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OBJECTIVE: To study the safety and efficacy of intravitreal infliximab administered at the conclusion of pars plana vitrectomy (PPV) in the treatment of proliferative vitreoretinopathy (PVR) associated with rhegmatogenous retinal detachment (RRD). DESIGN: Randomized controlled phase II clinical trial. SUBJECTS: Patients with primary RRD and grade C PVR, according to the updated Retina Society Classification. METHODS: Sixty-six patients were randomized in a 1:1 ratio to undergo PPV and silicone oil (SO) injection with or without intravitreal injection of 1 mg/0.05 mL of infliximab in the air-filled globe before SO injection at PPV conclusion. Surgeons were masked to treatment allocation until PPV conclusion. MAIN OUTCOME MEASURES: The primary outcome measure was anatomic success (defined as complete retinal reattachment without a tamponade at 6 months post SO removal). Secondary outcome measures were final best-corrected visual acuity (BCVA), single-operation success rate (SOSR), rate of recurrent detachment, central macular thickness (CMT) by macular OCT, macular function by multifocal electroretinogram, and macular vascular density (VD) by OCT angiography. RESULTS: Sixty eyes of 60 patients, 30 eyes in each group, completed the study. At baseline, there were no differences regarding age, gender, history of trauma, lens status, duration of RRD, BCVA, intraocular pressure (IOP), intraocular inflammation (IOI), detachment extent in clock hours, number/size of breaks, presence of vitreous hemorrhage, axial length, or grade/extent of PVR between both groups. For the outcome measures, 30 eyes in the infliximab group achieved anatomic success vs. 29 eyes in the control group. The SOSR was higher in the infliximab group (26) vs. the control (23), but this was not statistically significant (P = 0.317). Final logarithm of the minimum angle of resolution BCVA was better in the infliximab group (mean, 0.96; standard deviation [SD], 0.4; Snellen equivalent ≈ 20/180) vs. the control (mean, 1.14; SD, 0.4); Snellen equivalent ≈ 20/280; P = 0.044). There were no differences regarding IOP, IOI, time of SO removal, macular function, CMT, or VD. CONCLUSIONS: Pars plana vitrectomy with SO tamponade with or without intravitreal infliximab is effective in treating PVR-associated RRD. Infliximab may be associated with modest improvement in final visual outcomes but not anatomic outcomes. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any materials discussed in this article.
RESUMO
PURPOSE: To evaluate the efficacy and safety of epithelial-island crosslinking (EI-CXL) in keratoconus with corneas thinner than 400 µm. METHODS: Twenty-six patients (30 eyes) underwent EI-CXL (preserving the epithelium over the thinnest area), using standard protocol (3 mW/cm2 for 30 min). Uncorrected and best spectacle-corrected distance visual acuity (UCDVA, BCDVA), manifest refractive spherical equivalent (SEQ), mean simulated keratometry (Kmean), maximum keratometry (Kmax), and thinnest corneal thickness (TCT) were determined preoperatively and at 1, 3, 6, and 12 months following CXL. Endothelial cell count (ECC) was determined preoperatively and at 6 months. Anterior segment optical coherence tomography (AS-OCT) was done at 1 month to determine the depth of the corneal stromal demarcation line (DL). RESULTS: After 1 year, mean UCDVA improved from 1.29 preoperatively to 1.17 (P = 0.001) and BCDVA from 0.62 to 0.57 (P = 0.011). Mean manifest SEQ decreased from -7.63 to-7.32D (P = 0.001). Mean Kmean decreased from 54.92 to 54.81D (P = 0.045), and Kmax from 67.60 to 67.42D (P = 0.072), and mean TCT changed minimally from 377.17 to 375.30 µ (P = 0.11). The mean ECC decreased from 2329 to 2268 cells/mm2 (2.6% decrease, P < 0.001). AS-OCT showed a DL in 29 out of 30 eyes at an average depth of 215.9 µ under the spared epithelium, and 299.9 µ in the de-epithelialized cornea. CONCLUSION: EI-CXL halted keratoconus progression over a 1-year period. This was associated with statistically significant endothelial loss, but less than seen with conventional epi-off CXL in thinner corneas.