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Hurley DJ, Murtagh P, Guerin M. Posterior vitreous detachment rates post-uncomplicated phacoemulsification surgery: a systematic review. Int Ophthalmol 2024; 44:155. [PMID: 38512501 DOI: 10.1007/s10792-024-03091-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 03/05/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE It is commonly accepted that phacoemulsification surgery is a risk factor for the development of posterior vitreous detachment (PVD) and may accelerate the process. This is an important consideration particularly in cases involving young patients who pre-operatively have no PVD, given the increased risk of retinal tears and detachments. METHODS A comprehensive literature search was conducted to identify studies reporting incidence of PVD post-uncomplicated phacoemulsification surgery. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was used for search strategy. Of 3071 titles, 7 studies met the inclusion criteria; The outcomes measured were PVD occurrence by (1) time, (2) type, (3) age, (4) gender and (5) axial length, with all statistical analysis performed using Review Manager. RESULTS A total of 2034 eyes were included for analysis with a mean follow-up time of 28.3 months. 33.3% of patients developed a PVD, either partial or complete, with rates increasing in a time dependent manner. No significant difference was noted in sub-group analysis by age, gender or axial length. CONCLUSIONS The results from our systematic review show that uncomplicated phacoemulsification accelerates the physiological process of PVD development. Pre-operative evaluation of the vitreoretinal interface should be performed with careful post-operative follow-up advised in those without a pre-existing PVD.
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Affiliation(s)
- Daire J Hurley
- Department of Ophthalmology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, D07 R2WY, Ireland.
| | - Patrick Murtagh
- Department of Ophthalmology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, D07 R2WY, Ireland
| | - Marc Guerin
- Department of Ophthalmology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, D07 R2WY, Ireland
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Matoba R, Kanzaki Y, Morita T, Kimura S, Hosokawa MM, Shiode Y, Morizane Y. Evaluation of epiretinal membrane formation after scleral buckling for treating rhegmatogenous retinal detachment: En face optical coherence tomography image-based study. Graefes Arch Clin Exp Ophthalmol 2024; 262:469-476. [PMID: 37864637 DOI: 10.1007/s00417-023-06285-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/07/2023] [Accepted: 10/12/2023] [Indexed: 10/23/2023] Open
Abstract
PURPOSE To assess epiretinal membrane (ERM) formation, severity, and the associated risk factors after scleral buckling using en face optical coherence tomography (OCT) images. METHODS Medical records of 61 consecutive patients (66 eyes) with rhegmatogenous retinal detachment who underwent scleral buckling were retrospectively reviewed. Posterior vitreous detachment (PVD) was determined based on B-scan OCT images. En face OCT images were used to visualize the ERM and retinal folds. ERM formation was identified by comparing en face images pre- and post-surgery. The maximum depth of the retinal folds (MDRF) was measured using en face imaging to objectively assess traction strength. RESULTS ERM formation occurred in 15 (22.7%) eyes at the final visit; the foveal pit was preserved in all cases. Parafoveal retinal folds were present in 5 (7.6%) eyes, with a mean MDRF of 21.8 ± 12.6 µm. No significant difference was observed in best-corrected visual acuity (logarithm of the minimal angle of resolution) between the ERM formation (-0.019 ± 0.128) and non-ERM formation (-0.001 ± 0.213) groups at the final visit (P = 0.593; Mann-Whitney U test). Multivariate logistic regression analysis revealed that older age and the presence of PVD were significant risk factors for ERM formation (odds ratio 1.07, 95% confidence interval 1.01-1.14, P = 0.032; odds ratio 5.26, 95% confidence interval 1.06-26.10, P = 0.042; respectively). CONCLUSION ERM occurred in 22.7% of cases but was mild and did not affect visual acuity. Older age and the presence of PVD are risk factors for ERM formation.
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Affiliation(s)
- Ryo Matoba
- Department of Ophthalmology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-Cho Kita-Ku, Okayama City, Okayama, 700-8558, Japan.
| | - Yuki Kanzaki
- Department of Ophthalmology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-Cho Kita-Ku, Okayama City, Okayama, 700-8558, Japan
| | - Tetsuro Morita
- Department of Ophthalmology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-Cho Kita-Ku, Okayama City, Okayama, 700-8558, Japan
| | - Shuhei Kimura
- Department of Ophthalmology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-Cho Kita-Ku, Okayama City, Okayama, 700-8558, Japan
| | - Mio Morizane Hosokawa
- Department of Ophthalmology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-Cho Kita-Ku, Okayama City, Okayama, 700-8558, Japan
| | - Yusuke Shiode
- Department of Ophthalmology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-Cho Kita-Ku, Okayama City, Okayama, 700-8558, Japan
| | - Yuki Morizane
- Department of Ophthalmology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-Cho Kita-Ku, Okayama City, Okayama, 700-8558, Japan
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Sakaguchi H, Kabata D, Sakimoto S, Shiraki A, Fujimoto H, Fukushima Y, Hara C, Nishida K, Shintani A, Nishida K. Relationship between Full-Thickness Macular Hole Onset and Posterior Vitreous Detachment: A Temporal Onset Theory. Ophthalmol Sci 2023; 3:100339. [PMID: 37409190 PMCID: PMC10318498 DOI: 10.1016/j.xops.2023.100339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 04/30/2023] [Accepted: 05/22/2023] [Indexed: 07/07/2023]
Abstract
Purpose To evaluate the relationship between full-thickness macular hole (FTMH) onset and perifoveal posterior vitreous detachment using OCT data. Design Retrospective study. Participants A total of 742 patients with FTMH or impending macular hole (MH) in ≥ 1 eye, as determined by ophthalmoscopy and OCT. Methods Macular holes were staged using OCT results. Patients with the posterior vitreous membrane clearly detected in the OCT images and vitreoretinal adhesion size ≤ 1500 μm-eyes with MH stages 1-3-were included in the study. The contralateral eyes were also included in the analyses if they showed the focal type of vitreomacular adhesion (VMA) (i.e., vitreoretinal adhesion ≤ 1500 μm). The distance between the posterior vitreous membrane and the surface of the retina was defined as the posterior vitreous separation height (PVSH). Using the OCT images, PVSHs of each eye in 4 directions (nasal, temporal, superior, and inferior) at 1 mm from the center of the MH or fovea were calculated. Main Outcome Measures The main outcome measures were PVSHs according to the MH stage and VMA, the relationship of the foveal inner tear with PVSH, and the likelihood of a foveal inner tear based on the direction. Results The PVSH trends in each of the 4 directions were as follows: VMA < MH stage 1 = MH stage 2 < MH stage 3. Initial MH stage 2 (onset of FTMH) was defined as the presence of a gap in only 1 of the 4 directions from the center of the MH. With increased PVSH, the likelihood of a gap increased (P = 0.002), and a temporal gap was more likely to occur than a nasal gap (P = 0.002). Conclusions At FTMH onset, a foveal inner tear likely appears on the temporal side or the side showing a high PVSH value. Financial Disclosures The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Hirokazu Sakaguchi
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
- Department of Ophthalmology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Daijiro Kabata
- Department of Medical Statistics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Susumu Sakimoto
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Akihiko Shiraki
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hisataka Fujimoto
- Department of Ophthalmology, Kawasaki Medical School, Kurashiki, Japan
| | - Yoko Fukushima
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives (OTRI), Osaka University, Suita, Japan
| | - Chikako Hara
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kentaro Nishida
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Ayumi Shintani
- Department of Medical Statistics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Kohji Nishida
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives (OTRI), Osaka University, Suita, Japan
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Zvorničanin J, Zvorničanin E, Popović M. Accuracy of biomicroscopy, ultrasonography and spectral-domain OCT in detection of complete posterior vitreous detachment. BMC Ophthalmol 2023; 23:488. [PMID: 38017434 PMCID: PMC10685579 DOI: 10.1186/s12886-023-03233-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/20/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND To evaluate the accuracy of preoperative biomicroscopy (BM), ultrasonography (US), and spectral domain optical coherence tomography (SD-OCT) to determine complete posterior vitreous detachment (PVD) confirmed by intraoperative findings of triamcinolone acetonide-assisted pars plana vitrectomy (PPV). METHODS This prospective study included all consecutive patients admitted for surgical treatment of the epiretinal membrane (ERM) and macular hole (MH). The presence of complete PVD was determined one day before PPV using BM, US, SD-OCT. The preoperative findings were compared to the PVD status determined during PPV. RESULTS A total of 123 eyes from 123 patients were included in the study. Indications for PPV included ERM in 57 (46.3%), full thickness macular hole in 57 (46.3%) and lamellar macular hole in 9 (7.3%) patients. Complete PVD during PPV was observed in 18 (31.6%; 95%CI:18.7-49.9) patients with ERM and 13 (19.7%; 95%CI:10.4-33.7) patients with MH. The sensitivity of preoperative BM, US, SD-OCT was 48.4% (95%CI:30.2-66.9), 61.3% (95%CI:42.2-78.2) and 54.8% (95%CI:36.0-72.7) respectively. The specificity of preoperative BM, US, SD-OCT was 81.5% (95%CI:72.1-88.9), 90.2% (95%CI:82.2-95.4) and 85.9% (95%CI:77.0-92.3) respectively. With a prevalence of 25.2% of PVD in our sample the positive predictive value of preoperative BM, US, SD-OCT was 46.9% (95%CI:29.1-65.3), 67.9% (95%CI:47.6-84.1) and 56.7% (95%CI:37.4-74.5) respectively. CONCLUSION Preoperative BM, US, and SD-OCT showed relatively low sensitivity but also good specificity in assessing complete PVD. A combination of all three diagnostic methods can provide a good assessment of the vitreoretinal interface state.
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Affiliation(s)
- Jasmin Zvorničanin
- Department of Ophthalmology, University Clinical Centre Tuzla, 75000, Tuzla, Bosnia and Herzegovina.
- Faculty of Health Studies, University of Bihać, 77000, Bihać, Bosnia and Herzegovina.
| | - Edita Zvorničanin
- Private Healthcare Institution "Vase Zdravlje", 75000, Tuzla, Bosnia and Herzegovina
| | - Maja Popović
- Department of Medical Sciences, Cancer Epidemiology Unit, University of Turin and CPO-Piemonte, 10125, Turin, Italy
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Tang Y, Yao S, Chu Y, Han Q. Vitreous management in Yamane's technique for crystalline lens dislocation: anterior vitrectomy or PPV? BMC Ophthalmol 2023; 23:466. [PMID: 37978463 PMCID: PMC10655444 DOI: 10.1186/s12886-023-03204-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 11/06/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE To study the postoperative visual outcomes and surgical complications of anterior/pars plana vitrectomy and concurrent Yamane's IOL fixation for crystalline lens dislocation. METHODS Fifty-three patients (56 eyes) with crystalline lens subluxation/dislocation were enrolled in this retrospective interventional study. Patients received anterior/pars plana vitrectomy and concurrent Yamane's IOL fixation. Main outcome measures were postoperative BCVA and surgical complications. Proportion of spontaneous PVD and preoperative undetected retinal holes/degeneration (PURH/D) were recorded. RESULTS Twenty-four eyes were treated with anterior vitrectomy (Group AnV) and 32 eyes with pars plana vitrectomy (Group PPV). Overall incidence of PURH/D was 10.7% (6/56). Spontaneous PVD occurred in 68.8% (24/32) in Group PPV. During six months follow-up, one case of postoperative RRD and one case of choroidal detachment occurred in Group AnV. There was no significant difference between anterior vitrectomy and PPV in the final BCVA and postoperative complications. CONCLUSION Anterior or pars plana vitrectomy, which are both applicable in YAMANE technique for crystalline lens dislocation, exhibit similar surgical outcomes. Patient's age, PVD status and PURH helps to determine the route of vitrectomy. Pediatric patients might be potential candidates for transcorneal vitreolensectomy. For adult, PURH managed with total vitrectomy and intraoperative lase retinopexy might be beneficial to decrease the incidence of postoperative RRD.
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Affiliation(s)
- Yong Tang
- Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology, Tianjin Medical University, Gansu Road 4, Heping District, Tianjin, 300020, China
| | - Shiqi Yao
- Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology, Tianjin Medical University, Gansu Road 4, Heping District, Tianjin, 300020, China
| | - Yanhua Chu
- Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology, Tianjin Medical University, Gansu Road 4, Heping District, Tianjin, 300020, China
| | - Quanhong Han
- Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology, Tianjin Medical University, Gansu Road 4, Heping District, Tianjin, 300020, China.
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Haritoglou C, Boneva S, Schultheiss M, Sebag J, Binder S. [Vitreoretinal surgery in age-related macular degeneration]. Ophthalmologie 2023; 120:1004-1013. [PMID: 37728619 DOI: 10.1007/s00347-023-01933-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 09/21/2023]
Abstract
The structure of the vitreous body, its interaction with the retinal surface and tractive alterations of the vitreoretinal interface may play a role in the pathogenesis and the development of age-related macular degeneration (AMD). From clinical trials it can be concluded that posterior vitreous detachment (PVD) or vitreous removal may protect against the development of neovascular AMD. Vitreomacular adhesions may promote neovascular AMD and may have an impact on the efficacy and frequency of intravitreal vascular endothelial growth factor (VEGF) inhibition. Therefore, vitreomacular surgery may be considered as a treatment option in selected cases. Peeling of epimacular membranes and the internal limiting membrane (ILM) may contribute to stabilizing visual acuity and reducing the treatment burden of current intravitreal pharmacotherapy. At present, surgical interventions in AMD are mainly performed in cases of submacular hemorrhage involving the fovea. The treatment is not standardized and consists of liquefaction of the blood using recombinant tissue plasminogen activator (rTPA) and its pneumatic displacement, potentially combined with VEGF inhibition. Other submacular surgical strategies, such as choroidal neovascularization (CNV) extraction, macular translocation or transplantation of retinal pigment epithelium (RPE) are currently limited to selected cases as a salvage treatment; however, the development of these submacular surgical interventions has formed the basis for new approaches in the treatment of dry and neovascular AMD including submacular or intravitreal gene and stem cell therapy.
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Affiliation(s)
| | - Stefaniya Boneva
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | | | - J Sebag
- VMR Institute for Vitreous Macula Retina, Huntington Beach, CA, USA
- Doheny Eye Institute, Pasadena, CA, USA
- Department of Ophthalmology, Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Susanne Binder
- Lehrstuhl für Ophthalmologie, Sigmund Freud Universität, Wien, Österreich
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Powell SK, Garrahy D, Hurley DJ, Zaidi SBH, McEllistrem B, Stephenson KAJ. Presentations to eye emergency departments with flashes and floaters differ dependent on incident solar radiation. Ir J Med Sci 2023; 192:2527-2532. [PMID: 36658378 PMCID: PMC9851890 DOI: 10.1007/s11845-023-03281-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 01/11/2023] [Indexed: 01/21/2023]
Abstract
AIM The aim of this retrospective review was to analyse the frequency of patients presenting with flashes and/or floaters (F/F) on bright versus dark days to the eye emergency department of a tertiary referral hospital (the Mater Misericordiae University Hospital) over a 3-year period. The diagnostic and clinical outcomes of F/F presentations were also analysed. METHODS This retrospective study assessed eye casualty attendances between January 2018 and December 2020. Solar irradiation (j/cm2) at ground level was retrieved from the records of Met Eireann (Irish National Meteorological Service) via their open access records. A review of electronic patient medical records using the in-house database patient centre was carried out of all patients who attended EED of during the study timeline on the 5 'brightest' and 5 'darkest' days of each year. RESULTS Seven hundred forty patient presentations were analysed in total. Overall, 16% (n = 119) of all patients that attended EED during the timeframe of the study presented with F/F. One hundred six patients (89%) presented with floaters, 40 patients (34%) presented with flashing lights/photopsia, and 35 patients (29%) presented with both F/F. More patients presented to EED with F/F on bright days when compared with dark days (74 vs 45, p < 0.05). Eighty-nine percent of all patients with F/F presented with monocular floaters. There were more floater presentations during bright when compared with dark days (70 vs 36, p < 0.05). More patients were diagnosed with PVD on bright days when compared with those diagnosed with PVD on dark days (43vs 15, p < 0.05). More RDs were diagnosed on dark days compared with bright days (7 vs 3, p < 0.05). CONCLUSION This study established that F/F presentations were more likely to present during bright days when compared with dark days. The diagnosis of PVD was more common during bright days, and RDs were diagnosed significantly more frequently on dark days. Although incident solar radiation was correlated with greater floaters/PVD presentation, causation is unlikely, and the duration of PVD may have been longer in patients presenting on bright days (i.e. pseudo-sudden symptoms).
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Affiliation(s)
- Sarah K Powell
- Department of Ophthalmology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Dublin, Ireland.
| | - Darragh Garrahy
- Department of Ophthalmology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Dublin, Ireland
| | - Daire J Hurley
- Department of Ophthalmology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Dublin, Ireland
| | - Syed Bilal Hassan Zaidi
- Department of Ophthalmology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Dublin, Ireland
| | - Brian McEllistrem
- Irish College of General Practitioners, 4/5 Lincoln Place, Dublin 2, Dublin, Ireland
| | - Kirk A J Stephenson
- Department of Ophthalmology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Dublin, Ireland
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Joo CW, An Y, Kim YK, Kim YD, Park SP, Kim KL. Tractional Retinal Detachment in Eyes with Vitreous Hemorrhage and Proliferative Diabetic Retinopathy and Posterior Vitreous Detachment in Fellow Eye. Korean J Ophthalmol 2023:kjo.2022.0161. [PMID: 37068834 DOI: 10.3341/kjo.2022.0161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 04/16/2023] [Indexed: 04/19/2023] Open
Abstract
Purpose To predict the presence of tractional retinal detachment (TRD) in eyes with dense vitreous hemorrhage (VH) and proliferative diabetic retinopathy (PDR) by evaluating the status of posterior vitreous detachment (PVD) in fellow eyes using optical coherence tomography (OCT). Methods A total of 44 eyes from 22 patients who underwent vitrectomy due to dense VH with PDR were enrolled. Using OCT, the PVD status in the fellow eye was divided into two groups (incomplete and complete PVD). The incomplete PVD group included eyes without PVD and eyes with partial PVD. B-scan ultrasonography (USG) was performed on eyes with dense VH to evaluate the presence of TRD. Both OCT and B-scan images were reviewed by four ophthalmologists (two novices and two experienced), and the inter-observer agreement was evaluated. Results There was a difference in the inter-observer agreement regarding the presence of TRD in eyes with dense VH evaluated by B-scan between novice and experienced ophthalmologists (novice, kappa = 0.421 versus experienced, kappa = 0.814), although there was no difference between novice and experienced ophthalmologists in the inter-observer agreement regarding the status of PVD in the fellow eye evaluated by OCT (novice, kappa = 1.000 versus experienced, kappa = 1.000). All observed TRD during vitrectomy occurred in eyes with incomplete PVD in the fellow eye. Logistic regression analysis revealed a statistically significant relation between TRD and the age of the patient (odds ratio [OR] = 0.874, p = 0.047), and between TRD and incomplete PVD in the fellow eye evaluated by OCT (OR = 13.904, p = 0.042). Conclusion Evaluation of the PVD status in the fellow eye using OCT may be a useful predictor for detecting the presence of TRD in eyes with dense VH and PDR.
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Affiliation(s)
- Chan Woong Joo
- Department of Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Yerim An
- Department of Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Yong-Kyu Kim
- Department of Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Yong Dae Kim
- Department of Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Sung Pyo Park
- Department of Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Kyoung Lae Kim
- Department of Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
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Jindachomthong KK, Cabral H, Subramanian ML, Ness S, Siegel NH, Chhablani J, Hsu SX, Chen X. Incidence and Risk Factors for Delayed Retinal Tears after an Acute, Symptomatic Posterior Vitreous Detachment. Ophthalmol Retina 2023; 7:318-324. [PMID: 36307014 DOI: 10.1016/j.oret.2022.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 10/16/2022] [Accepted: 10/17/2022] [Indexed: 04/24/2023]
Abstract
PURPOSE To determine the long-term incidence of and risk factors for delayed retinal tears after acute, symptomatic posterior vitreous detachment (PVD) without concurrent retinal tears. DESIGN Retrospective, observational case series. SUBJECTS Patients diagnosed with an acute, symptomatic PVD without concurrent retinal tears at a tertiary eye center between 2013 and 2018. METHODS This is a retrospective, consecutive, and observational case series. Acute and symptomatic PVD was defined as experiencing flashes or floaters for 1 month or less at the time of diagnosis. Patients with a retinal tear or detachment at or before the time of diagnosis were not included. The occurrence and timing of subsequent retinal tears after initial PVD diagnosis were recorded. The age, sex, race, refractive error, lens status, lattice degeneration status, and type of physician (retina specialist vs. nonretina specialist) who saw the patient were also recorded. MAIN OUTCOME MEASURES Time to the development of a delayed retinal tear. RESULTS A total of 389 eyes from 389 patients had acute and symptomatic PVDs without concurrent retinal tears or detachments at diagnosis. Kaplan-Meier analysis showed that 7.39% of eyes developed delayed retinal tears by 6.24 years after initial PVD diagnosis. Of these tears, 50% occurred within 4.63 months of PVD diagnosis, and 63.46% occurred within 1 year of PVD diagnosis. Cox-Mantel log-rank analysis showed that those who were younger (age < 60 years), myopic, or had lattice degeneration were more likely to develop tears. A multivariate Cox proportional-hazards models controlling for other significant risk factors supported lattice degeneration as a likely risk factor for delayed retinal tear. CONCLUSIONS This study demonstrates that 7.39% of patients with acute, symptomatic PVD without concurrent retinal tears develop delayed retinal tears by 6.24 years after PVD diagnosis, with many developing tears well after a typical 6-week follow-up time for PVD. Lattice degeneration is a significant risk factor for delayed tears. These findings can guide clinicians in establishing optimal follow-up protocols for patients with acute, symptomatic PVD. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
| | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Manju L Subramanian
- Boston University School of Medicine, Boston, Massachusetts; Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts
| | - Steven Ness
- Boston University School of Medicine, Boston, Massachusetts; Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts
| | - Nicole H Siegel
- Boston University School of Medicine, Boston, Massachusetts; Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts
| | - Jay Chhablani
- Department of Ophthalmology, UPMC Eye Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Samuel X Hsu
- Boston University School of Medicine, Boston, Massachusetts
| | - Xuejing Chen
- Boston University School of Medicine, Boston, Massachusetts; Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts.
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Gibelalde A, Pinar-Sueiro S, Ibarrondo O, Martínez-Soroa I, Mendicute J, Ruiz Miguel M. Are all primary retinal detachments the same? Anatomic and functional differences between phakic and pseudophakic patients. Int J Retina Vitreous 2023; 9:17. [PMID: 36967392 PMCID: PMC10040123 DOI: 10.1186/s40942-023-00455-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Given differences in the pathogenic mechanisms underlying primary retinal detachment (RD) as a function of the status of the lens, the objective was to explore differences between pseudophakic and phakic patients with primary RD. METHODS A retrospective study including 821 patients who underwent surgery for RD [491 cases of phakic and 330 of pseudophakic RD (pRD and psRD, respectively)] in our hospital between 2012 and 2020. RESULTS The mean age was 58.24 ± 12.76 years in the pRD group and 66.87 ± 11.18 years in the psRD group (p = 0.001). There were more men in both groups (70% and 64.23% of pseudophakic and phakic patients, respectively; p = 0.07). The most common location for the RD was superior in both groups (43.94% and 51.93% of pseudophakic and phakic patients, respectively), rates of inferior and total RD were somewhat higher in the psRD group (31.82% and 13.33% in pseudophakic vs 25.25% and 11.0% in phakic patients, p = 0.001). In pseudophakic and phakic patients respectively, macular involvement in 69.09% and 62.73% of cases (p = 0.067). Proliferative vitreoretinopathy was significantly more common in the psRD group (7.88% vs 3.6% in phakic patients, p = 0.01).The rate of final anatomic reattachment differed markedly between groups, with a higher rate in phakic (94.03%) than pseudophakic (87.27%) patients (p = 0.001). CONCLUSIONS The specific pathogenic mechanism involved in psRD seems to be responsible for worse evolution characteristics which are associated with poorer final anatomic and functional outcomes in pseudophakic patients.
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Affiliation(s)
- Ane Gibelalde
- Department of Ophthalmology, Donostia University Hospital, Paseo del Dr Beguiristain sn. San Sebastian, 20014, Donostia San-Sebastian, Gipuzkoa, Spain.
| | - Sergio Pinar-Sueiro
- Department of Ophthalmology, Donostia University Hospital, Paseo del Dr Beguiristain sn. San Sebastian, 20014, Donostia San-Sebastian, Gipuzkoa, Spain
| | - Oliver Ibarrondo
- AP-OSI Research Unit, Alto Deba Integrated Health Care Organization, Mondragon, Spain
| | - Itziar Martínez-Soroa
- Department of Ophthalmology, Donostia University Hospital, Paseo del Dr Beguiristain sn. San Sebastian, 20014, Donostia San-Sebastian, Gipuzkoa, Spain
| | - Javier Mendicute
- Department of Ophthalmology, Donostia University Hospital, Paseo del Dr Beguiristain sn. San Sebastian, 20014, Donostia San-Sebastian, Gipuzkoa, Spain
| | - Miguel Ruiz Miguel
- Department of Ophthalmology, Donostia University Hospital, Paseo del Dr Beguiristain sn. San Sebastian, 20014, Donostia San-Sebastian, Gipuzkoa, Spain
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11
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Patel PR, Minkowski J, Dajani O, Weber J, Boucher N, MacCumber MW. Analysis of Posterior Vitreous Detachment and Development of Complications Using a Large Database of Retina Specialists. Ophthalmol Retina 2023; 7:203-214. [PMID: 36423892 DOI: 10.1016/j.oret.2022.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 11/13/2022] [Accepted: 11/14/2022] [Indexed: 04/24/2023]
Abstract
PURPOSE To examine the incidence of complications after posterior vitreous detachment (PVD) through an extended follow-up period and to identify patient-specific factors associated with a greater incidence of complication. DESIGN Multicenter, retrospective observational study. PARTICIPANTS Eyes with acute PVDs between 2015 and 2019 were identified through the Vestrum Health database. METHODS Complications (vitreous hemorrhage, retinal break, and retinal detachment) were evaluated after acute PVD at presentation and throughout the 6-month follow-up period. MAIN OUTCOME MEASURES Rate of complications throughout the 6 month follow-up period after PVD and odds of complications by patient-specific factors. RESULTS A total of 9635 eyes were included. The rate of any complication was 25.0%, isolated vitreous hemorrhage was 13.1%, retinal breaks without detachment was 16.0%, and retinal detachment was 4.2%. The majority of each complication was noted at presentation; however, 8.0% of isolated vitreous hemorrhages, 19.2% of retinal breaks without detachment, and 25.8% of retinal detachments were first noted within the 6-month follow-up period. Men experienced a significantly higher rate of any complication than women (30.0% versus 21.7%, P < 0.001), as well as retinal breaks and retinal detachments at both presentation and within 6-month follow-up. Patients with pseudophakia experienced significantly higher rates of delayed retinal detachment than phakic eyes (odds ratio, 1.85 [1.13, 3.04], P = 0.01). Among eyes with lattice/peripheral retinal degeneration, 44.2% experienced any complication throughout the clinical course. The presence of a retinal break in the fellow eye and retinal detachment in the fellow eye was associated with a significantly increased rate of any complication at any time point (retinal break: P < 0.0001; retinal detachment: P = 0.02), as well as each individual complication within the 6 month follow-up period. Among eyes with vitreous hemorrhage at presentation, 42.0% had a concurrent or delayed retinal break and 10.5% had concurrent or delayed retinal detachments. CONCLUSIONS A clinically significant proportion of PVD-related complications are detected late, warranting extended follow-up, especially in higher-risk groups such as men, pseudophakic eyes, eyes with lattice/peripheral retinal degeneration, and eyes with a history of retinal breaks or detachment in the fellow eye. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Palak R Patel
- Department of Ophthalmology, Rush University Medical Center, Chicago, Illinois
| | - Jonathan Minkowski
- Department of Ophthalmology, Rush University Medical Center, Chicago, Illinois
| | - Omar Dajani
- Department of Ophthalmology, Rush University Medical Center, Chicago, Illinois
| | - Jacob Weber
- Department of Ophthalmology, Rush University Medical Center, Chicago, Illinois
| | | | - Mathew W MacCumber
- Department of Ophthalmology, Rush University Medical Center, Chicago, Illinois.
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12
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Milner DC, Le C, Marin AI, Smith JM, Manoharan N. Outcomes of chronic macula-off retinal detachment repair. Graefes Arch Clin Exp Ophthalmol 2023; 261:709-714. [PMID: 36289075 PMCID: PMC9607701 DOI: 10.1007/s00417-022-05876-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 10/06/2022] [Accepted: 10/14/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE There have been disparate outcomes in the few studies that have looked at anatomic success and visual acuity (VA) in chronic retinal rhegmatogenous detachment (RRD) repair. Chronic retinal detachments (RD) without a posterior vitreous detachment (PVD) occur in young myopes often secondary to an atrophic hole. These patients are often asymptomatic, and studies report good surgical anatomic results. However, chronic RD with a PVD is symptomatic but presents late due to patient compliance. This paper aims to evaluate this lesser-studied chronic macula-off RD with PVD. METHODS After obtaining Institutional Review Board (IRB) approval, patients who had undergone surgical intervention for all diagnosis codes of RD were identified in the Denver Health Medical Center database. Medical records were reviewed, and patients found to have open-globe injuries, tractional RD due to proliferative diabetic retinopathy, macula-on detachments, and RD due to previous ocular surgery were excluded. Similarly, patients without PVD were also excluded. A total of 37 patients with PVD-type chronic macula-off RD were thus identified and preoperative characteristics, surgical intervention, and complications were analyzed. RESULTS The average patient age was 53.8 years. The length of RRD duration ranged from 30 to 365 days (mean 136.7 days). Twenty-six (70.3% patients had proliferative vitreoretinopathy (PVR) grade C or greater. Initial anatomic success-defined as re-attachment after one surgery-was 54.1%. The final attachment was 94.6%. Fifteen of 37 (40.5%) of the patients had issues with drop adherence, positioning, or missing post-operative appointments. CONCLUSION Chronic macula-off RD with a PVD should be identified as it is associated with much lower rates of initial re-attachment. Socioeconomic factors likely are the driving factor for patients with PVD-type chronic macula-off RD to present late, struggle with positioning, and have difficulty with follow-up and drop compliance. These extended periods without treatment then lead to high rates of PVR and poor initial anatomic success. However, repair of PVD-type chronic macula-off RD should still be pursued as final anatomic success is high.
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Affiliation(s)
- Dallin C Milner
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA.,Denver and Health Sciences Center, University of Colorado, Denver, CO, USA.,Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Christopher Le
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA.,Denver and Health Sciences Center, University of Colorado, Denver, CO, USA
| | - Alejandro I Marin
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA.,Denver and Health Sciences Center, University of Colorado, Denver, CO, USA.,Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Jesse M Smith
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA.,Denver and Health Sciences Center, University of Colorado, Denver, CO, USA.,Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Niranjan Manoharan
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA. .,Denver and Health Sciences Center, University of Colorado, Denver, CO, USA. .,Anschutz Medical Campus, University of Colorado, Aurora, CO, USA.
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13
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Wang N, Peng A, Li S, Ding C. Clinic study on macular epiretinal membrane in patients under the age of 40 years. BMC Ophthalmol 2023; 23:79. [PMID: 36841759 DOI: 10.1186/s12886-023-02813-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 02/09/2023] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND To describe the risk factors and clinical characteristics of macular epiretinal membrane (MEM) disease in patients up to the age of 40 years and to evaluate the therapeutic effect of IVTA on MEM. METHODS Clinical records were reviewed and the etiology of each case and the age distribution data were collected in this retrospective, cohort study. The clinical characteristics of MEM and the factors affecting VA were analyzed. Additionally, we contrasted the effects of MEM peeling with and without intravitreal triamcinolone acetonide on visual acuity (VA) and central foveal thickness (CFT). RESULTS In young patients, the incidence of partial posterior vitreous detachment (P-PVD) was considerably higher in IMEM than SMEM (P = 0.007). Furthermore, patients with stage 3 MEM had lower BCVA values than patients with stage 4 MEM (P < 0.001). Patients who live in urban had lower BCVA values than patients in rural (P < 0.001). Patients with IS/OS integrity had lower BCVA values than patients without IS/OS integrity (P < 0.001). The BCVA values in patients with IMEM were significantly lower than those of patients with SMEM (P < 0.001). BCVA was associated most commonly with etiology (P = 0.001), followed by region (P = 0.002). All patients had a decrease in logMAR Vas and CFT, but the combination of intraoperative IVTA resulted in a more significant decrease in logMAR Vas (P = 0.007) and CFT (P = 0.046). CONCLUSION In young patients, the incidence of P-PVD was significantly higher in IMEM cases than in SMEM cases. The region, MEM stage, IS/OS integrity, and etiology influenced VA. Etiology was associated most commonly with BCVA. In individuals under 40, the combination of intraoperative IVTA resulted in a more significant decrease in logMAR Vas and CFT.
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14
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Wallsh JO, Langevin ST, Kumar A, Huz J, Falk NS, Bhatnagar P. Fellow-Eye Retinal Detachment Risk as Stratified by Hyaloid Status on OCT. Ophthalmology 2023; 130:624-630. [PMID: 36773761 DOI: 10.1016/j.ophtha.2023.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/31/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023] Open
Abstract
PURPOSE To evaluate the risk of a rhegmatogenous retinal detachment (RRD) in the fellow eye using posterior hyaloid status as determined by OCT at the time of initial RRD. DESIGN Retrospective chart review. PARTICIPANTS Patients with a diagnosis of RRD. METHODS Posterior hyaloid status-presence or absence of a posterior vitreous detachment (PVD)-in both eyes at the time of initial RRD was determined by OCT imaging. Baseline characteristics, including lattice degeneration, refractive error, prior ocular laser procedures, lens status, and family history of RRD, were recorded. MAIN OUTCOME MEASURES The main outcome measures were the development of fellow-eye RRD and the time to fellow-eye RRD. In addition, OCT imaging was used in those fellow eyes with a visible posterior hyaloid to document whether a PVD developed during follow-up and time to such an event. RESULTS A total of 1049 patients with an RRD were followed up for an average of 5.7 ± 0.3 years. Overall, 153 patients (14.6%) received a diagnosis of bilateral sequential RRD during this follow-up period. OCT images were available for 582 fellow eyes; PVD was noted in 229 fellow eyes (39.3%), and an attached hyaloid was noted in 353 fellow eyes (60.7%). An RRD occurred in 7 fellow eyes (3.1%) with a PVD at presentation. Within the cohort of fellow eyes with an attached hyaloid, 28 eyes (7.9%) demonstrated an RRD during follow-up; however, when evaluating only those in which a PVD developed during follow-up, 23.7% of such eyes were found to have an RRD as well. At the time of PVD development in the fellow eye, an additional 21 eyes (17.8%) were noted to have a retinal tear that was treated without progression to RRD. CONCLUSIONS OCT imaging of the fellow eye at the time of presentation with an RRD offers a significant amount of information regarding risk stratification for RRD in this eye. Patients noted to have a completely detached posterior hyaloid are at a significantly lower risk of RRD than those with a visible posterior hyaloid, who need to be monitored closely at the time of PVD development. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Josh O Wallsh
- Retina Consultants PLLC, Slingerlands, New York; Albany Medical College, Department of Ophthalmology, Albany, New York
| | - Spencer T Langevin
- Retina Consultants PLLC, Slingerlands, New York; Albany Medical College, Department of Ophthalmology, Albany, New York
| | - Aman Kumar
- Albany Medical College, Department of Ophthalmology, Albany, New York
| | - Jonathan Huz
- Retina Consultants PLLC, Slingerlands, New York; Albany Medical College, Department of Ophthalmology, Albany, New York
| | - Naomi S Falk
- Retina Consultants PLLC, Slingerlands, New York; Albany Medical College, Department of Ophthalmology, Albany, New York
| | - Pawan Bhatnagar
- Retina Consultants PLLC, Slingerlands, New York; Albany Medical College, Department of Ophthalmology, Albany, New York.
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15
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Balikov DA, Zhou Y, Miller JML. A Telephone Triage System for Patients Calling with Symptoms of a Posterior Vitreous Detachment. Ophthalmol Retina 2023:S2468-6530(23)00003-9. [PMID: 36634817 DOI: 10.1016/j.oret.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 01/11/2023]
Abstract
PURPOSE The purpose of the study was to develop a simple telephone questionnaire, without physical examination input, that predicts which patients calling with symptoms of a posterior vitreous detachment (PVD) have a retinal tear (RT) or rhegmatogenous retinal detachment (RD). DESIGN Prospective cohort (quality improvement) study. PARTICIPANTS All patients with symptoms consistent with a PVD calling a major academic ophthalmology department over a 4-month period in 2020 and who were seen on follow-up within 1.5 months (211 screened and 193 included). METHODS A comprehensive telephone questionnaire assessing for RT/RD risk factors was administered by telephone triage staff to all patients calling with symptoms of flashes, floaters, or curtain/veil in their vision. Multivariable logistic regression was used to determine risk factors most predictive of having an RT/RD during the add-on visit. Risk factor odds ratios were used to develop an RT/RD risk score. MAIN OUTCOMES MEASURES Development of a clinical risk score for having an RT/RD at the add-on visit after telephone triage. RESULTS Approximately 55% of patients were previously established in the retina clinic, 26% were new to the department, 19% were previously established in the comprehensive clinic, and 7% had an RT/RD at the add-on visit. Out of 23 questions and 70 prespecified possible answers from the telephone questionnaire, the final clinical risk score for RT/RDs was derived from 7 questions and 15 possible answers. The simplified questionnaire can be administered quickly by telephone operators without any reference to physical examination or the patient's chart. The receive-operator curve for our final multivariable logistic regression and clinical risk score models have an area under the curve of > 0.90. Using a conservative clinical risk score, approximately 50% of all patients without an RT/RD can be safely seen nonurgently. Progressively higher scores can be used to determine relative urgency of an appointment. CONCLUSIONS To our knowledge, this is the first study to predict risk of an RT/RD in a patient calling with symptoms consistent with a PVD without reference to the patient's physical examination or chart. Our clinical risk scoring system can be used to determine urgency of an add-on appointment and increase the number of low-risk patients with symptomatic PVDs who are scheduled routinely. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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16
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Yang X, Shi C, Liu Q, Pazo EE, Lin T. Spontaneous remission of vision degrading myodesopsia of posterior vitreous detachment type. Graefes Arch Clin Exp Ophthalmol 2022. [PMID: 36565330 DOI: 10.1007/s00417-022-05948-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/21/2022] [Accepted: 12/13/2022] [Indexed: 12/25/2022] Open
Abstract
PURPOSE The study aims to observe the spontaneous remission of posterior vitreous detachment (PVD)-type vision degrading myodesopsia (VDM) during long-term follow-up. METHODS We retrospectively reviewed VDM patients with PVD type that refused any treatment. The ratio and time of significant spontaneous remission of floater symptoms occurring were described. The associated factors with significant remission of floater symptoms were analyzed in the univariate and multivariate logistic regression analyses. RESULTS In total, 179 patients with VDM were assessed. The mean age of all patients was 60.56 ± 0.47 years old, and the mean duration of follow-up was 23.89 ± 6.63 months. Of the patients, 40.78% have significant improvement in their floater symptoms after mean 16.55 ± 10.63-month follow-up. Myopia (OR = 0.280, 95% CI = 0.084-0.932, P = 0.038), the number of floaters > 3 (OR = 0.343, 95% CI = 0.172-0.683, P = 0.002), and floaters with string-like pattern (OR = 0.370, 95% CI = 0.166-0.824, P = 0.015) and blocky pattern (OR = 0.299, 95% CI = 0.090-0.993, P = 0.049) were negatively correlated with the significant spontaneous remission of VDM symptoms in the multiple binary logistic regression analysis. CONCLUSIONS Approximately 40% of VDM patients with PVD may experience significant spontaneous remission during long-term follow-up. Patients that are non-myopic and with fewer floaters are more likely to feel relief from VDM symptoms. Floaters with string-like or blocky patterns are less likely to undergo spontaneous remission.
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Aziz IA, Hussein MM, Fouad YA. Perfluorocarbon liquid-assisted vitreo-dissection in eyes with firmly adherent posterior hyaloid. BMC Ophthalmol 2022; 22:475. [PMID: 36476333 PMCID: PMC9727894 DOI: 10.1186/s12886-022-02715-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Induction of posterior vitreous detachment (PVD) is a critical step during pars plana vitrectomy. Multiple techniques and utilities have been proposed for assistance with this step with no consensus on the safest and most effective means, especially in eyes with firmly adherent posterior hyaloid. Viscodissection or the utilization of perfluorocarbon liquid (PFCL) can be used to dissect the posterior hyaloid and widely adherent epiretinal membranes. METHODS A technique of PFCL dissection of the posterior hyaloid in eyes with abnormal adhesion of the posterior hyaloid. After core vitrectomy, breaking into the posterior hyaloid face is made via active aspiration and cutting or a sharp dissection. This is followed by active and slow injection of PFCL into the potential space between the posterior cortical vitreous and the neurosensory retina. A wave of PFCL propagates anteriorly causing "vitreo-dissection" of the peripheral cortical vitreous. RESULTS The technique was effective and safe in 8 successive cases, 4 cases with vitreoretinal traction syndrome and 4 with diabetic tractional membranes. CONCLUSION The technique can be considered in cases with abnormal firmly adherent posterior hyaloid when induction of PVD proves difficult.
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Affiliation(s)
- Ihab Abdel Aziz
- Al Mashreq Eye Center, Cairo, Egypt ,The Memorial Institute for Ophthalmic Research, Cairo, Egypt
| | - Moaaz M. Hussein
- Al Mashreq Eye Center, Cairo, Egypt ,Department of Ophthalmology, Electricity Hospital, Cairo, Egypt
| | - Yousef A. Fouad
- Al Mashreq Eye Center, Cairo, Egypt ,grid.7269.a0000 0004 0621 1570Department of Ophthalmology, Ain Shams University Hospitals, Cairo, Egypt
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Mititelu M, Uschner D, Doherty L, Bjornstad P, Domalpally A, Drews KL, Gubitosi-Klug R, Levitsky LL, Pak JW, White NH, Blodi BA. Retinal Thickness and Morphology Changes on OCT in Youth with Type 2 Diabetes: Findings from the TODAY Study. Ophthalmol Sci 2022; 2:100191. [PMID: 36531589 PMCID: PMC9754955 DOI: 10.1016/j.xops.2022.100191] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/13/2022] [Accepted: 06/22/2022] [Indexed: 06/17/2023]
Abstract
Objective To evaluate changes in retinal thickness and morphology using OCT in youth with type 2 diabetes (T2D) and to identify systemic biomarkers correlating with these changes. Design Retrospective subgroup analysis of a prospective study. Participants Participants who underwent OCT imaging in the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) trial and its follow-up study TODAY2. Methods In 2010-2011 (TODAY) and 2017-2018 (TODAY2), 6 × 6-mm macular volume OCT scans were acquired, segmented, and analyzed to generate total retinal thickness, inner retinal thickness, and outer retinal thickness. The main retinal morphologies graded were intraretinal cystoid spaces, subretinal fluid, and posterior vitreous detachment (PVD). Main Outcome Measures Changes in total and individual retinal layer thickness and development of abnormal vitreomacular morphology between TODAY and TODAY2. Results Participants had a mean age of 17.9 ± 2.4 years and glycated hemoglobin (HbA1c) of 8.2 ± 2.8% in TODAY and a mean age of 25.0 ± 2.4 years and mean HbA1c of 9.5 ± 2.8% in TODAY2. Longitudinally between assessments, there were overall decreases in outer retinal thickness from 167.2 ± 11.5 microns to 158.4 ± 12.8 microns (P < 0.001) and in photoreceptor thickness from 30.3 ± 2.9 microns to 29.8 ± 4.1 microns (P = 0.04) in the central subfield, while in the inner subfield, we noted a decrease in outer retinal thickness from 150.5 ± 10.1 microns to 144.9 ± 10.5 microns (P < 0.001) and an increase in inner retinal thickness from 136.9 ± 11.5 microns to 137.4 ± 12.6 microns (P = 0.01). Multivariate analysis showed that in the center subfield, HbA1c increases were associated with increases in total retinal thickness (r: 0.67, P = 0.001), whereas fasting glucose was positively correlated with inner retinal thickness (r: 0.02, P = 0.02). In the inner subfield, both systolic (r: -0.22, P < 0.001) and diastolic (r: -0.22, P = 0.003) blood pressures were negatively correlated with total retinal thickness. There was an increase in PVD (18.9%) and cystoid spaces (4.2%). Conclusions Youth with T2D develop retinal thickness changes on OCT, including increases in total retinal and inner retinal thickness in the center subfield that correlate with HbA1c and fasting glucose, respectively. Taken together with the increased prevalence of abnormal vitreomacular morphology in this cohort at risk, these findings emphasize the importance of controlling risk factors to prevent the development of sight-threatening retinal complications.
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Key Words
- DR, diabetic retinopathy
- EZ, ellipsoid zone
- Glycemic control
- HbA1c, glycated hemoglobin
- ILM, internal limiting membrane
- INL, inner nuclear layer
- Macular morphology
- NPDR, nonproliferative DR
- OPL, outer plexiform layer
- PVD, posterior vitreous detachment
- Posterior vitreous detachment
- RPE, retinal pigment epithelium
- Retinal thickening
- SD-OCT, spectral-domain OCT
- T2D, type 2 diabetes
- TD-OCT, time-domain OCT
- TODAY, Treatment Options for Type 2 Diabetes in Adolescents and Youth
- Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study
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Affiliation(s)
- Mihai Mititelu
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Diane Uschner
- The Biostatistics Center, George Washington University, Rockville, Maryland
| | - Lindsay Doherty
- The Biostatistics Center, George Washington University, Rockville, Maryland
| | - Petter Bjornstad
- University of Colorado, School of Medicine, Department of Pediatrics, Section of Endocrinology, Department of Medicine, Division of Renal Diseases and Hypertension, Denver, Colorado
| | - Amitha Domalpally
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Kimberly L. Drews
- The Biostatistics Center, George Washington University, Rockville, Maryland
| | | | - Lynne L. Levitsky
- MassGeneral for Children, Harvard Medical School, Boston, Massachusetts
| | - Jeong W. Pak
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Neil H. White
- School of Medicine, Washington University, St. Louis, Missouri
| | - Barbara A. Blodi
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
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Li AL, Feng M, Wang Z, Baxter SL, Huang L, Arnett J, Bartsch DG, Kuo DE, Saseendrakumar BR, Guo J, Nudleman E. Automated Detection of Posterior Vitreous Detachment on OCT Using Computer Vision and Deep Learning Algorithms. Ophthalmol Sci 2023; 3:100254. [PMID: 36691594 DOI: 10.1016/j.xops.2022.100254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/03/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022]
Abstract
Objective To develop automated algorithms for the detection of posterior vitreous detachment (PVD) using OCT imaging. Design Evaluation of a diagnostic test or technology. Subjects Overall, 42 385 consecutive OCT images (865 volumetric OCT scans) obtained with Heidelberg Spectralis from 865 eyes from 464 patients at an academic retina clinic between October 2020 and December 2021 were retrospectively reviewed. Methods We developed a customized computer vision algorithm based on image filtering and edge detection to detect the posterior vitreous cortex for the determination of PVD status. A second deep learning (DL) image classification model based on convolutional neural networks and ResNet-50 architecture was also trained to identify PVD status from OCT images. The training dataset consisted of 674 OCT volume scans (33 026 OCT images), while the validation testing set consisted of 73 OCT volume scans (3577 OCT images). Overall, 118 OCT volume scans (5782 OCT images) were used as a separate external testing dataset. Main Outcome Measures Accuracy, sensitivity, specificity, F1-scores, and area under the receiver operator characteristic curves (AUROCs) were measured to assess the performance of the automated algorithms. Results Both the customized computer vision algorithm and DL model results were largely in agreement with the PVD status labeled by trained graders. The DL approach achieved an accuracy of 90.7% and an F1-score of 0.932 with a sensitivity of 100% and a specificity of 74.5% for PVD detection from an OCT volume scan. The AUROC was 89% at the image level and 96% at the volume level for the DL model. The customized computer vision algorithm attained an accuracy of 89.5% and an F1-score of 0.912 with a sensitivity of 91.9% and a specificity of 86.1% on the same task. Conclusions Both the computer vision algorithm and the DL model applied on OCT imaging enabled reliable detection of PVD status, demonstrating the potential for OCT-based automated PVD status classification to assist with vitreoretinal surgical planning. Financial Disclosures Proprietary or commercial disclosure may be found after the references.
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Ahmad MT, Sein J, Wang J, Scott AW, Ramroop J, Jiramongkolchai K, Zimmer-Galler IE, Handa JT, Arevalo JF. Symptom-Based Risk Factors for Retinal Tears and Detachments in Suspected Posterior Vitreous Detachment. Ophthalmologica 2022; 245:570-576. [PMID: 36228586 DOI: 10.1159/000527295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/19/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The aim of this study was to determine symptom-level risk factors for retinal tear/retinal detachment (RT/RD) in our patients presenting with symptoms of posterior vitreous detachment (PVD). METHODS We conducted a prospective cohort study of patients presenting to outpatient ophthalmology clinics at a single academic institution with complaint(s) of flashes, floaters, and/or subjective field loss (SFL). Patients received a standardized questionnaire regarding past ocular history and symptom characteristics including number, duration, and timing of flashes and floaters, prior to dilated ocular examination. Final diagnosis was categorized as RT/RD, PVD, ocular migraine, vitreous syneresis, or "other." Simple and multivariate logistic regressions were used to identify symptoms predictive of various pathologies. RESULTS We recruited 237 patients (age 20-93 years) from March 2018 to March 2019. The most common diagnosis was PVD (141, 59.5%), followed by vitreous syneresis (38, 16.0%) and RT/RD (34, 14.3%). Of those with RT/RD, 16 (47.1%) had retinal tear and 15 (44.1%) had RD. Significant differences in demographic and examination-based factors were observed between these groups. Symptom-based predictive factors for RT/RD were the presence of subjective visual reduction (SVR; OR 2.77, p = 0.03) or SFL (OR 2.47, p = 0.04), and the absence of either floaters (OR 4.26, p = 0.04) or flashes (OR 2.95, p = 0.009). The number, duration, and timing of flashes and floaters did not predict the presence of RT/RD in our cohort. Within the RT/RD group, patients with RT were more likely to report floaters (100% vs. 66.7%, p = 0.018) and less likely to report SFL (0% vs. 86.7%, p < 0.001) compared to those with RD. CONCLUSION While well-known demographic and exam-based risk factors for RT/RD exist in patients with PVD symptoms, the relative importance of symptom characteristics is less clear. We found that the presence of SVR and SFL, as well as the absence of either flashes or floaters, predicts RT/RD in patients with PVD symptoms. However, the number, duration, and timing of flashes and floaters may be less relevant in the triage of these patients.
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Affiliation(s)
- Meleha T Ahmad
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Julia Sein
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jiangxia Wang
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Adrienne W Scott
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Janelle Ramroop
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kim Jiramongkolchai
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ingrid E Zimmer-Galler
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - James T Handa
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - J Fernando Arevalo
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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21
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Creveling CJ, Alsanea Y, Coats B. Correlation of collagen fibril properties and inner limiting membrane thickness with vitreoretinal adhesion in human eyes. Exp Eye Res 2022; 223:109189. [PMID: 35868365 PMCID: PMC9553025 DOI: 10.1016/j.exer.2022.109189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/10/2022] [Accepted: 07/06/2022] [Indexed: 02/02/2023]
Abstract
Vitreoretinal adhesive strength is thought to play a mechanical role in various retinal diseases; however, collagen fibril properties and inner limiting membrane (ILM) thickness have not been quantitatively correlated to adhesive strength. In this work, we quantified the relationship between collagen fibril density, angle, length, and ILM thickness with vitreoretinal adhesive strength to advance our understanding of structure-function relationships in vitreoretinal adhesion. Following mechanical peel tests, human retinal sections from the equator and posterior pole of donors 42-89 years of age were extracted and processed for transmission electron microscopy. Collagen fibrils at the vitreoretinal interface were segmented and fibril density, angle, length, and ILM thickness quantified. Morphological measurements were correlated with vitreoretinal adhesion measured in the same location. We found that collagen fibril density was 1.6 times greater in the equator compared to the posterior pole across all ages (p=0.0305). Steady-state peel force showed a slight positive correlation with increasing density in both the equator and posterior pole, but was only statistically significant in the equator (p<0.05). Collagen fibril angle and length did not significantly vary with age or region. ILM thickness was 3.8 times thicker in the posterior pole compared to the equator (p<0.0001). ILM thickness was 1.8 times greater in eyes ≤60 years of age compared to eyes >60 of age (p=0.0136). Maximum peel force was significantly correlated with increasing ILM thickness in the equator (p=0.015). A similar trend was seen in the posterior pole, but this was not significant. These data suggest that collagen contributes to adhesion at the vitreoretinal interface, but the structure of the ILM is more influential on the initiation of separation between the vitreous and retina.
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Affiliation(s)
- C J Creveling
- Department of Mechanical Engineering, University of Utah, 1495 E 100 S, Salt Lake City, 84112, United States.
| | - Y Alsanea
- Department of Mechanical Engineering, University of Utah, 1495 E 100 S, Salt Lake City, 84112, United States.
| | - B Coats
- Department of Mechanical Engineering, University of Utah, 1495 E 100 S, Salt Lake City, 84112, United States.
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22
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Phillips JD, Hwang ES, Morgan DJ, Creveling CJ, Coats B. Structure and mechanics of the vitreoretinal interface. J Mech Behav Biomed Mater 2022; 134:105399. [PMID: 35963021 PMCID: PMC9552593 DOI: 10.1016/j.jmbbm.2022.105399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 07/17/2022] [Accepted: 07/24/2022] [Indexed: 12/24/2022]
Abstract
Vitreoretinal mechanics plays an important role in retinal trauma and many sight-threatening diseases. In age-related pathologies, such as posterior vitreous detachment and vitreomacular traction, lingering vitreoretinal adhesions can lead to macular holes, epiretinal membranes, retinal tears and detachment. In age-related macular degeneration, vitreoretinal traction has been implicated in the acceleration of the disease due to the stimulation of vascular growth factors. Despite this strong mechanobiological influence on trauma and disease in the eye, fundamental understanding of the mechanics at the vitreoretinal interface is limited. Clarification of adhesion mechanisms and the role of vitreoretinal mechanics in healthy eyes and disease is necessary to develop innovative treatments for these pathologies. In this review, we evaluate the existing literature on the structure and function of the vitreoretinal interface to gain insight into age- and region-dependent mechanisms of vitreoretinal adhesion. We explore the role of vitreoretinal adhesion in ocular pathologies to identify knowledge gaps and future research areas. Finally, we recommend future mechanics-based studies to address the critical needs in the field, increase fundamental understanding of vitreoretinal mechanisms and disease, and inform disease treatments.
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Affiliation(s)
- Joseph D Phillips
- Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, United States
| | - Eileen S Hwang
- Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT, United States
| | - Denise J Morgan
- Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT, United States
| | | | - Brittany Coats
- Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, United States.
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23
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Shah D. Vitreomacular traction release: Finding the edge. Indian J Ophthalmol 2022; 70:2777-2778. [PMID: 35791254 PMCID: PMC9426162 DOI: 10.4103/ijo.ijo_1430_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Vitreomacular traction (VMT) is a commonly encountered entity in our routine practice. The key question is whether to observe or operate by clinical and imaging based judgement of the visual prognosis in every case. Purpose This video encapsulates diagnostics, surgical method, and prognosis in a case of VMT released with vitrectomy. Synopsis A 56-year-old businessman was diagnosed with VMT in the OPD and was advised surgical release of the same. The patient was extremely keen to know the visual prognosis, where the OCT imaging helped. The surgical method demonstrates the method to find the edge of the PVD to release the traction. Also, a simple ILM peel procedure has been described to reduce recurrences in cases like these. Highlights 1. Judging the prognosis in VMT cases on basis of imaging. 2.Finding the edge (FTE) method of inducing the PVD. 3. ILM peeling simplified. Online Video Link https://youtu.be/oSZQGQgYmQ8.
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Affiliation(s)
- Dhaivat Shah
- Department of Vitreoretina, Choithram Netralaya, Indore, MP, India
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24
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Aras C, Senturk F, Koytak A, Dogramaci M, Erdur SK, Kocabora S. In vivo generated autologous plasmin assisted vitrectomy in young patients. Int J Retina Vitreous 2022; 8:36. [PMID: 35690857 PMCID: PMC9188042 DOI: 10.1186/s40942-022-00391-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 06/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Autologous plasmin enzyme facilitates the induction of posterior vitreous detachment(PVD) during vitrectomy in young patients. We proposed the concept of in-vivo generated plasmin which is based on the injection of tissue plasminogen activator(t-PA) and autologous whole blood(AWB) into the vitreous cavity. The purpose of this pilot study is to report the efficacy of preoperative simultaneous intravitreal injection of(t-PA) and autologous whole blood in facilitating the intraoperative induction of PVD in young patients with various vitreoretinal pathologies. METHODS Seventeen eyes of 16 young patients with various vitreoretinal pathologies requiring vitrectomy, who received simultaneous intravitreal injection of 0.1 ml of AWB and 25 µg of t-PA, 3 days prior to surgery were retrospectively reviewed. Outcome measures were the number of attempts required to achieve successful intraoperative separation of the posterior hyaloid; the postoperative visual acuity; and intraoperative and postoperative complications. RESULTS The mean age of the patients was 23.87 ± 10.09 years, ranging from 10 to 39 years. Eight of 16 patients were men. The mean follow-up time was 19.35 ± 5.04 months, ranging from 12 to 26 months. Surgical indications for vitrectomy were chronic retinal detachment (n = 7), traumatic retinal detachment without proliferative vitreoretinopathy(n = 3), traumatic macular hole(n = 1), secondary vasoproliferative tumor(n = 4) and optic pit maculopathy(n = 2). Patients with retinal detachment complicated with PVR and those who were older than 40 years of age were excluded from the study. Separation of the Weiss ring from the optic nerve head was achieved intraoperatively in all cases, with a mean number of 2.86 ± 1.4 attempts. While the mean preoperative LogMAR visual acuity was 1.38 ± 0.59, ranging from 2.40 to 0.50, it was a mean of 0.51 ± 0.29, ranging from 1.00 to 0.10 at final postoperative exam(p < 0.001; paired samples t-test). No preoperative or intraoperative complications were noted. CONCLUSION Preoperative simultaneous intravitreal injection of 25 µg t-PA with 0.1 ml of AWB facilitates the intraoperative induction of posterior vitreous detachment in young patients.
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Affiliation(s)
- Cengiz Aras
- Department of Ophthalmology, Istanbul Medipol Medical School, Istanbul, Turkey.
| | - Fevzi Senturk
- Department of Ophthalmology, Istanbul Medipol Medical School, Istanbul, Turkey
| | - Arif Koytak
- Department of Ophthalmology, Medical Faculty, Bezmialem Vakif University, Istanbul, Turkey
| | - Mahmut Dogramaci
- Department of Ophthalmology, Istanbul Medipol Medical School, Istanbul, Turkey.,MBchB, MD, ICO, MRCOphth The Princess Alexandra Hospital NHS Trust, London, UK
| | - Sevil Karaman Erdur
- Department of Ophthalmology, Istanbul Medipol Medical School, Istanbul, Turkey
| | - Selim Kocabora
- Department of Ophthalmology, Istanbul Medipol Medical School, Istanbul, Turkey
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25
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Driban M, Chhablani J. Clinical findings in acute posterior vitreous detachment. Graefes Arch Clin Exp Ophthalmol 2022; 260:3465-3469. [PMID: 35622141 DOI: 10.1007/s00417-022-05708-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 04/13/2022] [Accepted: 05/06/2022] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To analyze the typical presentation of acute posterior vitreous detachment (PVD), including demographics and prevalence of various treatable findings in the same and fellow eye. METHODS Retrospective analysis of medical records from 2346 patients with acute PVD. Descriptive statistics were generated on age, sex, contact date, visual acuity, and slit lamp, and fundoscopy findings. Multivariate regressions were used to generate odds ratios with 95% confidence intervals (CI) to quantify associations between variables. RESULTS A total of 4692 eyes from 2346 patients were analyzed. Most patients were female (60.5%) with an average age of 62.8 years old. Overall, 605 patients (25.8%) had any additional ocular finding on fundus exam, including pigmentation (N = 184, 7.8%), lattice degeneration (N = 158, 6.7%), tear (N = 131, 5.6%), and hole (N = 131, 5.2%). Unilateral retinal detachment was present in 26 patients (1.1%), and these patients demonstrated a similar rate (26.9%) of additional ocular findings compared to the entire sample size. Female sex (OR 1.21, 95% CI 1.03-1.43, p = 0.020) was independently associated with presentation during spring or summer. CONCLUSION Acute PVD is associated with a number of risk factors and peripheral lesions. These findings may be useful in treating and predicting the course and development of PVD.
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Affiliation(s)
- Matthew Driban
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Mizobuchi T, Nishiuchi T, Miura Y, Fukuda K. Long-term follow-up of a case of Coats disease in a 10-year-old boy with spontaneous peeling of preretinal macular fibrosis: a case report. BMC Ophthalmol 2022; 22:194. [PMID: 35477388 PMCID: PMC9044609 DOI: 10.1186/s12886-022-02414-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 04/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Coats disease is a retinal vascular disorder characterized by aneurysms and telangiectasias. Macular fibrosis is a complication of Coats disease that results in vision loss. Macular fibrosis rarely develops in the natural course and often occurs after treatment with intravitreal bevacizumab, photocoagulation, or cryotherapy. Here, we have described an unusual case of spontaneous peeling of preretinal macular fibrosis in a patient with untreated Coats disease. CASE PRESENTATION A 10-year-old Japanese boy presented with vision loss in his left eye. The patient's left visual acuity was 20/28. Fundus examination of his left eye revealed thick preretinal macular fibrosis around the optic disc and macula. In addition, retinal telangiectasis, microaneurysms, hard exudates, and retinal hemorrhages were observed in the left peripheral temporal retina. We diagnosed his condition as Coats disease with preretinal macular fibrosis. Two months later, optical coherence tomography revealed preretinal macular fibrosis detachment at the foveal lesion without any treatment. During follow-up, preretinal macular fibrosis at the macular lesion was completely detached. Further, posterior vitreous detachment was observed and the shape of the macula and the patient's left visual acuity had improved. CONCLUSIONS In our case, both formation and spontaneous peeling of preretinal macular fibrosis occurred without any treatment for Coats disease, which is an unusual finding. Vitreous changes might have occurred during the natural clinical course, causing subsequent posterior vitreous detachment and resulting in spontaneous peeling of fibrosis.
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Affiliation(s)
- Tomoka Mizobuchi
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku City, Kochi, 783-8505, Japan
| | - Takashi Nishiuchi
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku City, Kochi, 783-8505, Japan
| | - Yusaku Miura
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku City, Kochi, 783-8505, Japan
| | - Ken Fukuda
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku City, Kochi, 783-8505, Japan.
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Karaca Adıyeke S, Ture G. Vitreoretinal interface anomalies in patients with a history of toxoplasmosis retinochoroiditis. Jpn J Ophthalmol 2022; 66:320-325. [PMID: 35344110 DOI: 10.1007/s10384-022-00912-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 01/28/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate vitreoretinal interface anomalies over time in patients diagnosed with toxoplasmosis retinochoroiditis (TRC) and progression of the chronic disease. STUDY DESIGN Retrospective clinical study. METHODS The clinical records of 36 patients with TRC were studied retrospectively. All patients underwent standard ophthalmological examinations and optical coherence tomography (optical coherence tomography: OCT). Vitreoretinal interface changes and retinal layers in the macula and lesion area were evaluated. RESULTS The fovea was involved in 9 (25%) patients. OCT of the scar region showed retinal layer thinning and disorganization in all cases. Complete posterior vitreous detachment (PVD) was detected in 9 (25%) cases, incomplete PVD in 22 (61%) cases and no PVD in 5 (13.8%) cases. In 23 (63%) of the 36 patients with inactive TRC lesions, an epiretinal membrane (ERM) was detected by follow-up OCT, i.e., in 14 (60%) patients with incomplete PVD, 8 (34.7%) with complete PVD, and 1 (4%) with no PVD. Vitreoschisis was found in 5 of 22 patients with incomplete PVD; an ERM developed in 4 of these 5 patients. No ERM developed only in the macula, i.e., independent of the TRC scar region. CONCLUSIONS Vitreoretinal interface anomalies are common in patients diagnosed with TRC, including those with incomplete PVD. We observed no progression of vitreoretinal interface anomalies during the follow-up of patients diagnosed with TRC.
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Affiliation(s)
- Seda Karaca Adıyeke
- Tepecik Research and Training Hospital Ophthalmology Department, Izmir, Turkey.
| | - Gamze Ture
- Tepecik Research and Training Hospital Ophthalmology Department, Izmir, Turkey
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Saraf SS, Lacy M, Hunt MS, Lee CS, Lee AY, Chee YE. Demographics and Seasonality of Retinal Detachment, Retinal Breaks, and Posterior Vitreous Detachment from the Intelligent Research in Sight Registry. Ophthalmol Sci 2022; 2:100145. [PMID: 36249681 PMCID: PMC9559074 DOI: 10.1016/j.xops.2022.100145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 03/08/2022] [Accepted: 03/14/2022] [Indexed: 12/27/2022]
Abstract
Purpose To investigate the incidence, seasonal variation, and differences among age, sex, and race for rhegmatogenous retinal detachment (RRD) repair, retinal break (RB) treatment, and posterior vitreous detachment (PVD) in the Intelligent Research in Sight (IRIS) Registry. Design Retrospective database study. Participants Patients in the IRIS Registry who underwent RRD repair, RB treatment, or cataract surgery (CS) based on Current Procedural Terminology codes and PVD diagnosis based on International Classification of Diseases, Ninth and Tenth Revision, codes. Methods Daily incidence rates were defined as the ratio of patients who underwent RRD repair or RB treatment and patients with a diagnosis of PVD to the total number of patients followed on a given day within the IRIS Registry. The CS group was included as a comparison for seasonal variation. Rates were stratified by decade of life, sex, and race. Main Outcome Measures Time series trends for incidence rates of RRD, RB, and PVD. Results A total of 7 115 774 patients received a diagnosis of incident PVD, 237 646 patients underwent RRD repair, and 359 022 patients underwent RB treatment. Also included were 5 940 448 patients who underwent CS. The mean daily incidence for RRD repair, RB treatment, PVD diagnosis, and CS were 0.46 per 100 000 patients, 0.70 per 100 000 patients, 13.90 per 100 000 patients, and 11.80 per 100 000 patients, respectively. Men showed higher incidence of RRD repair and RB treatment than women, whereas women showed higher incidence of PVD diagnosis. Rhegmatogenous retinal detachment incidence was higher in White people compared with other races. Seasonal decreases in PVD, RB treatment, RRD repair, and CS corresponded to national holidays, with larger decreases in winter months. Kaplan-Meier estimates showed that RRD repair and RB treatment typically occurred within 60 days of PVD diagnosis. Conclusions Within the IRIS Registry, the highest incidence of RRD was in the 6th and 7th decade of life. There was a higher incidence of RRD repair and RB treatment in men compared with women. The seasonal variation associated with national holidays was less pronounced for RRD repair and RB treatment.
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Affiliation(s)
- Steven S. Saraf
- Department of Ophthalmology, University of Washington, Seattle, Washington
- Correspondence: Steven S. Saraf, MD, Department of Ophthalmology, University of Washington, 325 Ninth Avenue, Box 359608, Seattle, WA 98104.
| | - Megan Lacy
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Matthew S. Hunt
- Department of Ophthalmology, University of Washington, Seattle, Washington
- Washington University in St. Louis, St. Louis, Missouri
| | - Cecilia S. Lee
- Department of Ophthalmology, University of Washington, Seattle, Washington
- Karalis Johnson Retina Center, Seattle, Washington
| | - Aaron Y. Lee
- Department of Ophthalmology, University of Washington, Seattle, Washington
- Karalis Johnson Retina Center, Seattle, Washington
| | - Yewlin E. Chee
- Department of Ophthalmology, University of Washington, Seattle, Washington
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Hayashi K, Yoshida M, Hayashi S, Hirata A. Posterior vitreous detachment after cataract surgery in eyes with high myopia: an optical coherence tomography study. Jpn J Ophthalmol 2022. [PMID: 35122563 DOI: 10.1007/s10384-022-00903-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 12/23/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To compare the progression of posterior vitreous detachment (PVD) after cataract surgery in eyes with high myopia with that in eyes without high myopia. STUDY DESIGN Prospective observational study. METHODS Eighty eyes of 80 patients with high myopia and 160 eyes of 160 patients without high myopia scheduled for phacoemulsification were recruited. PVD status was examined using swept-source optical coherence tomography at 2 days postoperatively (baseline) and at 3, 6, and 12 months postbaseline and classified into 5 stages: 0 (no PVD), 1 (paramacular PVD), 2 (perifoveal PVD), 3 (peripapillary PVD), and 4 (complete PVD). The PVD stage and incidence of progression to complete PVD of the 2 groups were compared. RESULTS The mean PVD stage did not differ significantly between the groups at baseline or at 3 months postbaseline but was significantly more progressed in the high myopia group than in the nonhigh myopia group at 6 months and 12 months postbaseline (P ≤ 0.0201). The Kaplan-Meier survival rate for complete PVD was significantly lower in the high myopia group (P = 0.0129). After adjusting for age, sex, and baseline PVD stage, the hazard ratio for complete PVD was 1.68-fold higher in the high myopia group than in the nonhigh myopia group (P = 0.0326, 95% CI 1.04-2.70). CONCLUSION After cataract surgery, PVD progressed significantly faster in eyes with high myopia than in eyes without high myopia, and the relative risk for complete PVD was 1.68-fold higher in eyes with high myopia, suggesting that highly myopic eyes are at considerably high risk for retinal disease postoperatively.
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Lin T, Li T, Zhang X, Hui Y, Moutari S, Pazo EE, Dai G, Shen L. The Efficacy and Safety of YAG Laser Vitreolysis for Symptomatic Vitreous Floaters of Complete PVD or Non-PVD. Ophthalmol Ther 2021. [PMID: 34778916 DOI: 10.1007/s40123-021-00422-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/01/2021] [Indexed: 10/29/2022] Open
Abstract
INTRODUCTION To evaluate and compare the efficacy and safety of YAG laser vitreolysis in treating symptomatic vitreous floaters of complete posterior vitreous detachment (PVD) and non-PVD. METHODS In this prospective cohort study, 51 eyes with symptomatic floaters were treated with YAG laser vitreolysis. Participants were divided into complete PVD and non-PVD groups. Objective visual quality measures including the Strehl ratio (SR), internal spherical aberration (SA), internal comatic aberration (CA), internal high-order aberration (HOA), area ratio of modulation transfer function (MTFa) and Vitreous Floaters Symptom Questionnaire (VFSQ-13) scores were used to compare the efficacy of YAG laser vitreolysis treatment between two groups. RESULTS The mean age of all patients was 56.80 ± 10.82 years old. In total, 36 of 51 (70.59%; 95% CI 58.10-83.10) patients reported their symptoms as significant or complete improvement after YAG laser vitreolysis treatment. Post-treatment MTFa, internal SA and internal HOA were significantly better compared to baseline (26.19 ± 14.73 vs. 29.19 ± 17.98, p = 0.013; 0.05 ± 0.05 vs. 0.04 ± 0.04, p = 0.031 and 0.23 ± 0.22 vs. 0.16 ± 0.07, p = 0.044; respectively) in all eyes. Twenty-nine of 51 (56.86%) eyes had floaters of non-PVD type. Significant or complete subjective improvements in the PVD group and non-PVD group were 72.73% and 68.97% (p = 0.344), respectively. CONCLUSIONS Improved subjective and objective visual quality in participants with symptomatic floaters following YAG laser vitreolysis was found in both groups. The efficacy of YAG laser vitreolysis was comparable in floaters of complete PVD and non-PVD types.
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Ankamah E, Green-Gomez M, Roche W, Ng E, Welge-Lüßen U, Kaercher T, Barbur J, Nolan JM. Impact of symptomatic vitreous degeneration on photopic and mesopic contrast thresholds. Clin Exp Optom 2021; 105:609-616. [PMID: 34751082 DOI: 10.1080/08164622.2021.1981116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
CLINICAL RELEVANCE Contrast thresholds under photopic and mesopic luminance conditions are compromised in subjects with vitreous degeneration. A plausible explanation is needed for the visual discomfort expressed by patients suffering from symptomatic vitreous degeneration. BACKGROUND The current study investigates the effect of symptomatic vitreous degeneration on photopic and mesopic contrast at high spatial frequencies. METHODS An age-matched sample of 115 subjects, comprising 30 subjects with symptomatic vitreous floaters (cases) and 85 healthy subjects (controls), was included in this study. Visual acuity and flicker thresholds were measured for all participants. Photopic and mesopic functional contrast thresholds at 10 cycles per degree were measured for all participants to assess the effect of floaters on contrast. Further, to determine the effect of posterior vitreous detachment on contrast, the sample was divided into three groups: cases with posterior vitreous detachment (n = 12); cases without posterior vitreous detachment (n = 18); and controls (n = 85), and their contrast thresholds were compared. RESULTS Photopic and mesopic contrast thresholds were lower by 37.4% and 27.5%, respectively, when the cases were compared with the controls (p = 0.028 and p < 0.001 for photopic and mesopic contrast thresholds, respectively). Photopic contrast was lower by 64.0% in cases with posterior vitreous detachment compared with controls (p = 0.001). Compared with controls, mesopic contrast was lower in cases with posterior vitreous detachment and in cases without posterior vitreous detachment by 30.3% and 25.6%, respectively (p = 0.014 and p = 0.017 for cases with and without posterior vitreous detachment, respectively). CONCLUSION : Subjects with vitreous degeneration have diminished photopic and mesopic contrast thresholds compared with controls. This finding highlights the negative impact of vitreous degeneration on the quality of vision.
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Affiliation(s)
- Emmanuel Ankamah
- Nutrition Research Centre Ireland, School of Health Science, Waterford Institute of Technology, Co, Waterford, Ireland
| | - Marina Green-Gomez
- Nutrition Research Centre Ireland, School of Health Science, Waterford Institute of Technology, Co, Waterford, Ireland
| | - Warren Roche
- Nutrition Research Centre Ireland, School of Health Science, Waterford Institute of Technology, Co, Waterford, Ireland
| | - Eugene Ng
- Nutrition Research Centre Ireland, School of Health Science, Waterford Institute of Technology, Co, Waterford, Ireland.,Institute of Eye Surgery, UPMC Whitfield Hospital, Co, Waterford, Ireland
| | | | | | - John Barbur
- Applied Vision Research Centre, School of Health Sciences, University of London, London, UK
| | - John M Nolan
- Nutrition Research Centre Ireland, School of Health Science, Waterford Institute of Technology, Co, Waterford, Ireland
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Patel SN, Lee C, Cui D, Wingert AM, Zhou S, Scott IU. Association of staffing with Incidence of delayed retinal break or detachment after posterior vitreous detachment in a resident urgent care clinic. Graefes Arch Clin Exp Ophthalmol 2021; 260:791-798. [PMID: 34661735 DOI: 10.1007/s00417-021-05437-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/26/2021] [Accepted: 09/30/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To compare the incidence rate of delayed retinal break or detachment after diagnosis of acute, symptomatic posterior vitreous detachment (PVD) in a resident-run urgent care clinic (UCC) when staffed by a retina attending, non-retina ophthalmology attending, optometrist, or ophthalmology resident only. METHODS Retrospective consecutive case series. Of the 594 patients with acute, symptomatic PVD evaluated in the UCC at Penn State Eye Center between 1/1/2016 and 10/10/2019, 454 were included in the study; 140 were excluded because they were diagnosed with a retinal break or detachment on presentation to the UCC, had media opacity precluding examination, or had no follow-up within one year. Demographics, presenting examination findings, and type of staffing were recorded; subsequent visits up to 1 year were analyzed for presence of delayed retinal break or detachment. RESULTS Among 491 eyes of 454 patients with a mean follow-up of 147 days, ten delayed breaks (10/491, 2.0%) and three delayed detachments (3/491, 0.6%) were discovered. Incidence rates of delayed breaks and detachments were 1.8% (5/282) and 0.7% (2/282), respectively, in the retina attending group, 1.0% (1/105) and 1.0% (1/105) in the non-retina ophthalmology attending group, 4.7% (3/64) and 0% (0/64) in the optometrist group, and 2.5% (1/40) and 0% (0/40) in the ophthalmology resident only group. There was no statistically significant difference in the incidence of delayed break or detachment among the staffing groups (P = 0.7312), but this study was underpowered to detect a statistically significant difference among staffing groups. Patients with a delayed break or detachment were more likely to have lattice degeneration (P = 0.0265) or a history of retinal break in the contralateral eye (P = 0.0014), and most eyes (10 [76.9%]) with a delayed break or detachment were left eyes (P = 0.0466). CONCLUSIONS The overall rate of delayed retinal break or detachment in the current study is similar to previously published rates among retinal physician and retinal fellow examiners. Although no statistically significant difference among staffing groups in the incidence rates of delayed retinal tears or detachments was identified in the study, it is important to note that the optometry and ophthalmology resident only groups had higher incidence rates of delayed retinal breaks than did the retina and non-retina ophthalmology attending groups, and this may be clinically important. Larger cohort studies would be needed in order to have the power to detect statistically significant differences among staffing groups. Varied staffing for acute, symptomatic PVD may assist with resource allocation in similar settings.
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Affiliation(s)
- Saagar N Patel
- Department of Ophthalmology, Penn State College of Medicine, 500 University Drive, HU19, Hershey, PA, 17033-0850, USA
| | - Charles Lee
- Penn State College of Medicine, Hershey, PA, USA
| | - David Cui
- Penn State College of Medicine, Hershey, PA, USA
| | | | - Shouhao Zhou
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Ingrid U Scott
- Department of Ophthalmology, Penn State College of Medicine, 500 University Drive, HU19, Hershey, PA, 17033-0850, USA. .,Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.
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Seider MI, Conell C, Melles RB. Complications of Acute Posterior Vitreous Detachment. Ophthalmology 2021; 129:67-72. [PMID: 34324945 DOI: 10.1016/j.ophtha.2021.07.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/12/2021] [Accepted: 07/20/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To evaluate the risk factors for retinal tear (RT) or rhegmatogenous retinal detachment (RRD) associated with acute, symptomatic posterior vitreous detachment (PVD) in a large comprehensive eye care setting. DESIGN Retrospective cohort study. PARTICIPANTS A total of 8305 adult patients in the Kaiser Permanente Northern California Healthcare System (KPNC) during calendar year 2018 who met inclusion criteria. METHODS The KPNC electronic medical record was queried to capture acute, symptomatic PVD events. Each chart was reviewed to confirm diagnoses and capture specific data elements from the patient history and ophthalmic examination. MAIN OUTCOME MEASURES Presence of RT or RRD at initial presentation or within 1 year thereafter. RESULTS Of 8305 patients who presented with acute PVD symptoms, 448 (5.4%) were diagnosed with RT and 335 (4.0%) were diagnosed with RRD. When considering variables available before examination, blurred vision (odds ratio [OR], 2.7; confidence interval [CI], 2.2-3.3), male sex (OR, 2.1; CI, 1.8-2.5), age < 60 years (OR, 1.8; CI, 1.5-2.1), prior keratorefractive surgery (OR, 1.6; CI, 1.3-2.0), and prior cataract surgery (OR, 1.4; CI, 1.2-1.8) were associated with higher risk of RT or RRD, whereas symptoms of flashes were mildly protective (OR, 0.8; CI, 0.7-0.9). Examination variables associated with a high risk of RT or RRD included vitreous pigment (OR, 57.0; CI, 39.7-81.7), vitreous hemorrhage (OR, 5.9; CI, 4.6-7.5), lattice degeneration (OR, 6.0; CI, 4.7-7.7), and visual acuity worse than 20/40 (OR, 3.0; CI, 2.5-3.7). Late RTs or RRDs occurred in 12.4% of patients who had vitreous hemorrhage, lattice degeneration, or a history of RT or RRD in the fellow eye at initial presentation but only 0.7% of patients without any of these 3 risk factors. Refractive error had an approximately linear relationship with age at presentation of PVD, with myopic patients presenting at a younger age (r = 0.4). CONCLUSIONS This study, based in a comprehensive eye care setting, found the rate of RT and RRD associated with acute PVD to be lower than rates previously reported by retina subspecialty practices. Several patient features strongly predicted the presence of initial and late complications of acute PVD.
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Affiliation(s)
- Michael I Seider
- Department of Ophthalmology, The Permanente Medical Group, Oakland, California; Department of Ophthalmology, The University of California - San Francisco, San Francisco, California
| | - Carol Conell
- Division of Research, Kaiser Permanente, Northern California, Oakland, California
| | - Ronald B Melles
- Department of Ophthalmology, The Permanente Medical Group, Oakland, California.
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Bringmann A, Unterlauft JD, Barth T, Wiedemann R, Rehak M, Wiedemann P. Müller cells and astrocytes in tractional macular disorders. Prog Retin Eye Res 2021; 86:100977. [PMID: 34102317 DOI: 10.1016/j.preteyeres.2021.100977] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 02/04/2023]
Abstract
Tractional deformations of the fovea mainly arise from an anomalous posterior vitreous detachment and contraction of epiretinal membranes, and also occur in eyes with cystoid macular edema or high myopia. Traction to the fovea may cause partial- and full-thickness macular defects. Partial-thickness defects are foveal pseudocysts, macular pseudoholes, and tractional, degenerative, and outer lamellar holes. The morphology of the foveal defects can be partly explained by the shape of Müller cells and the location of tissue layer interfaces of low mechanical stability. Because Müller cells and astrocytes provide the structural scaffold of the fovea, they are active players in mediating tractional alterations of the fovea, in protecting the fovea from such alterations, and in the regeneration of the foveal structure. Tractional and degenerative lamellar holes are characterized by a disruption of the Müller cell cone in the foveola. After detachment or disruption of the cone, Müller cells of the foveal walls support the structural stability of the foveal center. After tractional elevation of the inner layers of the foveal walls, possibly resulting in foveoschisis, Müller cells transmit tractional forces from the inner to the outer retina leading to central photoreceptor layer defects and a detachment of the neuroretina from the retinal pigment epithelium. This mechanism plays a role in the widening of outer lameller and full-thickness macular holes, and contributes to visual impairment in eyes with macular disorders caused by conractile epiretinal membranes. Müller cells of the foveal walls may seal holes in the outer fovea and mediate the regeneration of the fovea after closure of full-thickness holes. The latter is mediated by the formation of temporary glial scars whereas persistent glial scars impede regular foveal regeneration. Further research is required to improve our understanding of the roles of glial cells in the pathogenesis and healing of tractional macular disorders.
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Affiliation(s)
- Andreas Bringmann
- Department of Ophthalmology and Eye Hospital, University of Leipzig, 04103, Leipzig, Germany.
| | - Jan Darius Unterlauft
- Department of Ophthalmology and Eye Hospital, University of Leipzig, 04103, Leipzig, Germany
| | - Thomas Barth
- Department of Ophthalmology and Eye Hospital, University of Leipzig, 04103, Leipzig, Germany
| | - Renate Wiedemann
- Department of Ophthalmology and Eye Hospital, University of Leipzig, 04103, Leipzig, Germany
| | - Matus Rehak
- Department of Ophthalmology and Eye Hospital, University of Leipzig, 04103, Leipzig, Germany
| | - Peter Wiedemann
- Department of Ophthalmology and Eye Hospital, University of Leipzig, 04103, Leipzig, Germany
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Stavrakas P, Christou EE, Ananikas K, Tsiogka A, Tranos P, Theodossiadis P, Stefaniotou M, Chatziralli I. Sensitivity of spectral domain optical coherence tomography in the diagnosis of posterior vitreous detachment in vitreomacular interface disorders: A prospective cohort study. Eur J Ophthalmol 2021; 32:11206721211020644. [PMID: 34058907 DOI: 10.1177/11206721211020644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the sensitivity of Spectral Domain Optical Coherence Tomography (SD-OCT) regarding the diagnosis of posterior vitreous detachment (PVD) in vitreomacular interface disorders (VID). METHODS A total of 48 eyes of 48 patients were included in this prospective cohort study. PVD in eyes with VID was investigated. We determined the status of posterior vitreous cortex using slit lamp (SL) biomicroscopy and SD-OCT preoperatively, during vitrectomy and on the intraoperative video recording. Sensitivity and specificity of the examining methods were analysed. Four masked independent examiners participated in this study. RESULTS PVD was diagnosed in 16 eyes (33.3%) on SD-OCT, 20 eyes (41.7%) on SL examination and 28 eyes (58.3%) during vitrectomy. Sensitivity and specificity for diagnosis of PVD was 37.5% and 31.3% using SD-OCT, 90% and 64.3% on the SL examination, 92.9% and 90% on the video recording respectively, compared to the intraoperative PVD diagnosis. CONCLUSION SD-OCT shows a relatively low detection sensitivity of PVD in VID. Thorough OCT investigation is necessary to establish an appropriate diagnosis of PVD and treatment in VID.
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Affiliation(s)
| | | | - Konstantinos Ananikas
- Second Department of Ophthalmology, University of Athens Medical School, Athens, Greece
| | | | | | | | | | - Irini Chatziralli
- Second Department of Ophthalmology, University of Athens Medical School, Athens, Greece
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Taniguchi H, Yoshida I, Sakamoto M, Maeno T. Epiretinal membrane appearance or progression after intravitreal injection in age-related macular degeneration. BMC Ophthalmol 2021; 21:190. [PMID: 33906612 PMCID: PMC8080384 DOI: 10.1186/s12886-021-01944-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study is to evaluate the influence of anti-vascular endothelial growth factor (VEGF) in the appearance or progression of epiretinal membranes (ERMs) in age-related macular degeneration (ARMD) and investigate confounding factors causing ERMs. METHODS Seventy-six eyes that were treated for more than 36 months from the first anti-VEGF injection were assessed. Binary logistic regression analysis was performed between smoking, lens status, subretinal hemorrhage, posterior vitreous detachment (PVD) status, peripheral retinal degeneration, type of AMD, conditions of contralateral eye, and the number of injections as independent variables and appearance or progression of ERMs during 36 months as dependent variables. RESULTS The presence of vitreomacular adhesion (VMA) or development of PVD during the observation period was significantly associated (Odds ratio [OR]: 5.77; 95% confidence interval [CI], 1.72-19.4; p = 0.005) with the appearance or progression of ERMs. Moreover, peripheral retinal degeneration was significantly associated (OR: 3.87; 95% CI, 1.15-13.0; p = 0.029). Injection number of anti-VEGF was not significantly associated (OR: 1.02; 95% CI, 0.90-1.16; p = 0.72). CONCLUSION This study suggests possibilities that anti-VEGF injections alone are unable to cause the development of ERMs, that VMA or developing PVD has a prior impact on the developing ERMs in ARMD similar to that of idiopathic ERMs, and that peripheral retinal degenerations and vitreomacular adhesion were both related to ERMs development and pathogenesis of ARMD.
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Affiliation(s)
- Hikari Taniguchi
- Sakura Medical Center, Toho University, 285-8741 Sakura-shi, Chiba, Japan
| | - Izumi Yoshida
- Sakura Medical Center, Toho University, 285-8741 Sakura-shi, Chiba, Japan. .,Toho-Kamagaya Hospital, 273-0132 Kamagaya-shi, Chiba, Japan.
| | - Masashi Sakamoto
- Sakura Medical Center, Toho University, 285-8741 Sakura-shi, Chiba, Japan
| | - Takatoshi Maeno
- Sakura Medical Center, Toho University, 285-8741 Sakura-shi, Chiba, Japan
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Khalsa A, Kelgaonkar A, Padhy SK, Agarwal T, Patel A, Behera UC, Basu S. Posterior Subhyaloid Precipitates: 'KPs' of the Posterior Segment. Semin Ophthalmol 2021; 36:751-756. [PMID: 33734863 DOI: 10.1080/08820538.2021.1900291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: To describe the course of posterior subhyaloid precipitates (PSPs) accompanying active retinitis. Methods: Retrospective study of three retinitis cases associated with PSPs and literature review. Results: Cases 1 and 2 were Toxoplasma retinochoroiditis. Case 3 had bilateral retinitis post-febrile illness. PSPs were yellowish-white spherical lesions seen in the presence of partial posterior hyaloid detachment (PVD) in the retro-hyaloid space lining the inferior PVD margin. In all 3 cases, PSPs resolved during treatment for primary disease. Resolution of PSPs preceded resolution of retinitis. Literature review revealed similar lesions in CMV retinitis and syphilis in addition to Toxoplasma retinochoroiditis. Conclusion: PSPs were seen in the presence of active retinitis and partial PVD when inflammatory aggregates gravitate inferiorly in the subhyaloid space. They were observed during active retinitis and their resolution preceded the resolution of retinitis, thus providing a potential marker for disease resolution.
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Affiliation(s)
- Ashish Khalsa
- Retina and uveitis services, LV Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar, Odisha, India
| | - Anup Kelgaonkar
- Retina and uveitis services, LV Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar, Odisha, India
| | - Srikanta Kumar Padhy
- Retina and uveitis services, LV Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar, Odisha, India
| | - Tushar Agarwal
- Retina and uveitis services, LV Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar, Odisha, India
| | - Anamika Patel
- Retina and uveitis services, LV Prasad Eye Institute, GMR Varalaxmi Campus, Visakhapatnam, Andhra Pradesh, India
| | - Umesh Chandra Behera
- Retina and uveitis services, LV Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar, Odisha, India
| | - Soumyava Basu
- Retina and uveitis services, LV Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar, Odisha, India
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Alamou S, Agbahoungba L, Longue L, Abouki COA, Aigbe N, Odoulami L, Sounouvou I, Tchabi S. [Tomographic appearance and etiologies of epimacular membranes in Cotonou]. J Fr Ophtalmol 2021; 44:519-22. [PMID: 33612325 DOI: 10.1016/j.jfo.2020.06.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 05/30/2020] [Accepted: 06/05/2020] [Indexed: 11/23/2022]
Abstract
PURPOSE To study the tomographic appearance and etiologies of epimacular membranes in Cotonou. PATIENTS, MATERIALS AND METHODS This was a descriptive, analytical study with retrospective data collection. It took place at the Cotonou Retinal Testing Center and included all patients who underwent macular OCT testing between January 1, 2016 and June 30, 2018. RESULTS Of the 604 subjects examined, 32 patients (5.3%) exhibited an epimacular membrane. Epimacular membrane in combination with posterior vitreous detachment and contraction accounted for 44.74% of cases. 42.31% of the fellow eyes had developed a posterior vitreous detachment. The majority of the membranes were idiopathic. Proliferative diabetic retinopathy and posterior uveitis were the main risk factors for secondary membranes. CONCLUSION Epimacular membrane is a potentially blinding condition. The risk of bilateral involvement is significant, and patient access to OCT remains a concern in developing countries.
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Venkatesh R, James E, Jayadev C. Screening and prophylaxis of retinal degenerations prior to refractive surgery. Indian J Ophthalmol 2020; 68:2895-2898. [PMID: 33229665 PMCID: PMC7856971 DOI: 10.4103/ijo.ijo_2101_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The need and demand for surgical correction of refractive errors, particularly myopia, has been increasing. Degenerations involving the peripheral retina are common in myopes and can result in a rhegmatogenous retinal detachment. There are no clear guidelines for retinal screening and management of asymptomatic retinal degenerations prior to refractive surgery or for follow-up of these patients. This article aims to provide a set of guidelines for the management of retinal degenerations in eyes undergoing refractive surgeries.
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Affiliation(s)
- Ramesh Venkatesh
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Edwin James
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Chaitra Jayadev
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, Karnataka, India
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Zhang F, Chang P, Zhao Y, Zhao YE. Incidence of posterior vitreous detachment after congenital cataract surgery: an ultrasound evaluation. Graefes Arch Clin Exp Ophthalmol 2020; 259:1045-1051. [PMID: 33180157 DOI: 10.1007/s00417-020-04997-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 10/04/2020] [Accepted: 10/27/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND To investigate the incidence of developing posterior vitreous detachment (PVD) in children after congenital cataract surgery. METHODS This is a prospective study which recruited 131 children with congenital cataracts who underwent cataract surgery between June 1, 2015, and September 1, 2018. The patients were divided into two groups depending on their post-operation phakic status (with or without IOL implantation). Infants aged from 6 to 12 months from two groups were analyzed as subgroups, respectively. B-scan ultrasonography was performed before the procedure and at 1, 3, 6, 9, and 12-month follow-ups, respectively, after the operation. RESULTS Of the 131 eyes included in the analyses, 74 were aphakic, and 57 were pseudophakic after surgery. The postoperative rate of PVD in all analyzed eyes was 6.9% (9 of 131 eyes). After 12 months, PVD was significantly more prevalent in the eyes that underwent cataract surgery with IOL implantation (10.5%, 6 of 57 eyes) compared to the eyes without IOL implantation (4.1%, 1 of 74 eyes, P < 0.05); however, the eyes in the aphakic group were significantly younger than the eyes in the pseudophakic group, while the mean axial length (AL) of the pseudophakic eyes (21.11 ± 2.07 mm) was significantly higher than that of the aphakic eyes (18.93 ± 1.86 mm) (P < 0.01). In patients between the ages of 6 and 12 months of age from the two groups, the AL of patients with IOL implantation continued to be significantly increased compared to the group without IOL implantation (20.44 ± 1.68 mm vs. 19.78 ± 1.52 mm, P < 0.01). At the follow-up appointments, two patients with PVD were observed among the 14 eyes that had undergone cataract surgery with IOL implantation, while one eye was observed to have developed PVD among the 15 eyes without IOL implantation. CONCLUSIONS PVD occurs with greater frequency after congenital cataract surgery, particularly in eyes that have undergone IOL implantation. We suggest that PVD should be carefully monitored in children after congenital cataract surgery to avoid subsequent ocular pathologies such as retinal detachment. Future studies are needed to determine other potential risk factors that have not been as thoroughly explored, as opposed to better-known factors such as older age, longer axial length, and IOL implantation.
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Affiliation(s)
- Fan Zhang
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou Xueyuan Road, Wenzhou, 325102, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Pingjun Chang
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou Xueyuan Road, Wenzhou, 325102, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Yuyu Zhao
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou Xueyuan Road, Wenzhou, 325102, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Yun-E Zhao
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou Xueyuan Road, Wenzhou, 325102, Zhejiang, China.
- National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China.
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Preti RC, Zacharias LC, Cunha LP, Monteiro MLR, Sarraf D. Spontaneous macular hole closure after posterior vitreous detachment in an eye with hyperreflective OCT stress line. Am J Ophthalmol Case Rep 2020; 20:100950. [PMID: 33195877 PMCID: PMC7644851 DOI: 10.1016/j.ajoc.2020.100950] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/05/2020] [Accepted: 09/26/2020] [Indexed: 12/01/2022] Open
Abstract
Purpose The aim of this report is to describe a patient who presented with a central hyper-reflective line (HRL) with spectral domain-optical coherence tomography (SD-OCT) after posterior vitreous detachment that evolved to full thickness macular hole (FTMH) with subsequent spontaneous resolution. Observations A 59-year-old patient presented with a history of photopsia and floaters followed by the development of a central scotoma in the right eye (OD). The left eye (OS) was normal. On examination, visual acuity (VA) was 20/20- OD and 20/20 OS. Retinal examination OD was remarkable for a retinal tear, and SD-OCT demonstrated a central HRL. The patient underwent laser retinopexy to barricade the retinal tear. Sequential SD-OCT of the macula was performed and the patient eventually developed a small FTMH 8 months after the baseline presentation. VA was correspondingly reduced to 20/80 OD. Upon return after 4 months, the hole was completely resolved with improvement of VA to 20/20 OD. Conclusion Vitreomacular traction (VMT) may lead to foveal dehiscence. This instability can be detected with SD-OCT as a vertical hyperreflective stress line that is a risk factor for progression to a FTMH. With release of VMT, FTMH can spontaneously close.
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Affiliation(s)
- Rony C Preti
- Division of Ophthalmology, University of São Paulo Medical School, São Paulo, Brazil
| | - Leandro C Zacharias
- Division of Ophthalmology, University of São Paulo Medical School, São Paulo, Brazil
| | - Leonardo P Cunha
- Division of Ophthalmology, University of São Paulo Medical School, São Paulo, Brazil
| | - Mario L R Monteiro
- Division of Ophthalmology, University of São Paulo Medical School, São Paulo, Brazil
| | - David Sarraf
- Retina Disorders and Ophthalmic Genetics, Stein Eye Institute, University of California-Los Angeles, Los Angeles, CA, USA.,Greater Los Angeles VA Healthcare Center, Los Angeles, CA, USA
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Jarocki A, Durrani A, Zhou Y, Miller JML. On-Call Examinations for Acute Onset of Flashes, Floaters, or Curtain by Junior Ophthalmology Residents: Outcomes, Safety, and Resource Use. Ophthalmol Retina 2020; 5:330-336. [PMID: 32795660 DOI: 10.1016/j.oret.2020.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/28/2020] [Accepted: 07/30/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To determine whether an on-call system serviced by junior residents can safely triage patients with symptoms concerning for posterior vitreous detachment, retinal tear, and retinal detachment. DESIGN Quality improvement study structured as a prospective cohort study. PARTICIPANTS All symptomatic patients seen in 2017 by an on-call junior resident were followed up (257 patients). Those with follow-up within 6 months of initial presentation (228 patients, 246 unique encounters) were included. METHODS We prospectively tracked all symptomatic patients seen on-call by a junior resident in 2017 at a major academic medical center. MAIN OUTCOME MEASURES Incidence and predictors of true retinal tears or detachments, false-positive tears or detachments, false-negative tears or detachments, and resource use. RESULTS Of 246 symptomatic encounters, 83 (33.7%) had a perceived retinal tear or detachment. Residents used B-scan ultrasonography in a high number of encounters (41.0%). Ten (4.1%) false-positive tears or detachments were identified, with the presence of intraretinal hemmorhage predicting a false-positive examination (adjusted odds ratio, 3.86; 95% confidence interval, 1.1-13.5). Thirteen (5.3%) false-negative tears and no false-negative detachments were identified. Eleven (84.6%) false-negative tears underwent follow-up within days based on high-risk characteristics, and no false-negative tears progressed to detachment at follow-up. Measures of resource use included an in-person confirmation of examination findings by the senior resident or fellow in 59 encounters (24.0%) and shorter follow-up times to a retina rather than a nonretina clinic for 52 of 151 patients who showed no pathologic features on initial examination. CONCLUSIONS Junior residents can safely provide on-call triage of patients with symptoms concerning for a posterior vitreous detachment, retinal tear, or retinal detachment. The system requires moderate resource use, including occasional confirmatory examinations by a second physician and shorter follow-up times to retina clinic for high-risk patients.
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Affiliation(s)
| | - Asad Durrani
- Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan
| | - Yunshu Zhou
- Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan
| | - Jason M L Miller
- Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan.
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Park JH, Yang H, Kwon H, Jeon S. Risk Factors for Onset or Progression of Posterior Vitreous Detachment at the Vitreomacular Interface after Cataract Surgery. Ophthalmol Retina 2020; 5:270-278. [PMID: 32688082 DOI: 10.1016/j.oret.2020.07.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/06/2020] [Accepted: 07/13/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To study the incidence and risk factors for onset or progression of posterior vitreous detachment (PVD) at the vitreomacular interface (VMI) after cataract surgery. DESIGN Retrospective case series. PARTICIPANTS Patients with a history of phacoemulsification from April 2018 through April 2019 at the Keye Eye Center, Seoul, Korea, and postoperative monitoring for more than 2 months. METHODS Cox proportional hazard ratios for the onset or development of PVD after cataract surgery in the presence of selected risk factors and demographic data were calculated. To evaluate the ocular risk factors, various ocular metrics, including spherical equivalent (SE), axial length (AL), anterior chamber depth, lens thickness, central subfield thickness, PVD status at macula and optic nerve head (ONH), peripapillary retinal nerve fiber layer thickness, and ONH parameters from OCT scans, were used for the analysis. MAIN OUTCOME MEASURES Onset or development of PVD at the VMI. RESULTS Among 988 eyes without PVD at baseline, 174 eyes (17.6%) showed changes in the VMI. Univariate analysis showed that age, SE, AL, PVD status at macula and ONH, and average and vertical cup-to-disc ratios (CDRs) were associated significantly with PVD onset or development (P = 0.046, P = 0.004, P = 0.040, P < 0.001, P < 0.001, P = 0.008, and P = 0.042, respectively). In a multivariate analysis, PVD status at the macula and ONH and smaller CDR were associated with PVD onset or progression after cataract surgery after adjustment for age, SE, and AL (P < 0.001, P < 0.001, and P = 0.005, respectively). CONCLUSIONS The risk of PVD onset or progression was dependent on PVD status and the CDR detected on OCT scans, not on age or AL, in a large patient cohort. Patients who show risk factors on OCT should be monitored carefully during the postoperative period.
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Mano F, LoBue SA, Eno A, Chang KC, Mano T. Impact of posterior vitreous detachment on contrast sensitivity in patients with multifocal intraocular lens. Graefes Arch Clin Exp Ophthalmol 2020; 258:1709-1716. [PMID: 32318806 DOI: 10.1007/s00417-020-04705-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/08/2020] [Accepted: 04/13/2020] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To investigate posterior vitreous detachment (PVD) and pars plana vitrectomy (PPV) effects on contrast sensitivity function (CSF) in patients with a multifocal intraocular lens (MfIOL). METHODS This single-center prospective case-control study analyzed 27 patients with 43 consecutive eyes. Twenty patients with 36 consecutive eyes received MfIOL implantation with either ZLB00 or ZMB00. CSF was measured as the area under the log contrast sensitivity function (AULCSF) in the presence and absence of PVD (PVD+ group and PVD- group, respectively). Seven eyes associated with a symptomatic PVD and severe visual dissatisfaction after MfIOL implantation underwent PPV (symptomatic PVD+ group). CSF was measured prior to and after PPV. RESULTS The mean AULCSF was significantly lower in the PVD+ group (1.5 ± 0.1) versus the PVD- group (1.7 ± 0.1, p < 0.0001). Major complaints in the symptomatic PVD+ group included floaters (n = 2) and blurry vision (n = 5). The preoperative AULCSF (1.4 ± 0.1) was significantly lower in the symptomatic PVD+ group versus the PVD- group (p < 0.0001) and PVD+ group (p = 0.02). The preoperative AULCSF in the symptomatic PVD+ group was significantly improved after PPV (1.4 vs. 1.7, respectively, p = 0.002). CONCLUSIONS PVD significantly decreased CSF in patients with MfIOL. Patients with symptomatic PVD exhibited the greatest decrease in CSF, which was significantly improved after PPV. Measurement of CSF and careful assessment of PVD may be useful in determining the appropriateness of surgical intervention for improving visual performance and satisfaction in MfIOL patients with symptomatic PVD.
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Affiliation(s)
- Fukutaro Mano
- Suita Tokushukai Hospital Eye Center, 21-1 Senriokanishi, Suita, Osaka, Japan. .,Department of Ophthalmology, Kindai University Faculty of Medicine, Osakasayama, Japan.
| | - Stephen A LoBue
- Department of Ophthalmology, LoBue Laser & Eye Medical Centers, Murrieta, CA, USA
| | - Ayako Eno
- Suita Tokushukai Hospital Eye Center, 21-1 Senriokanishi, Suita, Osaka, Japan
| | - Kuo-Chung Chang
- Suita Tokushukai Hospital Eye Center, 21-1 Senriokanishi, Suita, Osaka, Japan
| | - Tomiya Mano
- Suita Tokushukai Hospital Eye Center, 21-1 Senriokanishi, Suita, Osaka, Japan
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Katsanos A, Tsaldari N, Gorgoli K, Lalos F, Stefaniotou M, Asproudis I. Safety and Efficacy of YAG Laser Vitreolysis for the Treatment of Vitreous Floaters: An Overview. Adv Ther 2020; 37:1319-1327. [PMID: 32086749 PMCID: PMC7140748 DOI: 10.1007/s12325-020-01261-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Indexed: 12/11/2022]
Abstract
Emerging evidence has suggested that the entoptic phenomena associated with vitreous opacities (i.e. vitreous floaters) are more bothersome than previously believed. In addition, the prevalence of vitreous floaters is likely increasing due to the evolving global pandemic of myopia. The use of YAG laser vitreolysis for the treatment of annoying vitreous floaters has attracted significant attention in recent years as the technique offers a number of potential advantages. Unfortunately, the currently available evidence that is needed to guide clinical practice is both very limited and contradictory. As a consequence, the technique remains highly controversial. A review of the existing literature sheds light on patient- and treatment-related factors that may significantly affect both the effectiveness and the safety of the procedure. The current article discusses important aspects of key publications on the topic, offers suggestions for clinical practice, and highlights unmet needs that should be addressed by future research.
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Affiliation(s)
- Andreas Katsanos
- Ophthalmology Department, University of Ioannina, Ioannina, Greece.
| | - Nikoleta Tsaldari
- General Hospital "G. Genimatas- Ag. Dimitrios", Thessaloniki, Greece
| | | | - Fotios Lalos
- Department of Ophthalmology, University of Essen, Essen, Germany
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Hayashi K, Sato T, Manabe SI, Hirata A, Yoshimura K. Posterior vitreous detachment in patients with diabetes mellitus. Jpn J Ophthalmol 2020; 64:187-195. [PMID: 32048080 DOI: 10.1007/s10384-020-00720-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 12/27/2019] [Indexed: 01/10/2023]
Abstract
PURPOSE To compare the progression of posterior vitreous detachment (PVD) during aging among eyes of diabetics with diabetic retinopathy (DR), eyes of diabetics without DR, and eyes of nondiabetics. STUDY DESIGN Prospective cross-sectional study. METHODS One-hundred thirty-three diabetic eyes with DR (DR group), 254 diabetic eyes without DR (non-DR group), and 577 nondiabetic eyes (nondiabetic group) were divided into four age categories: 1) 40-49 years, 2) 50-59 years, 3) 60-69 years, and 4) 70-79 years. The PVD state was examined using swept source-optical coherence tomography and classified into five stages: 0 (non PVD), 1 (paramacular PVD), 2 (perifoveal PVD), 3 (vitreofoveal separation), and 4 (complete PVD). RESULTS The PVD stage significantly progressed in the DR, non-DR, and nondiabetic groups (p <0.0001). At 40-49 and 50-59 years, the PVD stage did not differ significantly among the three groups. At 60-69 and 70-79 years, the PVD stage was significantly less progressed in the DR than the non-DR and nondiabetic groups (p ≤0.0027), and did not differ significantly between the non-DR and nondiabetic groups. At 70-79 years, complete PVD was detected in 40.6% of eyes in the DR group, 69.6% in the non-DR group, and 73.5% of eyes in the nondiabetic group. CONCLUSION PVD progresses later in diabetic eyes with DR than in diabetic eyes without DR and nondiabetics eyes at 60 and 70 years of age, suggesting a stronger vitreomacular adhesion in diabetics with DR.
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Affiliation(s)
- Ken Hayashi
- Hayashi Eye Hospital, 4-23-35 Hakataekimae, Hakata-Ku, Fukuoka, 812-0011, Japan.
| | - Tatsuhiko Sato
- Hayashi Eye Hospital, 4-23-35 Hakataekimae, Hakata-Ku, Fukuoka, 812-0011, Japan
| | - Shin-Ichi Manabe
- Hayashi Eye Hospital, 4-23-35 Hakataekimae, Hakata-Ku, Fukuoka, 812-0011, Japan
| | - Akira Hirata
- Hayashi Eye Hospital, 4-23-35 Hakataekimae, Hakata-Ku, Fukuoka, 812-0011, Japan
| | - Koichi Yoshimura
- Hayashi Eye Hospital, 4-23-35 Hakataekimae, Hakata-Ku, Fukuoka, 812-0011, Japan
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Hanai K, Hashimoto M, Sasaki M, Nakamura H. Microsurgical observation of the posterior vitreous in patients with vitreous hemorrhage caused by Terson syndrome. Am J Ophthalmol Case Rep 2020; 17:100613. [PMID: 32083223 PMCID: PMC7019118 DOI: 10.1016/j.ajoc.2020.100613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 01/08/2020] [Accepted: 01/28/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose To describe features characteristic of vitreous hemorrhage in patients with Terson syndrome observed through a microsurgical scope. Methods Between May 2015 and February 2019, 12 eyes of 10 patients with vitreous hemorrhage occurring after subarachnoid hemorrhage (SAH) underwent pars plana vitrectomy. Results During vitreous surgery, we found 10 of 12 eyes did not have posterior vitreous detachment (PVD). Furthermore, we observed in 9 of the 10 eyes without PVD (90.0%) that there was no hemorrhage in the posterior vitreous cavity at the posterior pole while we removed vitreous hemorrhage. We confirmed that this clean space could be the posterior precortical vitreous pocket (PPVP). Conclusion and importance Terson syndrome may have no hemorrhage in the PPVP regardless of the presence of severe vitreous hemorrhage. The cases presented in our study may suggest one of the mechanisms of Terson syndrome.
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Affiliation(s)
- Kaori Hanai
- Department of Ophthalmology, Nakamura Memorial Hospital, S-1, W-14, Chuo-ku, Sapporo, Japan
| | - Masato Hashimoto
- Department of Ophthalmology, Nakamura Memorial Hospital, S-1, W-14, Chuo-ku, Sapporo, Japan
| | - Masako Sasaki
- Department of Ophthalmology, Nakamura Memorial Hospital, S-1, W-14, Chuo-ku, Sapporo, Japan
| | - Hirohiko Nakamura
- Department of Neurosurgery, Nakamura Memorial Hospital, S-1, W-14, Chuo-ku, Sapporo, Japan
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Marafon SB, Miron JP, Juncal VR, Figueiredo N, Downar J, Blumberger DM, Daskalakis ZJ, Muni RH. Retinal tear and posterior vitreous detachment following repetitive transcranial magnetic stimulation for major depression: A case report. Brain Stimul 2019; 13:467-469. [PMID: 31884185 DOI: 10.1016/j.brs.2019.12.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 12/12/2019] [Accepted: 12/15/2019] [Indexed: 11/26/2022] Open
Affiliation(s)
- Samara B Marafon
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, ON, Canada; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Jean-Philippe Miron
- Krembil Research Institute, University Health Network, Toronto, ON, Canada; Poul Hansen Family Centre for Depression, University Health Network, Toronto, ON, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Unité de Neuromodulation Psychiatrique (UNP), Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montréal, QC, Canada
| | - Verena R Juncal
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, ON, Canada; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Natalia Figueiredo
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, ON, Canada; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Jonathan Downar
- Krembil Research Institute, University Health Network, Toronto, ON, Canada; Poul Hansen Family Centre for Depression, University Health Network, Toronto, ON, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Daniel M Blumberger
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Zafiris J Daskalakis
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Rajeev H Muni
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, ON, Canada; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada; Kensington Vision and Research Centre, Toronto, ON, Canada.
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Wallace D, Hazell L, Loo C. Transcranial magnetic stimulation and photopsiae. Brain Stimul 2020; 13:487-8. [PMID: 31882371 DOI: 10.1016/j.brs.2019.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 12/19/2019] [Indexed: 11/21/2022] Open
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Abed E, D'Amico G, Rossi S, Perna A, Bianchi MLE, Silvestri G. Spectral domain optical coherence tomography findings in myotonic dystrophy. Neuromuscul Disord 2019; 30:144-150. [PMID: 32005494 DOI: 10.1016/j.nmd.2019.11.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 11/25/2019] [Accepted: 11/26/2019] [Indexed: 12/26/2022]
Abstract
The purpose of the study is to evaluate retinal involvement in a cohort of patients affected by Myotonic Dystrophy type 1 (DM1). Both eyes of 30 patients and one eye of a 31st patient with genetically proven diagnosis of DM1 and both eyes of 20 healthy age- and gender-matched subjects were enrolled. All patients underwent complete ophthalmologic examination including best-corrected visual acuity, intraocular pressure measurement, fundoscopy, fundus autofluorescence, infrared imaging and spectral-domain optical coherence tomography with central macular thickness measurement. DM1 patients showed statistically significant higher central macular thickness values than controls. In the DM1 group, butterfly (14.8%) and reticular (13.1%) pigment abnormalities were found with corresponding drusenoid deposit and focal disruption of photoreceptor and retinal pigment epithelium layers. Compared with the controls, DM1 group had higher prevalence of epiretinal membrane. In the DM1 group, the prevalence of epiretinal membrane and retinal pigment epithelium alterations were directly correlated with age, whereas no correlation was found with disease duration, CTG expansion and MIRS score. In conclusion, in addition to the typical retinal pigment epithelium changes, DM1 is also associated with abnormalities of the vitreoretinal interface, particularly epiretinal membrane, resulting in central macular thickness increase. Both inner and outer retinal alterations were associated with increasing age, suggesting that DM1 may cause a premature aging of the retina.
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Affiliation(s)
- Edoardo Abed
- Department of Ophthalmology, Università Cattolica del Sacro Cuore, Largo F. Vito 1, Rome, Italy
| | - Guglielmo D'Amico
- Department of Ophthalmology, Fondazione Policlinico A. Gemelli IRCSS, Largo A. Gemelli 8, Rome, Italy
| | - Salvatore Rossi
- Institute of Neurology, Università Cattolica del Sacro Cuore, Largo F. Vito 1, Rome, Italy
| | - Alessia Perna
- Institute of Neurology, Università Cattolica del Sacro Cuore, Largo F. Vito 1, Rome, Italy
| | | | - Gabriella Silvestri
- Institute of Neurology, Università Cattolica del Sacro Cuore, Largo F. Vito 1, Rome, Italy; Area Neuroscienze, Fondazione Policlinico A. Gemelli IRCSS, Largo A. Gemelli 8, Rome, Italy.
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