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To compare the effectiveness and safety of scleral buckling and pars plana vitrectomy in treating retinal detachment without posterior vitreous detachment. A total of 88 eyes of 83 patients with retinal detachment without prior posterior vitreous detachment were investigated retrospectively. Group A comprised patients who underwent scleral buckling (n = 47) and Group B (n = 36) patients who were treated with pars plana vitrectomy. Anatomical success, postoperative visual acuity, and ocular adverse events were evaluated. The primary and final anatomical success rate showed a nonsignificant difference (p = 0.465 and p = 0.37 respectively). No significant difference was observed in the reoperation rate or development of epiretinal membrane between the groups (p = 0.254 and p = 0.254 respectively). However, scleral buckling resulted in significantly better visual acuity at the last follow-up (0.12 ± 0.23) compared to pars plana vitrectomy (0.37 ± 0.46, p = 0.001). The incidence of cataract progression was also significantly higher in the pars plana vitrectomy group (46%) compared to the scleral buckling group (10%, p < 0.001). Scleral buckling and pars plana vitrectomy show similar success rates in treating retinal detachment without vitreous detachment. However, due to less cataract progression and better visual acuity outcomes, scleral buckling is recommended for these cases. Determining vitreous status before surgery is crucial for optimal outcomes.
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Descolamento Retiniano , Recurvamento da Esclera , Acuidade Visual , Vitrectomia , Descolamento do Vítreo , Humanos , Descolamento Retiniano/cirurgia , Vitrectomia/métodos , Recurvamento da Esclera/métodos , Masculino , Feminino , Pessoa de Meia-Idade , Descolamento do Vítreo/cirurgia , Estudos Retrospectivos , Adulto , Idoso , Resultado do TratamentoRESUMO
BACKGROUND/OBJECTIVES: To analyse short-term changes of mean photoreceptor thickness (PRT) on the ETDRS-grid after vitrectomy and membrane peeling in patients with epiretinal membrane (ERM). SUBJECTS/METHODS: Forty-eight patients with idiopathic ERM were included in this prospective study. Study examinations comprised best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) before surgery, 1 week (W1), 1 month (M1) and 3 months (M3) after surgery. Mean PRT was assessed using an automated algorithm and correlated with BCVA and central retinal thickness (CRT). RESULTS: Regarding PRT changes of the study eye in comparison to baseline values, a significant decrease at W1 in the 1 mm, 3 mm and 6 mm area (all p-values < 0.001), at M1 (p = 0.009) and M3 (p = 0.019) in the central 1 mm area, a significant increase at M3 in the 6 mm area (p < 0.001), but no significant change at M1 in the 3 mm and 6 mm area and M3 in the 3 mm area (all p-values > 0.05) were observed. BCVA increased significantly from baseline to M3 (0.3LogMAR-0.15LogMAR, Snellen equivalent = 20/40-20/28 respectively; p < 0.001). There was no correlation between baseline PRT and BCVA at any visit after surgery, nor between PRT and BCVA at any visit (all p-values > 0.05). Decrease in PRT in the 1 mm (p < 0.001), 3 mm (p = 0.013) and 6 mm (p = 0.034) area after one week correlated with the increase in CRT (449.9 µm-462.2 µm). CONCLUSIONS: Although the photoreceptor layer is morphologically affected by ERMs and after their surgical removal, it is not correlated to BCVA. Thus, patients with photoreceptor layer alterations due to ERM may still benefit from surgery and achieve good functional rehabilitation thereafter.
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Membrana Epirretiniana , Humanos , Membrana Epirretiniana/cirurgia , Estudos Prospectivos , Estudos Retrospectivos , Retina , Tomografia de Coerência Óptica/métodos , Vitrectomia/métodosRESUMO
BACKGROUND: At the Department of Ophthalmology and Optometry at the MUV surgical method (scleral buckling, vitrectomy, combined vitrectomy/scleral buckling) and timing (daytime, nighttime) for the treatment of primary rhegmatogenous retinal detachment (RRD) changed continuously in the years 2004 to 2012. This study aims to evaluate changes in surgical strategies over time including their impact on functional and anatomical outcomes. METHODS: Retrospective evaluation of patients operated on primary RRD between the years 2004 and 2012. Baseline demographic data, month 3 best-corrected visual acuity (BCVA), surgical method, single success surgery, surgical timing, and intraoperative complications were analyzed. RESULTS: Overall, 812 eyes of 812 patients with a mean (±SD) age of 58.1 ± 13.3 years were included. A total of 413 (51%) patients presented with macula-on and 359 (44%) with macula-off RRD. Month 3 BCVA increased over time, both in macula-on or macula-off groups (p < 0.001). The rate of complete retinal reattachment 3 months postoperatively increased significantly from 65% in 2004 to 83% in 2012 in both groups. Scleral buckling surgeries decreased continuously from 95% to 16% with an appropriate increase in vitrectomies as well as a decrease in surgeries during nighttime (68% in 2004, 6% in 2012) with equal or better visual and functional outcomes. CONCLUSION: Our data showed that improving functional and single-success surgery outcomes in patients operated on for primary RRD. In the years 2004 to 2012, surgical techniques shifted from scleral buckling to primary vitrectomy and were increasingly scheduled during the daytime.
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PURPOSE: To evaluate neuroretinal integrity in different subtypes of optical coherence tomography (OCT)-graded partial-thickness macular holes. METHODS: Fovea-centred SD-OCT images (Cirrus, Carl Zeiss Meditec AG; Spectralis, Heidelberg Engineering GmbH) and visual acuity (VA) acquired at every visit were analysed by two retina specialists retrospectively in 71 eyes of 65 patients. Partial-thickness macular holes were classified as lamellar macular hole (LMH), epiretinal membrane foveoschisis (ERMF) or macular pseudohole (MPH). RESULTS: Lamellar macular hole, ERMF and MPH were diagnosed in 33 (47%), 31 (43%) and 7 (10%) eyes with a VA of 0.18 ± 0.25, 0.15 ± 0.2, and 0.06 ± 0.08 (p = 0.323), respectively. Median follow-up time was 11 (interquartile range 4-32.5), 10 (interquartile range 5-18) and 19 (interquartile range 8-24) months in LMH, ERMF and MPH. In all subgroups, VA remained stable during the follow-up (p = 0.652, p = 0.915 and p = 1.000). Epiretinal proliferations (EP) were present in 12 LMH and 3 ERMF. At baseline, eyes with EP had significantly worse VA (p < 0.001), wider foveal cavities (p = 0.007) and thinner foveal floors (p < 0.001) compared with eyes without EP. Twelve out of 15 eyes with EP showed exudative cystoid spaces. Among all 71 eyes, 51 remained morphologically and functionally stable during follow-up. CONCLUSION: In our study cohort, EP are associated with worse VA and advanced neuroretinal tissue loss presenting with wider foveal cavities and thinner foveal floors. During the follow-up period, VA remained stable in all entities of partial-thickness macular holes.
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Membrana Epirretiniana , Perfurações Retinianas , Membrana Epirretiniana/complicações , Membrana Epirretiniana/diagnóstico , Seguimentos , Fóvea Central , Humanos , Perfurações Retinianas/complicações , Perfurações Retinianas/diagnóstico , Estudos Retrospectivos , Tomografia de Coerência Óptica/métodosRESUMO
PURPOSE: To investigate the effects of vitrectomy (Vy) with or without same time cataract surgery and membrane plus internal limiting membrane peeling (MP+ILMP) on retinal oxygenation and choroidal volume and their role on postoperative outcome. METHODS: Thirty-two eyes were included in this prospective clinical study. All patients received 23 gauge Vy+MP+ILMP without endotamponade. Additional cataract surgery was performed in 14 patients. Follow-up visits were scheduled at day 1, week 1, month 1 and month 3. At each visit, best corrected visual acuity (BCVA) using ETDRS charts (except at day 1), oxygenation of retinal vessels using the Oxymap T1, and optical coherence tomography (OCT, Heidelberg Spectralis) was performed. RESULTS: Mean BCVA increased significantly from 73 ± 11 letters to 77 ± 7 letters at month 3 (p = 0.02). Mean central retinal thickness (CRT) decreased from 456 ± 84 µm at baseline to 418±58µm (p = 0.01 baseline versus month 3). In the cataract surgery group, CRT was higher at month 3 than in the group without (400 ± 58 µm versus 441 ± 51 µm; p = 0.007). There was no statistically significant difference in choroidal volume or oxygenation of retinal vessels between groups (additional cataract surgery versus vitrectomy alone). Oxygenation of retinal arteries tended to decrease at day 1 followed by an increase, but the changes did not reach the level of significance (p = 0.29 baseline versus month 3). Oxygenation of retinal veins increased significantly (p = 0.02 baseline versus month 1; p = 0.04 baseline versus month 3, accordingly). There was a significant negative correlation (Spearman correlation coefficient rs = -0.35, p = 0.047) between visual acuity and oxygenation of retinal veins at month 3. No statistically significant correlation was found between CRT and oxygenation of neither retinal arteries nor veins. Choroidal volume (CV) of the central mm did not change significantly during the study period (baseline: 0.203 ± 0.04 mm3 , median: 0.206, month 3: 0.205 ± 0.04 mm3 , p = 0.54). There was no statistically significant effect of choroidal volume at baseline on postoperative clinical outcomes (change in BCVA estimate [95% CI]: 7 [-76; 90], p = 0.86; change in CRT: 147 [-577; 871], p = 0.68). CONCLUSION: Oxygen saturation may affect the visual acuity outcome but not the CRT in patients after vitrectomy for epiretinal membrane. Choroidal thickness had no statistically significant influence on the study outcomes. Further studies are needed to evaluate if the measurement of retinal oxygenation may be helpful in the decision for surgery.
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Catarata , Membrana Epirretiniana , Membrana Epirretiniana/diagnóstico , Membrana Epirretiniana/cirurgia , Humanos , Saturação de Oxigênio , Estudos Prospectivos , Estudos Retrospectivos , Tomografia de Coerência Óptica/métodos , Acuidade Visual , Vitrectomia/métodosRESUMO
INTRODUCTION: The aim of this study was to evaluate the relation between choroidal thickness (CT), central retinal thickness (CRT) and best-corrected visual acuity (BCVA) after surgery for idiopathic epiretinal membrane (iERM). METHODS: Patients with 4 severity stages of iERM, who underwent vitrectomy with membrane- and internal limiting membrane peeling, were included in this prospective study. CRT, CT, and BCVA were assessed at baseline (BSL), 1 week, 1 and 3 months postoperatively. RESULTS: Twenty-one eyes were phakic, 11 eyes pseudophakic at BSL, in 14 cases combined cataract surgery was performed. BCVA was highest in stage 1 and 2, lowest in stage 4 iERM (p < 0.001) and correlated with CRT. After surgery, CRT decreased and BCVA increased significantly (p < 0.05). CT did not show significant differences among stages (p = 0.23). BSL CRT did not differ between phakic and pseudophakic eyes, the least reduction after surgery was detected in patients who underwent combined cataract surgery and vitrectomy. BSL CT was greater in phakic than in pseudophakic eyes (p = 0.033). Postoperative CT decreased in pseudophakic and phakic eyes, but remained higher after combined surgery (p = 0.0048). CONCLUSION: CT is not related to the severity of iERM. Choroidal changes did not influence the BCVA. Additional cataract surgery seems to cause longer recovery in CT and CRT.
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Catarata , Membrana Epirretiniana , Corioide , Membrana Epirretiniana/cirurgia , Humanos , Estudos Prospectivos , Tomografia de Coerência Óptica , VitrectomiaRESUMO
PURPOSE: To assess and compare safety and effectiveness between 23-gauge and 25-gauge vitrectomy systems for the treatment of common vitreoretinal diseases in non-vitrectomized eyes. METHODS: Retrospective evaluation of patients who underwent pars plana vitrectomy from April 2018 to December 2019 at the Department of Ophthalmology and Optometry at the Medical University of Vienna (MUV) for the following indications: macular epiretinal membrane, macular hole, macular lamellar hole, vitreous hemorrhage, vitreous opacities, vitreomacular traction syndrome and macular edema. RESULTS: 201 eyes of 195 patients that underwent 23-gauge (n = 105 eyes) or 25-gauge (n = 96 eyes) vitrectomy were included in this study. The mean best-corrected visual acuity (BCVA) improved at 1-3 months postoperatively and beyond 3 months in both gauge groups. Risk of any complication within 1 month postoperatively was lower in the 25-gauge group, but the difference was statistically not significant (HR [95% CI]: 0.95 [0.53; 1.70], p = 0.85). Intraocular pressure less than 5 mmHg was observed in 2 eyes (2%) in the 23-gauge group at the first postoperative day. Intraocular pressure elevation over 25 mmHg occurred in 5 eyes (2 eyes, 2%, in 23-gauge and 3 eyes, 3%, in 25-gauge group) at postoperative day 1, between 7 and 28 days in 5 cases (2 eyes, 2%, in 23-gauge and 3 eyes, 3%, in 25-gauge group), and in 2 eyes (2%) of the 23-gauge group at postoperative day 145 and 61, respectively. Retinal detachment occurred in 1 eye (1%) in the 23-gauge and in 3 eyes (3%) in the 25-gauge group. We did not observe any cases of endophthalmitis. CONCLUSION: Results in terms of safety, surgical success and visual outcomes for the treatment of common vitreoretinal surgery indications seem to be comparable between 23-gauge and 25-gauge vitrectomy systems, indicating that the two gauge systems can be used equally in the clinical routine.
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Oftalmopatias/fisiopatologia , Oftalmopatias/cirurgia , Pressão Intraocular , Vitrectomia/instrumentação , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Vitrectomia/métodosRESUMO
PURPOSE: To assess the influence of the SARS-CoV-2 lockdown in spring on frequency, severity and quality of care of rhegmatogeneous retinal detachments (RRD) in a tertiary referral center in Vienna, Austria. METHODS: Single center, consecutive case series with historical controls. Patients presenting with primary RRD during the first Austrian SARS-CoV-2 lockdown (March 16th-May 3rd 2020) and a corresponding control group consisting of the same time period of the preceding 3 years. RESULTS: The mean number of patients with RD in the reference group (RG) was 22 (± 1) and in the lockdown group (LG) 15. Median total delay, defined as onset of symptoms until surgery, in the RG was 5 (lower quartile: 3.0; upper quartile: 8.0) compared to 7 (3.0; 12.0) days in the LG, (p = 0.740). During the lockdown 67% of patients were referred from an external ophthalmologist compared to 52% in the RG, (p = 0.395). 34% of patients in the RG presented with an attached macula compared to 33% in the LG (p = 0.597). PVR was present in 49% of cases in the RG compared to 73% in the LG. Single surgery success (SSS) rates were lower in the LG (73.3%) compared to the RG (85.3%), (p = 0.275). CONCLUSION: Patients with RRD during the SARS-CoV-2 lockdown presented and were treated within acceptable time limits, showed the same macula-on ratios but a higher PVR rate and a tendency towards worse SSS rates compared to the time period of the preceding 3 years.
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COVID-19 , Descolamento Retiniano , Idoso , Áustria , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Quarentena , Descolamento Retiniano/epidemiologia , Descolamento Retiniano/cirurgia , Estudos Retrospectivos , Centros de Atenção TerciáriaRESUMO
PURPOSE: To evaluate the change in the fovea's postoperative location after successful pars plana vitrectomy with combined epiretinal and internal limiting membrane peeling in patients with idiopathic epiretinal membranes (iERMs). METHODS: In this prospective study 32 eyes of 32 patients with iERMs were followed from baseline before until 3 months after surgery. Study measures included 4-m Early Treatment Diabetic Retinopathy Study best-corrected visual acuity, enhanced-depth imaging-optical coherence tomography, and intraoperative fundus photographs. Foveal movement was assessed by measuring the change in the papillofoveal distance (∆PFD). RESULTS: Mean ∆PFD in the study eye was -124 µm (±138) and -272 µm (±213) one day and 3 months after surgery, respectively. Mean ∆PFD after 3 months was greater in the study than in the fellow eye (P < 0.001). ∆PFD at Month 3 did not correlate with the internal limiting membrane area peeled (P = 0.78). CONCLUSION: Foveal movement starts immediately after surgery and causes a statistically significant reduction in PFD after uneventful macular pucker surgery. ∆PFD correlates statistically significantly with baseline best-corrected visual acuity and baseline central retinal thickness. The internal limiting membrane peeling size had no significant effect on the amount of postoperative foveal dislocation.
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Membrana Epirretiniana/cirurgia , Fóvea Central/fisiopatologia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Tomografia de Coerência Óptica/métodos , Idoso , Idoso de 80 Anos ou mais , Membrana Epirretiniana/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Prospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVE: The aim of this study was to evaluate and compare the underlying pathologies, demographic and retinal detachment characteristics in pediatric and early adulthood retinal detachment. METHODS: Patients with rhegmatogenous, serous, or tractional retinal detachment aged 0-26 years were retrospectively reviewed. The preschool group (n = 4) comprised children aged 0-6 years, the pediatric group (n = 19) comprised children aged 7-16 years, and the early adulthood group (n = 13) aged 17-26 years. Demographic information and retinal detachment characteristics, type of surgery, and intraocular tamponade were analyzed. Postoperatively, the functional outcome, anatomic success, and ocular adverse events were evaluated. Due to the low patient number in the preschool group, statistical analysis was performed for pediatric group and early adulthood group only. RESULTS: All causes of retinal detachment were present in the pediatric group, but only rhegmatogenous retinal detachment in the early adulthood group. In both groups, the main type of surgical intervention was pars plana vitrectomy (pediatric group: 52%, early adulthood group: 38%; p = 0.36). The type of intraocular tamponade varied statistically significantly between the groups (p = 0.014). Silicone oil was the main intraocular tamponade in the pediatric group (48%), whereas no tamponade (54%) followed by gas tamponade (46%) in the early adulthood group. Final attachment rate was similar in both groups (pediatric group: 89%, early adulthood group: 100%; p = 0.35). Re-detachment occurred significantly sooner in the pediatric group (1.3 ± 0.3 months) than in the early adulthood group (4.3 ± 1.4 months; p = 0.03). CONCLUSION: In pediatric and early adulthood retinal detachment, pars plana vitrectomy appeared as a successful surgical intervention. Re-attachment rate and re-treatment were similar in both groups with a better functional outcome observed in cases of retinal detachment in early adulthood and poorer results in young children.
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Descolamento Retiniano , Adulto , Criança , Pré-Escolar , Humanos , Descolamento Retiniano/cirurgia , Estudos Retrospectivos , Recurvamento da Esclera , Óleos de Silicone , Resultado do Tratamento , Acuidade Visual , VitrectomiaRESUMO
BACKGROUND: To prospectively investigate retinal vascular changes in patients undergoing epiretinal membrane (ERM) and internal limiting membrane (ILM) peeling using swept source optical coherence tomography angiography (SSOCTA). METHODS: Consecutive patients were grouped based on ERM severity and followed using SSOCTA up to month 3 after surgical intervention. Superficial and deep foveal avascular zone (s/dFAZ) as well as foveal and parafoveal vessel density (VD) were correlated with ERM severity and visual acuity. Differences between groups were evaluated. RESULTS: Significant correlations were found between ERM severity and baseline sFAZ, dFAZ and best corrected visual acuity (BCVA), central retinal subfield thickness (CST) and ΔCST (r = -0.52, r = -0.43, r = -0.42, r = 0.58, r = 0.39; all p<0.05). Vascular flow parameters did not correlate with age, peeling size, pseudophakia or CST, but correlated with intraretinal cysts presence. No associations of BCVA with any of the OCTA parameters across time were found. Significant differences between ERM severity groups 1 and 2 were found for sFAZ at baseline (p = 0.005) and at the 3-month follow-up (p = 0.014), and for dFAZ at baseline (p = 0.017). Superficial foveal and parafoveal VD were not significantly different between groups (all p>0.05). CONCLUSIONS: This study clearly shows that ERM severity based on ERM staging has to be taken into account when undertaking studies in patients with idiopathic ERM using SSOCTA. Further, specific changes in the superficial and deep retinal vasculature in eyes undergoing ERM and ILM peeling were found. However, the clinical usefulness and prognostic value for post-surgical treatment BCVA of the SSOCTA-derived variables (sFAZ and dFAZ area, as well as foveal and parafoveal VD) used remains questionable.
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Membrana Epirretiniana/fisiopatologia , Retina/diagnóstico por imagem , Vasos Retinianos/diagnóstico por imagem , Tomografia de Coerência Óptica , Idoso , Vasos Sanguíneos/diagnóstico por imagem , Vasos Sanguíneos/crescimento & desenvolvimento , Vasos Sanguíneos/fisiopatologia , Membrana Epirretiniana/diagnóstico por imagem , Feminino , Angiofluoresceinografia , Fóvea Central/irrigação sanguínea , Fóvea Central/fisiopatologia , Humanos , Macula Lutea/irrigação sanguínea , Macula Lutea/diagnóstico por imagem , Macula Lutea/fisiopatologia , Masculino , Pessoa de Meia-Idade , Retina/fisiopatologia , Vasos Retinianos/crescimento & desenvolvimento , Vasos Retinianos/fisiopatologia , Acuidade Visual/fisiologia , VitrectomiaRESUMO
PURPOSE: To identify the correlation between preoperative funduscopic and optical coherence tomography characteristics of epiretinal membranes and the difficulty of surgical removal. METHODS: Fifty eyes of 50 patients with an idiopathic epiretinal membrane (ERM) scheduled for pars plana vitrectomy (PPV) and ERM peeling were included. Surgical videos were analyzed and the difficulty of ERM removal (easy or difficult) determined subjectively by an independent surgeon. Furthermore, the peeling time and amount of grasping were measured on the videos to provide an objective factor of surgery difficulty. Preoperative spectral-domain optical coherence tomography (OCT) images and color fundus photos were analyzed to identify predictive factors for membrane removal difficulty. RESULTS: The subjective surgical difficulty of ERM removal was strongly associated with fibrillary changes between the ERM and retinal nerve fiber layer (RNFL), severe retinal vascular tortuosity and severe glinting fundus reflex. Higher fundus pigmentation was associated with fewer and cystoid spaces with more attempts of grasping ERM. No other preoperative signs were found to be associated with the duration of the peeling time. CONCLUSION: The presence of fibrillary changes between the ERM and RNFL, severe retinal vascular tortuosity and severe glinting reflex are preoperative findings that have a strong association with the difficulty in ERM peeling.
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Membrana Epirretiniana/cirurgia , Fibras Nervosas/patologia , Oftalmoscopia , Células Ganglionares da Retina/patologia , Vasos Retinianos/patologia , Tomografia de Coerência Óptica , Idoso , Idoso de 80 Anos ou mais , Membrana Epirretiniana/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Período Pré-Operatório , Estudos Prospectivos , VitrectomiaRESUMO
PURPOSE: Limited information is available on morphologic and functional regeneration of photoreceptors after retinal detachment (RD) surgery. This observational clinical study compared morphologic and functional changes of cones after vitrectomy for macula-off retinal detachment. DESIGN: Prospective, fellow-eye comparative case series. METHODS: StudyPopulation: Five eyes after vitrectomy with gas for macula-off retinal detachment (retinal detachment eyes, RDE) and 5 healthy fellow eyes (HFE) of 5 patients (mean age 59.8 years, macula-off duration 0.5 days to 5.5 days). ObservationProcedures: Eyes were examined with adaptive-optics optical coherence tomography (AO-OCT), spectral-domain OCT (SDOCT), and microperimetry (MP) at 6 (baseline, BL) and 56 weeks (follow-up, FUP) after 23 gauge pars plana vitrectomy and SF6 gas tamponade. Eight corresponding regions at foveal eccentricities of 2.5° (ecc 2.5°) and 6.5° (ecc 6.5°) were analyzed in every eye. AO-OCT en face images and SD-OCT B-scans were graded regarding irregularity and loss of photoreceptor signals ranging from none to severe changes. The number of detectable cones at height of the inner-outer segment junction (IS/OS) and cone outer segment tips (COST) was counted manually in AO-OCT images. MP with a custom grid was used to assess retinal sensitivity at these locations. MainOutcomeMeasures: Cone density, cone pattern regularity and signal attenuation, retinal sensitivity. RESULTS: In comparison to HFE, RDE showed highly irregular cone patterns in AO-OCT and irregular outer retinal bands in SDOCT. Despite significant improvement of cone pattern regularity compared to BL (P < .001), 63% of AO images showed remaining cone pattern irregularity and 45.5% of SDOCT B-scans showed severe signal reduction at FUP. In HFE, mean cone density retrieved from IS/OS and COST remained around 20,000/mm2 (ecc 2.5°) and 16,000/mm2 (ecc 6.5°) at BL and FUP. Cone density of RDE was significantly reduced and ranged between 200/mm2 and 15,600/mm2 (P < .001) at BL. Despite improvement at FUP (P < .001), mean cone density at IS/OS and COST was still lower compared to HFE and ranged between 7790 and 9555 cones/mm2 (P < .001). Mean retinal sensitivity of all measured locations remained 18 dB in HFE and was significantly lower in RDE, with 14.30 dB at BL and 14.64 dB at FUP. Both SDOCT grading and microperimetry sensitivity showed strong correlation with AO-OCT grading and cone density (rho values > 0.750). CONCLUSIONS: The combination of AO-OCT, SDOCT, and microperimetry is a powerful tool to capture cone regeneration after vitreoretinal surgery. Our study shows that cone morphology and function improve within 56 weeks after RD surgery but structural and functional impairment is still present.
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Células Fotorreceptoras Retinianas Cones/fisiologia , Descolamento Retiniano/fisiopatologia , Descolamento Retiniano/cirurgia , Tomografia de Coerência Óptica , Testes de Campo Visual , Vitrectomia , Idoso , Comprimento Axial do Olho , Contagem de Células , Tamponamento Interno , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Óptica e Fotônica , Estudos Prospectivos , Descolamento Retiniano/diagnóstico por imagem , Acuidade Visual/fisiologia , Campos Visuais/fisiologiaRESUMO
Purpose: To evaluate the functional and morphological outcomes of patients with SO tamponade due to primary rhegmatogenous retinal detachment (primRD) and recurrent rhegmatogenous detachment (recRD).Methods: Seventy-five eyes were enrolled in this prospective study between January 2009 and December 2016. Patients with primRD and recRD were evaluated in a complete ophthalmic examination including best-corrected visual acuity (BCVA) and OCT before and after silicone oil removal (SOR).Results: The primRD group comprised 35 eyes and the recRD group 40 eyes with a duration of SO tamponade of 9 ± 4/12 ± 11 months in the primRD/recRD groups (p = .088). The preoperative OCT revealed a high rate of morphological changes such as ERM (primRD: 24%; recRD: 69%) and CME (primRD: 10%; recRD: 55%) in the recRD compared with the primRD group (ERM: p = .18; CME: p = .04). No such difference was observed postoperatively. Disruption of the ellipsoid zone (EZ) was similar in both groups (primRD: 52%; recRD: 72%) before SOR and was restored in 66%/58% (primRD/recRD) after SOR. No difference was found regarding pre- and postoperative VA (0.91 ± 0.54/0.90 ± 0.54logMAR primRD/recRD preoperative; 0.76 ± 0.56/0.71 ± 0.53logMAR primRD/recRD at the last follow-up; p = .96/p = .70). EZ integrity (0.43 ± 0.31logMAR) was associated with better functional results than an interrupted EZ (0.86 ± 0.43logMAR; p < .001). A significant positive correlation of the duration of SO tamponade and the final VA was found in the primRD (r = 0.396, p = .02) whereas none in the recRD group (r = 0.196; p = .31).Conclusion: Morphological changes including ERM and CME were more pronounced in the recRD group, but only before SOR. Interestingly, the pre- and postoperative BCVA were similar in both groups with EZ integrity being a factor of good functional outcome. The duration of SO tamponade had a statistically significant negative impact on the postoperative VA in the primary detachments.
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Tamponamento Interno/métodos , Descolamento Retiniano/cirurgia , Óleos de Silicone/farmacologia , Tomografia de Coerência Óptica/métodos , Acuidade Visual , Vitrectomia/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Prospectivos , Descolamento Retiniano/diagnósticoRESUMO
BACKGROUND: To evaluate the change in peripheral perfusion status in patients with retinal vein occlusion (RVO) during dexamethasone treatment. METHODS: Thirty-five eyes of patients with macular oedema due to either branch or central retinal vein occlusion were included. At baseline, patients were treated with an intravitreal dexamethasone implant (Ozurdex® ) and followed until month 6. Wide-field angiographies were classified as ischaemic and nonischaemic. Peripheral nonperfusion (PNP) was determined manually by calculating the percentage of nonperfusion area in relation to the total visible retina (ischaemic index). RESULTS: Thirteen eyes showed evidence of >10 disc area of PNP at baseline and were graded as ischaemic RVO. In nonischaemic eyes, the mean area of PNP was 0.3% at baseline, 0.6% after 1 month, 0.6% after 3 months and 0.6% after 6 months, respectively (p > 0.05). In ischaemic RVO, the ischaemic index was calculated to be 18% at baseline. One month after treatment, mean area of PNP was 16% and after 3 months was 19% (p = 0.8; p = 0.6). After retreatment, total PNP area was 18% (month 6; p = 0.9). During treatment, best-corrected visual acuity (BCVA) increased and central retinal thickness (CRT) decreased from baseline to final follow-up with no differences between nonischaemic/ischaemic RVO. A significant negative correlation between the total area of PNP and visual acuity was identified (r = -0.6; p = 0.04). CONCLUSION: Using 200° wide-field fluorescein angiography, the ischaemic index was shown to remain stable during dexamethasone treatment. This finding was consistent in ischaemic as well as in nonischaemic conditions.
Assuntos
Dexametasona/administração & dosagem , Oclusão da Veia Retiniana/tratamento farmacológico , Vasos Retinianos/diagnóstico por imagem , Acuidade Visual , Idoso , Implantes de Medicamento , Feminino , Angiofluoresceinografia , Seguimentos , Fundo de Olho , Glucocorticoides/administração & dosagem , Humanos , Injeções Intravítreas , Masculino , Estudos Prospectivos , Oclusão da Veia Retiniana/diagnóstico , Tomografia de Coerência ÓpticaRESUMO
PURPOSE: To evaluate the evolution of surgical methods over a 7-year period in patients with primary rhegmatogenous retinal detachment (RRD) and its relation to functional outcome and intra- and postoperative complications. METHODS: This prospective observational study included 628 patients with primary RRD who underwent surgical repair between January 2009 and December 2015. The main outcome measures were the type of surgical procedure ((scleral buckle (SB), pars plana vitrectomy (PPV), combination of SB and PPV or cryocoagulation (CC)) and intraocular tamponades. In addition, functional outcome and intra/postoperative complications were assessed over the observational period. RESULTS: During the 7-year observation, the percent of SB procedures decreased from 40.5% in 2009 to 2.7% in 2014, while PPV increased from 38% in 2009 to above 90% in 2014. In 2015, the SB procedure was performed in 10.3% and PPV in 85.6% of patients with RRD (p < 0.001). No consistent trend was observed for the use of intraocular gas tamponade. The functional outcome within the 7-year observation ranged from 0.25 ± 0.31logmar in 2012 to 0.42 ± 0.40logmar in 2009 and showed no statistically significant trend (p = 0.28). Intraoperative complications did not change between 2009 and 2015. The rate of cataract surgery and epiretinal membrane development did not change (p = 0.27; p = 0.09). The percent of re-detachment ranged from 6.2 to 16.5% within the observational period (p = 0.14). CONCLUSION: A shift toward PPV alone for primary RRD repair was observed during the 7-year observation. No decrease in functional outcome or increase of intra- and postoperative complications or decrease of primary and final anatomic success rate was observed following the change in surgical procedure.
Assuntos
Complicações Intraoperatórias/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Descolamento Retiniano/cirurgia , Recurvamento da Esclera/métodos , Acuidade Visual , Vitrectomia/métodos , Áustria/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
Purpose/aim of the study: To observe and analyze the weekly changes in morphology and size of vacuoles, so called Wedl cells, in eyes with posterior subcapsular cataract (PSC). MATERIALS AND METHODS: Thirty-six eyes of 36 patients with pronounced PSC were included in this prospective study. High-resolution retroillumination images were taken, and the changes in size and shape of Wedl cells were analyzed at baseline and at 2 and 4 weeks later using dedicated imaging software. RESULTS: In total, 1087 Wedl cells were observed. Within 2 and 4 weeks, 31 and 22 Wedl cells appeared and 13 and 40 Wedl cells disappeared, respectively. Median Wedl cell size at baseline and after 2 and 4 weeks was 4000 µm2 (range: 40-212120 µm2), 4080 µm2 (range: 40-274520 µm2), and 4160 µm2 (range: 40-212200 µm2), respectively. For the absolute size change within 4 weeks, a significant difference was observed (p = 0.045). The median change in absolute solidity within 2 and 4 weeks was 0.01 (range: 0.00-0.19) and 0.02 (range: 0.00-0.53), respectively. CONCLUSIONS: Wedl cells undergo morphological changes within a short time period of 4 weeks and even appearance and disappearance of Wedl cells can be observed within weeks. The fact that spontaneous regression occurs may, when properly understood, have some relevance for the development of therapeutical approaches to reverse existing PSC in the future.
Assuntos
Catarata/patologia , Células Epiteliais/patologia , Cápsula Posterior do Cristalino/patologia , Idoso , Extração de Catarata , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fotografação , Estudos Prospectivos , Pseudofacia/etiologia , VacúolosRESUMO
We report a human case of ocular Dirofilaria infection in a traveler returning to Austria from India. Analysis of mitochondrial sequences identified the worm as Candidatus Dirofilaria hongkongensis, a close relative of Dirofilaria repens, which was only recently described in Hong Kong and proposed as a new species.
Assuntos
Dirofilaria , Dirofilariose/epidemiologia , Dirofilariose/parasitologia , Infecções Oculares/epidemiologia , Infecções Oculares/parasitologia , Doença Relacionada a Viagens , Adulto , Animais , Áustria , Dirofilaria/classificação , Dirofilaria/genética , Dirofilaria/isolamento & purificação , Dirofilariose/diagnóstico , Infecções Oculares/diagnóstico , Feminino , Genes Bacterianos , Humanos , Índia , FilogeniaRESUMO
PURPOSE: To differentiate retinoschisis (RS) from non-acute retinal detachment (naRD) in clinical routine using optical coherence tomography (OCT), describe unique morphological OCT characteristics and monitor disease progression. METHODS: This prospective, observational study included 64 eyes of 44 patients with either RS or naRD. Patients were examined clinically and using Heidelberg Spectralis OCT® , Topcon DRI OCT® and Cirrus HRA-OCT® over 2 years with follow-up at 1, 3, 6, 12 and 24 months. Main outcomes were typical morphologic findings of RS and naRD described in OCT. Progression was monitored using Spectralis OCT® follow-up mapping and an eye-tracking method. RESULTS: Forty-seven eyes were diagnosed with RS and 17 with naRD. Optical coherence tomography (OCT) provided a definite diagnosis in four eyes diagnosed clinically as uncertain. Seventy-seven percentage of eyes with RS were atrophic in the inner leaf (IL), whereas 41% with naRD showed cystoid alteration. A discontinuation of the IL clinically observed as an inner-layer break (ILB) could be imaged. We described a tissue retraction within the outer leaf (OL), which corresponded to outer-layer breaks (OLBs) in clinical examinations in nine eyes (19%). CONCLUSION: Optical coherence tomography (OCT) is a reliable method to differentiate and monitor RS from naRD. Morphological characteristics, including ILB and OLB, could be accurately illustrated in RS.
Assuntos
Monitorização Fisiológica/métodos , Retina/patologia , Descolamento Retiniano/diagnóstico , Retinosquise/diagnóstico , Tomografia de Coerência Óptica/métodos , Diagnóstico Diferencial , Seguimentos , Humanos , Estudos Prospectivos , Reprodutibilidade dos Testes , Fatores de TempoRESUMO
PURPOSE: To investigate the influence of intravitreal dexamethasone implant on inflammatory and angiogenic cytokine levels in the aqueous of patients with retinal vein occlusion (RVO). METHODS: Forty eyes of 40 consecutive patients with macular oedema (ME) due to branch and central retinal vein occlusion (BRVO/CRVO) were treated with an intravitreal dexamethasone implant (Ozurdex® ) at baseline and evaluated until month 6. Retreatment was performed in case of recurrent ME earliest 4 months after the baseline treatment. Aqueous humour samples were taken at baseline, months 1, 3, 6 and at the time of each retreatment. Concentrations of 29 different cytokines were measured by Luminex® bead assays. The control group comprised healthy patients undergoing cataract surgery. RESULTS: At baseline concentrations of interleukin (IL)-8, angiopoietin (ANG)-2 and intercellular adhesion molecule (ICAM)-1 were highly elevated in patients with CRVO compared with controls (p = 0.006; p = 0.02; p = 0.03). Vascular endothelial growth factor (VEGF) concentrations were upregulated in patients with BRVO and CRVO (p = 0.003; p = 0.001). Retreatment with a dexamethasone implant was necessary after 4 months in 14/8 (BRVO/CRVO) patients, 5 months in 5/3 patients and 6 months in one patient (BRVO). After the initial treatment, macrophage chemo-attractant protein (MCP)-1 and IL17-E concentrations decreased in BRVO (p < 0.001; p = 0.01) and MCP-1 and IL1-α in CRVO (p = 0.01; p = 0.003). Vascular endothelial growth factor (VEGF) concentrations did not change during treatment in either group (p = 0.3). A mixed-effect model showed that cytokine concentrations positively correlated with central retinal thickness changes. CONCLUSIONS: Intravitreal dexamethasone treatment resulted in alterations in the concentrations of pro-inflammatory cytokines MCP-1 and IL17-E in patients with BRVO and MCP-1 and IL1-α in patients with CRVO. These data highlight the important role of inflammatory mediators involved in ME due to RVO.