1
|
Celiker H, Çam F, Özkoçak BY. Outcomes of pars plana vitrectomy in the management and diagnosis of patients with infectious, non-infectious, and unidentified uveitis. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06407-y. [PMID: 38363356 DOI: 10.1007/s00417-024-06407-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/22/2024] [Accepted: 02/05/2024] [Indexed: 02/17/2024] Open
Abstract
PURPOSE To present the outcomes of pars plana vitrectomy (PPV) in patients with infectious, non-infectious, and unidentified uveitis, focusing on visual and clinical outcomes, diagnostic yield, and surgery-related complications. METHODS This retrospective, single-center study included patients who underwent 23-gauge PPV for the management of uveitis and had at least 6 months of follow-up. Patients were divided into infectious, non-infectious, and unidentified uveitis groups based on definitive diagnosis after surgery. Etiologies of uveitis, indications for surgery, diagnostic yield, visual outcomes, presence of cystoid macular edema (CME), immunosuppressive drugs, intraoperative and postoperative complications, and repeated vitrectomies were reviewed. RESULTS This study included 62 eyes of 54 patients. Twenty eyes were diagnosed with infectious uveitis, 24 eyes with non-infectious uveitis, and 18 eyes with unidentified uveitis. The diagnostic yield of vitrectomy was 41.7%. Mean BCVA significantly improved at postoperative 1 month compared to baseline and remained stable at following time-points in all groups. The most common early postoperative complication was increased intraocular pressure (17%), and late complication was cataract (36%). Nine eyes underwent re-vitrectomy and the most common cause was retinal detachment with proliferative vitreoretinopathy (PVR). CONCLUSION PPV seems to be effective in diagnosing cases of unknown origin, improving visual acuity, and reducing the need for systemic immunosuppressive drugs. PVR is the most serious complication with poor prognosis that requires repeated surgery in patients with uveitis.
Collapse
Affiliation(s)
- Hande Celiker
- Department of Ophthalmology, Marmara University School of Medicine, Istanbul, Turkey.
- Department of Ophthalmology, Marmara University Pendik Education and Research Hospital, Pendik, Istanbul, Turkey.
| | - Furkan Çam
- Department of Ophthalmology, Marmara University School of Medicine, Istanbul, Turkey
| | - Berru Yargı Özkoçak
- Beyoglu Eye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| |
Collapse
|
2
|
Testi I, Calcagni A, Barton K, Gooch J, Petrushkin H. Hypotony in uveitis: an overview of medical and surgical management. Br J Ophthalmol 2023; 107:1765-1770. [PMID: 36575621 DOI: 10.1136/bjo-2022-322814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/11/2022] [Indexed: 12/24/2022]
Abstract
Hypotony is a well-recognised, sight-threatening complication of uveitis. It can also be the final common endpoint for a multitude of disease entities. Multiple mechanisms underlie hypotony, and meticulous clinical history alongside ocular phenotyping is necessary for choosing the best intervention and therapeutic management. In this narrative review, a comprehensive overview of medical and surgical treatment options for the management of non-surgically induced hypotony is provided. Management of ocular hypotony relies on the knowledge of the aetiology and mechanisms involved. An understanding of disease trajectory is vital to properly educate patients. Both anatomical and functional outcomes depend on the underlying pathophysiology and choice of treatment.
Collapse
Affiliation(s)
- Ilaria Testi
- Uveitis and Scleritis Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Rheumatology Department, Great Ormond Street Hospital for Children, London, UK, London, UK
| | - Antonio Calcagni
- Department of Electrophysiology, Moorfields Eye Hospital, National Health Service Foundation Trust, London, United Kingdom, London, UK
| | | | - James Gooch
- Uveitis and Scleritis Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Harry Petrushkin
- Uveitis and Scleritis Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Rheumatology Department, Great Ormond Street Hospital for Children, London, UK, London, UK
| |
Collapse
|
3
|
Mazzeo TJMM, Cristina Mendonça Freire R, Guimarães Machado C, Gomes AMV, Curi ALL. Vitreoretinal Surgery in Uveitis: From Old to New Concepts - A Review. Ocul Immunol Inflamm 2023:1-14. [PMID: 37093650 DOI: 10.1080/09273948.2023.2193842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
PURPOSE The aim of this article is to do a comprehensive literature review about the current role of pars plana vitrectomy in uveitis and in its different structural complications such as cystoid macular edema, epiretinal membrane, macular hole, and retinal detachment. METHODS This comprehensive literature review was performed based on a search on PubMed, BioMed Central, Science Open, and CORE databases, of relevant articles abording pars plana vitrectomy in uveitis. DISCUSSION Uveitis is a complex disease with multiple etiologies and pathogenic mechanisms. Therapeutic pars plana vitrectomy (PPV) may aid in uveitic structural complications such as cystoid macular edema, epiretinal membranes, macular hole, and retinal detachments even though some cases may present unpredictable visual outcomes. Diagnostic PPV with appropriate ancillary testing is also a valuable tool for the assessment and diagnosis of uveitis in a large proportion of patients. CONCLUSION Over the years, pars plana vitrectomy has undergone significant transformations since its invention nearly 5 decades ago, however, the quality of evidence in the literature regarding its use for uveitis has not improved in the same way. Even though some structural uveitis complications (as previously mentioned) may respond well to surgery, there is still a certain unpredictability regarding its visual outcomes. On the other hand, diagnostic vitrectomy with appropriate ancillary testing is also a valuable tool for the assessment and diagnosis of uveitis in a large proportion of patients.
Collapse
Affiliation(s)
| | | | - Cleide Guimarães Machado
- Retina and Vitreous Department, Suel Abujamra Institute, São Paulo, Brazil
- Retina and Vitreous Department, University of São Paulo (USP), São Paulo, Brazil
| | | | - André Luiz Land Curi
- Clinical Research Laboratory of Infectious Diseases in Ophthalmology, National Institute of Infectious Diseases (INI - Fiocruz), Rio de Janeiro, Brazil
| |
Collapse
|
4
|
Chern KJ, Nettesheim ER, Reid CA, Li NW, Marcoe GJ, Lipinski DM. Prostaglandin-based rAAV-mediated glaucoma gene therapy in Brown Norway rats. Commun Biol 2022; 5:1169. [PMID: 36329259 PMCID: PMC9633612 DOI: 10.1038/s42003-022-04134-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022] Open
Abstract
Prostaglandin analogs are first-line treatments for open angle glaucoma and while effective at lowering intraocular pressure, they are undermined by patient non-compliance, causing atrophy of the optic nerve and severe visual impairment. Herein, we evaluate the safety and efficacy of a recombinant adeno-associated viral vector-mediated gene therapy aimed at permanently lowering intraocular pressure through de novo biosynthesis of prostaglandin F2α within the anterior chamber. This study demonstrated a dose dependent reduction in intraocular pressure in normotensive Brown Norway rats maintained over 12-months. Crucially, therapy could be temporarily halted through off-type riboswitch activation, reverting intraocular pressure to normal. Longitudinal multimodal imaging, electrophysiology, and post-mortem histology revealed the therapy was well tolerated at low and medium doses, with no major adverse effects to anterior chamber health, offering a promising alternative to current treatment strategies leading to clinically relevant reductions in intraocular pressure without the need for adherence to a daily treatment regimen.
Collapse
Affiliation(s)
- Kristina J Chern
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Emily R Nettesheim
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Christopher A Reid
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Nathan W Li
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Gavin J Marcoe
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Daniel M Lipinski
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA.
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, WI, USA.
| |
Collapse
|
5
|
Intra-vitreal gas injection and supine positioning for hypotony post-intrascleral intraocular lens fixation. Am J Ophthalmol Case Rep 2022; 26:101385. [PMID: 35243148 PMCID: PMC8858868 DOI: 10.1016/j.ajoc.2022.101385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 01/21/2022] [Accepted: 01/28/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose This study aimed to report a case of intravitreal gas injection in the supine position for hypotony after intrascleral intraocular lens (IOL) fixation in a patient with Vogt-Koyanagi-Harada (VKH) disease. Observations A 72-year-old Japanese female patient presented with blurred vision in her right eye. Both eyes exhibited a sunset glow fundus due to VKH disease. The right IOL was dislocated; therefore, IOL fixation was performed. The patient's hypotony and choroidal effusion persisted postoperatively and her intraocular pressure (IOP) remained 2–4 mmHg despite the performance of two steroid courses. C3F8 (perfluoro pane gas) was injected into the vitreous cavity on postoperative day 35. The patient was instructed to assume a supine position on the third day after injection. At 6 days post-injection, her IOP began to rise; her IOP remained within the normal range until 1 year later. Conclusions and Importance This is the first report of successful intravitreal gas injection in a supinated patient with VKH disease to treat postoperative hypotony.
Collapse
|
6
|
Abstract
Clear vision is dependent on features that protect the anatomical integrity of the eye (cornea and sclera) and those that contribute to internal ocular homeostasis by conferring hemangiogenic (avascular tissues and antiangiogenic factors), lymphangiogenic (lack of draining lymphatics), and immunologic (tight junctions that form blood-ocular barriers, immunosuppressive cells, and modulators) privileges. The later examples are necessary components that enable the eye to maintain an immunosuppressive environment that responds to foreign invaders in a deviated manner, minimizing destructive inflammation that would impair vision. These conditions allowed for the observations made by Medawar, in 1948, of delayed rejection of allogenic tissue grafts in the anterior chamber of mouse eye and permit the sequestration of foreign invaders (eg, Toxoplasma gondii) within the retina of healthy individuals. Yet successful development of intraocular drugs (biologics and delivery devices) has been stymied by adverse ocular pathology, much of which is driven by immune pathways. The eye can be intolerant of foreign protein irrespective of delivery route, and endogenous ocular cells have remarkable plasticity when recruited to preserve visual function. This article provides a review of current understanding of ocular immunology and the potential role of immune mechanisms in pathology observed with intraocular drug delivery.
Collapse
Affiliation(s)
| | | | - Sharmila Masli
- 12259Boston University School of Medicine, Boston, MA, USA
| |
Collapse
|
7
|
Ghassemi F, Niyousha MR, Hassanpoor N, Khojasteh H. Uveitis-induced Refractory Ocular Hypotony Managed with High-dose Latanoprost. J Ophthalmic Vis Res 2020; 15:408-411. [PMID: 32864071 PMCID: PMC7431716 DOI: 10.18502/jovr.v15i3.7459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 08/14/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose To report a case of refractory ocular hypotony due to chronic Behcet's disease with good response to high-dose topical latanoprost. Case Report We present a 26-year-old man with a known history of Behcet's disease who developed decreasing vision and severe ocular hypotony that was refractory to multiple treatment modalities including subtenon triamcinolone acetonide, ibopamine, pars plana vitrectomy, and silicone oil injection. We decided to try high-dose topical latanoprost for the management of ocular hypotony based on recent reports. After six months, intraocular pressure (IOP) increased by 5 mm Hg, became stable at 7 mm Hg, and remained unchanged at month 24. Conclusion High-dose topical latanoprost could lead to significant increase in IOP in uveitis-induced refractory ocular hypotony.
Collapse
Affiliation(s)
- Fariba Ghassemi
- Retina & Vitreous Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Niyousha
- Retina & Vitreous Service, Nikookari Eye Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Narges Hassanpoor
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hassan Khojasteh
- Retina & Vitreous Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
8
|
Marchese A, Giuffrè C, Miserocchi E, Cicinelli MV, Bandello F, Modorati G. Severe Hypotony Maculopathy in Anterior Uveitis Associated with Hodgkin Lymphoma. Ocul Immunol Inflamm 2019; 29:460-464. [PMID: 31647699 DOI: 10.1080/09273948.2019.1668952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Purpose: To describe the clinical course and management of anterior uveitis complicated by ocular hypotony associated with Hodgkin lymphoma.Design: Case report.Methods: Chart and multimodal imaging review, including ultrasound biomicroscopy, widefield fundus pictures, fundus autofluorescence, fluorescein angiography, and indocyanine green angiography.Results: A 44-year-old female with progressive visual deterioration and history of low-grade fever developed bilateral granulomatous anterior uveitis complicated by severe hypotony maculopathy, not improving with systemic and topical steroids. After starting ibopamine 2% eye drops, ocular hypotony progressively resolved with visual recovery. Histologic examination of a biopsied enlarged lymph node of the neck revealed the presence of Hodgkin lymphoma, for which the patient underwent systemic chemotherapy.Conclusion: Severe hypotony maculopathy complicating anterior uveitis can be associated with Hodgkin lymphoma. Topical ipobamine 2% was safe and effective in the treatment of ocular hypotony in this case.
Collapse
Affiliation(s)
- Alessandro Marchese
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Chiara Giuffrè
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Elisabetta Miserocchi
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Maria Vittoria Cicinelli
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Giulio Modorati
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| |
Collapse
|
9
|
Schmalfuss IM, Davenport J, Harris ME. Orbital Implants: Normal Imaging Appearance, Pitfalls and Complications. Semin Roentgenol 2019; 54:227-243. [PMID: 31376864 DOI: 10.1053/j.ro.2019.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Jake Davenport
- Medical Center Radiology Group, Orlando, FL; University of Florida, Gainesville, FL
| | - Matthew E Harris
- Radiology Partners MBB Radiology, Jacksonville, FL; University of Florida, Gainesville, FL
| |
Collapse
|
10
|
Gürelik G, Korkmaz S, Disli G, Sül S. A Novel Surgical Method to Treat Chronic Ocular Hypotony. Ophthalmic Surg Lasers Imaging Retina 2019; 50:e56-e60. [PMID: 30893457 DOI: 10.3928/23258160-20190301-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 05/09/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVES To assess the effect of a novel surgical method for the treatment of chronic ocular hypotony (COH). The surgical method involves partially blocking the iridocorneal angle and decreasing aqueous humor outflow. A capsular tension ring (CTR) is placed in the iridocorneal angle. PATIENTS AND METHODS Thirteen eyes of 13 patients were included in this retrospective, interventional case series. All of the eyes had severe ocular hypotony with a diagnosis of hypotony after vitreoretinal surgery or glaucoma filtration surgery. A CTR was placed in the iridocorneal angle via a corneal incision. The follow-up period was at least 1 year. Main outcome measurement was intraocular pressure (IOP). RESULTS IOP increased in all of the eyes. The increase in IOP persisted during the follow-up period. Visual acuity increased or stabilized in all of the eyes. No ocular complications were noted due to the procedure. CONCLUSIONS The authors have described a novel and simple technique for the setting of IOP in COH. Mechanical obstruction of aqueous humor outflow with a CTR can increase IOP and stabilize or improve vision in eyes with COH for a follow-up time longer than 12 months. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:e56-e60.].
Collapse
|
11
|
Keith TA, Tidmore E. The development of multiple ocular complications in a patient with Parry-Romberg syndrome. Clin Exp Optom 2018; 102:437-439. [PMID: 30467888 DOI: 10.1111/cxo.12848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/21/2018] [Accepted: 10/23/2018] [Indexed: 11/29/2022] Open
Affiliation(s)
- Thomas A Keith
- School of Optometry, University of Alabama at Birmingham and Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA
| | - Eric Tidmore
- School of Optometry, University of Alabama at Birmingham and Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA
| |
Collapse
|
12
|
Reid G, Lorigan P, Heimann H, Hovan M. Management of Chronic Hypotony Following Bilateral Uveitis in a Patient Treated with Pembrolizumab for Cutaneous Metastatic Melanoma. Ocul Immunol Inflamm 2018; 27:1012-1015. [PMID: 29672247 DOI: 10.1080/09273948.2018.1459733] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Purpose: To describe the presentation and management of severe ocular adverse events following treatment with pembrolizumab for cutaneous metastatic melanoma. Methods: Interventional case report. Results: A 73-year-old Caucasian man receiving pembrolizumab treatment for metastatic melanoma presented with panuveitis and subsequent profound hypotony, choroidal effusions, and optic disk swelling bilaterally. Oral prednisolone controlled intraocular inflammation. However, bilateral hypotony persisted which was managed over a 12-month period with ocular viscoelastic device injections into the anterior chamber of both eyes. There was also phacoemulsification with pars plana vitrectomy (PPV) and silicone oil (SO) tamponade performed on the left eye only. Intraocular pressure (IOP) stabilized (>6 mmHg) with best-corrected visual acuity of 6/60. Conclusion: We report a severe adverse event from pembrolizumab therapy resulting in uveitis and persistent hypotony. Repeat injections of high viscosity OVD achieved an increase in IOP up to 12 months. This technique may be a useful adjuvant or alternative to PPV and SO.
Collapse
Affiliation(s)
- Gerard Reid
- Department of Ophthalmology, Royal Victoria Hospital , Belfast , Northern Ireland.,Department of Ophthalmology, Warrington & Holton Hospitals NHS Foundation Trust, Lovely Lane , Warrington , UK
| | - Paul Lorigan
- Department of Medical Oncology, The Christie Clinic , Manchester , UK
| | - Heinrich Heimann
- Department of Ocular Oncology, The Royal Liverpool University Hospital , Liverpool , UK
| | - Marta Hovan
- Department of Ophthalmology, Warrington & Holton Hospitals NHS Foundation Trust, Lovely Lane , Warrington , UK
| |
Collapse
|
13
|
Zhu D, Ameri H, Reznik A, Rao NA. Acute hypotony maculopathy following the initiation of a topical aqueous suppressant in a patient with a history of panuveitis without prior filtering surgery. Am J Ophthalmol Case Rep 2017; 7:95-98. [PMID: 29260088 PMCID: PMC5722180 DOI: 10.1016/j.ajoc.2017.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 04/23/2017] [Accepted: 06/20/2017] [Indexed: 12/01/2022] Open
Abstract
Purpose To report a case of profound hypotony maculopathy as a complication of single-agent glaucoma therapy in a patient with a history of panuveitis without previous filtering surgery. Observations A 70-year old Hispanic male with a history of resolved bilateral panuveitis, chronic angle closure glaucoma, and pars plana vitrectomy was started on topical timolol 0.5% daily in the left eye for mildly elevated intraocular pressure (15 mmHg). The patient returned 1.5 weeks later with new onset hypotony (1 mmHg), chorioretinal folds, and cystoid macular edema in the same eye without associated signs of inflammation. The drop was discontinued. The patient returned 1 month later with normalized eye pressure and improved vision with near-resolution of chorioretinal changes on optical coherence tomography (OCT). Conclusions and importance Hypotony maculopathy is most commonly seen following glaucoma filtering surgery and ocular trauma. The development of hypotony maculopathy following the administration of topical glaucoma medication alone is rare. Our case is the first to our knowledge to describe the rapid onset of visually significant hypotony maculopathy characterized by profound OCT changes upon the administration of a single topical glaucoma agent in a patient without prior filtering surgery. Treatment with glaucoma medications in patients with complex ocular histories including uveitis and vitreoretinal surgery requires caution and close follow-up.
Collapse
Affiliation(s)
- Dagny Zhu
- Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, 1450 San Pablo Street, Los Angeles, CA 90033, United States
| | - Hossein Ameri
- Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, 1450 San Pablo Street, Los Angeles, CA 90033, United States
| | - Alena Reznik
- Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, 1450 San Pablo Street, Los Angeles, CA 90033, United States
| | - Narsing A Rao
- Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, 1450 San Pablo Street, Los Angeles, CA 90033, United States
| |
Collapse
|
14
|
Bayoudh W, Carstesen D, Walter P, Weinberger AWA. Intraocular silicone implant to treat chronic ocular hypotony: an in vivo trial. Graefes Arch Clin Exp Ophthalmol 2017; 255:1947-1955. [DOI: 10.1007/s00417-017-3714-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 05/28/2017] [Accepted: 06/05/2017] [Indexed: 11/29/2022] Open
|
15
|
Intraocular silicone implant to treat chronic ocular hypotony-preliminary feasibility data. Graefes Arch Clin Exp Ophthalmol 2016; 254:2131-2139. [PMID: 27165132 DOI: 10.1007/s00417-016-3364-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 04/13/2016] [Accepted: 04/19/2016] [Indexed: 10/21/2022] Open
Abstract
PURPOSE Ocular hypotony secondary to proliferative vitreoretinopathy-related retinal detachment, trauma or inflammation is difficult to treat. Besides endotamponades such as silicone oil, vitreous implants such as iris diaphragms or balloons have been developed to stabilize the eye and to prevent phthisis of the globe. Vitreous implants tested thus far exhibit a seam at the attachment site of the hemispheres, or micropores. This manuscript reports the development of a seamless silicone balloon implant without micropores, which can be filled with silicone oil and surface-modified to improve its biocompatibility. Developed for intraocular placement in the management of chronic hypotony and phthisis prevention, it may also be suitable for tamponading retinal detachments. METHODS Silicone was used as the basic structure for the fabrication of a seamless balloon-shaped intraocular implant, which was coated by employing a six-arm star-shaped (sP) macromer of a copolymer of 80 % ethylene oxide (EO) and 20 % propylene oxide (PO) with conjugated functional terminal isocyanate groups, NCO-sP(EO-stat-PO), with and without heparin. Three variants of implants, which differ in their surfaces, were manufactured: uncoated silicone, NCO-sP (EO-stat-PO) coated silicone and heparin-NCO-sP (EO-stat-PO) coated silicone implants. To exert a tamponade effect, the implant was filled with silicone oil and its properties were studied. RESULTS Seamless thin balloon implants made of silicone, which are considered biocompatible and intrinsically resistant to biological attacks in vivo, could be fabricated in different sizes. The silicone oil-filled implant can mimic the mechanism of buoyant force and high surface tension of silicone oil, which is the only long-term vitreous substitute currently available. The silicone oil-filled implant can also mimic the natural vitreous body by occupying the entire posterior segment. CONCLUSIONS The intraocular silicone implant as an alternative long-term treatment of chronic ocular hypotony might offer a new option for clinical ophthalmological practice. In vivo studies need to be performed to collect more data on the implant's long-term mechanical and optical properties, as well as long-term biocompatibility.
Collapse
|
16
|
Yazıcı H, Gürelik G, Yaylacıoğlu Tuncay F, Uyar Göçün P. Ciliary Tissue Transplantation in the Rabbit Eye: Does the Localization of the Graft Affect Survival? Ophthalmic Res 2016; 57:70-76. [PMID: 27388749 DOI: 10.1159/000446320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 04/19/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE To examine whether ciliary body transplantation is applicable, the graft is viable and the localization of the graft material affects graft survival. METHODS Fifteen female New Zealand white rabbits were used. Three of them were used as donors, and a ciliary body graft was prepared from their enucleated eyes. There are two groups in the study according to the localization of the ciliary body graft in the anterior chamber. The graft was placed on the iris surface close to the pupil margin in group 1 and adjacent to the anterior chamber angle in group 2. Immunosuppressive treatment with cyclosporine A was given to the rabbits of both groups. The rabbits were sacrificed 1 month after ciliary transplantation, and their eyes were enucleated. After fixation, the graft and the surrounding tissue were examined by a pathologist macroscopically and microscopically with hematoxylin and eosin staining. RESULTS One month after the transplantation, the treated eyes remained inflammation free, and the transplants seemed to be viable with evident vascularization and without hemorrhage and necrotic tissue. When we compared groups 1 and 2, there were no statistically significant differences in the histopathological findings between the groups. The grafts were found to be similar with normal ciliary tissue in regard to necrosis, hemorrhage and fibrosis, and there were no statistically significant differences in inflammatory cell density and in the epithelial cell morphology between the normal ciliary tissue and the grafts. CONCLUSION Transplantation of allograft ciliary tissue either onto the surface of the iris or the anterior chamber angle under immunosuppression could be an effective treatment for chronic ocular hypotony.
Collapse
Affiliation(s)
- Hülya Yazıcı
- Department of Ophthalmology, Kızılcaham State Hospital, Ankara, Turkey
| | | | | | | |
Collapse
|
17
|
Surgical Management of Uveitis Patients. CURRENT SURGERY REPORTS 2015. [DOI: 10.1007/s40137-015-0121-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
18
|
Lee YH, Oh HJ, Cha SC. Comparative Results of Trabeculectomy with Mitomycin C in Uveitic Glaucoma versus Primary Open-Angle Glaucoma. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2015. [DOI: 10.3341/jkos.2015.56.9.1408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Yeon Ho Lee
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
| | - Hyun Ju Oh
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
| | - Soon Cheol Cha
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
| |
Collapse
|
19
|
Manuguerra-Gagné R, Boulos PR, Ammar A, Leblond FA, Krosl G, Pichette V, Lesk MR, Roy DC. Transplantation of mesenchymal stem cells promotes tissue regeneration in a glaucoma model through laser-induced paracrine factor secretion and progenitor cell recruitment. Stem Cells 2014; 31:1136-48. [PMID: 23495088 DOI: 10.1002/stem.1364] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2012] [Accepted: 02/05/2013] [Indexed: 12/23/2022]
Abstract
Among bone marrow cells, hematopoietic and mesenchymal components can contribute to repair damaged organs. Such cells are usually used in acute diseases but few options are available for the treatment of chronic disorders. In this study, we have used a laser-induced model of open angle glaucoma (OAG) to evaluate the potential of bone marrow cell populations and the mechanisms involved in tissue repair. In addition, we investigated laser-induced tissue remodeling as a method of targeting effector cells into damaged tissues. We demonstrate that among bone marrow cells, mesenchymal stem cells (MSC) induce trabecular meshwork regeneration. MSC injection into the ocular anterior chamber leads to far more efficient decrease in intraocular pressure (IOP) (p < .001) and healing than hematopoietic cells. This robust effect was attributable to paracrine factors from stressed MSC, as injection of conditioned medium from MSC exposed to low but not to normal oxygen levels resulted in an immediate decrease in IOP. Moreover, MSC and their secreted factors induced reactivation of a progenitor cell pool found in the ciliary body and increased cellular proliferation. Proliferating cells were observed within the chamber angle for at least 1 month. Laser-induced remodeling was able to target MSC to damaged areas with ensuing specific increases in ocular progenitor cells. Thus, our results identify MSC and their secretum as crucial mediators of tissue repair in OAG through reactivation of local neural progenitors. In addition, laser treatment could represent an appealing strategy to promote MSC-mediated progenitor cell recruitment and tissue repair in chronic diseases.
Collapse
Affiliation(s)
- Renaud Manuguerra-Gagné
- Division of Hematology-Oncology, Hopital Maisonneuve-Rosemont Research Center, Montreal, Canada
| | | | | | | | | | | | | | | |
Collapse
|
20
|
SIX MONTHS TREATMENT WITH IBOPAMINE IN PATIENTS WITH HYPOTONY AFTER VITREORETINAL SURGERY FOR RETINAL DETACHMENT, UVEITIS OR PENETRATING TRAUMA. Retina 2012; 32:742-7. [DOI: 10.1097/iae.0b013e3182265177] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
21
|
Pars plana vitrectomy, fluocinolone acetonide implantation, and silicone oil infusion for the treatment of chronic, refractory uveitic hypotony. Am J Ophthalmol 2011; 152:849-56.e1. [PMID: 21794844 DOI: 10.1016/j.ajo.2011.04.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Revised: 04/25/2011] [Accepted: 04/29/2011] [Indexed: 11/23/2022]
Abstract
PURPOSE To assess the feasibility and outcomes of combining fluocinolone acetonide sustained drug delivery implant insertion, pars plana vitrectomy, and silicone oil infusion to treat patients with chronic, refractory ocular hypotony resulting from uveitis. DESIGN Retrospective chart review. METHODS A retrospective, institutional chart review was performed. Outcome measures included visual acuity, intraocular pressure, and adverse events. RESULTS A total of 13 eyes of 11 patients were studied. All patients were women, had a mean age of 57 years (range, 26 to 73 years), and had a diagnosis of panuveitis. The mean duration of preoperative hypotony was 42 months (range, 11 to 108 months). Patients were followed up on average for 22 months (range, 9 to 46 months) after the combined surgical procedure. The mean preoperative visual acuity was 20/1000 (logarithm of the minimal angle of resolution, 1.7). At the 6- and 12-month visits, the mean visual acuity remained stable at 20/800 (logarithm of the minimal angle of resolution, 1.6; P = .74) and 20/600 (P = .34), respectively. At baseline, the mean intraocular pressure (IOP) was 2.3 mm Hg. The average IOP was 5.9 mm Hg, 5.1 mm Hg, and 5.0 mm Hg at 6, 12, and 24 months after surgery, respectively. The increase in IOP relative to the baseline IOP was statistically significant at 6 and 12 months (P = .027 and P = .004, respectively). The duration of preoperative hypotony inversely correlated with the IOP at 6 months (P = .027). No intraoperative complications were encountered and the procedure was well tolerated. CONCLUSIONS Fluocinolone acetonide implantation combined with pars plana vitrectomy and silicone oil infusion is feasible and is well tolerated in the management of chronic, refractory ocular hypotony associated with uveitis.
Collapse
|
22
|
Yu EN, Paredes I, Foster CS. Surgery for Hypotony in Patients with Juvenile Idiopathic Arthritis-Associated Uveitis. Ocul Immunol Inflamm 2009; 15:11-7. [PMID: 17365801 DOI: 10.1080/09273940601147729] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To describe the clinical response to cyclitic membrane excision of eyes with juvenile idiopathic arthritis (JIA)-associated uveitis and hypotony. METHODS The clinical records of patients with JIA-associated uveitis in a tertiary referral center were reviewed. Those patients with JIA-associated uveitis and hypotony who underwent cyclitic membrane excision were included in the study. Patients with hypotony secondary to active inflammation, retinal detachment, and surgical intervention (filtering, cyclo-destructive procedures, and glaucoma valve implantation) were excluded. RESULTS Two pediatric and two adult patients (4 eyes) were identified. The range of pre-operative intraocular pressure (IOP) was 0-5 mmHg. The two adult patients were noted to have atrophic ciliary processes intra-operatively, while the two pediatric patients had normal ciliary processes. At six months follow-up, the adult patients had IOPs of 5 mmHg, while the two pediatric patients had IOPs of 16 mmHg. At last consultation (mean duration of follow-up: 3.6 years), IOP was normal in all eyes. None of the eyes had a decrease in vision. CONCLUSIONS Release of traction on the ciliary body by inflammatory membranes may play a role in the management of hypotony in patients with JIA-associated uveitis. However, even though the IOP was successfully elevated, preventing phthisis, vision remained poor due to the long-standing complications secondary to chronic uveitis. This emphasizes the critical importance of early diagnosis and appropriate treatment of the inflammation before vision-robbing complications occur.
Collapse
Affiliation(s)
- Ellen N Yu
- Massachusetts Eye Research & Surgery Institute, Ocular Immunology and Uveitis Foundation, Harvard Medical School, Cambridge, MA 02142, USA
| | | | | |
Collapse
|
23
|
[Spontaneous scleral rupture revealed by hypotony maculopathy]. J Fr Ophtalmol 2009; 32:438.e1-6. [PMID: 19515458 DOI: 10.1016/j.jfo.2009.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Accepted: 04/17/2009] [Indexed: 11/20/2022]
Abstract
Cases of a spontaneous scleral rupture are very uncommon. Their diagnosis can be challenging because the scleral lesion might be invisible on clinical examination. We describe herein one case revealed by hypotony maculopathy. A 30-year-old woman presented with severe visual loss in one eye caused by sudden hypotony. Funduscopy revealed a chorioretinal coloboma in the periphery of the retina associated with a hypotony maculopathy. Extensive work-up included optical coherence tomography (OCT), fluoroangiography, ultrasonography, and magnetic resonance imaging examinations. A search for infectious and inflammatory diseases was conducted. Inflammatory and infectious work-ups were not contributive. A surgical exploration was performed, which showed a spontaneous scleral perforation within the coloboma. A patch of polytetrafluoroethylene was sutured on the damaged sclera and air was injected into the vitreous cavity. Vision and ocular pressure were rapidly restored. Spontaneous scleral rupture cases associated with hypotony and visual loss are rare, with only a few cases reported in the literature. Hypotony maculopathy with sclerochoroidal lesion may be the cause of such cases. Excellent outcome can be obtained with surgical diagnosis and repair.
Collapse
|
24
|
Abstract
PURPOSE To report outcome of pars plana vitrectomy in patients with chronic hypotony due to uveitis. METHODS Assessment of ciliary body was done preoperatively by ultrasound biomicroscopy and intraoperatively by direct visualization. Surgical procedure included pars plana or limbal lensectomy and vitrectomy with removal of ciliary membranes and traction. Silicone oil tamponade was used in selected eyes. Postoperatively subtenon triamcinolone acetonide was given if intraocular pressure (IOP) remained low. RESULTS Fifteen eyes of nine patients, all woman at mean age of 15.66 +/- 12.57 (4-40) years, were included. In 7 eyes with intact ciliary processes, mean pre- and postoperative IOP was 4.00 +/- 1.6 mmHg and 9.1 +/- 4.1 mmHg, respectively. In 4 eyes with ciliary atrophy that did not receive silicone oil tamponade, mean pre- and postoperative IOP was 4.25 +/- 1.7 and 3.75 +/- 0.9 mmHg, respectively. In 4 eyes with ciliary atrophy that received silicone oil tamponade mean pre- and postoperative IOP was 3.75 +/- 1.7 and 11.5 +/- 2.3 mmHg, respectively. Mean follow-up was 19.9 +/- 14.9 (8-56) months. Postoperative mean logMAR visual acuity improved significantly (P < 0.001) from 2.29 +/- 0.67 to 1.01 +/- 0.89. CONCLUSION In eyes with normal ciliary processes, removal of ciliary membranes alone was sufficient to restore IOP. However, if ciliary atrophy was present, IOP was restored only in those eyes that received silicone oil tamponade.
Collapse
|
25
|
Abstract
Hypotony maculopathy, first described in 1954 by Dellaporta, usually occurs after antiglaucomatous surgery or after perforating eye injuries; it is characterized by hypotony associated with fundus abnormalities, including papilloedema, vascular tortuosity and chorioretinal folds. In hypotony maculopathy, the scleral wall collapses inward, resulting in redundancy of the choroid and retina, leading to chorioretinal wrinkling. As the antero-posterior diameter of the vitreous cavity decreases, the very thick perivofeal retina surrounding the very thin foveal retina is thrown into radial folds around the fovea. It has been reported that hypotony maculopathy occurs in up to 20% of cases of glaucoma filtering surgery and has become more common after the introduction of antimetabolites. Young age, myopia, primary filtering surgery, systemic illnesses and elevated preoperative intraocular pressure (IOP) have been found to be associated with hypotony maculopathy. Hypotony maculopathy is treated with procedures designed to elevate IOP, which may reverse the inward scleral bowing and improve visual acuity. The successful treatment of hypotony maculopathy depends on the correct identification of its cause. Once the cause is detected, treatment should be employed as soon as possible because delayed normalization of the IOP may result in permanent macular chorioretinal changes and poor vision. This review will explore the definition, mechanisms, clinical findings and treatment of hypotony maculopathy.
Collapse
Affiliation(s)
- Vital Paulino Costa
- Glaucoma Service, Department of Ophthalmology, University of Campinas, São Paulo, Brazil.
| | | |
Collapse
|
26
|
de Smet MD, Mura M. Minimally invasive surgery—endoscopic retinal detachment repair in patients with media opacities. Eye (Lond) 2007; 22:662-5. [PMID: 17277754 DOI: 10.1038/sj.eye.6702710] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Evaluate the use of an ophthalmic endoscope in patients with a retinal detachment and anterior media opacity. MATERIALS AND METHODS A retrospective interventional case series. Search of a comprehensive database of retinal detachment patients with pre-operatively impaired anterior segments such that lens extraction, a keratoprosthesis, or extensive anterior segment manipulation was required for adequate repair. Pars plana vitrectomy was carried out with an endoscope without manipulation of the anterior segment. Characteristics of the detachment were recorded, as were complications/subsequent surgeries, pre-operative, 3-month post-operative, and final follow-up visual acuities. RESULTS Before surgery, five patients had a gas-induced cataract after a failed pneumatic retinopexy; one patient had a Reis-Buckler's dystrophy and corneal ulcer; three patients had synechiae around iris-fixed lenses. One patient had proliferative vitreoretinopathy. The median pre-operative vision was hand motion (20/30 to light perception). The median final visual acuity was 20/30 (20/20-20/200). Two patients required a subsequent lens extraction, one patient had a recurrent detachment. CONCLUSION In appropriate retinal detachment patients, endoscopy can be safe and effective, while limiting the scope of the surgical intervention.
Collapse
Affiliation(s)
- M D de Smet
- Department of Ophthalmology, ZNA Middelheim Campus, Antwerp, Belgium.
| | | |
Collapse
|
27
|
Liu DTL, Li CL, Lee VYW. The surgical management of chronic hypotony due to uveitis. Eye (Lond) 2005; 20:1373-4; author reply 1373. [PMID: 16341131 DOI: 10.1038/sj.eye.6702207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
|