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1.
Sci Rep ; 14(1): 13044, 2024 06 06.
Artigo em Inglês | MEDLINE | ID: mdl-38844441

RESUMO

High intraocular pressure (IOP) is one of the early complications after pars plana vitrectomy (PPV), which may cause glaucoma and poor visual prognosis secondary to surgery. Proliferative vitreoretinopathy (PVR) is one of the complications of retinal detachment (RD) and is the main reason for the poor prognosis, which is related to different kinds of cytokines. It's essential for the basic mechanism to analyze the relative aqueous humor cytokine profiles with IOP after PPV for RD. In this study, we have collected the aqueous humor of 16 patients and qualified 27 cytokines using Luminex and compared biomarkers with the high IOP group and the normal group. As a result, the concentrations of VEGF, IL-6, FGF2, and G-CSF upregulated significantly (P < 0.05), while VEGFR2 downregulated significantly (P < 0.05) in the high IOP group. IL-6 was positively correlated with high IOP (r = 0.561, P = 0.041). Meanwhile, the concentrations of IL-6 (r = 0.543, P = 0.03), IL-5 (r = 0.576, P = 0.019), IL-15 (r = 0.614, P = 0.011), IL-4 (r = 0.517, P = 0.04), ICAM-1 (r = 0.611, P = 0.012), and G-CSF (r = 0.636, P = 0.008) were significantly associated with preoperative PVR classification, and the aqueous humor levels of IL-4 (r = 0.567, P = 0.022), HGF (r = 0.701, P = 0.005), and MCP-1 (r = 0.565, P = 0.035) are significant relative to laser points. Hence, cytokines might potentially be the therapeutic target of high IOP after PPV.


Assuntos
Humor Aquoso , Citocinas , Pressão Intraocular , Descolamento Retiniano , Vitrectomia , Humanos , Descolamento Retiniano/cirurgia , Descolamento Retiniano/metabolismo , Humor Aquoso/metabolismo , Feminino , Masculino , Citocinas/metabolismo , Pressão Intraocular/fisiologia , Pessoa de Meia-Idade , Vitrectomia/efeitos adversos , Idoso , Adulto , Biomarcadores/metabolismo , Vitreorretinopatia Proliferativa/metabolismo , Vitreorretinopatia Proliferativa/etiologia
2.
Int Ophthalmol ; 44(1): 210, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38691217

RESUMO

PURPOSE: To evaluate the effect of adjuvant Mitomycin C (MMC) use on the anatomical and functional success of vitreoretinal surgery (VRS) in severe diabetic tractional retinal detachment (dTRD) patients. METHODS: A retrospective analysis of consecutive patients undergoing VRS due to severe dTRD was conducted. Patients were categorized into those who received 20 µg/0.1 mL MMC via MMC sandwich method (Group 1) and those who did not (Group 2). Demographics, surgical characteristics, visual outcomes, and complications that may related to MMC were analyzed. RESULTS: A total of 25 eyes were included, 13 in Group 1 and 12 in Group 2. No statistical difference was observed in baseline characteristics between the groups. The mean best-corrected visual acuity was 1.90 ± 0.43 logMAR and 1.93 ± 0.41 logMAR preoperatively and 1.60 ± 0.78 logMAR and 1.56 ± 0.78 logMAR postoperatively in Groups 1 and 2, respectively (p = 0.154). The postoperative mean intraocular pressure was 16.23 ± 2.55 mmHg and 13.08 ± 4.94 mmHg in Groups 1 and 2, respectively (p = 0.225). The rate of re-surgery was significantly lower in Group 1 (0% vs. 41.7% in Group 2, p = 0.015). Retina was attached in all patients at the last visit. No MMC-related complication was recorded. CONCLUSION: Intraoperative adjuvant MMC application for severe dTRD significantly reduces re-surgery rates with good anatomical and functional outcomes safely.


Assuntos
Retinopatia Diabética , Mitomicina , Descolamento Retiniano , Acuidade Visual , Vitrectomia , Humanos , Estudos Retrospectivos , Masculino , Feminino , Mitomicina/administração & dosagem , Vitrectomia/métodos , Pessoa de Meia-Idade , Retinopatia Diabética/complicações , Retinopatia Diabética/fisiopatologia , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/cirurgia , Descolamento Retiniano/cirurgia , Descolamento Retiniano/diagnóstico , Idoso , Resultado do Tratamento , Quimioterapia Adjuvante/métodos , Alquilantes/administração & dosagem , Seguimentos , Adulto
3.
BMC Ophthalmol ; 24(1): 231, 2024 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-38822280

RESUMO

BACKGROUND: The main purpose of this paper is to introduce a method that can accurately locate the posterior capsule of the lens to facilitate a relatively complete resection of the anterior vitreous body. METHODS: A total of 51 patients in the experimental group and control group were enrolled in this study. Phacoemulsification combined with vitrectomy was performed in all cases. After the cataract procedure was completed in the control group, the surgeon performed a conventional anterior vitrectomy with the operative eye. In the experimental group, anterior vitrectomy was performed according to the threadiness corrugation of the posterior capsule of the lens. During the operation, with the help of triamcinolone, two surgeons confirmed the resection of the anterior vitreous cortex; the best corrected visual acuity and intraocular pressure of all patients were recorded at 1 week, 1 month and 3 months after surgery. RESULTS: Fifty patients underwent phacoemulsification combined with vitrectomy, except one patient in the experimental group who was lost to follow-up. After surgery, no significant complications were observed in all patients except two patients in the control group with temporary increases in intraocular pressure. There was no significant difference in preoperative visual acuity between the two groups (t = 0.83, P = 0.25). Both groups had varying degrees of improvement in best corrected visual acuity at 1 week, 1 month and 3 months after surgery. Moreover, there was no significant difference in BCVA between the two groups at the three follow-up time points (t=-1.15, -1.65, -1.09, P = 0.53, 0.21, 0.23). After surgery, no significant complications were observed in all patients except two patients in the control group with temporary increases in intraocular pressure. Incomplete resection of the anterior vitreous cortex was observed in 2 patients in each group, but there was no significant difference (χ2 = 7.81, P > 0.05). CONCLUSION: In the process of cataract surgery combined with vitrectomy, thready corrugation appears in the posterior capsule of the lens and is an important sign of its localization. Anterior vitrectomy can be accomplished safely and effectively with the help of thread-like corrugation, and the surgical effect is almost the same as that of traditional surgery. Especially suitable for beginners in vitreous surgery.


Assuntos
Pressão Intraocular , Facoemulsificação , Acuidade Visual , Vitrectomia , Corpo Vítreo , Humanos , Vitrectomia/métodos , Facoemulsificação/métodos , Feminino , Masculino , Idoso , Pessoa de Meia-Idade , Corpo Vítreo/cirurgia , Pressão Intraocular/fisiologia , Cápsula Posterior do Cristalino/cirurgia , Idoso de 80 Anos ou mais
4.
Int Ophthalmol ; 44(1): 220, 2024 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-38713261

RESUMO

BACKGROUND: This study was conducted to compare concentrations of VEGF family growth factors, inflammation-related factors, and adhesion molecules in the aqueous humor of eyes with diabetic macular edema (DME), with and without prior vitrectomy. METHODS: A total of 31 eyes were included, 11 with DME that had undergone vitrectomy, 9 with DME but without vitrectomy, and 11 from age-related cataract patients as controls. The concentrations of cytokines including TNF-α, IL-6, IL-8, IP-10, MCP-1, IFN-γ, MIP-1 α, MIP-1 ß, PECAM-1, MIF, VCAM-1, ICAM-1, PIGF were quantified using Luminex Human Discovery Assay. Central macular thickness (CMT) values of all eyes were measured using optical coherence tomography (OCT). RESULTS: (1) Vitrectomized DME eyes exhibited significantly higher levels of IL-6 and IL-8 compared to non-vitrectomized eyes (P < 0.05). (2) In vitrectomized group, after Benjamini-Hochberg correction, there was a significant positive correlation between the levels of VEGF and PlGF (rs = 0.855, P < 0.05), as well as the levels of TNF-α and IFN-γ (rs = 0.858, P < 0.05). In non-vitrectomized group, significant positive correlations were found between VEGF and PlGF levels after correcting for multiple comparisons (rs = 0.9, P < 0.05). (3) In non-vitrectomized group, the concentrations of VEGF and PlGF in aqueous humor were significantly positively correlated with CMT values (rs = 0.95, P < 0.05; rs = 0.9, P < 0.05, respectively). CONCLUSIONS: The concentrations of IL-6 and IL-8 in the aqueous humor were significantly higher in vitrectomized DME eyes compared to nonvitrectomized DME eyes and the levels of VEGF were similar in the two groups, suggesting that inflammation after vitrectomy may be a key factor in the occurrence and development of DME.


Assuntos
Humor Aquoso , Citocinas , Retinopatia Diabética , Edema Macular , Tomografia de Coerência Óptica , Vitrectomia , Humanos , Humor Aquoso/metabolismo , Edema Macular/metabolismo , Edema Macular/etiologia , Edema Macular/diagnóstico , Masculino , Citocinas/metabolismo , Feminino , Retinopatia Diabética/metabolismo , Retinopatia Diabética/cirurgia , Retinopatia Diabética/diagnóstico , Idoso , Pessoa de Meia-Idade , Tomografia de Coerência Óptica/métodos , Biomarcadores/metabolismo
5.
Indian J Ophthalmol ; 72(6): 920, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38804807

RESUMO

BACKGROUND: Anterior vitrectomy is a skill all cataract surgeons should develop and master. Every surgeon will have complications at some point in his/her career. Complication management should be part of the surgical training for all cataract surgeons. Posterior capsular rent does not translate to poor visual outcomes. If managed properly, excellent visual outcomes can be achieved and complications minimized. We aim to simplify the anterior vitrectomy procedure by this video. PURPOSE: This video will serve as a step-by-step practical guide to the intraoperative management of posterior capsular rent by simplifying the anterior vitrectomy procedure. SYNOPSIS: This video will demonstrate how to tackle the dreaded complication of a posterior capsular rent with vitreous disturbance, and achieve optimal postoperative outcomes. HIGHLIGHTS: We demonstrate how a PCR appears, and once identified, how to proceed. In addition, nuances regarding foot positions and different vitrectomy modes are included. Biaxial vitrectomy is explained. Lens placement post-PCR is demonstrated. Furthermore, a brief about postoperative management is included. VIDEO LINK: https://youtu.be/dTo7sMpe8h8.


Assuntos
Vitrectomia , Humanos , Vitrectomia/métodos , Acuidade Visual , Extração de Catarata/métodos
6.
Indian J Ophthalmol ; 72(6): 921, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38804808

RESUMO

BACKGROUND: Submacular hemorrhage (SMH) is a sight-threatening disorder. Choroidal neovascularization secondary to age-related macular degeneration, polypoidal choroidal vasculopathy, trauma, angioid streaks, and pathological myopia are a few important causes. The conventional treatment of massive SMH is vitrectomy with manual removal of the clot with extensive retinectomy with/without tissue plasminogen activator (tPA). The usual dose of subretinal tPA is 10-25 µg. PURPOSE: To describe a new surgical approach in a case of massive SMH with retinal detachment without retinectomy. SYNOPSIS: In our case of near total hemorrhagic retinal detachment due to subretinal hemorrhage caused by trauma (road traffic accident), the patient presented with a visual acuity of counting fingers. Core vitrectomy was performed and posterior vitreous detachment was induced. The locations for retinotomy to inject and aspirate subretinal blood were selected at the maximum height of retinal elevation near the arcades. Recombinant tPA (10 µg/0.1 ml concentration; 0.3 ml injected in two locations) was injected subretinally with a 23-G soft tip cannula in the superotemporal and inferonasal quadrant causing subretinal bleb formation. Subsequently, the surgeon waited for approximately 20 min on the table for the liquefaction of the clot. The liquefied blood and tPA were drained with a silicone soft tip. Endolaser was performed at the retinotomy site and 1000cs silicone oil was injected. No signs of toxicity such as vitritis, vasculitis, or retinal necrosis were noted. HIGHLIGHTS: Our unique technique of high-dose intraoperative subretinal tPA (60 µg) is safe and helpful in rapid clot lysis and recovery of visual acuity. The patient gained a visual acuity of 20/80 from counting fingers after 1 month of surgery and 20/60 after silicone oil removal. A high dose of tPA aids in the immediate aspiration of blood from a small retinotomy. A 23-G soft tip was used instead of a 41-G subretinal cannula to inject a large quantity of subretinal tPA. VIDEO LINK: https://youtu.be/JzZBDUfa3NA.


Assuntos
Fibrinolíticos , Hemorragia Retiniana , Ativador de Plasminogênio Tecidual , Tomografia de Coerência Óptica , Acuidade Visual , Vitrectomia , Humanos , Ativador de Plasminogênio Tecidual/administração & dosagem , Hemorragia Retiniana/diagnóstico , Hemorragia Retiniana/etiologia , Hemorragia Retiniana/cirurgia , Vitrectomia/métodos , Fibrinolíticos/administração & dosagem , Masculino , Fundo de Olho , Angiofluoresceinografia , Relação Dose-Resposta a Droga
8.
Retina ; 44(6): 982-990, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38767849

RESUMO

PURPOSE: To evaluate macular sensitivity using microperimetry in patients with proliferate diabetic retinopathy following vitrectomy and to investigate the relationship between the sensitivity and foveal microstructures with optical coherence tomography/angiography. METHODS: Eighty-four eyes of 84 patients with proliferative diabetic retinopathy, who were indicated for vitrectomy, had no intraocular surgery history 3 months preoperatively, and were able to ensure fundus examination after the vitrectomy, were included. A logMAR best-corrected visual acuity, macular sensitivity of microperimetry, macular retinal thickness, and macular vessel perfusion using optical coherence tomography/angiography were examined at 1 week, 1 month, and 3 months postoperatively. RESULTS: The logMAR best-corrected visual acuity and mean macular sensitivity of patients with proliferative diabetic retinopathy improved postoperatively (P < 0.05). There was a significant correlation between best-corrected visual acuity and mean sensitivity (P < 0.05). Postoperative mean macular sensitivity was significantly correlated with outer retinal thickness in the 0 to 6 mm macular area (P < 0.05) and also significantly correlated with deep capillary plexus perfusion (P < 0.05). Fixation stability and mean macular sensitivity did not show any correlation with glycated hemoglobin, triglyceride, serum total cholesterol, carbamide, and creatinine and duration of diabetes mellitus (P > 0.05). CONCLUSION: Postoperative mean macular sensitivity was significantly correlated with outer retinal thickness and deep capillary plexus perfusion for patients with proliferative diabetic retinopathy. The authors found that the visual performance of patients can be evaluated by the outer retinal thickness and deep capillary plexus perfusion, so optical coherence tomography/angiography examination can be an important prognostic factor for visual performance in patients.Clinical Trial Registration: This trial is registered with the Chinese Clinical Trial Registry (http://www.chictr.org.cn; Registration No.: ChiCTR2100043399).


Assuntos
Retinopatia Diabética , Angiofluoresceinografia , Macula Lutea , Tomografia de Coerência Óptica , Acuidade Visual , Testes de Campo Visual , Vitrectomia , Humanos , Retinopatia Diabética/fisiopatologia , Retinopatia Diabética/cirurgia , Retinopatia Diabética/diagnóstico , Vitrectomia/métodos , Masculino , Feminino , Tomografia de Coerência Óptica/métodos , Acuidade Visual/fisiologia , Pessoa de Meia-Idade , Testes de Campo Visual/métodos , Angiofluoresceinografia/métodos , Macula Lutea/irrigação sanguínea , Macula Lutea/diagnóstico por imagem , Idoso , Adulto , Campos Visuais/fisiologia , Vasos Retinianos/fisiopatologia , Vasos Retinianos/diagnóstico por imagem , Período Pós-Operatório
9.
BMC Ophthalmol ; 24(1): 219, 2024 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-38783230

RESUMO

PURPOSE: Vitreous humor (VH) is used for postmortem biochemical studies because it is well protected in an uncontaminated state even after death. The goal of this research was to investigate electrolyte concentrations in the VH from human eyes with and without a history of vitrectomy surgery. METHODS: We analyzed the sodium (Na), potassium (K), chloride (Cl) and magnesium (Mg) concentrations from 34 VH samples from 34 patients. Eleven samples were from eyes with a history of vitrectomy, and the remaining 23 eyes had no history of vitrectomy. The correlations of Na, K, Cl and Mg concentrations with patient age, interval between first and second vitrectomy, and lens status (history of cataract surgery) were also evaluated. RESULTS: The Na, K, Cl and Mg concentrations in VH from vitrectomized eyes were 134.1 ± 7.9 mmol/L, 3.7 ± 0.2 mmol/L, 99.7 ± 6.7 mmol/L and 0.59 ± 0.09 mmol/L, respectively; all were significantly lower than the corresponding concentrations in VH from control eyes (lower by 5.0%, 11.0%, 11.7%, and 22.6%, respectively). Na, K, Cl and Mg concentrations in VH from vitrectomized eyes did not show significant correlations with patient ages or the interval between their first and second vitrectomies. There were no significant differences in Na, K, Cl and Mg concentrations in VH between phakic eyes and intraocular lens-implanted eyes. CONCLUSIONS: With the increasing number of vitrectomies being performed, it is necessary to consider the history of vitrectomy when using a subject's VH in forensic examination.


Assuntos
Vitrectomia , Corpo Vítreo , Humanos , Corpo Vítreo/metabolismo , Feminino , Masculino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto , Eletrólitos/análise , Medicina Legal/métodos , Sódio/análise , Potássio/análise , Magnésio/análise
10.
Transl Vis Sci Technol ; 13(5): 17, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38776109

RESUMO

Purpose: This study aimed to develop artificial intelligence models for predicting postoperative functional outcomes in patients with rhegmatogenous retinal detachment (RRD). Methods: A retrospective review and data extraction were conducted on 184 patients diagnosed with RRD who underwent pars plana vitrectomy (PPV) and gas tamponade. The primary outcome was the best-corrected visual acuity (BCVA) at three months after the surgery. Those with a BCVA of less than 6/18 Snellen acuity were classified into a vision impairment group. A deep learning model was developed using presurgical predictors, including ultra-widefield fundus images, structural optical coherence tomography (OCT) images of the macular region, age, gender, and preoperative BCVA. A fusion method was used to capture the interaction between different modalities during model construction. Results: Among the participants, 74 (40%) still had vision impairment after the treatment. There were significant differences in age, gender, presurgical BCVA, intraocular pressure, macular detachment, and extension of retinal detachment between the vision impairment and vision non-impairment groups. The multimodal fusion model achieved a mean area under the curve (AUC) of 0.91, with a mean accuracy of 0.86, sensitivity of 0.94, and specificity of 0.80. Heatmaps revealed that the macular involvement was the most active area, as observed in both the OCT and ultra-widefield images. Conclusions: This pilot study demonstrates that artificial intelligence techniques can achieve a high AUC for predicting functional outcomes after RRD surgery, even with a small sample size. Machine learning methods identified The macular region as the most active region. Translational Relevance: Multimodal fusion models have the potential to assist clinicians in predicting postoperative visual outcomes prior to undergoing PPV.


Assuntos
Inteligência Artificial , Descolamento Retiniano , Tomografia de Coerência Óptica , Acuidade Visual , Vitrectomia , Humanos , Descolamento Retiniano/cirurgia , Feminino , Masculino , Estudos Retrospectivos , Pessoa de Meia-Idade , Acuidade Visual/fisiologia , Vitrectomia/métodos , Tomografia de Coerência Óptica/métodos , Idoso , Adulto , Tamponamento Interno , Resultado do Tratamento , Aprendizado Profundo
11.
BMC Ophthalmol ; 24(1): 218, 2024 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-38773500

RESUMO

PURPOSE: Comparing between the visual outcomes and post operative complications of two surgical treatments for sub macular hemorrhage, pars plana vitrectomy with tissue plasminogen activator (tPA) injection procedure, and pneumatic displacement of submacular hemorrhage with intravitreal tPA injection. METHODS: A retrospective chart review of patients with sub macular hemorrhage (SMH) was performed. Data was collected from 150 patients with sub macular hemorrhage. Patients were followed up from the day of admission and up to a year post surgery. Evaluation included visual acuity, optical coherence tomography (OCT), fundus examination and rates of complications. RESULTS: Pars plana vitrectomy procedure has showed a better visual outcome in small SMH. Comparing complications between the two treatment modalities, no significant difference has been found in the study. CONCLUSIONS: Pars plana vitrectomy and tPA showed a clear advantage with a trend of better visual acuity as well as a significant predictor to better visual acuity for small and medium sub macular hemorrhage.


Assuntos
Fibrinolíticos , Injeções Intravítreas , Hemorragia Retiniana , Ativador de Plasminogênio Tecidual , Tomografia de Coerência Óptica , Acuidade Visual , Vitrectomia , Humanos , Ativador de Plasminogênio Tecidual/administração & dosagem , Vitrectomia/métodos , Hemorragia Retiniana/terapia , Hemorragia Retiniana/diagnóstico , Hemorragia Retiniana/tratamento farmacológico , Estudos Retrospectivos , Masculino , Feminino , Idoso , Fibrinolíticos/administração & dosagem , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais
12.
Invest Ophthalmol Vis Sci ; 65(5): 20, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38727692

RESUMO

Purpose: Vision-degrading myodesopsia (VDM) from vitreous floaters significantly degrades vision and impacts visual quality of life (VQOL), but the relationship to light scattering is poorly understood. This study compared in vitro measures of light scatter and transmission in surgically excised human vitreous to preoperative indexes of vitreous structure, visual function, and VQOL. Methods: Pure vitreous collected during vitrectomy from 8 patients with VDM had wide-angle straylight measurements and dark-field imaging, performed within 36 hours of vitrectomy. Preoperative VQOL assessment with VFQ-25, contrast sensitivity (CS) measurements with Freiburg acuity contrast testing, and quantitative ultrasonography were compared to light scattering and transmission in vitro. Results: All indices of vitreous echodensity in vivo correlated positively with straylight at 0.5° (R = 0.708 to 0.775, P = 0.049 and 0.024, respectively). Straylight mean scatter index correlated with echodensity (R = 0.71, P = 0.04) and VQOL (R = -0.82, P = 0.0075). Dark-field measures in vitro correlated with degraded CS in vivo (R = -0.69, P = 0.04). VQOL correlated with straylight mean scatter index (R = -0.823, P = 0.012). Conclusions: Increased vitreous echodensity in vivo is associated with more straylight scattering in vitro, validating ultrasonography as a clinical surrogate for light scattering. Contrast sensitivity in vivo is more degraded in the presence of dark-field scattering in vitro and VQOL is decreased in patients whose vitreous has increased light scattering. These findings could form the basis for the development of optical corrections for VDM or support new laser treatments, as well as novel pharmacotherapy.


Assuntos
Sensibilidades de Contraste , Luz , Espalhamento de Radiação , Acuidade Visual , Vitrectomia , Corpo Vítreo , Humanos , Corpo Vítreo/diagnóstico por imagem , Feminino , Masculino , Pessoa de Meia-Idade , Acuidade Visual/fisiologia , Sensibilidades de Contraste/fisiologia , Idoso , Qualidade de Vida , Transtornos da Visão/fisiopatologia , Adulto , Ultrassonografia , Oftalmopatias/fisiopatologia , Oftalmopatias/diagnóstico por imagem
13.
Medicine (Baltimore) ; 103(20): e38150, 2024 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-38758916

RESUMO

RATIONALE: Acute retinal necrosis (ARN) was first reported in 1971 by Urayama et al as an acute uveitis accompanied by retinal arteritis and white retinal lesions in the peripheral retina that can progress to a rhegmatogenous retinal detachment (RRD). We have experienced a case of ARN that, unlike the common developmental course to an RRD associated with ARN, progressed to proliferative vitreoretinopathy (PVR) involving the entire retina in 2 days. The purpose of this report is to present our findings in the case of ARN with an atypical rapid time course. PATIENT CONCERNS: The patient was a 56-year-old woman who was treated for uveitis of unknown origin by her primary care physician. She was referred to our hospital because of a worsening of the fundus findings. DIAGNOSIS: Fundus examination in our hospital revealed vitreous opacities in the right eye, yellowish-white lesions extending around the retina, and some retinal hemorrhages. Because the retinal changes suggested ARN, we performed a polymerase chain reaction of the anterior atrial fluid and detected varicella-zoster virus. Then, the diagnosis of ARN was confirmed, and treatment was begun. At 1 month and a half after beginning the treatment, focal retinal traction was observed in the right fundus. Two days later, a circumferential PVR and a total retinal detachment were detected. INTERVENTIONS: We then performed vitrectomy with an encircling buckle and a silicone oil tamponade. OUTCOMES: Our examination 6 months postoperatively showed that the retina was attached and the BCVA was 20/200. LESSONS: Our findings of a case of ARN showed that the progression from a local vitreous traction to a full circumferential PVR can develop in 2 days.


Assuntos
Progressão da Doença , Síndrome de Necrose Retiniana Aguda , Vitreorretinopatia Proliferativa , Humanos , Feminino , Síndrome de Necrose Retiniana Aguda/diagnóstico , Pessoa de Meia-Idade , Vitreorretinopatia Proliferativa/diagnóstico , Descolamento Retiniano/etiologia , Descolamento Retiniano/diagnóstico , Vitrectomia/métodos
14.
Sci Rep ; 14(1): 10986, 2024 05 14.
Artigo em Inglês | MEDLINE | ID: mdl-38744994

RESUMO

To assess the efficacy and safety of topical insulin (TI) for treating neurotrophic keratopathy (NK) within one-month post-diabetic vitrectomy (DV) compared to conventional non-invasive measures, we conducted this retrospective case-control study including all eyes that developed acute NK (stages 2 and 3) following DV between October 2020 and June 2023. The control group included NK cases managed with preservative-free lubricant eye drops and prophylactic topical antibiotics. In contrast, the study group included NK cases treated with TI [1 unit per drop] four times daily, in addition to the previously mentioned treatment. The primary outcome measure was time to epithelial healing. Secondary outcome measures included any adverse effect of TI or the need for amniotic membrane transplantation (AMT). During the study period, 19 patients with a mean age of 49.3 ± 8.6 years received TI versus 18 controls with a mean age of 52.5 ± 10.7 years. Corneal epithelial healing was significantly faster in the TI-treated group compared to controls, with a mean difference of 12.16 days (95% CI 6.1-18.3, P = 0.001). Survival analysis indicated that the insulin-treated group had 0% and 20% of NK stages 2 and 3, respectively, that failed to achieve corneal epithelial healing, compared to 20% and 66.7% for the control group (P < 0.001). In the control group, two eyes required AMT due to progressive thinning. Additionally, three patients in the control group, progressing to stage 3 NK, were switched to TI, achieving healing after a mean of 14 days. No adverse effects were reported in the TI-treated group. Our study suggests that TI can effectively and safely promote the healing of NK after DV.


Assuntos
Doenças da Córnea , Insulina , Vitrectomia , Humanos , Pessoa de Meia-Idade , Masculino , Feminino , Insulina/administração & dosagem , Estudos Retrospectivos , Vitrectomia/métodos , Estudos de Casos e Controles , Adulto , Doenças da Córnea/tratamento farmacológico , Doenças da Córnea/cirurgia , Retinopatia Diabética/tratamento farmacológico , Cicatrização/efeitos dos fármacos , Administração Tópica , Idoso , Resultado do Tratamento
17.
Vestn Oftalmol ; 140(2. Vyp. 2): 21-27, 2024.
Artigo em Russo | MEDLINE | ID: mdl-38739127

RESUMO

The incidence of diabetic retinopathy (DR) requiring vitreorentinal surgery is increasing. The search for new effective and safe methods of treatment, the choice of the optimal time for surgery, and the assessment of long-term treatment outcomes are relevant problems. PURPOSE: This study evaluates the long-term results of vitreorentinal surgery using the bimanual technique in DR with different stages of fibrovascular proliferation. MATERIAL AND METHODS: The study included 135 patients (135 eyes) who were divided into groups depending on the predominant type of proliferation - vascular or fibrous. Patients underwent vitrectomy with membranectomy using the bimanual technique, with peripheral panretinal endolaser coagulation of the retina and tamponade of the vitreous cavity with balanced salt solution. The postoperative observation period lasted up to 12 months. RESULTS: Both groups showed statistically significant improvement in visual function and anatomical changes in central retinal thickness. A statistically significant improvement in best corrected visual acuity (BCVA) was found in patients with initially predominantly vascular proliferation. Correlation analysis showed that initially higher BCVA tends to persist in the postoperative period. A negative correlation was found between the final BCVA and the presence of type 2 diabetes mellitus, fibrous stage of proliferation, high central retinal thickness, and the presence of diabetic macular edema (DME) - both initially and after treatment. The frequency of complications in the groups was comparable, except for postoperative DME, which was more often detected in patients with fibrous proliferation. CONCLUSION: The bimanual technique of vitreorentinal surgery for complications of DR allows achieving high anatomical and functional results. Higher BCVA is noted in patients with the vascular stage of proliferation and initially high BCVA. The obtained data allow us to form a hypothesis about the possibility of earlier surgery in patients with high BCVA, but require further investigation.


Assuntos
Retinopatia Diabética , Acuidade Visual , Cirurgia Vitreorretiniana , Humanos , Retinopatia Diabética/cirurgia , Retinopatia Diabética/diagnóstico , Masculino , Feminino , Pessoa de Meia-Idade , Resultado do Tratamento , Cirurgia Vitreorretiniana/métodos , Cirurgia Vitreorretiniana/efeitos adversos , Vitrectomia/métodos , Vitrectomia/efeitos adversos , Idoso , Adulto , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle
18.
BMJ Case Rep ; 17(5)2024 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-38802253

RESUMO

A female in her 20s presented with a diminution of vision in the right eye (RE) following an open globe injury (scleral penetration) and repair a year back. At the presentation, she had low intraocular pressure (IOP) of 7 mm Hg, posterior subcapsular cataract (PSC), retrolental vitreous bands incarcerated at the penetration site, disc oedema, tortuous vessels and choroidal folds. Inferotemporal and superonasal cyclodialysis clefts were detected on CASIA 2 optical coherence tomography (OCT). The diagnosis of RE repaired scleral penetration, PSC and cyclodialysis cleft with hypotony maculopathy was made. The case was managed by phacoemulsification with an intraocular lens in the bag and a capsular tension ring in the sulcus, as a tamponading agent to close the cleft. Intraoperatively on endoscopic visualisation, vitreous membrane was noticed encasing the ciliary processes causing a tractional cyclodialysis and hence single port 23G pars plana vitrectomy was performed to relieve the traction. Postsurgery, IOP was 14 mm Hg, and the repaired cleft was visualised on anterior segment OCT.


Assuntos
Fendas de Ciclodiálise , Tomografia de Coerência Óptica , Vitrectomia , Adulto , Feminino , Humanos , Fendas de Ciclodiálise/cirurgia , Fendas de Ciclodiálise/etiologia , Tamponamento Interno/métodos , Ferimentos Oculares Penetrantes/cirurgia , Ferimentos Oculares Penetrantes/complicações , Pressão Intraocular/fisiologia , Facoemulsificação , Esclera/cirurgia , Vitrectomia/métodos
19.
JAMA Ophthalmol ; 142(5): e235766, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38770957

RESUMO

This case report describes a woman aged 43 years with Stickler syndrome and bilateral vitreopapillary traction who presented with shadows and ghosting of vision in both eyes.


Assuntos
Descolamento Retiniano , Humanos , Masculino , Descolamento Retiniano/diagnóstico , Descolamento Retiniano/cirurgia , Colágeno Tipo IV/genética , Corpo Vítreo/patologia , Corpo Vítreo/diagnóstico por imagem , Vitrectomia , Feminino , Oftalmopatias/diagnóstico , Descolamento do Vítreo/diagnóstico
20.
JAMA Ophthalmol ; 142(5): e234933, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38770960

RESUMO

This case report discusses a diagnosis of X-linked Alport syndrome in a 54-year-old male patient who presented with a lamellar macular hole in his left eye.


Assuntos
Perfurações Retinianas , Tomografia de Coerência Óptica , Acuidade Visual , Humanos , Perfurações Retinianas/diagnóstico , Masculino , Pessoa de Meia-Idade , Acuidade Visual/fisiologia , Vitrectomia
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