018). We analyzed patients via spectral-domain optical coherence tomography before intravitreal air injection and at 1 month. The primary outcome measure was release of VMT. Results: We observed release of VMT in 55% of individuals. An analysis limited to phakic eyes demonstrated release of VMT in 69%, and 65% developed improved best-corrected visual acuity. Individuals with persistent VMT and visual improvement had a significant reduction in angle of vitreoretinal insertion (P < .01), area under VMT (P < .05), and subfoveal cyst area (P < .05). Conclusions: Intravitreal air is an effective treatment for focal VMT. In individuals with persistent VMT, visual-acuity improvement was associated with a reduction in overall VMT.
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Purpose: We report a case of relentless placoid chorioretinitis (RPC) that developed branch retinal vein occlusion and peripheral retinal neovascularization in one eye. Methods: A case report is presented. Results: A 33-year-old healthy man presented with decreased visual acuity (20/150) in both eyes. Slit-lamp examination revealed anterior chamber and vitreous inflammation. Multiple yellow-white lesions were evident in the macula and scattered throughout the fundus. Following workup, a diagnosis of RPC was made. The patient was started on Pred Forte (prednisolone acetate 1%) and atropine drops. Three months later, visual acuity improved to 20/70 and 20/100 in the right and left eyes, respectively. At this time, fundus examination and fluorescein angiography revealed peripheral retinal neovascularization. Sectoral scatter laser photocoagulation was performed in the areas of nonperfusion. Conclusions: We describe a novel presentation of RPC associated with branch retinal vein occlusion and retinal neovascularization. Although the pathophysiology of RPC is believed to be primarily a choroidal vasculitis, retinal vascular changes may also occur, as observed in other white dot syndromes.
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The authors describe the case of a 25-year-old male who presented with a cilioretinal artery occlusion secondary to posterior scleritis. The patient had a history of juvenile spondyloarthritis that evolved into ankylosing spondylitis. Cilioretinal artery occlusion is a rare complication of posterior scleritis, having only been described once previously in the literature. This is the first reported case of a cilioretinal artery occlusion in posterior scleritis that was associated with an underlying systemic disease. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:102-106.].
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Oclusão da Artéria Retiniana , Esclerite , Espondilite Anquilosante , Adulto , Artérias , Humanos , Masculino , Oclusão da Artéria Retiniana/diagnóstico , Oclusão da Artéria Retiniana/etiologia , Esclerite/diagnóstico , Esclerite/etiologia , Espondilite Anquilosante/complicações , Espondilite Anquilosante/diagnósticoRESUMO
PURPOSE: To describe the complication of subretinal gas after pars plana vitrectomy for rhegmatogenous retinal detachment, as well as its management. METHODS: The presence of subretinal gas was noted on postoperative Day 1 after pars plana vitrectomy for a chronic rhegmatogenous retinal detachment. Resolution of subretinal gas was facilitated by an infusion line and external sclerotomy to expand the vitreous cavity. Residual subretinal gas was removed through a posterior retinotomy after fluid-air exchange. RESULTS: This technique resulted in the successful evacuation of subretinal gas, allowing for chorioretinal adhesion and reattachment of the retina. CONCLUSION: Subretinal gas can rarely occur after pars plana vitrectomy for rhegmatogenous retinal detachment. This complication can be successfully managed by way of external drainage, followed by evacuation of residual gas through fluid-air exchange and posterior retinotomy.
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Fluorocarbonos/efeitos adversos , Descolamento Retiniano/cirurgia , Vitrectomia/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/cirurgiaRESUMO
Partial-thickness folds of the inner retina and outer retina, as well as full-thickness retinal folds, may occur after the repair of rhegmatogenous retinal detachment. Although these can look similar on clinical examination, imaging with optical coherence tomography facilitates differentiation. With optical coherence tomography analysis, inner retinal folds exhibit corrugations of the inner retina while outer retinal folds display hyperreflective lesions located just above the retinal pigment epithelium that may extend into the outer nuclear layer. In the case of a classic full-thickness retinal fold, all layers of the neurosensory retina may separate together from the retinal pigment epithelium with retinal reduplication and base-to-base photoreceptor orientation. We review the pathogenesis, risk factors, prevention, and management options of retinal folds. As the terminology for retinal folds is diverse, we highlight optical coherence tomography-based descriptions for retinal folds that have been used in the literature. Factors predicting visual recovery, mechanisms of spontaneous fold regression, and the effect of internal limiting membrane peeling on the incidence of folds are potential areas of future study.
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Complicações Pós-Operatórias , Retina/patologia , Descolamento Retiniano/cirurgia , Doenças Retinianas/etiologia , Humanos , Retina/diagnóstico por imagem , Doenças Retinianas/diagnóstico por imagem , Tomografia de Coerência Óptica/métodos , Acuidade Visual , VitrectomiaRESUMO
PURPOSE: To describe a novel patient positioning apparatus for intraocular surgery capable of accommodating patients with thoracic kyphosis. METHODS: Case report. RESULTS: A 60-year-old man presented with a macula-off retinal detachment and severe ankylosing spondylitis. The patient was scheduled for combined pars plana vitrectomy and scleral buckle. Because of the patient's severe kyphosis, a custom-designed positioning apparatus was built. The setup involved a canvas with 10 sewn-on straps and a Skytron operating table with strap inserts. Padding and blankets were also used to secure the patient comfortably in the Trendelenburg position. Surgery was uncomplicated and retinal detachment repair was successfully performed. CONCLUSION: To the authors' knowledge, this is the first report detailing a vest-like support apparatus for patients with thoracic kyphosis used in vitreoretinal surgery. This apparatus can be prepared using any conventional operating table, and it offers an effective approach to intraocular surgery for patients who cannot lie flat.