New Treatment Horizons in Uveal and Cutaneous Melanoma.

Melanoma is a complex and heterogeneous malignant tumor with distinct genetic characteristics and therapeutic challenges in both cutaneous melanoma (CM) and uveal melanoma (UM). This review explores the underlying molecular features and genetic alterations in these melanoma subtypes, highlighting the importance of employing specific model systems tailored to their unique profiles for the development of targeted therapies. Over the past decade, significant progress has been made in unraveling the molecular and genetic characteristics of CM and UM, leading to notable advancements in treatment options. Genetic mutations in the mitogen-activated protein kinase (MAPK) pathway drive CM, while UM is characterized by mutations in genes like GNAQ, GNA11, BAP1, EIF1AX, and SF3B1. Chromosomal aberrations, including monosomy 3 in UM and monosomy 10 in CM, play significant roles in tumorigenesis. Immune cell infiltration differs between CM and UM, impacting prognosis. Therapeutic advancements targeting these genetic alterations, including oncolytic viruses and immunotherapies, have shown promise in preclinical and clinical studies. Oncolytic viruses selectively infect malignant cells, inducing oncolysis and activating antitumor immune responses. Talimogene laherparepvec (T-VEC) is an FDA-approved oncolytic virus for CM treatment, and other oncolytic viruses, such as coxsackieviruses and HF-10, are being investigated. Furthermore, combining oncolytic viruses with immunotherapies, such as CAR-T cell therapy, holds great potential. Understanding the intrinsic molecular features of melanoma and their role in shaping novel therapeutic approaches provides insights into targeted interventions and paves the way for more effective treatments for CM and UM.

Differences and Similarities in Epidemiology and Risk Factors for Cutaneous and Uveal Melanoma.

Both cutaneous melanoma (CM) and uveal melanoma (UM) represent important causes of morbidity and mortality. In this review, we evaluate the available knowledge on the differences and similarities between cutaneous melanoma and uveal melanoma, focusing on the epidemiological aspects and risk factors. Uveal melanoma is a rare condition but is the most prevalent primary intra-ocular malignant tumor in adults. Cutaneous melanoma, on the other hand, is significantly more common. While the frequency of cutaneous melanoma has increased in the last decades worldwide, the incidence of uveal melanoma has remained stable. Although both tumors arise from melanocytes, they are very distinct entities biologically, with complex and varied etiologies. Both conditions are encountered more frequently by individuals with a fair phenotype. ultraviolet-radiation is an important, well-documented risk factor for the development of CM, but has shown not to be of specific risk in UM. Although cutaneous and ocular melanomas seem to be inherited independently, there are reported cases of concomitant primary tumors in the same patient.

The Learning Curve of Surgery of Diabetic Tractional Retinal Detachment-A Retrospective, Comparative Study.

Background and Objectives: There are few data in the literature concerning the learning curve of tractional retinal detachment (TRD) surgery. We have analyzed the experience gained by a vitreoretinal surgeon over 10 years. Materials and Methods: A retrospective, comparative study of 34 TRD cases operated using 20G instruments between 2008 and 2011 (group A) and 94 cases operated using 23G instruments between 2015 and 2019 (group B). The preoperative characteristics, the type of endotamponade, and the anatomical and functional success were reviewed. Results: The group A patients had a significantly higher rate of concomitant vitreous hemorrhage (VH) at presentation (64.7% vs. 37.2%) and of non-macular retinal detachments (52.9% vs. 39.3%). The rate of silicone oil endotamponade was high in both groups (76.4% vs. 68.1%), but in group B 25.5% were left without a tamponade (vs. none in group A). A postoperative anatomical success was obtained in 76.5% of eyes in group A and 84.04% of eyes in group B (where it was improved to 89.3% by reinterventions). The presenting visual acuity (VA) was very low in both groups (0.01 and 0.05, respectively). The proportion of eyes with improved or stabilized VA was 85.3% in group A and 79.8% in group B (statistically non-significant difference). Conclusions: The anatomical success rate improves quite slowly with increasing surgeon experience and can be further improved by reinterventions. Visual improvement does not match the rate of anatomical improvement. With increasing experience and self-confidence, the surgeon will approach more difficult cases, a fact that may slow down the increase in surgical success rates.

Uveal melanoma diagnosis and current treatment options (Review).

Uveal melanoma is a rare condition accounting for only 5% of all primary melanoma cases. Still, it is the most frequently diagnosed primary intraocular malignant tumor in adults. Almost 90% of the tumors involve the choroid and only a small percentage affects the ciliary body or the iris. There is a consistent difference in incidence between different regions with individuals of northern European descent having a significantly higher risk as compared to Hispanics, Asians, and Blacks. Among the many risk factors, mutations in the G protein subunit alpha Q (GNAQ) or G protein subunit alpha 11 (GNA11) genes and different receptors are highly suggestive. While iris melanoma can easily be noticed by the patient itself or diagnosed at a routine slit-lamp evaluation, a consistent percentage of posterior uveal tumors are incidentally diagnosed at funduscopic evaluation as they can evolve silently for years, especially if located in the periphery. Uveal melanoma classifications rely on the tumor size (thickness and basal diameter) and also on intraocular and extraocular extension. The differential diagnosis with pseudomelanomas is carried out according to the tumor aspect and position. Iris melanoma has a better prognosis and a lower mortality rate as compared to choroidal melanoma that has a much higher rate of metastasis (50% of the patients) and a subsequent limited life expectancy from 6 to 12 months. While conservative therapeutic options for the primary tumor, relying on different surgical excision techniques and/or irradiation therapies, offer good local tumor control, the treatment options for metastatic disease, although numerous, are still inadequate in preventing a fatal outcome.

Outcomes of simultaneous vs. sequential pars plana vitrectomy and cataract surgery.

The coexistence of cataract and vitreoretinal diseases is common in clinical practice. The technological achievements of the last decade in both types of surgeries, allow simultaneous interventions on lens and retina. This retrospective study assessed the morphofunctional results obtained after performing simultaneous surgeries in a series of 87 patients presenting with both pathologies. The cases were retrospectively reviewed from their clinical records from 2017 to 2019. The patients were divided into two groups: group 1 comprising 41 cases underwent the combined procedure and group 2 comprising 46 patients underwent vitrectomy, followed by cataract surgery after 3-10 months. The functional and anatomical outcomes and the complications were assessed pre- and post-operatively. The statistical analysis was carried out by MaxStat software. The final best corrected visual acuity (BCVA), in group 1 was <0.1 in 4.88% of the cases, 0.1 to 0.3 in 17.07%, 0.3 to 0.5 in 51.22% and >0.5 in 26.83% eyes. In group 2, the final BCVA, after both surgeries were completed was <0.1 in 8.7% cases, 0.1 to 0.3 in 30.43%, 41.3% were 0.3 to 0.5 and 19.57% were >0.5. During the cataract surgery, the most common intraoperative complication was miosis, followed by posterior capsule rupture. Postoperative, 12.2% cases from group 1 developed an immediate inflammatory reaction in the anterior chamber, and 17.07% presented with posterior capsular opacification (PCO). Simultaneous surgery is safe and effective in obtaining a good morphological and functional result and offers the advantage of a clear eye media that allows a safer vitrectomy and thus a quicker rehabilitation of the patient. The analysis of the risks and benefits of each procedure should be taken into account and the cases selected individually for either simultaneous or sequential surgery in order to obtain the best outcomes.

Intraocular pressure changes during and after silicone oil endotamponade (Review).

Silicone oil (SIO) has rapidly become an indispensable adjunct in vitreoretinal surgery. Constant improvements in purity and also in viscosity have not totally prevented specific complications that may occur during endotamponade. Results of in vitro studies that suggested that higher viscosity silicone oil might be superior in terms of stability and safety are confirmed in real life only if endotamponade lasts for more than 6 months. Intraocular pressure changes induced by the silicone oil endotamponade or oil extraction are documented from its very first use and are potentially threatening vision. The purpose of this review is to update current knowledge on the incidence, risk factors, pathogenesis, and management of secondary silicone oil glaucoma. Also, in a retrospective evaluation on cases with complex retinal detachments that underwent 23G vitrectomy and high viscosity SIO endotamponade, we have noticed that a considerable number of cases developed significant intraocular pressure changes during SIO endotamponade and after SIO removal, especially in early postoperative period.

Ocular cicatricial pemphigoid (Review).

Ocular cicatricial pemphigoid is a particular form of mucous membrane pemphigoid and it is characterized by a chronic bilateral conjunctivitis with relapsing-remitting periods. Without therapy 75% of the cases develop visual loss due to major ocular complications (e.g. severe dry-eye syndrome, corneal erosions, corneal keratinization, entropion, symblepharon). Pathogenesis remains uncertain and probably linked to an autoimmune type II hypersensitivity response in patients with a genetic predisposition and exposure to different environmental triggers. With a worldwide distribution, no racial predilection and an estimated incidence that largely varies from 1/10,000-1/60,000, ocular cicatricial pemphigoid predominantly affects women aged ~60 years. Conjunctival biopsy with direct immunofluorescence is the gold standard in diagnosis confirmation, but up to 40% of the patients have a negative biopsy result that does not rule out the diagnosis. The skin and many other mucous membranes (e.g. oral, trachea, esophagus, pharynx, larynx, urethra, vagina and anus) may be involved. The disease grading relies on Foster staging system (based on clinical signs) and Mondino and Brown system (based on the inferior fornix depth loss). The differential diagnosis includes atopy, allergies, trauma, chemical burns, radiation, neoplasia, infectious, inflammatory and autoimmune etiologies. The main goals of the treatment are to stop disease progression, to relieve symptoms and to prevent complications. With long-term systemic therapy 90% of the cases can be efficiently controlled. While Dapsone is the first-line treatment in mild to moderate disease in patients without G6PD deficiency, more severe cases require immunosuppressant therapy with azathioprine, mycophenolate mofetil, methotrexate or cyclosporine. Cyclophosphamide, biologics (etanercept or rituximab) and intravenous immunoglobulin therapy are usually reserved for recalcitrant disease and unsatisfactory results to conventional therapy. Dry eye syndrome requires constant lubricating medication and topical steroids, cyclosporine-A and tacrolimus. Surgery should be planed only in quiescent phase as minor conjunctival trauma can significantly worsen the disease.

Terson's Syndrome - case report.

Terson's Syndrome is represented by a vitreous, retrohyaloid, retinal, or subretinal hemorrhage occurring consequent to an acute intracranial hemorrhage or elevated intracranial pressure. The outcome may include a complete clearing of the blood and the restoration of VA or persistent hemorrhage. This report presents the case of a 43-year-old woman who underwent bilateral surgery for a persistent vitreous hemorrhage and a hematoma underneath the internal limiting membrane in the left eye. The event followed shortly after a subarachnoid hemorrhage due to the rupture of a posterior communicating artery aneurism. Vitrectomy was performed in both eyes, together with the peeling of the internal limiting membrane in the left eye, followed by a bilateral good outcome.

Incidence of ocular hypertension after intravitreal injection of anti-VEGF agents in the treatment of neovascular AMD.

Purpose. The assessment of the incidence of ocular hypertension over a period of 1 year in patients treated with multiple intravitreal injections of anti-VEGF agents for neovascular AMD. Methods. The study comprised 58 eyes diagnosed with neovascular age-related macular degeneration and receiving PRN intravitreal treatment with anti-VEGF agents (bevacizumab or aflibercept). The follow-up period was 1 year. Intraocular pressure was measured by using the Goldmann applanation tonometry before the intravitreal injection, at 24 hours after the administration of the anti-VEGF agent and at 1 and 4 weeks. Patients diagnosed with glaucoma or who underwent ophthalmic surgery were excluded. Results. The patients received an average of 7.54 intravitreal injections. The mean baseline intraocular pressure was 15.3 mm Hg; 19.8 mm Hg at 24 hours; 17,4 mmHg at 1 week and 14.8 mmHg at 4 weeks after the administration of the anti-VEGF agent. 4 patients required long-term topical hypotensive treatment. Raised intraocular pressure was related to increased frequency of treatment. At 1 year follow up, an average difference of 2.1 mmHg compared to baseline was registered in the cases that have received more than 6 intravitreal injections. By comparison, in the cases treated with a reduced number of doses of intravitreal anti VEGF agent, the difference from baseline was 0,9 mmHg. There were no significant differences in mean IOP depending on the anti VEGF (bevacizumab or aflibercept) agent used. Conclusions. Intravitreal treatment with anti VEGF agents produces a transient increase in intraocular pressure, predominantly immediately following administration, without causing long-term increased values.

Functional results of cataract surgery in the treatment of phacomorphic glaucoma.

Purpose. Analysis of functional outcome and complications reported in patients diagnosed with phacomorphic glaucoma, in which phacoemulsification or extracapsular extraction of the lens was performed. Methods. The retrospective study included 38 eyes diagnosed with phacomorphic glaucoma. In 25 cases, group 1, the lens was removed by phacoemulsification and in 13 cases, group 2, by extracapsular extraction. Intraocular pressure, visual acuity, and anterior chamber depth were evaluated preoperative and postoperative. The incidence of intra and postoperative complications was analyzed. The minimum follow-up period was 12 months. Results. The mean IOP decreased from the preoperative value of 38.4 +/ - 11.3 mmHg to 13.5 +/ - 3.4 mmHg in group 1 and 11.5 +/ - 3.2 mmHg in group 2. Persistent corneal edema was observed in 32% patients from group 1 and 23% of the patients from group 2. The inflammatory reaction of anterior chamber prevailed in patients from group 2 (46.1%). ACD modified from the preoperative mean of 1.3 +/- 0.5 mm to 2.3 +/- 0.2 mm in both groups. At the end of follow-up in both groups, the average BCVA was 0.6. 18.42% of the cases required long-term topical hypotensive therapy. Conclusions. Both phacoemulsification and extracapsular extraction were safe and effective procedures in the treatment of phacomorphic glaucoma, ensuring a rapid functional recovery and a satisfactory long-term IOP control. Although the rate of immediate postoperative complications and the final functional outcome were better in patients treated with phacoemulsification, not all the cases could be subjected to this type of surgery.

Anatomical results and complications after silicone oil removal.

The aim of the report was to evaluate anatomical results and intra and postoperative complications after silicone oil (SIO) removal. METHODS: Retrospective, interventional study evaluating consecutive cases with ambulatory SIO removal after vitrectomy for complex retinal detachments. The anatomical result was the main followed parameter. Intra and postoperative complications and also intraocular pressure changes were evaluated. Cases were followed-up for at least 12 months. RESULTS: A total of 98 consecutive cases were reviewed. The main duration of oil endotamponade was 5.46 months (3-16 months). In 15 cases (15.30%) signs of SIO emulsification were noted at the time of removal. A stable anatomical result after SIO removal was obtained in 94 out of 98 cases (95.91%). Retinal detachment recurrence appeared in first month postoperatively (1 case) and between the 3rd and 4th month postoperatively (3 cases). Main indications for 5000cs SIO endotamponade during ambulatory 23G vitrectomy were represented by proliferative vitreoretinopathy (PVR) (78 cases - 79.59%), proliferative diabetic retinopathy (17 cases - 17.34%) and giant retinal tears (3 cases - 3.06%). 29 eyes (29.59%) were pseudophakic at primary surgery. However, most phakic eyes showed cataract appearance and progression during SIO endotamponade and also after SIO removal. Intraocular pressure significantly decreased after SIO removal with the occurrence of various choroidal detachments in 8 cases (8.16%), resolving spontaneously within the first week postoperatively. CONCLUSIONS: In our experience, the retinal detachment recurrence rate after SIO removal was 4.08%. This promising anatomical result confirms the need for an accurate primary surgery and also for a safe moment of SIO removal according to the severity of primary pathology.

Vitrectomy surgery of diabetic retinopathy complications.

UNLABELLED: Abstract PURPOSE: To assess the anatomical and functional results after vitreoretinal surgery, in a large number of patients with complications due to diabetic retinopathy. Also, to compare the 23G vs. the 20G surgical procedures in these cases, regarding efficacy, facility, safety, and postoperative recovery. METHODS: Interventional, retrospective, comparative study of cases operated for different complications of diabetic retinopathy between January 2000 and December 2014. All cases were operated under a local anesthesia by the same surgeon, by using standard 20G Vitrectomy (between January 2000 and October 2011) and ambulatory 23G vitrectomy (since November 2011). Cases had a complete ophthalmic evaluation and were followed-up for at least 12 months. RESULTS: 1.267 eyes of 1.129 patients were operated between January 2000 and December 2014. 23G vitrectomy was performed in 578 eyes. The mean age in the study group was of 57.49 ± 14.17 years (ranging from 16 to 78 years old), with a male/female ratio of 0.916. The surgery indications were represented by media opacities (609 cases - 48.06%), vitreoretinal tractions and detachments (583 cases - 46.01%), persistent macular edema (38 cases - 3%) and persistent neovascularization with rubeosis (37 cases - 2.93%). A final anatomical success was obtained in 1174 cases (92.65%). Preoperative best corrected visual acuity (BCVA) (less or equal to counting fingers in 936 eyes - 73.87%), improved postoperatively in 923 eyes (72.84%), stabilized in 201 eyes (15.86%), and decreased in 143 eyes (11.28%). At a final examination, 932 eyes (73.55%) had a BCVA equal or better to 0.1. Cases operated with the 23G vitrectomy had a shorter surgery and a quicker postoperative recovery. Overall, simpler cases like vitreous hemorrhage and epimacular membranes had a better anatomical and functional result as compared to long standing or macular involvement detachments. The main intra and postoperative complications, lower with the 23G vitrectomy, were represented by iatrogenic retinal breaks, recurrent hemorrhages, redetachment, and neovascular glaucoma. CONCLUSIONS: These results confirmed the efficacy and safety of vitreoretinal surgery in improving most complications of diabetic retinopathy on a large series. With modern, less invasive techniques, the chance of a better surgery and also a quicker patient recovery increased significantly.

Aflibercept efficacy in refractory choroidal neovascularization.

The aim of the report is to evaluate the short-term efficacy and safety of aflibercept (EYLEA®) in patients with choroidal neovascularization (CNV) transformed into refractory during treatment with bevacizumab (AVASTIN ®). METHODS: Clinical, morphological, and functional changes were retrospectively evaluated in cases with refractory CNVs to monthly 1.25 mg bevacizumab intravitreal injections (AVASTIN ®) and switched to 3 monthly 2.0 mg intravitreal injections of aflibercept (EYLEA ®). RESULTS: In this pilot evaluation, 8 cases of CNVs that become refractory to intravitreal treatment with 1.25 mg intravitreal bevacizumab (AVASTIN ®), were switched to 2.0 mg intravitreal aflibercept (EYLEA ®) and evaluated. The mean age of patients was 67.6 years (54-74 years). In 7 cases, CNV was associated to age related macular degeneration and in 1 case to angioid streaks. The mean number of previous intravitreal bevacizumab (AVASTIN®) administrations was 9.32 (7-12). In all cases, the last 3 intravitreal injections of bevacizumab were performed at an interval of maximum 6 weeks. The refractory status was confirmed by the lack of improvement or worsening of the clinical features as revealed by SD-OCT. A slowly anatomical improvement was noticed in 5 out of 8 cases (62.5%) since the first aflibercept administration. The anatomical improvement was stable after 3 monthly administrations. During the treatment, only 3 out of 5 cases (60%) showing anatomical improvement had a minor visual benefit (one line of VA gain). In 3 cases, the treatment change was unremarkable. No side effects were noticed. CONCLUSIONS: The anatomical improvement confirms previous reports regarding the efficacy and safety of aflibercept (EYLEA®) in some cases of CNV that became refractory during conventional anti-VEGF therapy. The improvement can be, at least partially, explained by the more complex features of aflibercept. Unfortunately, a minor visual benefit was noticed in a limited number of cases.

[The results of intravitreal bevacizumab in subretinal neovascularisation in angioid streaks]. / Rezultatele tratamentului cu bevacizumab intravitrean în neovascularizatia subretiniana din striurile angioide.

PURPOSE: To assess the anatomical and functional results after intravitreal bevacizumab administration in choroidal neovascularization (CNV) due to angioid streaks; To assess the safety and results stability; METHODS: Prospective, nonrandomized, interventional case study on choroidal neovascularization due to angioid streaks treated with intravitreal bevacizumab (AVASTIN). Intravitreal injection was repeated, if needed, at 4-6 weeks until leakage stopped. In all cases fluorescein angiograms and Spectral 3D OCTs were performed. Visual acuity was measured with ETDRS optotype. Cases were followed-up at least 6 months. Statistical analysis was performed using ANOVA and Wilcoxon tests. RESULTS: 8 cases with CNV associated to angioid streaks were evaluated between January 2007 and January 2013. Mean age of patients in the study was 52,36 +/- 4,33 years (ranging 42-64 years). The mean number of intravitreal injections was 4.64 +/- 0,42 (ranging between 3-8 injections). Mean visual acuity improved significantly in all cases after 3 intravitreal injections with a gain of more than 15 letters in 6 out of 8 cases (75%). OCT confirmed reduced depth of lesion and also a reduced lesion volume after treatment. No major local or systemic side-effects were noted. At 6 months follow-up the CNV reoccurred in 5 out of 8 cases (62.5%) requiring additional treatment. 3 out of 8 cases finally lost more than 5 letters due to subretinal fibrosis. CONCLUSIONS: These results confirm the efficacy and safety of intravitreal bevacizumab in controlling the CNV due to angioid streaks. High recurrence rate and quick lesion progression to subretinal fibrosis might be responsible for long-term poor functional results in this type of CNVs. More cases are needed for validation.

[Ocular toxocariasis--case report]. / TOXOCAROZA OCULARA (PREZENTARE DE CAZ).

Ocular Toxocariasis is a parasitosis caused by Toxocara catis/canis larvae localized in the eye. The most frequent clinical manifestations are the central retinal granuloma, peripheral retinal granuloma and chronic endophthalmitis. Secondary complications due to the presence of parasite in the posterior segment of the eye may have significant consequences on visual function. We present the case of a 23 years old patient, admitted for progressive decrease of the right eye BCVA during the last 6 months. After performing clinical examination and serological tests we established the diagnosis of ocular Toxocariasis. The patient presented a particular form of the disease consisting in the presence of both a central retinal granuloma and a peripheral one. We performed 23G pars plana vitrectomy and membrane peeling. VA improved as soon as the first month after surgery.

[Therapeutic approach in persistent diabetic macular edema]. / ABORDARI TERAPEUTICE ÎN EDEMUL MACULAR DIABETIC PERSISTENT.

Terminology of persistent diabetic macular edema has been initially reserved to cases unresponsive to conventional laser photocoagulation according to ETDRS criteria. While knowledge about pathophysiology of macular edema evolved and new drugs became available, the terminology of persistent diabetic macular edema expanded to include resistance to most current therapies. The purpose of this paper is to review medical and surgical options in the treatment of such difficult cases according to literature data and personal experience.

[Macular serpiginous choroiditis complicated by macular hole]. / COROIDITA SERPIGINOASA MACULARA COMPLICATA CU GAURA MACULARA.

Macular serpiginouschoroiditis is a rare variant of serpiginous choroiditis characterized by a severe recurrent inflammation of both central choroid and retinal pigment epithelium. Visual prognosis is severe due to subsequent distruction of retinal structures. Permanent central visual loss is the consequence of retinal pigment epithelium hyper or hypoplasia and/or subretinal neovascularization leading to fibrous scarring. This article reports the unusual case of rapid development of a macular hole soon after the onset of characteristic clinical features. Despite anti-inflammatory treatment and successful macular hole surgery the visual function remained significantly impaired by secondary central retinal pigment epithelium changes.

[Macular surgery in a new point of view]. / Chirurgia suprafetei maculare într-o noua perspectiva.

PURPOSE: To reveal the differences in anatomical and functional results following standard 20-gauge vitrectomy and modern transconjunctival sutureless vitrectomy in macular surface pathology. MATERIALS AND METHODS: Retrospective, interventional, comparative evaluation of macular pathology cases operated by standard 20-gauge vitrectomy and transconjunctival 23 G sutureless vitrectomy. In evaluation were included a comparable number of epiretinal membranes (both idiopathic and secondary) and stage 3 and 4 macular holes. A postoperative anatomical and functional analysis was performed and also the incidence of pre-and postoperative complications was noted. RESULTS: Transconjunctival sutureless vitrectomy was associated with a shorter operating time and quicker anatomical and functional results. If in epiretinal membranes there was no significant difference in final results, in macular holes anatomical and functional results were better with sutureless vitrectomy. CONCLUSIONS: These results confirm the efficacy and safety of both surgical procedures in macular surface pathology. Better anatomical and functional results in macular holes and quicker functional rehabilitation in all cases promote sutureless vitrectomy as new standard procedure in these cases.

[Surgery for posterior segment intraocular foreign bodies -- anatomical and functional results]. / Chirurgia corpilor straini intraoculari cu localizare in segmentul posterior; rezultate anatomice si functionale.

PURPOSE: To assess the anatomical and visual outcome and also the retinal complications following vitreoretinal surgery for posterior segment intraocular foreign bodies (IOFBs). METHODS: Retrospective analysis of 59 IOFBs, with different locations within posterior segment,removed during pars plana vitrectomy (PPV) between January 1999 and January 2011, by the same surgeon, in Eye Clinic 1 Iasi. 47 out of 59 IOFBs (79.66%) were removed immediately after primary wound closure and 12 with a delay ranging from 48 hours to 5 years. All IOFBs were metallic. Total 20G pars plana vitrectomy with IOFB removal by forceps or intraocular magnet, careful membrane peeling and laser photocoagulation around the retinal injury (if present) was performed. Relaxing retinotomy was necessary in 3 cases of retinal incarceration. Endotamponade with SF6 (26 cases) or silicone oil (8 cases) were performed, if needed, at the end of surgery. The average follow-up period after surgery was 17.9 month (ranging 6 - 36 months). RESULTS: 18 out of 59 IOFBs (30.5%) were intraretinal. 39 out of 59 eyes (66.10%) showed signs of endophthalmitis at the time of surgery. Preoperative visual acuity ranged from light perception to 0.6. The mean visual acuity significantly increased after surgery from 0.16 preoperatively to 0.5 at the end of follow-up (range hand movements--1). 51 out of 59 cases (86.44%) had stable anatomical result. A final visual acuity equal or better than 0.1 was obtained in 45 cases (76.27%). Mild retinal folding could be noticed in some cases around the laser-treated retinal injury. In 8 out of 59 cases (13.56%) visual acuity remained low or decreased due to macular injury or PVR associated retinal detachment requiring additional surgery. CONCLUSIONS: IOFBs, and especially those intraretinal, require an early, complex and customized approach during PPV. Functional results do not match anatomical restoration if macula or optic nerve are impacted. Main postoperative complications were represented by retinal folds and PVR associated retinal detachment.

[Internal limiting membrane role in primary surgery of the macular hole]. / Rolul membranei limitante interne în chirurgia primara a gaurii maculare.

PURPOSE: To assess the anatomical result after primary macular hole surgery with or without internal limiting membrane (ILM) peeling. To assess the safety and stability results; METHODS: Prospective, comparative, interventional case study of 47 eyes with stage 3 or 4 macular hole treated by pars-plana vitrectomy between 2006 and 2011. In 19 cases (40.42%) only posterior hyaloid was removed (control group) while in the other 28 cases (59.57%) additional ILM peeling was performed. All cases had gas endotamponade. Postoperatively the cases were followed-up at least 6 months clinically and by OCT. Statistical analysis was performed using ANOVA and Wilcoxon tests. RESULTS: The mean age of patients in the study was 54, 47 +/- 4, 83 years (ranging from 47 to 74 years). In 36 cases (76.59%) the macular hole was idiopathic. After surgery, the macular hole closed in 22 out of 28 cases with ILM peeling (78.57%) as compared to only 13 out of 19 cases from the control group (68.42%). No intraoperative complications were noted. Main postoperative complications were cataract augmentation and macular hole enlargement in 4 out of 12 failed cases (33.33%). No recurrence was noted if macular hole closed after surgery. CONCLUSIONS: These results confirm the stability, safety and efficacy of both techniques but with a significant higher success rate if ILM is peeled. The main postoperative complication was macular hole enlargement if surgery failed.