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1.
BMC Ophthalmol ; 21(1): 200, 2021 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-33962561

RESUMO

BACKGROUND: During panretinal photocoagulation (PRP), the outer retina, especially the photoreceptors, are destroyed. During such procedures, the impact of the retinal photocoagulation, which is performed in the same photocoagulated area, may change if it is applied to different locations with different photoreceptor densities. Thus, we aimed to evaluate the influence of photoreceptor density on PRP. METHODS: We constructed a three-dimensional (3D) average distribution of photoreceptors with 3D computer-aided design (CAD) software using previously derived photoreceptor density data and calculated the number of photoreceptors destroyed by scatter PRP and full-scatter PRP (size 400-µm on the retina, spacing 1.0 spot) using a geometry-based simulation. To investigate the impact of photoreceptor density on PRP, we calculated the ratio of the number of photoreceptors destroyed to the total number of photoreceptors, termed the photoreceptor destruction index. RESULTS: In this 3D simulation, the total number of photoreceptors was 96,571,900. The total number of photoreceptors destroyed by scatter PRP and full-scatter PRP were 15,608,200 and 19,120,600, respectively, and the respective photoreceptor destruction indexes were 16.2 and 19.8%, respectively. CONCLUSIONS: Scatter PRP is expected to have 4/5 of the number of photoreceptors destroyed by full-scatter PRP.


Assuntos
Retinopatia Diabética , Corioide , Retinopatia Diabética/cirurgia , Humanos , Fotocoagulação a Laser , Lasers , Retina/diagnóstico por imagem , Retina/cirurgia
3.
Medicine (Baltimore) ; 100(17): e25611, 2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-33907112

RESUMO

BACKGROUND: Although conbercept has been used for other diseases associated with new vascular formation, the effect of single-dose conbercept in combination with proliferative diabetic retinopathy (PDR) have not been established. We thus conducted this protocol for systematic review and meta-analysis to compare the efficacy and acceptability of panretinal photocoagulation (PRP) associated with intravitreal conbercept injections versus PRP alone in the treatment of patients with PDR. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols reporting guidelines and the recommendations of the Cochrane Collaboration were followed to conduct this study. Reviewers will search the PubMed, Cochrane Library, Web of Science, and EMBASE online databases using the key phrases "panretinal photocoagulation," "conbercept," and "proliferative diabetic retinopathy" for all cohort studies published up to May 2021. The studies on cohort study focusing on PRP + conbercept and PRP alone for PDR patients will be included in our meta-analysis. At least one of the following outcomes should have been measured: PRP completion rate, proportion of eyes with visual gain/loss, central macular thickness, and incidence of complication. Review Manager software (v 5.4; Cochrane Collaboration) is used for the meta-analysis. RESULTS: It was hypothesized that intravitreal conbercept plus PRP was more effective than PRP alone. OSF REGISTRATION NUMBER: 10.17605/OSF.IO/HCQ2S.


Assuntos
Retinopatia Diabética/terapia , Fotocoagulação/métodos , Proteínas Recombinantes de Fusão/administração & dosagem , Estudos de Coortes , Terapia Combinada , Humanos , Injeções Intravítreas , Metanálise como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Retina/efeitos dos fármacos , Retina/cirurgia , Revisões Sistemáticas como Assunto , Resultado do Tratamento
4.
Medicine (Baltimore) ; 100(17): e25682, 2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-33907139

RESUMO

BACKGROUND: The argument on the optimal treatment for patients with proliferative diabetic retinopathy (PDR) remains to be resolved. Therefore, the primary objective of the present study was to evaluate the clinical efficacy of anti-vascular endothelial growth factor (anti-VEGF) therapy versus panretinal photocoagulation (PRP) for patients with PDR. METHODS: Two independent investigators followed The Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines and the recommendations of the Cochrane Collaboration to conduct this meta-analysis. The electronic databases of EMBASE, PubMed, Cochrane Library, and Web of Science were searched from the inception to April 2021 using the following key terms: "proliferative diabetic retinopathy," "anti-vascular endothelial growth factor," and "panretinal photocoagulation," for all relevant studies. We identified literature that met the following inclusion criteria: patients with PDR; studies focusing on assessing anti-VEGF therapy and PRP; the following outcome measures must be shown: anatomical outcomes, including complete regression and recurrence of neovascularization, mean change in best corrected vision acuity from baseline to the end of follow-up period. The Cochrane risk of bias tool was used to evaluate the risk of bias of included randomized clinical trials by 2 independent reviewers. RESULTS: This protocol will provide a reliable theoretical basis for the following research. TRIAL REGISTRATION NUMBER: 10.17605/OSF.IO/UHYDR.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Retinopatia Diabética/terapia , Fotocoagulação/métodos , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Humanos , Metanálise como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Análise de Regressão , Projetos de Pesquisa , Retina/cirurgia , Revisões Sistemáticas como Assunto , Resultado do Tratamento
5.
J Vis Exp ; (169)2021 03 11.
Artigo em Inglês | MEDLINE | ID: mdl-33779596

RESUMO

Neuronal and vascular structures of the retina in physiologic and pathologic conditions can be better visualized and characterized by using intact whole retina imaging techniques compared to conventional retinal flat mount preparations and sections. However, immunofluorescent imaging of intact whole retina is hindered by the opaque coatings of the eyeball, i.e., sclera, choroid, and retinal pigment epithelium (RPE) and the light scattering properties of retinal layers that prevent full thickness high resolution optical imaging. Chemical bleaching of the pigmented layers and tissue clearing protocols have been described to address these obstacles; however, currently described methods are not suitable for imaging endogenous fluorescent molecules such as green fluorescent protein (GFP) in intact whole retina. Other approaches bypassed this limitation by surgical removal of pigmented layers and the anterior segment of the eyeball allowing intact eye imaging, though the peripheral retina and hyaloid structures were disrupted. Presented here is an intact whole retina and vitreous immunofluorescent imaging protocol that combines surgical dissection of the sclera/choroid/retina pigment epithelium (RPE) layers with a modified tissue clearing method and light sheet fluorescent microscopy (LSFM). The new approach offers an unprecedented view of unperturbed vascular and neuronal elements of the retina as well as the vitreous and hyaloid vascular system in pathologic conditions.


Assuntos
Corioide/cirurgia , Dissecação/métodos , Microscopia de Fluorescência/métodos , Procedimentos Cirúrgicos Oftalmológicos/métodos , Retina/cirurgia , Esclera/cirurgia , Animais , Receptor 1 de Quimiocina CX3C/metabolismo , Corioide/diagnóstico por imagem , Corioide/metabolismo , Camundongos , Retina/diagnóstico por imagem , Retina/metabolismo , Esclera/diagnóstico por imagem , Esclera/metabolismo
8.
Vestn Oftalmol ; 137(1): 46-52, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33610149

RESUMO

PURPOSE: To evaluate the first outcomes of non-contact navigated laser retinopexy for peripheral tears and rhegmatogenous degenerations of the retina. MATERIAL AND METHODS: This prospective single-center interventional pilot study included 58 patients (68 eyes), among which 19 males and 39 females aged 47.5±16.9 years with peripheral retinal degenerations and symptomatic retinal tears who received non-contact laser retinopexy with the Navilas 577s navigated laser system and non-contact PRP widefield objective. All patients (68 eyes) underwent laser treatment for the following disorders: horseshoe tear in 13 eyes, retinal hole in 11 eyes, operculated retinal hole in 3 eyes, lattice degeneration in 19 eyes, snail track degeneration in 1 eye, vitreoretinal tufts in 16 eyes, and progressing bullous retinoschisis in 5 eyes. Pain intensity was assessed using a four-point verbal rating scale. RESULTS: All patients were followed up for 5 to 21 months (9.0±3.3 months on average). Stable condition of the retina was observed in 65 cases (95.5%). In 3 eyes (4.4%), newly formed retinal tears prompted additional laser treatment: horseshoe tear in 2 eyes and retinal hole in 1 eye. The mean pain score during non-contact navigated laser retinopexy was 0.9±0.5. No complications associated with laser treatment were observed. CONCLUSION: Non-contact navigated laser retinopexy performed with the Navilas 577s navigated laser system is a safe and well-tolerated procedure with effectiveness comparable to conventional laser retinopexy.


Assuntos
Descolamento Retiniano , Perfurações Retinianas , Adulto , Feminino , Humanos , Fotocoagulação a Laser , Lasers , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Retina/diagnóstico por imagem , Retina/cirurgia , Descolamento Retiniano/diagnóstico , Descolamento Retiniano/etiologia , Descolamento Retiniano/cirurgia , Perfurações Retinianas/diagnóstico , Perfurações Retinianas/etiologia , Perfurações Retinianas/cirurgia
9.
JAMA ; 324(23): 2383-2395, 2020 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-33320223

RESUMO

Importance: Vitreous hemorrhage from proliferative diabetic retinopathy can cause loss of vision. The best management approach is unknown. Objective: To compare initial treatment with intravitreous aflibercept vs vitrectomy with panretinal photocoagulation for vitreous hemorrhage from proliferative diabetic retinopathy. Design, Setting, and Participants: Randomized clinical trial at 39 DRCR Retina Network sites in the US and Canada including 205 adults with vison loss due to vitreous hemorrhage from proliferative diabetic retinopathy who were enrolled from November 2016 to December 2017. The final follow-up visit was completed in January 2020. Interventions: Random assignment of eyes (1 per participant) to aflibercept (100 participants) or vitrectomy with panretinal photocoagulation (105 participants). Participants whose eyes were assigned to aflibercept initially received 4 monthly injections. Both groups could receive aflibercept or vitrectomy during follow-up based on protocol criteria. Main Outcomes and Measures: The primary outcome was mean visual acuity letter score (range, 0-100; higher scores indicate better vision) over 24 weeks (area under the curve); the study was powered to detect a difference of 8 letters. Secondary outcomes included mean visual acuity at 4 weeks and 2 years. Results: Among 205 participants (205 eyes) who were randomized (mean [SD] age, 57 [11] years; 115 [56%] men; mean visual acuity letter score, 34.5 [Snellen equivalent, 20/200]), 95% (195 of 205) completed the 24-week visit and 90% (177 of 196, excluding 9 deaths) completed the 2-year visit. The mean visual acuity letter score over 24 weeks was 59.3 (Snellen equivalent, 20/63) (95% CI, 54.9 to 63.7) in the aflibercept group vs 63.0 (Snellen equivalent, 20/63) (95% CI, 58.6 to 67.3) in the vitrectomy group (adjusted difference, -5.0 [95% CI, -10.2 to 0.3], P = .06). Among 23 secondary outcomes, 15 showed no significant difference. The mean visual acuity letter score was 52.6 (Snellen equivalent, 20/100) in the aflibercept group vs 62.3 (Snellen equivalent, 20/63) in the vitrectomy group at 4 weeks (adjusted difference, -11.2 [95% CI, -18.5 to -3.9], P = .003) and 73.7 (Snellen equivalent, 20/40) vs 71.0 (Snellen equivalent, 20/40) at 2 years (adjusted difference, 2.7 [95% CI, -3.1 to 8.4], P = .36). Over 2 years, 33 eyes (33%) assigned to aflibercept received vitrectomy and 34 eyes (32%) assigned to vitrectomy received subsequent aflibercept. Conclusions and Relevance: Among participants whose eyes had vitreous hemorrhage from proliferative diabetic retinopathy, there was no statistically significant difference in the primary outcome of mean visual acuity letter score over 24 weeks following initial treatment with intravitreous aflibercept vs vitrectomy with panretinal photocoagulation. However, the study may have been underpowered, considering the range of the 95% CI, to detect a clinically important benefit in favor of initial vitrectomy with panretinal photocoagulation. Trial Registration: ClinicalTrials.gov Identifier: NCT02858076.


Assuntos
Inibidores da Angiogênese/administração & dosagem , Retinopatia Diabética/complicações , Fotocoagulação , Receptores de Fatores de Crescimento do Endotélio Vascular/administração & dosagem , Proteínas Recombinantes de Fusão/administração & dosagem , Retina/cirurgia , Vitrectomia , Hemorragia Vítrea/tratamento farmacológico , Hemorragia Vítrea/cirurgia , Idoso , Inibidores da Angiogênese/efeitos adversos , Extração de Catarata , Intervalos de Confiança , Feminino , Humanos , Injeções Intravítreas , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Proteínas Recombinantes de Fusão/efeitos adversos , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Acuidade Visual , Vitrectomia/efeitos adversos , Hemorragia Vítrea/etiologia
10.
Rom J Ophthalmol ; 64(3): 285-291, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33367162

RESUMO

Purpose: To describe the central three-dimensional (3D) thickness profile of the macula (CMT) and the subfoveal choroidal region (SFCT) in diabetic retinopathy (DR) following panretinal laser photocoagulation (PRP) using swept-source optical coherence tomography (SS-OCT). Methods: A prospective observational study including 17 eyes with proliferative DR (PDR) and 27 eyes with severe nonproliferative DR (sNPDR)] for whom PRP was done. All subjects received SS-OCT imaging before and 3 months after PRP (POM#3). SFCT and CMT changes were analysed at both visits. Intraclass Correlation Coefficients (ICC) and Coefficients of Variation (COV) were used to test the accuracy of thickness data. Results: SFCT has thinned from 233 ± 54 µm before PRP treatment to 216 ± 51 µm 3 months later (p < 0.001). Likewise, CMT declined at POM#3 as compared to pre-PRP status (p<0.001). SFCT was thinner in PDR before and at POM#3 (p<0.05) than sNPDR; whereas, no significant difference was observed in CMT between both groups in the two visits. No significant changes were found between groups in SFCT and CMT at POM#3. Regarding reliability, ICCSFCT=0.98 and ICCCMT=0.99. The COVs for CMT and SFCT were 5.03% and 5.91%, respectively. Conclusion: The mean SFCT and CMT decreased 3 months after PRP. We also reported reliability of SFCT measurements in DR using SS-OCT. Abbreviations: SS = Swept-Source, TD = time domain, SD = spectral domain, FD = Fourier-domain, 3D = three-dimensional, 2D = two-dimensional.


Assuntos
Corioide/patologia , Retinopatia Diabética/diagnóstico , Fotocoagulação a Laser/métodos , Retina/patologia , Tomografia de Coerência Óptica/métodos , Retinopatia Diabética/cirurgia , Feminino , Angiofluoresceinografia/métodos , Seguimentos , Fundo de Olho , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Retina/cirurgia , Estudos Retrospectivos
11.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 6049-6053, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019350

RESUMO

During vitreoretinal surgery, the surgeon is required to precisely manipulate multiple tools in a confined intraocular environment, while the tool tip to retina contact forces are at the limit of human sensation limits. During typical vitrectomy procedures, the surgeon inserts various tools through small incisions performed on the sclera of the eye (sclerotomies), and manipulates them to perform surgical tasks. During intraocular procedures, tool-tissue interactions occur at the sclerotomy ports and at the tool-tip when it contacts retina. Measuring such interactions may be valuable for providing force feedback necessary for robotic guidance. In this paper, we measure and analyze force measurements at the sclerotomy ports. To the best of our knowledge, this is the first time that the scleral forces are measured in an in vivo eye model. A force sensing instrument utilizing Fiber Bragg Grating (FBG) strain sensors was used to measure the scleral forces while two retinal surgeons performed intraocular tool manipulation (ITM) task in rabbit eyes as well as a dry phantom. The mean of the measured sclera forces were 129.11 mN and 80.45 mN in in vivo and dry phantom experiments, respectively.


Assuntos
Oftalmologia , Cirurgia Vitreorretiniana , Animais , Humanos , Fenômenos Mecânicos , Coelhos , Retina/cirurgia , Esclera/cirurgia
12.
Vestn Oftalmol ; 136(6): 50-56, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33084279

RESUMO

PURPOSE: To determine the indications and assess the effectiveness of laser coagulation of the retina (RLC) after different types of surgeries for retinal detachment (RD), except vitrectomy. MATERIAL AND METHODS: The study included 160 patients (165 eyes) with various types of retinal detachment and retinoschisis who remained under observation for 11 years. RESULTS: In case of retinal tear with a slight local RD (less than one quadrant), we recommend the use of RLC as monotherapy. Such patients are indicated to undergo regular examinations (1 month, 3 months, 6 months, 1 year). Due to risk of tractional defects of the retina in the lower quadrants during the introduction of gas-air mixture into the vitreous cavity, in the presence of retinal pathology it is recommended to perform RLC before the pneumatic retinopexy stage. In large retinal tears, despite their upper localization, pneumatic retinopexy is not indicated due to the possibility of gas spilling over the edges of the tear under the retina, leading to an increase in the initial size of the tear and spread of RD. We noted the effectiveness of RLC monotherapy for retinal detachment of various localization. After sealing the sclera, retinal laser coagulation on the shaft along the seal is necessary to limit the tear along the edge, since over time the seal may shift causing a relapse of RD. CONCLUSION: The study has confirmed the effectiveness of laser coagulation of the retina as an independent method for the treatment of retinoschisis and retinal tears with local detachment.


Assuntos
Descolamento Retiniano , Retinosquise , Humanos , Fotocoagulação a Laser , Retina/diagnóstico por imagem , Retina/cirurgia , Descolamento Retiniano/diagnóstico , Descolamento Retiniano/etiologia , Descolamento Retiniano/cirurgia , Retinosquise/diagnóstico , Retinosquise/etiologia , Retinosquise/cirurgia , Vitrectomia
13.
Klin Monbl Augenheilkd ; 237(10): 1225-1229, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-33059379

RESUMO

One of the most controversial discussions in retinal surgery is currently being held about the importance of intraoperative OCT (iOCT). The background is the desire to combine the 2-dimensional fundus view of the surgeon with the layered depth information of OCT to achieve a 4-dimensional "augmented reality" (3-D plus change over time). This should help to visualise fine structures, which have been hidden from the surgeon's view. Therefore, retinal surgery seems to be predestined for the use of iOCT. The great hope is that a dynamic live 3-D image with real-time feedback will provide the surgeon with additional information and improve safety. Although fascinating at the first glance, in the surgical routine, however, iOCT technology is disappointing, especially in macular surgery. It rarely provides substantial information that would not be obtainable without iOCT or that would not be available in much better quality through preoperative diagnostic testing. Only some special indications remain, particularly related to subretinal surgery.


Assuntos
Retina , Tomografia de Coerência Óptica , Fundo de Olho , Procedimentos Cirúrgicos Oftalmológicos , Retina/diagnóstico por imagem , Retina/cirurgia , Corpo Vítreo
14.
PLoS One ; 15(9): e0239138, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32970724

RESUMO

There are multiple surgical approaches to the repair of rhegmatogenous retinal detachment (RRD). Here, we evaluated the outcomes of small-gauge pars plana vitrectomy (PPV), alone or in combination with scleral buckle (SB-PPV), for RRD repair using a standardized technique by 3 vitreoretinal surgeons: "extensive" removal of the vitreous with scleral depression and dynamic examination of the peripheral retina. One hundred eighty seven eyes of 180 consecutive patients treated for primary RRD by three vitreoretinal surgeons at a tertiary academic medical center from September 2015 to March 2018 were analyzed. Most RRDs occurred in males (134 [71.3%] eyes), affected the left eye (102 [54.3%]), and were phakic (119 [63.3%]). PPV alone was performed in 159 eyes (84.6%), with a combined SB-PPV used in the remaining 29 eyes (15.4%); focal endolaser was used in all (100%) cases. The single surgery anatomic success rate was 186 eyes (99.5%) at 3 months, and 187 (100%) at last follow up. Overall best-corrected visual acuity (BCVA) had significantly improved at 3 months ([Snellen 20/47] P<0.00005) and last follow up ([Snellen 20/31] P<0.00005), as compared to day of presentation ([Snellen 20/234]). Our findings suggest that "extensive" removal of the vitreous and dynamic peripheral examination with scleral depression may lead to high single surgery success in primary uncomplicated RRD repair.


Assuntos
Oftalmopatias Hereditárias/cirurgia , Fotocoagulação a Laser/métodos , Descolamento Retiniano/cirurgia , Recurvamento da Esclera/métodos , Vitrectomia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada/métodos , Oftalmopatias Hereditárias/diagnóstico , Feminino , Seguimentos , Humanos , Fotocoagulação a Laser/instrumentação , Masculino , Pessoa de Meia-Idade , Retina/diagnóstico por imagem , Retina/cirurgia , Descolamento Retiniano/diagnóstico , Estudos Retrospectivos , Esclera/diagnóstico por imagem , Esclera/cirurgia , Recurvamento da Esclera/instrumentação , Fatores Sexuais , Tomografia de Coerência Óptica , Resultado do Tratamento , Acuidade Visual , Vitrectomia/instrumentação
16.
Am J Pathol ; 190(10): 2056-2066, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32693061

RESUMO

Glaucoma is a frequent and devastating long-term complication following ocular trauma, including corneal surgery, open globe injury, chemical burn, and infection. Postevent inflammation and neuroglial remodeling play a key role in subsequent ganglion cell apoptosis and glaucoma. To this end, this study was designed to investigate the amplifying role of monocyte infiltration into the retina. By using three different ocular injury mouse models (corneal suture, penetrating keratoplasty, and globe injury) and monocyte fate mapping techniques, we show that ocular trauma or surgery can cause robust infiltration of bone marrow-derived monocytes into the retina and subsequent neuroinflammation by up-regulation of Tnf, Il1b, and Il6 mRNA within 24 hours. This is accompanied by ganglion cell apoptosis and neurodegeneration. Prompt inhibition of tumor necrosis factor-α or IL-1ß markedly suppresses monocyte infiltration and ganglion cell loss. Thus, acute ocular injury (surgical or trauma) can lead to rapid neuroretinal inflammation and subsequent ganglion cell loss, the hallmark of glaucoma. Infiltrating monocytes play a central role in this process, likely amplifying the inflammatory cascade, aiding in the activation of retinal microglia. Prompt administration of cytokine inhibitors after ocular injury prevents this infiltration and ameliorates the damage to the retina-suggesting that it may be used prophylactically for neuroprotection against post-traumatic glaucoma.


Assuntos
Citocinas/antagonistas & inibidores , Glaucoma/metabolismo , Monócitos/patologia , Neuroglia/patologia , Retina/cirurgia , Animais , Queimaduras Químicas/metabolismo , Queimaduras Químicas/patologia , Córnea/metabolismo , Córnea/patologia , Modelos Animais de Doenças , Glaucoma/patologia , Camundongos Transgênicos , Monócitos/metabolismo , Retina/metabolismo
17.
PLoS One ; 15(7): e0236431, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32706833

RESUMO

PURPOSE: To compare the anatomical and visual outcomes of inverted internal limiting membrane (ILM) flap technique with the conventional ILM peeling for idiopathic large macular holes (MHs). METHODS: A meta-analysis of randomized control trials (RCTs) using online databases including NCBI PubMed, ClinicalTrials.gov, and ISI Web of Science was performed. Anatomic success and type 1 closure rates, the mean postoperative best-corrected visual acuity (BCVA) and the mean change of BCVA from baseline were analyzed. RESULTS: Out of 251 articles, four described clinical trials matching the inclusion criteria and were selected. They included 276 eyes (135 eyes in the inverted ILM flap group and 141 eyes in the ILM peeling group). All the studies used gas tamponade, with two studies having a follow-up duration of 3 months, while one study had a follow-up of 6 months and one study- 12 months. The meta-analysis demonstrated that anatomic success and type 1 closure rates (presence of neurosensory retina in MH) were better in the inverted ILM flap technique (odds ratio (OR) = 4.89; 95% confidence interval (CI), 2.09-11.47; P = 0.0003 and OR = 5.23; 95% CI, 2.83-9.66; P<0.00001). Similarly, the inverted flap technique was superior in terms of postoperative logMAR BCVA and mean change of logMAR BCVA from baseline (weighted mean difference (WMD) = 0.17, 95% CI, 0.11 to 0.24, P<0.00001 and WMD = 0.08, 95% CI, 0.01 to 0.16, P = 0.03). CONCLUSION: Inverted ILM flap treatment resulted in better closure rates and visual acuity when compared to the standard ILM peeling for large MHs.


Assuntos
Membrana Basal/cirurgia , Retina/cirurgia , Perfurações Retinianas/cirurgia , Idoso , Membrana Basal/patologia , Bases de Dados como Assunto , Humanos , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Retina/patologia , Retalhos Cirúrgicos , Resultado do Tratamento , Acuidade Visual
18.
Klin Monbl Augenheilkd ; 237(10): 1220-1224, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-32688400

RESUMO

Novel microscope-integrated OCT now allows targeted intraoperative high-resolution real-time imaging. In comparison to conventional surgical microscopes, intraoperative real-time OCT visualisation of retinal layers and vitreous body provides valuable information for surgical decision-making. In addition, simultaneous OCT imaging of retinal structures displayed within the funduscopic view through the eye-piece of the microscope allows direct guidance of instrument-tissue interaction and surgical manoeuvres. As a result, targeted iOCT imaging enables enhanced precision and the development of real-time guided surgical techniques at micron level.


Assuntos
Tomografia de Coerência Óptica , Corpo Vítreo , Microscopia , Procedimentos Cirúrgicos Oftalmológicos , Retina/diagnóstico por imagem , Retina/cirurgia
19.
Int J Comput Assist Radiol Surg ; 15(5): 827-836, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32323210

RESUMO

PURPOSE: Sustained delivery of regenerative retinal therapies by robotic systems requires intra-operative tracking of the retinal fundus. We propose a supervised deep convolutional neural network to densely predict semantic segmentation and optical flow of the retina as mutually supportive tasks, implicitly inpainting retinal flow information missing due to occlusion by surgical tools. METHODS: As manual annotation of optical flow is infeasible, we propose a flexible algorithm for generation of large synthetic training datasets on the basis of given intra-operative retinal images. We evaluate optical flow estimation by tracking a grid and sparsely annotated ground truth points on a benchmark of challenging real intra-operative clips obtained from an extensive internally acquired dataset encompassing representative vitreoretinal surgical cases. RESULTS: The U-Net-based network trained on the synthetic dataset is shown to generalise well to the benchmark of real surgical videos. When used to track retinal points of interest, our flow estimation outperforms variational baseline methods on clips containing tool motions which occlude the points of interest, as is routinely observed in intra-operatively recorded surgery videos. CONCLUSIONS: The results indicate that complex synthetic training datasets can be used to specifically guide optical flow estimation. Our proposed algorithm therefore lays the foundation for a robust system which can assist with intra-operative tracking of moving surgical targets even when occluded.


Assuntos
Aprendizado Profundo , Redes Neurais de Computação , Retina/cirurgia , Algoritmos , Humanos
20.
PLoS One ; 15(4): e0230713, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32267845

RESUMO

PURPOSE: To evaluate the surgical technique for subretinal implantation of two sizes of PRIMA photovoltaic wireless microchip in two animal models, and refine these surgical procedures for human trials. METHODS: Cats and Macaca fascicularis primates with healthy retina underwent vitrectomy surgery and were implanted with subretinal wireless photovoltaic microchip at the macula/central retina. The 1.5mm PRIMA chip was initially studied in feline eyes. PRIMA implant (2mm,1.5mm sizes) arrays were studied in primates. Feasibility of subretinal chip implantation was evaluated with a newly-developed surgical technique, with surgical complications and adverse events recorded. RESULTS: The 1.5mm implant was placed in the central retina of 11 feline eyes, with implantation duration 43-106 days. The 1.5mm implant was correctly positioned into central macula of 11 primate eyes, with follow-up periods of minimum 6 weeks (n = 11), 2 years (n = 2), and one eye for 3 years. One primate eye underwent multi-chip 1.5mm implantation using two 1.5mm chips. The 2mm implant was delivered to 4 primate eyes. Optical coherence tomography confirmed correct surgical placement of photovoltaic arrays in the subretinal space in all 26 eyes. Intraoperative complications in primate eyes included retinal tear, macular hole, retinal detachment, and vitreous hemorrhage that resolved spontaneously. Postoperatively, there was no case of significant ocular inflammation in the 1.5mm implant group. CONCLUSIONS: We report subretinal implantation of 1.5mm and 2mm photovoltaic arrays in the central retina of feline and central macula of primate eyes with a low rate of device-related complications. The in vivo PRIMA implantation technique has been developed and refined for use for a 2mm PRIMA implant in ongoing human trials.


Assuntos
Microtecnologia/instrumentação , Próteses e Implantes , Retina/cirurgia , Tecnologia sem Fio , Animais , Gatos , Macaca fascicularis , Segurança
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