Surgical outcomes for primary rhegmatogenous retinal detachments in phakic and pseudophakic patients: the Retina 1 Project--report 2.

AIMS: To compare anatomical and functional outcomes for 546 phakic and pseudophakic primary rhegmatogenous retinal detachments (RDs) treated by pars plana vitrectomy or scleral buckling. METHODS: Prospective, non-randomised, interventional study in 15 centres in Spain and Portugal, with data from RDs consecutively treated from January 2005 to May 2007. Cases with preoperative proliferative vitreoretinopathy grade C-1 or higher and perforating trauma were excluded. Minimum follow-up was 3 months. Twenty-seven pre-, intra- and post-surgical variables for each patient were analysed. Multivariate analysis was carried out by logistic regression analysis with stepwise selection of variables. RESULTS: Data from 546 patients were analysed. Global anatomical success was 94.7%. Logistic regression analysis showed that only the development of postoperative proliferative vitreoretinopathy was associated with a poor anatomical outcome. The poorest functional results were associated with macular involvement, extension of RD, previous RD surgery, time of evolution of RD, and age of patient. Hierarchical log-linear analysis showed no effect of the lens status (phakic versus pseudophakic) on the functional results. However, pars plana vitrectomy was most often performed in pseudophakic eyes and resulted in a worse final visual acuity (p<0.001). CONCLUSIONS: No differences in anatomical success between phakic and pseudophakic eyes were found in this series. Pars plana vitrectomy was most often performed in pseudophakic eyes and had a greater probability of a worse final visual acuity than scleral buckling.

Non-complicated retinal detachment management: variations in 4 years. Retina 1 project; report 1.

AIMS: To assess variations in the characteristics and management of two series of non-complicated rhegmatogenous retinal detachments (RD) carried out 4 years apart in Spain. METHODS: Prospective, multicentric, non-randomised comparative study. 339 consecutive cases of RD treated in five hospitals were included. Group 1 (G1) (n = 186) included cases operated on from 1999 to 2001; group 2 (G2) (n = 153) included cases from 2004 to 2006. 83 variables related to preoperative characteristics of RD, surgical management and postoperative evolution were recorded. Surgeons were allowed to treat patients following their personal criteria. Differences in preoperative characteristics, rate of vitrectomy and anatomical outcome were studied. Quantitative variables were compared by Mann-Whitney U test and qualitative variables by standard contingency tables. Multivariate analysis was carried out by logistic regression analysis. RESULTS: G1 showed a significantly longer delay in performing surgery, since the first symptoms appeared (G1: 29 (SD 50) days; G2: 22 (55); p<0.001) and more RD without visible retinal break than G2 (G1: 17.4%; G2: 9.2%; p = 0.028). In G2, cases with multiple retinal breaks (G1: 31.6%; G2: 44.6%) were more frequent (p = 0.022). No significant differences in other preoperative variables were observed. Vitrectomy was performed in 30.1% in G1 and in 78.4% in G2 as a primary surgical approach (p<0.001). Regardless of the characteristics of the RD, the rate of vitrectomy was higher in G2. The reattachment rate was over 94% in both groups (p = 0.833). Pseudophakic RD showed better anatomical outcomes in G2 (G1: 83.9%; G2: 96.4%; p = 0.028). CONCLUSION: There is an increasing tendency to treat RD with primary vitrectomy, which is related to neither a higher complexity of cases nor better anatomical results.

[Glutathione-related enzymes activity during vitrectomy. Effect of BSS Plus(R) in retinal tissue]. / Actividad de los enzimas glutation-dependientes durante la vitrectomía. Efecto de la solución BSS Plus(R) en retina.

PURPOSE: To determine changes in the retinal activity of two enzymes related to the glutathione metabolism (Glutathione synthetase -GSHS- and glutathione reductase -GSSGR-) after vitrectomy using BSS Plus(R). MATERIAL AND METHODS: Forty-five pigmented rabbits were distributed in 6 groups: group I (GSHS control in retinal tissue); Group II (analysis of GSHS at 3 hours post-vitrectomy); Group III (determination of GSHS at 48 hours after vitrectomy); Group IV (GSSGR control in retinal tissue); Group V (measurement of GSSGR at 3 hours post-surgery) and Group VI (study of GSSGR at 48 hours post-vitrectomy). Statistical analysis was done by a parametric test (ANOVA of single factor) (p<0.05). RESULTS: The activity of these enzymes was: Group I (n=5, basal GSHS). 2785,63 D.S. 419,51 U/g; Group II (n=4, GSHS at 3 hours). 6053,50 D.S. 2788,84 U/g; Group III (n=4, GSHS at 48 hours). 7424,30 D.S. 997,47 U/g; Group IV (n=10, basal GSSGR). 150,86 D.S. 24,40 mU/mL; Group V (n=7, GSSGR at 3 hours). 212,03 D.S. 53,30 mU/mL; Group VI (n=8, GSSGR at 48 hours). 210,84 D.S. 46,03 mU/mL. CONCLUSIONS: At retinal tissue, BSS Plus(R) intraocular irrigating solution increases GSHS activity without modifications of GSSGR levels. It seems to be related to the <> synthesis of glutathione.

Actividad de los enzimas glutation-dependientes durante la vitrectomía. Efecto de la solución bss plus® en retina / Glutathione-related enzymes activity during vitrectomy. Effect of bss plus® in retinal tissue

Objetivo: Determinar las modificaciones de la actividad retiniana de dos enzimas relacionados con el glutation (glutation sintetasa —GSHS— y glutation reductasa —GSSGR—) utilizando el BSS plus® como solución de irrigación intraocular durante la vitrectomía.Material y método: Cuarenta y cinco conejos pigmentados adultos fueron distribuidos en 6 grupos: grupo I (control GSHS en retina); grupo II (medida de la GSHS a las 3 horas post-cirugía); grupo III (análisis de la GSHS a las 48 horas después de la vitrectomía); grupo IV (control GSSGR en retina); grupo V (medida de la GSSGR a las 3 horas post-vitrectomía) y grupo VI (determinación de la GSSGR a las 48 horas post-cirugía). La determinación de la actividad enzimática fue realizada mediante un procedimiento cinético específico para cada uno de los enzimas estudiados. El análisis estadístico se llevó a cabo mediante un análisis de la varianza (p<0,05).Resultados: Los resultados fueron los siguientes: grupo I (n=5, GSHS basal). 2785,63 D.E. 419,51 U/g; grupo II (n=4, GSHS a las 3 horas). 6053,50 D.E. 2788,84 U/g; grupo III (n=4, GSHS a las 48 horas). 7424,30 D.E. 997,47 U/g; grupo IV (n=10, GSSGR basal). 150,86 D.E. 24,40 mU/mL; grupo V (n=7, GSSGR a las 3 horas). 212,03 D.E. 53,30 mU/mL; grupo VI (n=8, GSSGR a las 48 horas). 210,84 D.E. 46,03 mU/mL.Conclusiones: A nivel retiniano, la solución BSS plus® activa la enzima GSHS sin modificar la enzima GSSGR, lo que podría indicar una síntesis de novo del glutation (AU)

[Inhibition of lipid peroxidation in retinal tissue during vitrectomy. Effect of intraocular irrigating solution BSS plus]. / Inhibición de la lipoperoxidación retiniana durante la vitrectomía. Efecto de la solución de irrigación intraocular BSS plus.

PURPOSE: Several antioxidant substances have been included in intraocular solutions for vitrectomy in order to reduce oxidative stress. The objective of this work is to evaluate the antioxidant effect of BBS plus(R) (with oxidized glutathione) by means of determining scores of Malondialdehyde (MDA) in retinal tissue at different post vitrectomy time-periods. MATERIAL AND METHODS: Thirty pigmented rabbits distributed in three groups (n=10). Group I: Control (no surgery); group II: Vitrectomy adding BSS plus(R), scoring of malondialdehyde at 3 hours post surgery; group III: Vitrectomy adding BBS plus(R), analysis of malondialdehide at 48 hours after vitrectomy. Retinal samples were used to determine the score of malondialdehyde using ion-pairing high performance liquid chromatography. Statistical analysis was performed using ANOVA-Scheffé test (p<0.05). RESULTS: Scores of free MDA (microgram of retinal tissue) were: group I (n=8): 1.080 S.D. 0.389 microgram group II (n=8): 1.273 S.D. 0.710 microgram and group III (n=10): 0.639 S.D. 0.374 microgram. CONCLUSIONS: BSS plus(R) showed antioxidant effects in retinal tissue which were observed better at a later rather than early stage after a vitrectomy.

Inhibición de la lipoperoxidación retiniana durante la vitrectomía. Efecto de la solución de irrigación intraocular BSS Plus® / Inhibition of lipid peroxidation in retinal tissue during vitrectomy. Effect of intraocular irrigating solution BSS Plus®

Objetivo: El comportamiento prooxidante de la vitrectomía y sus efectos deletéreos sobre el globo ocular, especialmente a nivel de la retina, han determinado la necesidad de incorporar sustancias antioxidantes en las soluciones de irrigación intraocular. Se pretende valorar la capacidad antioxidante del BSS plus® (que incorpora el antioxidante glutation oxidado) mediante la determinación de los niveles del derivado de lipoperoxidación Malondialdehido (MDA) en la retina a distintos tiempos post-vitrectomía. Material y métodos: Treinta conejos pigmentados adultos fueron distribuidos en 3 grupos (n=10). Grupo I: Control (sin cirugía); Grupo II: Vitrectomía + BSS plus®, determinación de malondialdehido a las 3 horas; Grupo III: Vitrectomía + BSS plus®, determinación de malondialdehido a las 48 horas. Los niveles de malondialdehido libre en retina se determinaron mediante cromatografía líquida de alta resolución de pares iónicos. Para la comparación de resultados se utilizó un test anova-Scheffé (p<0,05). Resultados: Las concentraciones de MDA libre (µg/g de tejido retiniano) fueron: grupo I (n=8), 1.080 D.S. 0,389 µg/g; grupo II (n=8), 1.273 D.S. 0,710 µg/g y grupo III (n=10), 0,639 D.S. 0,374 µg/g. Conclusiones: La solución BSS plus® muestra mejor comportamiento como antioxidante sobre la retina en tiempos tardíos (p<0,05) que en tiempos precoces post-vitrectomía (AU)

[Flavonoid drugs as antioxidant in intraocular irrigating solution]. / Flavonoides como antioxidantes en solución de irrigación intraocular.

PURPOSE: To study the protective effect for vitrectomy of intraocular irrigating solutions containing different concentrations of two antioxidants: Meralop and Activadone and compare them with saline solutions and BSS plus. MATERIAL AND METHODS: Seventy-five pigmented rabbits were divided into 8 groups: I. Control (n=8); II. Gas-vitrectomy (n=15); III. Vitrectomy + saline solution (n=6); IV. Vitrectomy + BSS plus (n=9); V. Vitrectomy + Activadone 90 mg/l (n=8); VI. Vitrectomy + Activadone 180 mg/l (n=9); VII. Vitrectomy + Meralop 16 mg/l (n=10); VIII. Vitrectomy + Meralop 64 mg/l (n=10). Antioxidant activity in lens and retina was measured evaluating the levels of lipoperoxides malondyaldehide (MDA) and 4-hydroxynonenal (4-HNE) by spectrophotometry. RESULTS: MDA + 4-HNE concentrations in lens and retina of each group (mean and standard deviation in nmol/g) were: Group I= 3.806DE1.043, 38.787DE10.404. Group II= 4.353DE3.626, 41.554DE18.520. Group III= 297.306DE103.73, 156.69DE6.82. Group IV= 29.39DE15.38, 112.02DE50.12. Group V= 42.31DE20.82, 55.44DE42.21. Group VI= 27.66DE9.29, 181.061DE79.39. Group VII= 134.93DE133.52, 76.89DE36.02. Group VIII= 112.91DE60.30, 79.97DE38.005. CONCLUSIONS: All intraocular irrigation solutions containing antioxidant substances produced lower MDA + 4-HNE levels than saline solution. In the retina, Activadone 90 mg/l produces less MDA concentration than BSS plus.

Flavonoides como antioxidantes en solución de irrigación intraocular / Flavonoid drugs as antioxidant in intraocular irrigating solution

Objetivo: Determinar el efecto protector de diferentes soluciones de irrigación intraocular (SII) conteniendo Activadone® y Meralop® como antioxidantes frente a la peroxidación lipídica inducida durante la vitrectomía, comparándolas con la solución salina y el BSS plus®.Material y métodos: Setenta y cinco conejos pigmentados fueron distribuidos en 8 grupos: I. Control (n=8); II. Vitrectomía-gas (n=15); III. Vitrectomía mecánica + suero fisiológico (n=6); IV. Vitrectomía + BSS plus® (n=9); V. Vitrectomía + Activadone® 90 mg/l (n=8); VI. Vitrectomía + Activadone® 180 mg/l (n=9); VII. Vitrectomía + Meralop® 16 mg/l (n=10); VIII. Vitrectomía + Meralop® 64 mg/l (n=10). Una vez obtenidas las muestras de cristalino y retina, la actividad antioxidante de las soluciones de irrigación se midió indirectamente evaluando los niveles de los lipoperóxidos malondialdehido (MDA) y 4-hidroxinoneral (4-HNE) por espectrofotometría. Resultados: Las concentraciones de MDA + 4-HNE en cristalino y retina de cada grupo fueron (media y desviación estándar en nmol/g): I= 3,806DE1,042, 38,787DE10,404. II= 4,353DE3,626, 41,554DE18,520. III= 297,306DE103,73, 156,69DE6,82. IV= 29,39DE15,28, 112,02DE50,12. V= 42,31DE20,82, 55,44DE42,21. VI= 27,66DE9,29, 181,061DE79,39. VII= 134,93DE133,52, 76,89DE36,02. VIII= 112,91DE60,30, 79,97DE38,005. Conclusiones: Todas las soluciones de irrigación intraocular con antioxidante disminuyeron los niveles de MDA + 4-HNE en los grupos experimentales, pero sólo Activadone® 90 mg/l logró niveles más bajos que el BSS plus en la retina (AU)

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Determination of glutathione, cysteine and N-acetylcysteine in rabbit eye tissues using high-performance liquid chromatography and post-column derivatization with 5,5'-dithiobis(2-nitrobenzoic acid).

A high-performance liquid chromatographic method to determine glutathione, cysteine and N-acetylcysteine in rabbit retina, vitreous and lens has been developed. The thiols are separated using a 25 x 0.46-cm octadecylsilane column with 0.5 M phosphate buffer, pH 3, as mobile phase. The detection, at 412 nm, involves a post-column derivatization with 5,5-dithiobis(2-nitrobenzoic acid) in presence of cationic micelles of hexadecyltrimethylammonium bromide that enhances the sensitivity. The detection limits are 0.21, 0.92 and 0.61 mumol/g wet sample for glutathione, cysteine and N-acetylcysteine, respectively.

Intraocular irrigating solutions and vitrectomy-related changes (in protein, lactic and ascorbic acid) in rabbit vitreous.

Vitrectomy and the subsequent vitreous fluid exchange alter the chemical and physical properties of the vitreous. This study assessed the time course alterations of total protein, ascorbic acid and lactic acid in the rabbit vitreous cavity following vitrectomy. Normal values were 2.2 +/- 1.2 mg/ml, 8.5 +/- 1.0 mg/100 ml and 16.8 +/- 3.5 mumol/ml, respectively. Nine groups of 5-10 adult albino rabbits underwent closed vitrectomy using physiologic saline, Ringer's lactate and BSS plus solutions. Samples were withdrawn at 3 and 24 h and 7 days after vitrectomy. Total protein levels increased in all groups at 3 and 24 h (20-30 mg/ml). Ascorbic acid measurements at 24 h rose only with saline and BSS plus. At 24 h the BSS plus group was the only one demonstrating an increased lactic acid concentration.