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Shaheen F, Khan HA, Afzal F, Awan MA. Mean Ocular Perfusion Pressure Effect During Pars Plana Vitrectomy on the Foveal Avascular Zone: A Pilot Study. JOURNAL OF VITREORETINAL DISEASES 2024; 8:152-157. [PMID: 38465364 PMCID: PMC10924595 DOI: 10.1177/24741264231223389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Purpose: To evaluate the effect of mean ocular perfusion pressure on the foveal avascular zone (FAZ) area in eyes with successful retinal detachment (RD) surgery. Methods: This prospective pilot fellow eye-controlled study measured the intraoperative mean ocular perfusion pressure in eyes having surgery for rhegmatogenous RD (RRD). Postoperatively, the FAZ area was measured; the change was calculated as the difference in the FAZ area between the operated eye and the contralateral control eye. Results: The study comprised 8 patients with a mean age (±SD) of 53.38 ± 13.92 years. The mean superficial FAZ area was not different between operated eyes and control eyes, while the deep FAZ area was significantly larger in operated eyes. There was a strong negative correlation between the mean ocular perfusion pressure and the change in the deep FAZ area (Spearman ρ, -0.73; P = .04); the correlation between the mean ocular perfusion pressure and the change in the superficial FAZ area was not significant (Spearman ρ, -0.24; P = .57). A significant linear regression was found between the mean ocular perfusion pressure and the change in the deep FAZ area (R2 = 0.388). The predicted enlargement of the deep FAZ area was 0.03 mm with every 1 mm Hg decrease in the mean ocular perfusion pressure. Conclusions: Lower intraoperative mean ocular perfusion pressure is associated with enlargement of the deep FAZ area in eyes having successful RRD surgery.
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Affiliation(s)
- Fiza Shaheen
- Ophthalmology Department, Shifa International Hospital, Islamabad, Pakistan
- Ophthalmology Department, Alshifa Trust Eye Hospital, Islamabad, Pakistan
| | - Hashim Ali Khan
- Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia
| | - Farooq Afzal
- Ophthalmology Department, Shifa International Hospital, Islamabad, Pakistan
| | - Muhammad Amer Awan
- Ophthalmology Department, Shifa International Hospital, Islamabad, Pakistan
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Ong SS, Ahmed I, Gonzales A, Aguwa UT, Beatson B, Dai X, Pham AT, Shah YS, Zhou A, Arsiwala LT, Wang J, Handa JT. Management of uncomplicated rhegmatogenous retinal detachments: a comparison of practice patterns and clinical outcomes in a real-world setting. Eye (Lond) 2023; 37:684-691. [PMID: 35338355 PMCID: PMC9998441 DOI: 10.1038/s41433-022-02028-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/22/2022] [Accepted: 03/11/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To investigate practice patterns and clinical outcomes in the repair of uncomplicated rhegmatogenous retinal detachments (RRD) in a real-world setting over a 10-year period. METHODS We compared preferences for scleral buckling (SB), pars plana vitrectomy (PPV), PPV/SB, or pneumatic retinopexy (PR) over time, and examined the 1-year single surgery anatomic success (SSAS) and best-corrected visual acuity (BCVA) at a tertiary academic institution from 2008-2018. RESULTS Eight hundred eight eyes had RRD repair between 2008-2011 (n = 240), 2012-2014 (n = 271), and 2015-2017 (n = 297). Compared to 2008-2011, PPV was preferred over SB in 2012-2014 (OR: 2.93; 95% CI: 1.86-4.63) and 2015-2017 (OR: 5.94; 95% CI: 3.76-9.38), and over PPV/SB in 2012-2014 (OR: 2.74; 95% CI: 1.65-4.56) and 2015-2017 (OR: 3.16; 95% CI: 31.96-5.12). PR was uncommonly utilized (<10%). Younger surgeons (graduating 2010-2017) favored PPV over SB when compared to older surgeons [graduating 1984-2000 (OR: 1.77; 95% CI: 1.18-2.65) and 2001-2009 (OR 1.73; 95% CI: 1.14-2.65)], but similarly selected PPV vs. PPV/SB as their older counterparts (p > 0.05). Compared to PPV, SSAS was higher with SB (OR: 1.53; 95% CI: 1.03-2.26) and PPV/SB (OR: 2.55; 95% CI: 1.56-4.17). One-year BCVA was markedly improved compared to baseline only for eyes that achieved SSAS (p < 0.001). CONCLUSIONS Over the past 10 years, PPV has become the favored approach to repair uncomplicated RRD and this appears to be driven by younger surgeons' preferences. Given the superior long-term SSAS in SB and PPV/SB as compared to PPV, SB and PPV/SB should be more frequently considered when determining the appropriate repair strategy for uncomplicated RRD.
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Affiliation(s)
- Sally S Ong
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Ophthalmology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Ishrat Ahmed
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Anthony Gonzales
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ugochi T Aguwa
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Bradley Beatson
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Xi Dai
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Alex T Pham
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Yesha S Shah
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ashley Zhou
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Lubaina T Arsiwala
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jiangxia Wang
- Johns Hopkins Biostatistics Center, Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - James T Handa
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA.
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Jiang H, Yan B, Meng Z, Zhang L, Lei H, Luo J. The MDM2 Single-Nucleotide Polymorphism T309G Is Associated With the Development of Epimacular Membranes. Front Cell Dev Biol 2022; 10:841660. [PMID: 35359434 PMCID: PMC8963840 DOI: 10.3389/fcell.2022.841660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/15/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose: To investigate the role of the mouse double minute 2 (MDM2) gene single-nucleotide polymorphism (SNP) T309G in the development of epimacular membranes (EMMs) by analyzing the genotype distribution and consistency of the polymorphism in paired membrane-blood samples. Methods: This was a cross–sectional genetic association study of patients with proliferative vitreoretinopathy (PVR) or EMMs. PVR membranes (PVRMs), internal limiting membranes (ILMs) (PVR-ILMs) and blood samples (PVR-blood) from patients with PVR, and EMMs, EMM-ILMs and EMM-blood from patients with EMMs were collected. The genotype of all samples was determined by Sanger sequencing. Sex composition, mean age, the genotype distribution of MDM2 T309G, the allelic frequency of the MDM2 SNP309 G allele (% G) and the somatic mutation rate at the MDM2 T309G locus (% M) were analyzed and compared. The PVR and healthy Chinese donor groups were used as controls for different comparisons. Results: The EMM group of 62 patients was older than the PVR group of 61 patients by an average of 8.87 years (p < 0.0001), but the two groups were statistically similar in the sex composition (p = 0.1754). Importantly, G allele carriers were at a higher risk of developing EMMs than non-G allele carriers (p = 0.0479; OR = 2.047). Moreover, EMM-blood exhibited a significantly higher % G than blood samples from healthy Chinese donors (EMM-blood: 56.78%, donors: 45.61%; p = 0.0256; OR = 1.567). Regarding membrane-blood consistency, % M was significantly different between PVRMs and EMMs (PVRMs: 2.63%, EMMs: 21.57%; p = 0.0097; OR = 10.18) but not between different types of ILMs (PVR-ILMs: 18.18%, EMM-ILMs: 29.17%; p = 0.6855). Furthermore, EMMs (p = 0.0053; OR = 8.250) and EMM-ILMs (p = 0.0233; OR = 14.40) from patients with preoperative macular holes were more predisposed toward somatic mutations at the MDM2 T309G locus than those from patients without preoperative macular holes. Conclusions:MDM2 T309G is associated with the development of EMMs. Herein, the MDM2 SNP309 G allele is first reported as an associated factor of EMMs in a Chinese population. In addition, EMMs and ILMs are genetically unstable at the MDM2 T309G locus, especially when complicated with preoperative macular holes.
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Affiliation(s)
- Heng Jiang
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Bin Yan
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhishang Meng
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Lusi Zhang
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Hetian Lei
- Shenzhen Eye Institute, Shenzhen Eye Hospital, Jinan University, Shenzhen, China
- *Correspondence: Hetian Lei, , Jing Luo,
| | - Jing Luo
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Hetian Lei, , Jing Luo,
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The roles of mouse double minute 2 (MDM2) oncoprotein in ocular diseases: A review. Exp Eye Res 2022; 217:108910. [PMID: 34998788 DOI: 10.1016/j.exer.2021.108910] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 12/03/2021] [Accepted: 12/21/2021] [Indexed: 12/19/2022]
Abstract
Mouse double minute 2 (MDM2), an E3 ubiquitin ligase and the primary negative regulator of the tumor suppressor p53, cooperates with its structural homolog MDM4/MDMX to control intracellular p53 level. In turn, overexpression of p53 upregulates and forms an autoregulatory feedback loop with MDM2. The MDM2-p53 axis plays a pivotal role in modulating cell cycle control and apoptosis. MDM2 itself is regulated by the PI3K-AKT and RB-E2F-ARF pathways. While amplification of the MDM2 gene or overexpression of MDM2 (due to MDM2 SNP T309G, for instance) is associated with various malignancies, numerous studies have shown that MDM2/p53 alterations may also play a part in the pathogenetic process of certain ocular disorders (Fig. 1). These include cancers (retinoblastoma, uveal melanoma), fibrocellular proliferative diseases (proliferative vitreoretinopathy, pterygium), neovascular diseases, degenerative diseases (cataract, primary open-angle glaucoma, age-related macular degeneration) and infectious/inflammatory diseases (trachoma, uveitis). In addition, MDM2 is implicated in retinogenesis and regeneration after optic nerve injury. Anti-MDM2 therapy has shown potential as a novel approach to treating these diseases. Despite major safety concerns, there are high expectations for the clinical value of reformative MDM2 inhibitors. This review summarizes important findings about the role of MDM2 in ocular pathologies and provides an overview of recent advances in treating these diseases with anti-MDM2 therapies.
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Christou EE, Stavrakas P, Georgalas I, Batsos G, Christodoulou E, Stefaniotou M. Macular microcirculation changes after macula-off rhegmatogenous retinal detachment repair with silicone oil tamponade evaluated by OCT-A: preliminary results. Ther Adv Ophthalmol 2022; 14:25158414221105222. [PMID: 35734223 PMCID: PMC9208039 DOI: 10.1177/25158414221105222] [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: 01/26/2022] [Accepted: 05/18/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Rhegmatogenous retinal detachment (RRD) with macular involvement is a sight-threatening condition. Silicone oil (SO) is efficacious for retinal tamponade, especially in complex cases. Whether macular detachment per se or the potential tamponading agent may affect macular microcirculation after RRD repair is a matter of research. Objectives: To investigate macular microcirculation changes using optical coherence tomography angiography (OCT-A) after pars plana vitrectomy (PPV) with intravitreal SO for RRD repair in the early posttreatment period. Design: Prospective comparative cross-sectional study. Data sources and Methods: Fourteen eyes of 14 patients were included in the study. All eyes underwent a single successful PPV with SO tamponade for macula-off RRD. OCT-A was performed to analyze macular microcirculation and visual outcomes at 1 month postoperatively. The fellow unaffected eye was used as control. Results: Vessel density (VD) in the superficial capillary plexus (SCP) was significantly lower at each macular region (fovea, parafovea, and perifovea) of SO-treated eyes compared with the fellow eyes (all p = 0.001). Similarly, perfusion density (PD) in the SCP was significantly lower at each macular region than the fellow eyes (all p = 0.001). There was enlargement of foveal avascular zone (FAZ) area and decrease of circularity at RRD eyes compared with the fellow ones (all p = 0.001). Postoperative logMAR visual acuity (VA) was significantly lower in treated eyes than fellow eyes and correlated inversely with foveal, parafoveal, and perifoveal VD and PD SCP (all p < 0.001). Postoperative VA had no correlation with FAZ parameters. Conclusion: Enlargement of FAZ SCP and decrease in VD and PD SCP during the short-term follow-up were possibly attributable to ischemic changes in the macular area after RRD repair with SO tamponade. In this preliminary study, the flow density in macular capillary plexus may represent an indicator of visual outcomes.
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Affiliation(s)
- Evita Evangelia Christou
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45100 Ioannina, Greece
| | - Panagiotis Stavrakas
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece
| | - Ilias Georgalas
- First Department of Ophthalmology, General Hospital of Athens G. Gennimatas, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Batsos
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Eleni Christodoulou
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Maria Stefaniotou
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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Carducci NM, Li KX, Moinuddin O, Besirli CG, Wubben TJ, Zacks DN. Clinical Presentation and Outcomes of Rhegmatogenous Retinal Detachments During the COVID-19 Lockdown and Its Aftermath at a Tertiary Care Center in Michigan. Ophthalmic Surg Lasers Imaging Retina 2021; 52:593-600. [PMID: 34766850 DOI: 10.3928/23258160-20211015-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To investigate the effect of the coronavirus disease 2019 (COVID-19) lockdown on the presentation and management of acute, primary rhegmatogenous retinal detachment (RRD). PATIENTS AND METHODS This was a single-center, consecutive case series with historic controls, examining patients during the COVID-19 "stay-at-home" order (March 24 to June 1, 2020), the subsequent reopening phase (June 1 to July 31, 2020), and corresponding preceding intervals (March 24 to July 31, 2016 to 2019). RESULTS Despite a significant increase in patients presenting with macula-off RRD during the COVID-19 lockdown compared to the 2016 to 2019 timeframe (P = .03), the rate of single surgery anatomical success was similar between all groups (P = .66), as was final visual acuity (P = .61). No delays between presentation and surgical intervention were observed during the lockdown (P = .49). CONCLUSIONS Despite the limitations of the COVID-19 lockdown, patients underwent surgery in a timely manner and achieved comparable visual outcomes to controls before COVID-19. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:593-600.].
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CHARACTERISTICS AND SURGICAL OUTCOMES OF RHEGMATOGENOUS RETINAL DETACHMENT IN OLDER ADULTS: A Multicenter Comparative Cohort Study. Retina 2021; 41:947-956. [PMID: 32858667 DOI: 10.1097/iae.0000000000002969] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe characteristics and outcomes of primary rhegmatogenous retinal detachment in older adults (age ≥ 80). METHODS Consecutive patients with rhegmatogenous retinal detachment undergoing pars plana vitrectomy (PPV), scleral buckling (SB), or PPV/SB in the Primary Retinal Detachment Outcomes Study were evaluated. Outcome measures included single surgery anatomic success and visual acuity. RESULTS Of 2,144 patients included, 125 (6%) were 80 years or older. Compared with younger patients (age 40-79), older adults were more likely to be pseudophakic (P < 0.001), have macula-off detachments (P < 0.001), and have preoperative proliferative vitreoretinopathy (P = 0.02). In older adults, initial surgery was PPV in 73%, PPV/SB in 27%, and primary SB in 0%. Single surgery anatomic success was 78% in older adults compared with 84% in younger patients (P = 0.03). In older adults, single surgery anatomic success was 74% for PPV and 91% for PPV/SB (P = 0.03). The final mean logMAR was lower for older adults (0.79 [20/125] vs. 0.40 [20/40], [P < 0.001]). In older adults, the final mean logMAR for eyes that underwent PPV was 0.88 (20/160) compared with 0.50 (20/63) for PPV/SB (P = 0.03). CONCLUSION Octogenarians and nonagenarians presented with relatively complex pseudophakic rhegmatogenous retinal detachments. Single surgery anatomic success and visual outcomes were worse compared with younger patients, and PPV/SB had better outcomes compared with PPV alone.
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Moinuddin O, Abuzaitoun RO, Hwang MW, Sathrasala SK, Chen XD, Stein JD, Johnson MW, Zacks DN, Wubben TJ, Besirli CG. Surgical repair of primary non-complex rhegmatogenous retinal detachment in the modern era of small-gauge vitrectomy. BMJ Open Ophthalmol 2021; 6:e000651. [PMID: 33718613 PMCID: PMC7908907 DOI: 10.1136/bmjophth-2020-000651] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/01/2021] [Accepted: 02/11/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To report anatomic and visual outcomes of pars plana vitrectomy (PPV), as well as scleral buckling (SB) and PPV/SB as surgical treatments for the management of primary, non-complex rhegmatogenous retinal detachment (RRD). METHODS AND ANALYSIS Data from 751 eyes that underwent PPV, SB or combined PPV/SB as a surgical treatment for primary non-complex RRD with at least 3 months of follow-up were analysed to determine rates of single surgery anatomic success (SSAS) and final anatomic success (FAS). Patients or the public were not involved in the design, conduct or reporting of this research. RESULTS PPV accounted for 89.0% (n=668), PPV/SB for 6.8% (n=51) and SB for 4.2% (n=32) cases. Overall SSAS (91.2% PPV, 84.3% PPV/SB, 93.8% SB; p=0.267) and FAS (96.7% PPV, 94.1% PPV/SB and 100.0% SB; p=0.221) were reported for the three surgical groups. SSAS and FAS were similar for lens status, macular detachment status and the presence or absence of inferior retinal breaks for each of the PPV, PPV/SB and SB groups. CONCLUSIONS In this large, single institution, retrospective case series, we report surgical outcomes for patients with primary non-complex RRD managed with PPV, SB or PPV/SB in the modern era of small-gauge vitrectomy. We demonstrate that primary PPV without adjunct SB provides excellent anatomic and visual outcomes irrespective of lens status, macular involvement or pathology location.
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Affiliation(s)
- Omar Moinuddin
- Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Rebhi O Abuzaitoun
- Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Min W Hwang
- Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Sanjana K Sathrasala
- Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Xing D Chen
- Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Joshua D Stein
- Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Mark W Johnson
- Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - David N Zacks
- Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Thomas J Wubben
- Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Cagri G Besirli
- Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Abstract
BACKGROUND Proliferative vitreoretinopathy (PVR) is still an unsolved problem after half a century of research. METHODS This article provides a review of mechanisms leading to PVR in the context of wound healing research. RESULTS Wound healing is a physiological repair process that occurs in a similar way in all organs and may end in scar formation. The development of PVR is based on this wound healing mechanism. The localization and structures involved lead to specific characteristics and consequences. Up to now the pharmacotherapeutic strategies were not sufficiently effective. The growing understanding of the mechanisms of scar-free fetal wound healing, could however lead to a solution of the PVR problem. CONCLUSION The PVR is a physiological process with a pathological result. The complex steps involved in vitreoretinal wound healing are well understood. There is currently no therapeutic approach neither in ophthalmology nor in other medical disciplines that is able to restore the original function and structure of the involved tissue or organ but there is hope that this can succeed in the future.
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Maqsood S, Elalfy M, Abdou Hannon A, Hegazy SM, Elborgy ES. Functional and Structural Outcomes at the Foveal Avascular Zone with Optical Coherence Tomography Following Macula off Retinal Detachment Repair. Clin Ophthalmol 2020; 14:3261-3270. [PMID: 33116377 PMCID: PMC7568611 DOI: 10.2147/opth.s271944] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/11/2020] [Indexed: 11/23/2022] Open
Abstract
Background Visual recovery following macula involving rhegmatogenous retinal detachment remains poorly understood. The aim of this work is to correlate the functional and the anatomical changes in retinal vasculature in the foveal avascular zone using optical coherence tomography angiography (OCTA) after successful retinal reattachment repair and correlate this data with retinal thickness and post-operative visual recovery. Methods A prospective, comparative observational study of 28 eyes of 14 patients with 14 eyes undergoing macula off retinal detachment repair with pars plana vitrectomy, endo-laser and silicone oil-based tamponade compared with 14 fellow healthy eyes at 1, 6 and 12 weeks post-operative period. The study was conducted at the Research Institute of Ophthalmology, Giza, Egypt between February 2018 and August 2018. Results The foveal avascular zone (FAZ) area in the patients group was not significantly different compared to the control group and was found to be negatively correlated with the central retinal thickness in both the study and control group. The superficial capillary plexus (SCP) area at the FAZ was significantly larger than the deep capillary plexus (DCP) area at the FAZ in both the study and control group over the follow-up period. The DCP area at the FAZ was significantly larger at the 3rd follow-up than the 1st follow-up. The SCP FAZ area was significantly larger than the DCP FAZ area in both the study and control group over the follow-up period. BCVA was found to be negatively correlated to the retinal thickness of the temporal 3 mm paracentral quadrant with no correlation with central foveal thickness (CFT) and the FAZ area. Conclusion Optical coherence tomography (OCT) and OCTA are valuable noninvasive imaging tools to monitor and predict the structural changes at the foveal avascular zone during the recovery phase after successful retinal reattachment involving macula.
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Affiliation(s)
| | - Mohamed Elalfy
- Queen Victoria Hospital, East Grinstead, UK.,Research Institute of Ophthalmology, Giza, Egypt.,Maidstone and Tunbridge Wells Hospitals, Tunbridge Wells, UK
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11
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Egorov AV, Egorov VV, Smoliakova GP, Khudyakov AY. [Functional rehabilitation of patients after endovitreal surgery of rhegmatogenous retinal detachment with complete retinal attachment]. Vestn Oftalmol 2020; 136:66-74. [PMID: 32779458 DOI: 10.17116/oftalma202013604166] [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: 11/17/2022]
Abstract
Rhegmatogenous retinal detachment (RRD) is one of the most severe eye diseases typically occurring in people of working age. The annual rates of primary vision disability in patients with RRD is 2-9%. PURPOSE To increase the functional effectiveness of endovitreal surgery in patients with RRD by including Cytoflavin in the system of postoperative rehabilitation. MATERIAL AND METHODS The study involved 68 patients with RRD aged 37 to 65 years. Patients underwent vitrectomy using the 25 Gauge technology with endolaser coagulation of rupture zones and silicone oil tamponade in the vitreous cavity. Three months after the surgery, silicone oil was removed from the vitreous cavity. Patients were divided into 2 groups: the main - 34 people who received Cytoflavin in addition to standard therapy, and the control - 34 people receiving only standard postoperative treatment. The time course of the treatment's functional effectiveness was analyzed using best corrected visual acuity (BCVA) and macular photosensitivity. Laser Doppler flowmetry (LDF) was used to register the microcirculation and microcirculation efficiency indices. Morphological signs of macular ischemia were registered by optical coherence tomography angiography (OCT-A). RESULTS Patients of the main group showed higher level of restoration of macular function compared with the control group. The increase in functional activity of the macular area correlated with postoperative dynamics of restoration of central retinal thickness. Analysis of LDF and OCT-A indices showed that improvement of visual functions in patients treated with Cytoflavin is directly related to restoration of chorioretinal blood flow. CONCLUSION The use of Cytoflavin in patients after endovitreal surgery of RRD led to improvement of BCVA by an average of 2.6 times and photosensitivity of the macula by 2 times. The visual functions of patients improved after using Cytoflavin due to its positive effect on chorioretinal microcirculation and the density of macular capillary plexuses.
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Affiliation(s)
- A V Egorov
- Khabarovsk branch of S.N. Fyodorov National Medical Research Center «MNTK «Eye Microsurgery», Khabarovsk, Russia
| | - V V Egorov
- Khabarovsk branch of S.N. Fyodorov National Medical Research Center «MNTK «Eye Microsurgery», Khabarovsk, Russia.,Postgraduate Institute for Public Health Specialists, Khabarovsk, Russia
| | - G P Smoliakova
- Khabarovsk branch of S.N. Fyodorov National Medical Research Center «MNTK «Eye Microsurgery», Khabarovsk, Russia.,Postgraduate Institute for Public Health Specialists, Khabarovsk, Russia
| | - A Yu Khudyakov
- Khabarovsk branch of S.N. Fyodorov National Medical Research Center «MNTK «Eye Microsurgery», Khabarovsk, Russia
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Ryan EH, Ryan CM, Forbes NJ, Yonekawa Y, Wagley S, Mittra RA, Parke DW, Joseph DP, Emerson GG, Shah GK, Blinder KJ, Capone A, Williams GA, Eliott D, Gupta OP, Hsu J, Regillo CD. Primary Retinal Detachment Outcomes Study Report Number 2. Ophthalmology 2020; 127:1077-1085. [DOI: 10.1016/j.ophtha.2020.03.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/23/2020] [Accepted: 03/03/2020] [Indexed: 10/24/2022] Open
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Ryan EH, Joseph DP, Ryan CM, Forbes NJ, Yonekawa Y, Mittra RA, Parke DW, Ringeisen A, Emerson GG, Shah GK, Blinder KJ, Capone A, Williams GA, Eliott D, Gupta OP, Hsu J, Regillo CD. Primary Retinal Detachment Outcomes Study: Methodology and Overall Outcomes—Primary Retinal Detachment Outcomes Study Report Number 1. ACTA ACUST UNITED AC 2020; 4:814-822. [DOI: 10.1016/j.oret.2020.02.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 02/20/2020] [Accepted: 02/24/2020] [Indexed: 02/09/2023]
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14
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Eibenberger K, Sacu S, Rezar-Dreindl S, Schmidt-Erfurth U, Stifter E, Georgopoulos M. Clinical characteristics and surgical outcome of pediatric and early adulthood retinal detachment. Eur J Ophthalmol 2020; 31:1367-1374. [PMID: 32192354 DOI: 10.1177/1120672120913030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate and compare the underlying pathologies, demographic and retinal detachment characteristics in pediatric and early adulthood retinal detachment. METHODS Patients with rhegmatogenous, serous, or tractional retinal detachment aged 0-26 years were retrospectively reviewed. The preschool group (n = 4) comprised children aged 0-6 years, the pediatric group (n = 19) comprised children aged 7-16 years, and the early adulthood group (n = 13) aged 17-26 years. Demographic information and retinal detachment characteristics, type of surgery, and intraocular tamponade were analyzed. Postoperatively, the functional outcome, anatomic success, and ocular adverse events were evaluated. Due to the low patient number in the preschool group, statistical analysis was performed for pediatric group and early adulthood group only. RESULTS All causes of retinal detachment were present in the pediatric group, but only rhegmatogenous retinal detachment in the early adulthood group. In both groups, the main type of surgical intervention was pars plana vitrectomy (pediatric group: 52%, early adulthood group: 38%; p = 0.36). The type of intraocular tamponade varied statistically significantly between the groups (p = 0.014). Silicone oil was the main intraocular tamponade in the pediatric group (48%), whereas no tamponade (54%) followed by gas tamponade (46%) in the early adulthood group. Final attachment rate was similar in both groups (pediatric group: 89%, early adulthood group: 100%; p = 0.35). Re-detachment occurred significantly sooner in the pediatric group (1.3 ± 0.3 months) than in the early adulthood group (4.3 ± 1.4 months; p = 0.03). CONCLUSION In pediatric and early adulthood retinal detachment, pars plana vitrectomy appeared as a successful surgical intervention. Re-attachment rate and re-treatment were similar in both groups with a better functional outcome observed in cases of retinal detachment in early adulthood and poorer results in young children.
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Affiliation(s)
| | - Stefan Sacu
- Department of Ophthalmology, Medical University of Vienna (MUV), Vienna, Austria
| | - Sandra Rezar-Dreindl
- Department of Ophthalmology, Medical University of Vienna (MUV), Vienna, Austria
| | | | - Eva Stifter
- Department of Ophthalmology, Medical University of Vienna (MUV), Vienna, Austria
| | - Michael Georgopoulos
- Department of Ophthalmology, Medical University of Vienna (MUV), Vienna, Austria
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Schawkat M, Valmaggia C, Lang C, Scholl HPN, Harsum S, Guber I, Guber J. Influence of Postoperative Posture on Macular Slippage after Macula-Off Retinal Detachment: A Randomized Controlled Trial. Ophthalmol Ther 2019; 8:519-525. [PMID: 31396891 PMCID: PMC6858424 DOI: 10.1007/s40123-019-0204-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION To evaluate the effect of postoperative posture on the retinal shift after retinal detachment repair. METHODS Patients who underwent pars plana vitrectomy (PPV) for macula-off rhegmatogenous retinal detachment (RRD) were included prospectively in the current study. Patients were randomized into two groups: group A included patients who did a log roll postoperatively, and group B included patients who had to lie flat on their backs for 6 h postoperatively before moving into the end position. Patients in group A and patients in group B were reviewed after 3 weeks and after 6 weeks, respectively, and fundus autofluorescence images (FAF) were obtained to visualize the retinal rotation. RESULTS The sample included 50 eyes from 49 patients. Retinal shift occurred after RRD repair in 17 patients (34%). There was no statistically significant difference between the two groups (p = 0.94). Postoperative macular shift occurred significantly less often (p = 0.049) in participants in whom heavy fluid was used in the procedure. Metamorphopsia was reported postoperatively by 10 of 17 patients with retinal shift (p < 0.001). CONCLUSION In our study, postoperative posture did not significantly influence postoperative macular slippage after RRD repair. The use of intraoperative heavy liquid appears to be associated with a lower occurrence of retinal shift.
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Affiliation(s)
- Megir Schawkat
- Eye Clinic, Cantonal Hospital Sankt Gallen, St. Gallen, Switzerland
| | | | - Corina Lang
- Eye Clinic, Cantonal Hospital Sankt Gallen, St. Gallen, Switzerland
| | - Hendrik P N Scholl
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland
- Department of Ophthalmology, University of Basel, Basel, Switzerland
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, USA
| | - Steven Harsum
- Epsom and St Helier University Hospitals, NHS Trust, London, UK
| | - Ivo Guber
- Department of Ophthalmology, University of Geneva, Geneva, Switzerland
| | - Josef Guber
- Eye Clinic, Cantonal Hospital Sankt Gallen, St. Gallen, Switzerland.
- Department of Ophthalmology, University of Basel, Basel, Switzerland.
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Multimodal imaging for detecting metamorphopsia after successful retinal detachment repair. Graefes Arch Clin Exp Ophthalmol 2019; 258:57-61. [DOI: 10.1007/s00417-019-04498-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 09/23/2019] [Accepted: 09/26/2019] [Indexed: 10/25/2022] Open
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17
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Guber J, Bentivoglio M, Sturm V, Scholl HP, Valmaggia C. Combined pars plana vitrectomy with phacoemulsification for rhegmatogenous retinal detachment repair. Clin Ophthalmol 2019; 13:1587-1591. [PMID: 31686771 PMCID: PMC6709034 DOI: 10.2147/opth.s215352] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 07/04/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the outcome after combined phaco-vitrectomy in rhegmatogenous retinal detachment (RRD) repair. Patients and methods In this retrospective study, we included all patients who underwent pars plana vitrectomy (PPV) for RRD between January 2013 and December 2017. The main outcome measure was the retinal re-detachment rate after combined phaco-vitrectomy. Results Overall, 1017 eyes with RRD were included. All eyes received PPV, while in 516 eyes additional phacoemulsification was performed. A retinal re-detachment occurred in 103 patients (10.1%). No significant difference in the rate of re-detachment was found if additional phacoemulsification was performed (p=0.641). Subgroup calculations showed a significant higher rate of re-detachment in patients with a PVR (p=0.0003) and in patients where silicone oil was used as primary tamponade (p=0.0001) as well as in macula off RRDs (p=0.034). Conclusion Additional phacoemulsification during vitrectomy for RRD is not associated with higher rate of retinal re-detachment.
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Affiliation(s)
- Josef Guber
- Eye Clinic, Cantonal Hospital Sankt Gallen, Sankt Gallen, Switzerland.,Department of Ophthalmology, University of Basel, Basel, Switzerland
| | - Maico Bentivoglio
- Eye Clinic, Cantonal Hospital Sankt Gallen, Sankt Gallen, Switzerland
| | - Veit Sturm
- Eye Clinic, Cantonal Hospital Sankt Gallen, Sankt Gallen, Switzerland
| | - Hendrik Pn Scholl
- Department of Ophthalmology, University of Basel, Basel, Switzerland.,Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland.,Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA
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18
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How to Prevent Retinal Shift after Rhegmatogenous Retinal Detachment Repair. ACTA ACUST UNITED AC 2019; 3:417-421. [DOI: 10.1016/j.oret.2019.01.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 12/17/2018] [Accepted: 01/14/2019] [Indexed: 11/17/2022]
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Poulsen CD, Green A, Grauslund J, Peto T. Long-Term Outcome of Patients Operated with Pars Plana Vitrectomy for Primary Rhegmatogenous Retinal Detachment. Ophthalmic Res 2019; 63:25-33. [PMID: 31013505 DOI: 10.1159/000499130] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 02/26/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE To determine the long-term outcome of patients operated with pars plana vitrectomy (PPV) for primary rhegmatogenous retinal detachment (RRD) and to identify potential predictors for poor visual outcome. METHODS Prospective, observational 30-month study of patients operated for primary RRD with PPV. Examinations were performed preoperatively and after months 2, 6, and 30. RESULTS Eighty-four patients (84 eyes) were included and 73 (86.9%) participated at month 30. The macula was attached in 30 (35.7%) patients at primary operation. The majority of patients (n = 59, 80.8%) achieved a good final best corrected visual acuity (BCVA ≤0.3 logMAR, ≥0.5 Snellen) with a better outcome in patients with the macula attached than detached (0.02 vs. 0.17 logMAR, p = 0.007). Variables associated with poor visual outcome were baseline BCVA >0.3 logMAR (p = 0.03), female gender (p = 0.02), silicone oil (p = 0.03), and larger areas of retinal detachment (p = 0.01). In multivariable regression analysis, female gender (OR = 8.5 [95% CI 1.8-39.8]) was the strongest risk factor for poor visual outcome. CONCLUSION The majority of patients operated for primary RRD achieved a reasonable long-term visual outcome. Notably, female gender was associated with poor visual outcome, indicating a need for closer follow-up.
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Affiliation(s)
- Christina D Poulsen
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark, .,Department of Clinical Research, University of Southern Denmark, Odense, Denmark, .,OPEN, Odense Patient Data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark, Odense, Denmark,
| | - Anders Green
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,OPEN, Odense Patient Data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jakob Grauslund
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Tunde Peto
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
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Eibenberger K, Georgopoulos M, Rezar-Dreindl S, Schmidt-Erfurth U, Sacu S. Development of Surgical Management in Primary Rhegmatogenous Retinal Detachment Treatment from 2009 to 2015. Curr Eye Res 2018; 43:517-525. [PMID: 29364728 DOI: 10.1080/02713683.2018.1428996] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate the evolution of surgical methods over a 7-year period in patients with primary rhegmatogenous retinal detachment (RRD) and its relation to functional outcome and intra- and postoperative complications. METHODS This prospective observational study included 628 patients with primary RRD who underwent surgical repair between January 2009 and December 2015. The main outcome measures were the type of surgical procedure ((scleral buckle (SB), pars plana vitrectomy (PPV), combination of SB and PPV or cryocoagulation (CC)) and intraocular tamponades. In addition, functional outcome and intra/postoperative complications were assessed over the observational period. RESULTS During the 7-year observation, the percent of SB procedures decreased from 40.5% in 2009 to 2.7% in 2014, while PPV increased from 38% in 2009 to above 90% in 2014. In 2015, the SB procedure was performed in 10.3% and PPV in 85.6% of patients with RRD (p < 0.001). No consistent trend was observed for the use of intraocular gas tamponade. The functional outcome within the 7-year observation ranged from 0.25 ± 0.31logmar in 2012 to 0.42 ± 0.40logmar in 2009 and showed no statistically significant trend (p = 0.28). Intraoperative complications did not change between 2009 and 2015. The rate of cataract surgery and epiretinal membrane development did not change (p = 0.27; p = 0.09). The percent of re-detachment ranged from 6.2 to 16.5% within the observational period (p = 0.14). CONCLUSION A shift toward PPV alone for primary RRD repair was observed during the 7-year observation. No decrease in functional outcome or increase of intra- and postoperative complications or decrease of primary and final anatomic success rate was observed following the change in surgical procedure.
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Affiliation(s)
| | | | | | | | - Stefan Sacu
- a Department of Ophthalmology , Medical University of Vienna , Vienna , Austria
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21
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Abu El-Asrar A, Al-Kwikbi H, Kangave D. Prognostic Factors after Primary Vitrectomy and Perfluorocarbon Liquids for Bullous Rhegmatogenous Retinal Detachment. Eur J Ophthalmol 2018; 19:107-17. [DOI: 10.1177/112067210901900116] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose To identify prognostic factors for visual acuity and anatomic outcomes associated with bullous rhegmatogenous retinal detachment (RRD) management using primary pars plana vitrectomy, intraoperative perfluorocarbon liquids (PFCLs), and internal gas tamponade. Methods The authors studied a consecutive series of 115 eyes (115 patients) with a bullous RRD not complicated by proliferative vitreoretinopathy (PVR) associated with large, multiple, and/or posterior breaks in 58 (50.4%) eyes. All eyes underwent vitrectomy, injection of PFCL, and gas tamponade as the primary procedure. Encircling scleral bands were placed in all cases. The follow-up period ranged from 3 to 60 months (mean 16.6±14.1 months). Results Retinal reattachment was achieved in 92.2% of eyes (106/115) with one operation and in all eyes after a second procedure. PVR was observed in 1 (0.87%) eye and pre-retinal membranes in 3 (2.6%) eyes. Progression of pre-existing cataract and development of new cataract occurred in 45 (58.4%) of the 77 phakic eyes. The presence of inferior retinal breaks was significantly associated with redetachment after the first procedure (p=0.0156). On univariate analysis, better preoperative visual acuity (p<0.001), macular sparing retinal detachment (p<0.001), and fewer quadrants involved by the detachment (p=0.0015) were significant positive prognostic factors for final visual acuity. Logistic regression analysis highlighted that macular sparing retinal detachment and absence of trauma were associated with better final visual acuity. Conclusions Redetachment was associated with the presence of inferior retinal breaks. Visual recovery was dependent on preoperative visual acuity, macular involvement, extent of retinal detachment, and trauma.
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Affiliation(s)
- A.M. Abu El-Asrar
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh - Saudi Arabia
| | - H.F. Al-Kwikbi
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh - Saudi Arabia
| | - D. Kangave
- Research Center, College of Medicine, King Saud University, Riyadh - Saudi Arabia
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AGE, SEX, AND TIME-SPECIFIC TRENDS IN SURGICAL APPROACHES FOR RHEGMATOGENOUS RETINAL DETACHMENT. Retina 2017; 37:2326-2333. [DOI: 10.1097/iae.0000000000001485] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Pastor-Idoate S, Rodríguez-Hernández I, Rojas J, Gonzalez-Buendia L, Delgado-Tirado S, López JC, González-Sarmiento R, Pastor JC. Functional characterization of rs2229094 (T>C) polymorphism in the tumor necrosis factor locus and lymphotoxin alpha expression in human retina: the Retina 4 project. Clin Ophthalmol 2017; 11:973-981. [PMID: 28579748 PMCID: PMC5449105 DOI: 10.2147/opth.s135170] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Purpose The objective of this study is to determine the expression and localization of lymphotoxin alpha (LTA) in human retinas and the functionality of one of its polymorphisms rs2229094 (C13R) (T>C), previously associated with proliferative vitreoretinopathy (PVR) development. Materials and methods Total RNA from three healthy human retinas were extracted and subjected to reverse transcription-polymerase chain reaction (RT-PCR) analysis, using flanking primers of LTA cDNA. In addition, three human eyes with retinal detachment (RD) and three healthy control eyes were subjected to immunohistochemistry (IHC) with a specific antibody against LTA. The functionality of T and C alleles was assessed by using pCEFL-Flag expression vector and transient transfection assays in COS-1 cell line. In addition, expression analysis by RT-PCR, Western blot and subcellular localization of both alleles and by immunofluorescence assay was performed. Results RT-PCR analysis revealed no significant levels of messenger RNA (mRNA) LTA in healthy human retinas. Sequential IHC staining showed differences between healthy human and RD retinas. No differences in mRNA and protein expression levels and in subcellular localization between both alleles were found. Both alleles were located in the cytoplasm of COS-1 cells. Conclusion Although results suggest lack of functionality, the differences found in IHC study and its strong association with PVR and its relationship with tumor necrosis factor locus, warrant further studies and could justify the use of this polymorphism as a valid biomarker to identify high-risk patients to develop PVR after RD.
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Affiliation(s)
- Salvador Pastor-Idoate
- IOBA Eye Institute, University of Valladolid, Valladolid.,Molecular Medicine Unit, Department of Medicine
| | - Irene Rodríguez-Hernández
- Molecular Medicine Unit, Department of Medicine.,Molecular and Cellular Cancer Biology Institute, High Council of Scientific Research, Biomedical Research Institute of Salamanca, University of Salamanca, Salamanca
| | - Jimena Rojas
- IOBA Eye Institute, University of Valladolid, Valladolid
| | | | - Santiago Delgado-Tirado
- IOBA Eye Institute, University of Valladolid, Valladolid.,Department of Ophthalmology, Hospital Clínico Universitario, Valladolid, Spain
| | | | - Rogelio González-Sarmiento
- Molecular Medicine Unit, Department of Medicine.,Molecular and Cellular Cancer Biology Institute, High Council of Scientific Research, Biomedical Research Institute of Salamanca, University of Salamanca, Salamanca
| | - Jose C Pastor
- IOBA Eye Institute, University of Valladolid, Valladolid.,Department of Ophthalmology, Hospital Clínico Universitario, Valladolid, Spain
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VITREORETINAL SURGERY WITH SILICONE OIL TAMPONADE IN PRIMARY UNCOMPLICATED RHEGMATOGENOUS RETINAL DETACHMENT: Clinical Outcomes and Complications. Retina 2017; 36:1906-12. [PMID: 26966864 DOI: 10.1097/iae.0000000000001008] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND To determine the anatomical and functional outcomes and possible complications after pars plana vitrectomy (PPV) with silicone oil (SO) tamponade in primary uncomplicated rhegmatogenous retinal detachments. METHODS This is a prospective observational study. Overall, 62 consecutive patients who underwent surgical repair by PPV and SO injection for primary uncomplicated rhegmatogenous retinal detachment between January 01, 2006 and April 30, 2012 were followed. In general, PPV was chosen over scleral buckling when a significant cataract or a vitreous hemorrhage prevented adequate fundus visualization. Silicone oil was chosen over gas tamponade in patients living at 1,000 meters above the sea level, where SF6 or C3F8 tamponade could not be performed because of the risk of acute increase of intraocular pressure (IOP). One thousand centistokes SO was used in all eyes. At all visits, patients had a detailed ocular history and thorough bilateral evaluation, including best-corrected visual acuity, anterior segment examination, and IOP measurements by aplanation and fundus examination. Outcomes were assessed at 1 day, 1 week, 1 month, 3 months, 6 months, and every 6 months thereafter. Increased IOP was defined as an IOP of more than 21 mmHg. RESULTS Anatomical success rate, final best-corrected visual acuity, IOP elevation, cataract formation, and other complications were the main outcome measures. This study included 62 eyes of 62 patients (41 men and 21 women) that underwent retinal detachment repair by PPV and SO injection. The age at the time of intervention was 57.6 ± 10.5 years (mean ± standard deviation; range, 34-79 years). All patients were whites. Mean follow-up was 24.5 ± 17.3 months (range, 6-70 months). Anatomical success rate defined as retinal reattachment 6 months after SO removal was 93.5%. Final BCVA was improved in 55 eyes (88.7%), with a mean of 4 Snellen lines, unchanged in 5 (8.1%), and worse in 2 eyes (3.2%), with a mean of 3 Snellen lines. Mean duration of SO tamponade was 5.12 ± 2.37 months (range, 2-12 months). From the 30 eyes that were still phakic after vitrectomy, 24 eyes (80.0%) underwent cataract surgery within a period of 7.37 ± 3.00 months (range, 2-13 months). Thirty-five eyes (56.5%) had an increase in IOP during the follow-up period. Thirty-one patients had transient ocular hypertension requiring topical treatment during the immediate postoperative period (one month). Only 1 eye (2.9%) required filtrating drainage surgery for IOP control. No eyes developed optic neuropathy secondary to IOP elevation. CONCLUSION Pars plana vitrectomy with SO injection seems to be a safe and efficient surgical approach in the treatment of primary uncomplicated rhegmatogenous retinal detachment in patients living in high altitude (>1,000 m). Also, PPV and SO injection are associated with good anatomical and functional outcomes in our series. Reattachment rates are high, and rates of proliferative vitreoretinopathy are low. Cataract formation and elevated IOP represent frequent but successfully controlled complications.
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ASSOCIATION STUDY BETWEEN POLYMORPHISMS OF THE p53 AND LYMPHOTOXIN ALPHA (LTA) GENES AND THE RISK OF PROLIFERATIVE VITREORETINOPATHY/RETINAL DETACHMENT IN A MEXICAN POPULATION. Retina 2017; 38:187-191. [PMID: 28106707 DOI: 10.1097/iae.0000000000001508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE To report the results of an association study between single-nucleotide polymorphisms of the p53 and LTA genes and the risk of proliferative vitreoretinopathy (PVR)/retinal detachment (RD) in a Mexican cohort. METHODS A total of 380 unrelated subjects were studied, including 98 patients with primary rhegmatogenous RD without PVR, 82 patients with PVR after RD surgery, and 200 healthy, ethnically matched subjects. Genotyping of single-nucleotide polymorphisms rs1042522 (p53 gene) and rs2229094 (LTA gene) was performed by direct nucleotide sequencing. Allele frequencies, genotype frequencies, and Hardy-Weinberg equilibrium were assessed with HaploView software. RESULTS No significant differences in the allelic distributions of the previously identified risk C allele for LTA rs2229094 were observed between RD subjects and controls (odds ratio [95% confidence interval] = 0.8 [0.5-1.2]; P = 0.3). Conversely, the C allele for rs1042522 in p53 was positively associated with an increased risk for RD (odds ratio [95% confidence interval] = 1.4 [1.01-1.9]; P = 0.04). No significant differences were observed when the subgroup of 82 RD + PVR subjects was compared with the subgroup of 98 patients with RD. CONCLUSION The C allele for rs1042522 in p53 was genetically associated with a higher risk for RD but not for PVR in this cohort. This is the first association study attempting replication of PVR-associated risk alleles in a nonwhite population.
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Poulsen CD, Peto T, Grauslund J, Green A. Epidemiologic characteristics of retinal detachment surgery at a specialized unit in Denmark. Acta Ophthalmol 2016; 94:548-55. [PMID: 27238952 DOI: 10.1111/aos.13113] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 04/04/2016] [Indexed: 12/17/2022]
Abstract
PURPOSE To examine the incidence of retinal detachments and to evaluate patient profiles and surgical characteristics. METHODS Retrospective review of patients operated for primary retinal detachment (RD) and redetachment between 2010 and 2012 at the Department of Ophthalmology, Odense University Hospital, Denmark. We included all RD such as rhegmatogenous retinal detachment (RRD), tractional retinal detachment (TRD) and exudative retinal detachment (ERD). RESULTS In total, 779 RD surgeries were performed: 83.7% (n = 652) primary operations and 16.3% (n = 127) reoperation. For primary operation, pars plana vitrectomy (PPV), scleral buckling and combined operations were performed in 95.1% (n = 620), 4.6% (n = 30) and 0.3% (n = 2) respectively. Over time there was less use of silicone oil and greater use of gas tamponade (p = <0.001), less simultaneous cataract operations (p = <0.001), less use of cryotherapy (p = 0.045) and more use of peeling procedures (p = <0.001) in primary operations. The annual incidence of surgery for primary RD was 22.0 [95% confidence interval (CI) 20.4-23.8] per 100 000 inhabitants aged >15 years. Retinal detachment (RD) was more common in males than females (1.8:1), and mean age at presentation was 61.8 years (standard deviations ± 12.3). The annual incidence for RRD and TRD operation was 20.72 (95% CI 19.11-22.43) and 1.25 (95% CI 0.9-1.7) per 100 000 inhabitants >15 years. CONCLUSION This study presents the first overall incidence for RD in Denmark. The highest incidence of RRD was among males aged 60 to 79 years, whereas TRD was among females at same age. Pars plana vitrectomy (PPV) was the preferred surgical technique, and during 2012 all RD patients were treated with PPV, independent of lens status and age.
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Affiliation(s)
- Christina Doefler Poulsen
- Department of Ophthalmology; Odense University Hospital; Odense C Denmark
- OPEN, Odense Patient data Explorative Network; Odense University Hospital; Odense Denmark
- Department of Clinical Research; University of Southern Denmark; Odense Denmark
| | - Tunde Peto
- Department of Clinical Research; University of Southern Denmark; Odense Denmark
- The NIHR Biomedical Research Centre; Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology; London UK
| | - Jakob Grauslund
- Department of Ophthalmology; Odense University Hospital; Odense C Denmark
- Department of Clinical Research; University of Southern Denmark; Odense Denmark
| | - Anders Green
- OPEN, Odense Patient data Explorative Network; Odense University Hospital; Odense Denmark
- Department of Clinical Research; University of Southern Denmark; Odense Denmark
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Success Rates of Vitrectomy in Treatment of Rhegmatogenous Retinal Detachment. J Ophthalmol 2016; 2016:2193518. [PMID: 27478632 PMCID: PMC4961815 DOI: 10.1155/2016/2193518] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 06/01/2016] [Indexed: 12/02/2022] Open
Abstract
Aim. To investigate the anatomical success rates of pars plana vitrectomy (PPV) after primary rhegmatogenous retinal detachment (RRD). Methods. This retrospective study was conducted between December 2008 and October 2014 at Nagasaki University Hospital. The preoperative data recorded included the lens status, location of the retinal tear, whether a tear was visualized, presence of multiple tears, macula status, presence of peripheral lattice retinal degeneration, and best-corrected visual acuity (BCVA). The primary outcome measures were anatomical (primary and final) and functional success (visual acuity better than 6/60). Results. This study evaluated 422 eyes of 411 patients with a mean age of 57.7 ± 11.2 years. The single-operation reattachment rate (primary anatomical success) was 89.8%. The final anatomical success rate was 100% after 2–6 operations (mean = 3.14 ± 1.03). Functional success rate after the primary reattachment operation was 96.7%, while it was 97.2% at the end of the follow-up. Multiple logistic regression analysis of the possible risk factors for the primary anatomical failure showed a significant relation with the 25 G instruments (P = 0.002) and the presence of multiple tears (P = 0.01). Conclusion. The primary anatomical success of PPV for primary uncomplicated RRD was 89.8% and the final anatomical success rate was 100%.
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Di Lauro S, Castrejón M, Fernández I, Rojas J, Coco RM, Sanabria MR, Rodríguez de la Rua E, Pastor JC. Loss of Visual Acuity after Successful Surgery for Macula-On Rhegmatogenous Retinal Detachment in a Prospective Multicentre Study. J Ophthalmol 2015; 2015:821864. [PMID: 26640704 PMCID: PMC4660023 DOI: 10.1155/2015/821864] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 10/18/2015] [Accepted: 10/22/2015] [Indexed: 11/18/2022] Open
Abstract
Purpose. To quantify the frequency of visual loss after successful retinal detachment (RD) surgery in macula-on patients in a multicentric, prospective series of RD. Methods. Clinical variables from consecutive macula-on RD patients were collected in a prospective multicentric study. Visual loss was defined as at least a reduction in one line in best corrected visual acuity (VA) with Snellen chart. The series were divided into 4 subgroups: (1) all macula-on eyes (n = 357); (2) macula-on patients with visual loss at the third month of follow-up (n = 53) which were further subdivided in (3) phakic eyes (n = 39); and (4) pseudophakic eyes (n = 14). Results. Fifty-three eyes (14.9%) had visual loss three months after surgery (n = 39 phakic eyes; n = 14 pseudophakic eyes). There were no statistically significant differences between them regarding their clinical characteristics. Pars plana vitrectomy (PPV) was used in 67.2% of cases, scleral buckle in 57.7%, and scleral explant in 11.9% (36.1% were combined procedures). Conclusions. Around 15% of macula-on RD eyes lose VA after successful surgery. Development of cataracts may be one cause in phakic eyes, but vision loss in pseudophakic eyes could have other explanations such as the effect of released factors produced by retinal ischemia on the macula area. Further investigations are necessary to elucidate this hypothesis.
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Affiliation(s)
- Salvatore Di Lauro
- IOBA (Eye Institute), University of Valladolid, 47011 Valladolid, Spain
- Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
| | - Melissa Castrejón
- IOBA (Eye Institute), University of Valladolid, 47011 Valladolid, Spain
| | - Itziar Fernández
- IOBA (Eye Institute), University of Valladolid, 47011 Valladolid, Spain
- Ciber-BBN, 47011 Valladolid, Spain
| | - Jimena Rojas
- IOBA (Eye Institute), University of Valladolid, 47011 Valladolid, Spain
| | - Rosa M. Coco
- IOBA (Eye Institute), University of Valladolid, 47011 Valladolid, Spain
| | - María R. Sanabria
- IOBA (Eye Institute), University of Valladolid, 47011 Valladolid, Spain
- Complejo Asistencial de Palencia (CAPA), 34005 Palencia, Spain
| | | | - J. Carlos Pastor
- IOBA (Eye Institute), University of Valladolid, 47011 Valladolid, Spain
- Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
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Pastor-Idoate S, Rodríguez-Hernández I, Rojas J, Fernández I, García-Gutierrez MT, Ruiz-Moreno JM, Rocha-Sousa A, Ramkissoon YD, Harsum S, MacLaren RE, Charteris DG, Van Meurs JC, González-Sarmiento R, Pastor JC. BAX and BCL-2 polymorphisms, as predictors of proliferative vitreoretinopathy development in patients suffering retinal detachment: the Retina 4 project. Acta Ophthalmol 2015; 93:e541-9. [PMID: 25991504 DOI: 10.1111/aos.12718] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Accepted: 02/18/2015] [Indexed: 12/31/2022]
Abstract
PURPOSE To compare the distribution of BCL-2 -938C>A (rs2279115) and BAX -248G>A (rs4645878) genotypes among European subjects undergoing rhegmatogenous retinal detachment (RRD) surgery in relation to the further development of proliferative vitreoretinopathy (PVR). METHODS A case-control gene association study, as a part of Retina 4 project, was designed. rs2279115 and rs4645878 polymorphisms were analysed in 555 samples from patients with RRD (134 with PVR secondary to surgery). Proportions of genotypes and AA homozygous groups of BCL-2 and BAX polymorphisms between subsamples were analysed in two phases. Genotypic and allelic frequencies were compared in global sample and in subsamples. RESULTS BAX: Differences were observed in the genotype frequencies and in AA carriers between controls and cases in the global series. The odds ratio (OR) of A carriers in the global sample was 1.7 (95% CI: 1.23-2.51). Proportions of genotypes in Spain + Portugal were significant different. The OR of A carriers from Spain and Portugal was 1.8 (95% CI: 1.11-2.95). BCL-2: No significant differences were observed in genotype frequencies. However, proportions of genotypes in Spain + Portugal were significant. A protective effect (OR: 0.6 95% CI: 0.43-0.96) was found in A carriers from Spain and Portugal. CONCLUSIONS Results suggest that A allele of rs4645878 could be a biomarker of high risk of developing PVR in patients undergoing RD surgery. The possible role of BCL-2 (inhibitor of necroptosis pathway) as a possible new target in PVR prophylaxis should be investigated.
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Affiliation(s)
- Salvador Pastor-Idoate
- Instituto de Oftalmobiología Aplicada (IOBA-Retina Group); University of Valladolid; Valladolid Spain
- Unidad de Medicina Molecular; Departamento de Medicina; University of Salamanca; Salamanca Spain
| | - Irene Rodríguez-Hernández
- Unidad de Medicina Molecular; Departamento de Medicina; University of Salamanca; Salamanca Spain
- Instituto de Biología Molecular y Celular del Cáncer (IBMCC); Consejo Superior de Investigaciones Científicas (CSIC); Instituto de Investigación Biomédica de Salamanca (IBSAL); University of Salamanca; Salamanca Spain
| | - Jimena Rojas
- Instituto de Oftalmobiología Aplicada (IOBA-Retina Group); University of Valladolid; Valladolid Spain
| | - Itziar Fernández
- Instituto de Oftalmobiología Aplicada (IOBA-Retina Group); University of Valladolid; Valladolid Spain
| | | | | | - Amandio Rocha-Sousa
- Department of Sense Organs; Medical School; Hospital SanJoão; University of Porto; Porto Portugal
| | - Yashin D. Ramkissoon
- Moorfields Eye Hospital; National Institute of Health Research (NIHR); Biomedical Research Centre; London UK
- Royal Hallamshire Hospital; University of Sheffield; Sheffield UK
| | - Steven Harsum
- Moorfields Eye Hospital; National Institute of Health Research (NIHR); Biomedical Research Centre; London UK
| | - Robert E. MacLaren
- Moorfields Eye Hospital; National Institute of Health Research (NIHR); Biomedical Research Centre; London UK
- Nuffield Laboratory of Ophthalmology; John Radcliffe Hospital; University of Oxford; Oxford UK
| | - David G. Charteris
- Moorfields Eye Hospital; National Institute of Health Research (NIHR); Biomedical Research Centre; London UK
| | - Jan C. Van Meurs
- Rotterdam Eye Hospital; Erasmus Medical Center; University of Rotterdam; Rotterdam The Netherlands
| | - Rogelio González-Sarmiento
- Unidad de Medicina Molecular; Departamento de Medicina; University of Salamanca; Salamanca Spain
- Instituto de Biología Molecular y Celular del Cáncer (IBMCC); Consejo Superior de Investigaciones Científicas (CSIC); Instituto de Investigación Biomédica de Salamanca (IBSAL); University of Salamanca; Salamanca Spain
| | - Jose C. Pastor
- Instituto de Oftalmobiología Aplicada (IOBA-Retina Group); University of Valladolid; Valladolid Spain
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Pennock S, Haddock LJ, Mukai S, Kazlauskas A. Vascular endothelial growth factor acts primarily via platelet-derived growth factor receptor α to promote proliferative vitreoretinopathy. THE AMERICAN JOURNAL OF PATHOLOGY 2014; 184:3052-68. [PMID: 25261788 DOI: 10.1016/j.ajpath.2014.07.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 07/09/2014] [Accepted: 07/24/2014] [Indexed: 01/22/2023]
Abstract
Proliferative vitreoretinopathy (PVR) is a nonneovascular blinding disease and the leading cause for failure in surgical repair of rhegmatogenous retinal detachments. Once formed, PVR is difficult to treat. Hence, there is an acute interest in developing approaches to prevent PVR. Of the many growth factors and cytokines that accumulate in vitreous as PVR develops, neutralizing vascular endothelial growth factor (VEGF) A has recently been found to prevent PVR in at least one animal model. The goal of this study was to test if Food and Drug Administration-approved agents could protect the eye from PVR in multiple animal models and to further investigate the underlying mechanisms. Neutralizing VEGF with aflibercept (VEGF Trap-Eye) safely and effectively protected rabbits from PVR in multiple models of disease. Furthermore, aflibercept reduced the bioactivity of both experimental and clinical PVR vitreous. Finally, although VEGF could promote some PVR-associated cellular responses via VEGF receptors expressed on the retinal pigment epithelial cells that drive this disease, VEGF's major contribution to vitreal bioactivity occurred via platelet-derived growth factor receptor α. Thus, VEGF promotes PVR by a noncanonical ability to engage platelet-derived growth factor receptor α. These findings indicate that VEGF contributes to nonangiogenic diseases and that anti-VEGF-based therapies may be effective on a wider spectrum of diseases than previously appreciated.
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Affiliation(s)
- Steven Pennock
- The Schepens Eye Research Institute and Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Luis J Haddock
- The Schepens Eye Research Institute and Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Shizuo Mukai
- The Schepens Eye Research Institute and Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Andrius Kazlauskas
- The Schepens Eye Research Institute and Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
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Trends and factors related to outcomes for primary rhegmatogenous retinal detachment surgery in a large asian tertiary eye center. Retina 2014; 34:684-92. [PMID: 24169100 DOI: 10.1097/iae.0b013e3182a48900] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe trends and outcomes of vitreoretinal surgery for primary rhegmatogenous retinal detachment in a large Asian tertiary eye center. METHODS Retrospective review of 1,530 eyes with primary retinal detachment between 2005 and 2011 managed at the Singapore National Eye Center by one of the following: scleral buckling (SB), pars plana vitrectomy (PPV), and combined SB and PPV (SB + PPV). Anatomical and functional outcomes were assessed. RESULTS There was a trend toward PPV and PPV + SB as the primary reattachment procedure from 2005 to 2011. The primary anatomical success rate for PPV (78.6%) was worse than that for SB (88.8%) or SB + PPV (89.0%, P = 0.000). Final anatomical success rates were similar for all 3 procedures: SB 97.7%, PPV 95.2%, and SB + PPV 96.4%. Better functional success was achieved in the SB group (86.1%) than both the PPV (72.5%) and SB + PPV groups (77.5%, P = 0.000), partly attributable to the less complex nature of retinal detachments in the SB group. Older age and proliferative vitreoretinopathy were related to the poor functional outcomes in both phakic and pseudophakic eyes. CONCLUSION There was an increasing trend toward PPV and PPV + SB as the primary retinal reattachment surgery from 2005 through to 2011. High rates of anatomical and functional outcomes were achieved with SB, PPV, and SB + PPV, proliferative vitreoretinopathy and older age were negatively correlated with the functional success in both phakic and pseudophakic eyes.
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Rojas J, Fernandez I, Pastor JC, MacLaren RE, Ramkissoon Y, Harsum S, Charteris DG, Van Meurs JC, Amarakoon S, Garcia-Arumi J, Ruiz-Moreno JM, Rocha-Sousa A, Brion M, Carracedo A. Predicting proliferative vitreoretinopathy: temporal and external validation of models based on genetic and clinical variables. Br J Ophthalmol 2014; 99:41-8. [DOI: 10.1136/bjophthalmol-2014-305263] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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External validation of existing formulas to predict the risk of developing proliferative vitreoretinopathy: the Retina 1 Project; report 5. Retina 2014; 33:1519-27. [PMID: 23594721 DOI: 10.1097/iae.0b013e31828991ea] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To externally validate the accuracy of previously published formulas for predicting proliferative vitreoretinopathy development after retinal detachment surgery. METHODS Clinical variables from consecutive retinal detachment patients (n = 1,047) were collected from the Retina 1 Project conducted in 17 Spanish and Portuguese centers. These data were used for external validation of four previously published formulas, F1 to F4. Receiver-operating characteristic curves were used to validate the quality of formulas, and measures of discrimination, precision, and calibration were calculated for each. Concordance among the formulas was determined by Cohen kappa index. RESULTS The areas under the receiver-operating characteristic curves were as follows: F1, 0.5809; F2, 0.5398; F3, 0.5964; and F4, 0.4617. F1 had the highest accuracy, 74.21%. Almost 19% of proliferative vitreoretinopathy cases were correctly classified by F1 compared with 13%, 15%, and 10% for F2, F3, and F4, respectively. There was moderate concordance between F2 and F3 but little between the other formulas. CONCLUSION After external validation, none of the formulas were accurate enough for routine clinical use. To increase its usefulness, other factors besides the clinical ones considered here should be incorporated into future formulas for predicting risk of developing proliferative vitreoretinopathy.
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Feltgen N, Walter P. Rhegmatogenous retinal detachment--an ophthalmologic emergency. DEUTSCHES ARZTEBLATT INTERNATIONAL 2014; 111:12-21; quiz 22. [PMID: 24565273 PMCID: PMC3948016 DOI: 10.3238/arztebl.2014.0012] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 09/09/2013] [Accepted: 09/09/2013] [Indexed: 12/29/2022]
Abstract
BACKGROUND Rhegmatogenous retinal detachment is the most common retinological emergency threatening vision, with an incidence of 1 in 10 000 persons per year, corresponding to about 8000 new cases in Germany annually. Without treatment, blindness in the affected eye may result. METHOD Selective review of the literature. RESULTS Rhegmatogenous retinal detachment typically presents with the perception of light flashes, floaters, or a "dark curtain." In most cases, the retinal tear is a consequence of degeneration of the vitreous body. Epidemiologic studies have identified myopia and prior cataract surgery as the main risk factors. Persons in the sixth and seventh decades of life are most commonly affected. Rhegmatogenous retinal detachment is an emergency, and all patients should be seen by an ophthalmologist on the same day that symptoms arise. The treatment consists of scleral buckle, removal of the vitreous body (vitrectomy), or a combination of the two. Anatomical success rates are in the range of 85% to 90%. Vitrectomy is followed by lens opacification in more than 70% of cases. The earlier the patient is seen by an ophthalmologist, the greater the chance that the macula is still attached, so that visual acuity can be preserved. CONCLUSION Rhegmatogenous retinal detachment is among the main emergency indications in ophthalmology. In all such cases, an ophthalmologist must be consulted at once.
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Pastor-Idoate S, Rodríguez-Hernández I, Rojas J, Fernández I, García-Gutiérrez MT, Ruiz-Moreno JM, Rocha-Sousa A, Ramkissoon Y, Harsum S, MacLaren RE, Charteris D, VanMeurs JC, González-Sarmiento R, Pastor JC. The T309G MDM2 gene polymorphism is a novel risk factor for proliferative vitreoretinopathy. PLoS One 2013; 8:e82283. [PMID: 24349246 PMCID: PMC3857251 DOI: 10.1371/journal.pone.0082283] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 10/31/2013] [Indexed: 11/25/2022] Open
Abstract
Proliferative vitreoretinopathy (PVR) is still the major cause of failure in retinal detachment (RD) surgery. It is believed that down-regulation in the p53 pathway could be an important key in PVR pathogenesis. The purpose was to evaluate the impact of T309G MDM2 polymorphism (rs2279744) in PVR. Distribution of T309G MDM2 genotypes among European subjects undergoing RD surgery was evaluated. Proportions of genotypes between subsamples from different countries were analyzed. Also, a genetic interaction between rs2279744 in MDM2 and rs1042522 in p53 gene was analyzed. Significant differences were observed comparing MDM2 genotype frequencies at position 309 of intron 1 between cases (GG: 21.6%, TG: 54.5%, TT: 23.8%) and controls (GG: 7.3%, TG: 43.9%, TT: 48.7%). The proportions of genotypes between sub-samples from different countries showed a significant difference. Distribution of GG genotype revealed differences in Spain (35.1–53.0)/(22.6–32.9), Portugal (39.0–74.4)/(21.4–38.9), Netherlands (40.6–66.3)/(25.3–38.8) and UK (37.5–62.4)/(23.3–34.2). The OR of G carriers in the global sample was 5.9 (95% CI: 3.2 to 11.2). The OR of G carriers from Spain and Portugal was 5.4 (95% CI: 2.2–12.7), whereas in the UK and the Netherlands was 7.3 (95% CI: 2.8–19.1). Results indicate that the G allele of rs2279744 is associated with a higher risk of developing PVR in patients undergoing a RD surgery. Further studies are necessary to understand the role of this SNP in the development of PVR.
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Affiliation(s)
- Salvador Pastor-Idoate
- Instituto de Oftalmobiología (IOBA-Retina Group), University of Valladolid, Valladolid, Spain
- Unidad de Medicina Molecular, Departamento de Medicina, University of Salamanca, Salamanca, Spain
| | - Irene Rodríguez-Hernández
- Unidad de Medicina Molecular, Departamento de Medicina, University of Salamanca, Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL) and Instituto de Biología Molecular y Celular del Cáncer (IBMCC), University of Salamanca–CSIC-SACYL, Salamanca, Spain
| | - Jimena Rojas
- Instituto de Oftalmobiología (IOBA-Retina Group), University of Valladolid, Valladolid, Spain
| | - Itziar Fernández
- Instituto de Oftalmobiología (IOBA-Retina Group), University of Valladolid, Valladolid, Spain
| | | | | | - Amandio Rocha-Sousa
- Department of Sense Organs, Medical School, University of Porto, Hospital San João, Porto, Portugal
| | - Yashin Ramkissoon
- Moorfields Eye Hospital, National Institute of Health Research (NIHR), Biomedical Research Centre, London, United Kingdom
| | - Steven Harsum
- Moorfields Eye Hospital, National Institute of Health Research (NIHR), Biomedical Research Centre, London, United Kingdom
| | - Robert E. MacLaren
- Moorfields Eye Hospital, National Institute of Health Research (NIHR), Biomedical Research Centre, London, United Kingdom
- Nuffield Laboratory of Ophthalmology, University of Oxford, John Radcliffe Hospital Oxford, United Kingdom
| | - David Charteris
- Moorfields Eye Hospital, National Institute of Health Research (NIHR), Biomedical Research Centre, London, United Kingdom
| | - Jan C. VanMeurs
- Rotterdam Eye Hospital, Erasmus Medical Center, University of Rotterdam, The Netherlands
| | - Rogelio González-Sarmiento
- Unidad de Medicina Molecular, Departamento de Medicina, University of Salamanca, Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL) and Instituto de Biología Molecular y Celular del Cáncer (IBMCC), University of Salamanca–CSIC-SACYL, Salamanca, Spain
- * E-mail: (RGS); (JCP)
| | - José C. Pastor
- Instituto de Oftalmobiología (IOBA-Retina Group), University of Valladolid, Valladolid, Spain
- * E-mail: (RGS); (JCP)
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Zabalza I, Royo-Dujardin L, Rodríguez-García L, De La Rúa ER, Pastor JC. Regional practice patterns for retinal detachment repair in the United States. Am J Ophthalmol 2013; 156:206-7. [PMID: 23791378 DOI: 10.1016/j.ajo.2013.03.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Revised: 02/25/2013] [Accepted: 03/20/2013] [Indexed: 11/27/2022]
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The p53 Codon 72 Polymorphism (rs1042522) Is Associated with Proliferative Vitreoretinopathy. Ophthalmology 2013. [DOI: 10.1016/j.ophtha.2012.08.019] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Yu H, Li T, Zou X, Yuan L, Hu J, Xu Z, Peng L, Zhang C, Zou Y. Effects of Lysyl Oxidase Genetic Variants on the Susceptibility to Rhegmatogenous Retinal Detachment and Proliferative Vitreoretinopathy. Inflammation 2013; 36:839-44. [DOI: 10.1007/s10753-013-9610-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pastor JC, Fernández I, Coco RM, Sanabria MR, Rodríguez de la Rúa E, Piñon RM, Martinez V, Sala-Puigdollers A, Gallardo JM, Velilla S. Variations in Functional and Anatomical Outcomes and in Proliferative Vitreoretinopathy Rate along a Prospective Collaborative Study on Primary Rhegmatogenous Retinal Detachments: The Retina 1 Project-Report 4. ISRN OPHTHALMOLOGY 2012; 2012:206385. [PMID: 24527230 PMCID: PMC3912585 DOI: 10.5402/2012/206385] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 09/26/2012] [Indexed: 11/24/2022]
Abstract
Purpose. To analyse variations in the anatomical and functional outcomes and in proliferative vitreoretinopathy (PVR) rate of a prospective multicentric study that was primarily designed for identification of clinical risk factors for PVR. Methods. 1,046 retinal detachment (RD) cases were analysed. Cases were divided into two series based upon variation in PVR rate determined by logistic regression analysis. Series 1 (S1) included RD treated during 2004-2005 (n = 481) and Series 2 (S2) during 2006–2008 (n = 565). Pre-, intra-, and postoperative characteristics were recorded. Results. There were few differences in the preoperative characteristics. S2 had more vitrectomies and scleral bands and fewer explants and associated cataract extractions than S1. Anatomic reattachment improved from 87.9% to 92.9% in S1 and S2, respectively, (P = 0.006). Visual acuity at 3 months ≥20/40 increased from 36.5% of S1 to 44.2% in S2 (P = 0.049). PVR rate diminished from 14.1% in S1 to 8.1% in S2 (P = 0.002). Centres with higher rates of PVR in S1 showed the greatest reductions in S2. Conclusion. An improvement in anatomical and functional outcome and PVR rate occurred in participating centres cannot be attributed to the learning curve of surgeons. We speculated that it could be an effect of their participation in the study.
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Affiliation(s)
- J Carlos Pastor
- Institute of Applied Ophthalmobiology (IOBA), University of Valladolid, 47011 Valladolid, Spain ; Department of Ophthalmology, Hospital Clínico Universitario de Valladolid, 47005 Valladolid, Spain ; Ciber BBN, 50018 Zaragoza, Spain
| | - Itziar Fernández
- Institute of Applied Ophthalmobiology (IOBA), University of Valladolid, 47011 Valladolid, Spain ; Ciber BBN, 50018 Zaragoza, Spain
| | - Rosa M Coco
- Institute of Applied Ophthalmobiology (IOBA), University of Valladolid, 47011 Valladolid, Spain
| | - María R Sanabria
- Institute of Applied Ophthalmobiology (IOBA), University of Valladolid, 47011 Valladolid, Spain ; Department of Ophthalmology, Complejo Asistencial de Palencia (CAPA), 34005 Palencia, Spain
| | - Enrique Rodríguez de la Rúa
- Institute of Applied Ophthalmobiology (IOBA), University of Valladolid, 47011 Valladolid, Spain ; Department of Ophthalmology, Hospital Universitario Puerta del Mar, 11009 Cádiz, Spain
| | - Rosa M Piñon
- Department of Ophthalmology, Hospital General Universitario de Burgos, 09005 Burgos, Spain
| | - Vicente Martinez
- Department of Ophthalmology, Hospital Vall d'Hebrón, 08035 Barcelona, Spain
| | - Anna Sala-Puigdollers
- Institute of Applied Ophthalmobiology (IOBA), University of Valladolid, 47011 Valladolid, Spain ; Department of Ophthalmology, Hospital Clínico Universitario de Valladolid, 47005 Valladolid, Spain
| | - José M Gallardo
- Department of Ophthalmology, Hospital Reina Sofia, 14004 Córdoba, Spain
| | - Sara Velilla
- Department of Ophthalmology, Hospital San Millán, 26006 Logroño, Spain
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García-Arumí J, Martínez-Castillo V, Boixadera A, Blasco H, Marticorena J, Zapata MÁ, Macià C, Badal J, Distéfano L, Rafart JM, Berrocal M, Zambrano A, Ruíz-Moreno JM, Figueroa MS. Rhegmatogenous retinal detachment treatment guidelines. ACTA ACUST UNITED AC 2012; 88:11-35. [PMID: 23414946 DOI: 10.1016/j.oftal.2011.10.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Accepted: 10/10/2011] [Indexed: 11/15/2022]
Abstract
This paper outlines general guidelines following the initial diagnosis of rhegmatogenous retinal detachment. These include preoperative evaluation, treatment, possible intra- and post-operative complications, retinal re-detachment, and all therapeutic options available for each case. Treatment of the traumatic retinal detachment is also described, due to its importance and peculiarities. Treatment or prophylactic guidelines are suggested for the different types of retinal detachment described. These are based on both the experience of the ophthalmologists that have participated in preparing the guidelines, and also on evidence-based grading linked to bibliographical sources. However, these guidelines should not be interpreted as being mandatory. Given that there is a wide spectrum of options for treatment of retinal detachment, the surgeons' experience with one or other surgical technique will be of utmost importance in obtaining the best surgical result. As guidelines, they are intended as an additional aid to the surgeon during the decision-making process, with the expectation that the final choice will still be left to the surgeon's judgment and past experience.
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Affiliation(s)
- J García-Arumí
- Departamento de Oftalmología, Universidad Autónoma de Barcelona, Barcelona, Spain.
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A propensity score matching application: indications and results of adding scleral buckle to vitrectomy: The Retina 1 Project: Report 3. Eur J Ophthalmol 2012; 22:244-53. [PMID: 21484754 DOI: 10.5301/ejo.2011.6528] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2011] [Indexed: 11/20/2022]
Abstract
PURPOSE To identify the indications and differences in outcomes for adding a scleral buckle (SB) to pars plana vitrectomy (PPV) in a prospective series of rhegmatogenous retinal detachment (RD) by using propensity score matching (PSM) to analyze causal effects in observational studies. METHODS Data were collected from the Retina 1 Project, a prospective, interventional, nonrandomized study of consecutive RDs. Case selection was based upon treatment with PPV or PPV+SB. Surgeons followed personal criteria for the inclusion of SB in the PPV. Propensity score matching corrected for selection biases. Outcomes were assessed by anatomic and visual criteria and the development of proliferative vitreoretinopathy. RESULTS Of 523 patients analyzed, 251 had PPV and 272 had PPV+SB. Surgeons used PPV+SB more frequently in younger patients with RD, in those with posterior or unidentified breaks, in phakic eyes, in eyes with the posterior vitreous attached, and for more extended RDs. Overall single surgery anatomic success rate was 86.4%. Based on PSM, there were no difference in reattachment rates of the PPV group, 86.9%, and the PPV+SB group, 85.93%. The incidence of PVR was similar in both groups, with 8.5% in the PPV group and 10.5% in the PPV+SB group. CONCLUSIONS Data from the Retina 1 Project established the indications for adding SB to PPV in treating primary RD in this series. No anatomic or visual differences between PPV and PPV+SB were found.
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How we currently choose to repair retinal detachment in the United States medicare population. Am J Ophthalmol 2012; 153:1013-5.e1. [PMID: 22607970 DOI: 10.1016/j.ajo.2012.01.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 01/17/2012] [Accepted: 01/17/2012] [Indexed: 11/20/2022]
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Pastor JC, Fernández I, Rojas J, Coco R, Sanabria MR, Rodríguez-de la Rúa E, Sánchez D, Valverde C, Sala-Puigdollers A. Training and professional profile of retinologists in Spain: Retina 2 project, Report 4. Clin Ophthalmol 2011; 5:483-90. [PMID: 21573096 PMCID: PMC3090303 DOI: 10.2147/opth.s17100] [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: 04/19/2011] [Indexed: 11/23/2022] Open
Abstract
Background: Uniform postresidency systems to train medical specialists have not been developed in most European countries. Before developing a framework for such a system, we established the learning and professional profiles of Spanish ophthalmologists dedicated to medical retina and vitreoretina subspecialties. Methods: After identification of presumed subspecialists by experts from different autonomous regions, a self-administered questionnaire was mailed in 2006. A reminder was sent three weeks later. Postal mail was used. Nonresponder bias was determined. Results: Of 492 possible retina subspecialists, 261 replied to the questionnaires. While about 86% received specific retinal training, standardized fellowship programs were uncommon for both medical retina and vitreoretina (around 10%). Of the responders, 24.5% performed only medical retina, 11.8% vitreoretina, and 63.6% both. Most (60.5%) practiced anterior segment surgery, and 78.7% declared skills in vitrectomy. Conclusion: We have developed a database of Spanish ophthalmologists dedicated to retinal pathologies and identified some characteristics of their professional profile. Although most of them have received specific retinal training, standardized mastership programs are still uncommon. These data will be useful in creating a standardized Retina Mastership, an important goal of the European Higher Education Area.
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Affiliation(s)
- J Carlos Pastor
- University Institute of Applied Ophthalmobiology (IOBA), Retina Group
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Rojas J, Fernandez I, Pastor JC, Garcia-Gutierrez MT, Sanabria MR, Brion M, Coco RM, Ruiz-Moreno JM, Garcia-Arumi J, Elizalde J, Ruiz-Miguel M, Gallardo JM, Corrales RM, Carracedo A. A strong genetic association between the tumor necrosis factor locus and proliferative vitreoretinopathy: the retina 4 project. Ophthalmology 2010; 117:2417-2423.e1-2. [PMID: 20663564 DOI: 10.1016/j.ophtha.2010.03.059] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Revised: 03/15/2010] [Accepted: 03/26/2010] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To assess the genetic contribution to proliferative vitreoretinopathy (PVR) and report the strong association observed in the tumor necrosis factor (TNF) locus. DESIGN As a component of The Retina 4 Project, a case-controlled, candidate gene association study in the TNF locus was conducted. PARTICIPANTS AND CONTROLS Blood from 450 patients with (138 cases) and without (312 controls) post-rhegmatogenous retinal detachment (RD) PVR was genotyped to determine polymorphisms located in the TNFα gene. METHODS Single nucleotide polymorphisms (SNPs) with correlation coefficients of ≥ 0.8 and a minor allelic frequency of ≥ 10% were studied. Functional SNPs or SNPs previously described in association with other inflammatory diseases were also added for analysis. The SNPlex Genotyping System (Applied Biosystems, Foster City, CA) was used for genotyping. Single nucleotide polymorphism and haplotype analyses were performed. Bioinformatic tools were used to evaluate those SNPs that were significantly associated. MAIN OUTCOME MEASURES Single and haplotypic significant associations with PVR. RESULTS A total of 11 common tag SNPs in the following genes were analyzed: lymphotoxin alpha (LTA), TNFα, leukocyte-specific transcript 1 (LST1), and the activating natural killer receptor p30 (NCR3). After permutation, there was a significant association in the non-synonymous polymorphism rs2229094(T→C) in the LTA gene (P = 0.0283), which encodes a cysteine to arginine change in the signal peptide. This marker was also present in all significant haplotypic associations and was not observed in any nonsignificant associations. When this SNP was analyzed using bioinformatic tools, the hydropathy profile changed, as well as the transmembrane region and the splicing site predictions. CONCLUSIONS The strong association found in the rs2229094(T→C) of the LTA gene may indicate an important role of this polymorphism in the development of PVR. If supported in extended studies, the rs2229094(T→C) may have significant implications regarding the genetic risk of the retinal repairing process.
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Affiliation(s)
- Jimena Rojas
- Institute of Applied Ophthalmobiology, University of Valladolid, Spain
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