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Gouliopoulos N, Oikonomou D, Karygianni F, Rouvas A, Kympouropoulos S, Moschos MM. The association of symptomatic vitreous floaters with depression and anxiety. Int Ophthalmol 2024; 44:218. [PMID: 38713290 DOI: 10.1007/s10792-024-03006-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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 10/19/2023] [Indexed: 05/08/2024]
Abstract
PURPOSE To evaluate the levels of anxiety and depression in patients with symptomatic vitreous floaters and to determine the possible correlations of psychological implications with the symptoms duration and possible improvement, the degree of posterior vitreous detachment, and the discomfort severity. METHODS Ninety patients complaining for floaters and fifty-seven age- and gender-matched healthy-control subjects were recruited. Every participant underwent a complete ophthalmological examination, including funduscopy and optical coherence tomography scans, while clinical and demographic data were also gathered. The Patient Health Questionnaire-9 (PHQ-9), the Zung Depression Inventory-Self-Rating Depression Scale (Zung SDS), and the Hospital Anxiety and Depression Scale (HADS) were completed by everyone. RESULTS Between the studied groups, no significant differences were detected regarding the clinical and demographic data (p > 0.05). The patients with floaters had significantly higher scores of PHQ-9, Zung SDS, HADS Anxiety, and HADS Depression (p < 0.001). After adjustment for several confounders, PHQ-9 (p = 0.041), Zung SDS (p = 0.003), and HADS Anxiety (p = 0.036) values remained significantly impaired. Among the patients, PHQ-9 and Zung SDS scores were significantly elevated in the patients with floaters duration less than 4 weeks (p < 0.05). Finally, anxiety and depression were significantly correlated with the symptoms duration and intensity, with the floater-associated discomfort, and with the stage of posterior vitreous detachment. CONCLUSION Vitreous floaters have a negative impact on patients' psychological status, by the terms of enhanced depressive and anxiety levels. To the best of our knowledge, our study is the first in the literature to elaborate the aforementioned association, by assessing three different questionnaires simultaneously.
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Affiliation(s)
- Nikolaos Gouliopoulos
- 2nd Department of Ophthalmology, Medical School of National and Kapodistrian University of Athens, 'Attikon' University General Hospital, 1 Rimini Str, 12462, Haidari, Athens, Greece.
| | - Dimitra Oikonomou
- 2nd Department of Ophthalmology, Medical School of National and Kapodistrian University of Athens, 'Attikon' University General Hospital, 1 Rimini Str, 12462, Haidari, Athens, Greece
| | - Foteini Karygianni
- 2nd Department of Ophthalmology, Medical School of National and Kapodistrian University of Athens, 'Attikon' University General Hospital, 1 Rimini Str, 12462, Haidari, Athens, Greece
| | - Alexandros Rouvas
- 2nd Department of Ophthalmology, Medical School of National and Kapodistrian University of Athens, 'Attikon' University General Hospital, 1 Rimini Str, 12462, Haidari, Athens, Greece
| | - Stylianos Kympouropoulos
- 2nd Department of Psychiatry, Medical School of National and Kapodistrian University of Athens, 'Attikon' University General Hospital, Haidari, Athens, Greece
| | - Marilita M Moschos
- 1st Department of Ophthalmology, Medical School of National and Kapodistrian University of Athens, 'G. Gennimatas' General Hospital, Holargos, Athens, Greece
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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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3
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Li D, Sun S, Liang J, Yue Y, Yang J, Zhi Y, Zhang X, Yu R, Li X. Papillary vitreous detachment as a possible accomplice in non-arteritic anterior ischaemic optic neuropathy. Br J Ophthalmol 2024; 108:607-612. [PMID: 37055157 PMCID: PMC10958297 DOI: 10.1136/bjo-2022-322726] [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: 10/13/2022] [Accepted: 03/15/2023] [Indexed: 04/15/2023]
Abstract
AIM To evaluate the role of papillary vitreous detachment in the pathogenesis of non-arteritic anterior ischaemic optic neuropathy (NAION) by comparing the features of vitreopapillary interface between NAION patients and normal individuals. METHODS This study included 22 acute NAION patients (25 eyes), 21 non-acute NAION patients (23 eyes) and 23 normal individuals (34 eyes). All study participants underwent swept-source optical coherence tomography to assess the vitreopapillary interface, peripapillary wrinkles and peripapillary superficial vessel protrusion. The statistical correlations between peripapillary superficial vessel protrusion measurements and NAION were analysed. Two NAION patients underwent standard pars plana vitrectomy. RESULTS Incomplete papillary vitreous detachment was noted in all acute NAION patients. The prevalence of peripapillary wrinkles was 68% (17/25), 30% (7/23) and 0% (0/34), and the prevalence of peripapillary superficial vessel protrusion was 44% (11/25), 91% (21/23) and 0% (0/34) in the acute, non-acute NAION and control groups, respectively. The prevalence of peripapillary superficial vessel protrusion was 88.9% in the eyes without retinal nerve fibre layer thinning. Furthermore, the number of peripapillary superficial vessel protrusions in the superior quadrant was significantly higher than that in the other quadrants in eyes with NAION, consistent with the more damaged visual field defect regions. Peripapillary wrinkles and visual field defects in two patients with NAION were significantly attenuated within 1 week and 1 month after the release of vitreous connections, respectively. CONCLUSION Peripapillary wrinkles and superficial vessel protrusion may be signs of papillary vitreous detachment-related traction in NAION. Papillary vitreous detachment may play an important role in NAION pathogenesis.
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Affiliation(s)
- Dong Li
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
- Department of Ophthalmology, Shanxi Eye Hospital, Taiyuan, China
| | - Shuo Sun
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Jingli Liang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Yi Yue
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Jihong Yang
- Department of Ophthalmology, Shanxi Eye Hospital, Taiyuan, China
| | - Yuntao Zhi
- Department of Ophthalmology, Shanxi Eye Hospital, Taiyuan, China
| | - Xiaomin Zhang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Rongguo Yu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Xiaorong Li
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
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Nixon TRW, Davie RL, Snead MP. Posterior vitreous detachment and retinal tear - a prospective study of community referrals. Eye (Lond) 2024; 38:786-791. [PMID: 37798362 PMCID: PMC10920725 DOI: 10.1038/s41433-023-02779-3] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/22/2023] [Accepted: 09/25/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Retinal tears (RT) from posterior vitreous detachment (PVD) are an important and treatable cause of rhegmatogenous retinal detachment (RRD). Better understanding of the risk of RT from PVD will help plan urgent eye care. METHODS Prospective observational case series over two years. Patients presenting to their optometrist, family doctor or emergency department with flashes and floaters were directed to a research clinic. History and examination, including slit-lamp biomicroscopy (SLB) and indentation indirect ophthalmoscopy (IIO), were performed by a single investigator, with two month follow-up for patients with confirmed PVD. Main outcome measures were incidence of PVD, RT, and RRD. RESULTS 1010 patients were recruited. 896 (89%) patients had PVD at first assessment, of which 89 (8.8% of total cohort, 9.9% of PVD eyes) had RT and 8 had RRD. 21 (3%) of the remaining PVD patients developed RT in the subsequent two months and a further 9 (11%) patients with RT at initial assessment developed further tears by two months. 7 (0.7%) had asymptomatic RT in the fellow eye. 15% of RT were only visible on IIO and not SLB. Weiss ring was absent in 32% of eyes with RT. Patients with RT or RRD were more likely than 'PVD-only' eyes to have blurred or missing vision (p < 0.001), have higher rate of blue-green cataracts (p < 0.001), and longer axial lengths (p < 0.05). CONCLUSIONS AND RELEVANCE This large, prospective study demonstrates a 9.9% rate of RT or RRD at the time of PVD, and emphasises the importance of IIO examination.
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Affiliation(s)
- Thomas R W Nixon
- Vitreoretinal Research Group, John van Geest Centre for Brain Repair, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0PY, UK
- School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0SP, UK
| | - Rebecca L Davie
- Vitreoretinal Research Group, John van Geest Centre for Brain Repair, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0PY, UK
| | - Martin P Snead
- Vitreoretinal Research Group, John van Geest Centre for Brain Repair, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0PY, UK.
- School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0SP, UK.
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Govetto A, Sebag J, Lucchini S, Ballabio C, Matteucci M, Ranno S, Carini E, Virgili G, Bacherini D, Radice P. IMAGING RHEGMATOGENOUS RETINAL LESIONS AND PERIPHERAL VITREORETINAL INTERFACE WITH WIDEFIELD OPTICAL COHERENCE TOMOGRAPHY. Retina 2024; 44:269-279. [PMID: 37856780 DOI: 10.1097/iae.0000000000003946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
PURPOSE Analyze the peripheral vitreoretinal interface with widefield optical coherence tomography. METHODS Retrospective chart analysis and widefield optical coherence tomography in 120 consecutive cases of rhegmatogenous pathology. RESULTS There were 166 lesions in 120 eyes, including 106 horseshoe tears, 22 operculated holes, 30 nonoperculated holes, six giant tears, and two peripheral lamellar defects followed for 6.1 ± 1.2 months. Posterior vitreous detachment was present in all eyes (101/101, 100%) with tears and operculated holes, but only in 5/19 eyes (26.3%) with nonoperculated holes ( P < 0.001). Axial vitreous traction was evident at the anterior edge of horseshoe tears (106/106, 100%), but not the posterior border (18/106, 17%, P < 0.001). Operculated holes located posterior to the vitreous base were free from vitreous traction, displaying a morphology similar to the macular hole. Nonoperculated holes were farther anterior with signs of tangential traction in 23/30 (76.7%) cases. Peripheral vitreoschisis was more often associated with nonoperculated holes (25/30, 83.3%), than horseshoe tears (17/106, 16%; P < 0.001). Horseshoe tears and nonoperculated holes were more often associated with retinal detachment (58/106 [54.7%] and 15/30 [50%], respectively) than operculated holes (5/22, 22.7%), P = 0.023. CONCLUSION Peripheral vitreoretinal interactions are similar to vitreomaculopathies, with axial and vitreoschisis-related tangential traction playing different roles in different rhegmatogenous pathologies. Peripheral optical coherence tomography improves understanding of pathophysiology and risks of retinal detachment.
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Affiliation(s)
- Andrea Govetto
- Department of Ophthalmology, VR Division, Circolo and Macchi Foundation Hospital, ASST-Settelaghi, Varese, Italy
| | - J Sebag
- Doheny Eye Institute, UCLA, Pasadena, California
- Department of Ophthalmology, Geffen School of Medicine, UCLA, Los Angeles, California
- VMR Institute for Vitreous Macula Retina, Huntington Beach, California; and
| | - Sara Lucchini
- Department of Ophthalmology, VR Division, Circolo and Macchi Foundation Hospital, ASST-Settelaghi, Varese, Italy
- Doheny Eye Institute, UCLA, Pasadena, California
- Department of Ophthalmology, Geffen School of Medicine, UCLA, Los Angeles, California
- VMR Institute for Vitreous Macula Retina, Huntington Beach, California; and
- Ophthalmology Department, Careggi University Hospital, University of Florence, Florence, Italy
| | - Chiara Ballabio
- Department of Ophthalmology, VR Division, Circolo and Macchi Foundation Hospital, ASST-Settelaghi, Varese, Italy
| | - Martina Matteucci
- Department of Ophthalmology, VR Division, Circolo and Macchi Foundation Hospital, ASST-Settelaghi, Varese, Italy
| | - Stefano Ranno
- Department of Ophthalmology, VR Division, Circolo and Macchi Foundation Hospital, ASST-Settelaghi, Varese, Italy
| | - Elisa Carini
- Department of Ophthalmology, VR Division, Circolo and Macchi Foundation Hospital, ASST-Settelaghi, Varese, Italy
| | - Gianni Virgili
- Ophthalmology Department, Careggi University Hospital, University of Florence, Florence, Italy
| | - Daniela Bacherini
- Ophthalmology Department, Careggi University Hospital, University of Florence, Florence, Italy
| | - Paolo Radice
- Department of Ophthalmology, VR Division, Circolo and Macchi Foundation Hospital, ASST-Settelaghi, Varese, Italy
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Curran CD, Adams OE, Vagaggini T, Sodhi GS, Prairie ML, Baker MJ, Sastry A, Ryan EH, Parke DW, Mittra RA, Dev S, Tang PH. PROPHYLACTIC TREATMENT OF LATTICE DEGENERATION IN FELLOW EYES AFTER REPAIR OF UNCOMPLICATED PRIMARY RHEGMATOGENOUS RETINAL DETACHMENT. Retina 2024; 44:63-70. [PMID: 37536462 DOI: 10.1097/iae.0000000000003908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
PURPOSE To evaluate prophylactic treatment (PTx) of lattice degeneration (LD) on retinal tear (RT) and rhegmatogenous retinal detachment (RRD) risk in fellow eyes of patients after primary RRD repair in the first eye. METHODS This was a consecutive case series with cohort control involving patients with RRD repair from January 1, 2013, through December 31, 2017. Patients received PTx (PTx cohort) or no PTx (No-PTx cohort) in fellow eye with 5-year follow-up. Primary outcome measure was proportion with new fellow eye RT/RRD. Secondary outcomes included logarithm of minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) and status of myopia, posterior vitreous detachment, and pseudophakia. RESULTS Four hundred ninety-eight patients were divided into 146 and 352 in PTx and No-PTx cohorts, respectively. PTx cohort developed significantly ( P < 0.05) fewer RT/RRD (17%) than No-PTx cohort (41%). PTx significantly ( P < 0.05) lowered RT/RRD irrespective of posterior vitreous detachment and myopia status. PTx patients undergoing phacoemulsification demonstrated significantly ( P < 0.05) less RT/RRD (22%) than No-PTx cohort (31%). There was no significant ( P = 0.96) final BCVA difference between PTx (median = 0 logMAR) and No-PTx (median = 0 logMAR) cohorts. CONCLUSION PTx of asymptomatic fellow eye LD reduced RT/RRD risk.
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Affiliation(s)
- Christian D Curran
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Olufemi E Adams
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School, Minneapolis, Minnesota
| | | | | | | | - Mikayla J Baker
- University of Minnesota Medical School, Minneapolis, Minnesota; and
| | - Ananth Sastry
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Edwin H Ryan
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School, Minneapolis, Minnesota
- Retina Consultants of Minnesota, Edina, Minnesota
| | - David Wilkin Parke
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School, Minneapolis, Minnesota
- Retina Consultants of Minnesota, Edina, Minnesota
| | - Robert A Mittra
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School, Minneapolis, Minnesota
- Retina Consultants of Minnesota, Edina, Minnesota
| | - Sundeep Dev
- Retina Consultants of Minnesota, Edina, Minnesota
| | - Peter H Tang
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School, Minneapolis, Minnesota
- Retina Consultants of Minnesota, Edina, Minnesota
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Zheng Y, Woodward R, Feng HL, Lee T, Zhang X, Pant P, Thomas AS, Fekrat S. IMPLICATIONS OF COMPLETE POSTERIOR VITREOUS DETACHMENT IN EYES WITH CENTRAL RETINAL VEIN OCCLUSION. Retina 2024; 44:159-165. [PMID: 37683266 DOI: 10.1097/iae.0000000000003932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
BACKGROUND/PURPOSE To evaluate the status of the posterior vitreous hyaloid on presenting optical coherence tomography images of the macula and its relationship to clinical characteristics, treatment patterns, and outcomes in eyes with central retinal vein occlusion. METHODS This is a retrospective longitudinal cohort study of consecutive patients with acute, treatment-naive central retinal vein occlusion diagnosed between 2009 and 2021 who had at least 12 months of follow-up. Clinical characteristics, treatment patterns, and outcomes were analyzed between eyes stratified based on the presence or absence of a complete posterior vitreous detachment (PVD) on optical coherence tomography at presentation. RESULTS Of 102 acute, treatment-naive central retinal vein occlusions identified, 52 (51%) had complete PVD at presentation and 50 (49%) did not. Central subfield thickness was significantly lower in those with complete PVD (12 months: 284.9 ± 122.9 µ m vs. 426.8 ± 286.4 µ m, P < 0.001; last follow-up: 278 ± 127.9 vs. 372.8 ± 191.0 µ m, P = 0.022). One-year intravitreal injection burden was significantly less for those with a complete PVD than those without (5.1 ± 3.6 injections vs. 6.7 ± 3.3 injections, P = 0.013). CONCLUSION Central retinal vein occlusion with complete PVD on presentation had significantly lower central subfield thickness and 1-year injection burden. Assessment of the vitreomacular interface in central retinal vein occlusion may serve as a prognostic imaging biomarker.
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Affiliation(s)
- Yuxi Zheng
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Richmond Woodward
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Henry L Feng
- Illinois Retina Associates, Rush University Medical Center, Chicago, Illinois ; and
| | - Terry Lee
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Xinxin Zhang
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Praruj Pant
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | | | - Sharon Fekrat
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
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8
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Baba M, Best R. The BElfast Retinal Tear and detachment Score (BERT Score) in vitreous haemorrhage. Eye (Lond) 2024; 38:202-204. [PMID: 37414932 PMCID: PMC10764311 DOI: 10.1038/s41433-023-02660-3] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 07/08/2023] Open
Abstract
OBJECTIVE To establish if the BElfast Retinal Tear and detachment Score (BERT Score) can be used in triaging patients presenting with vitreous haemorrhage to allow safe differentiation between those with retinal tears and detachments, versus haemorrhagic posterior vitreous detachments. METHODS Retrospective audit of 122 patients presenting to eye casualty with vitreous haemorrhage excluding trauma and vascular causes. Twenty-two patients were excluded from the study as they had no follow-up. The BERT Score was applied to the remaining 100 patients. RESULTS Vitreous haemorrhages with a BERT score ≥4 points were more likely to have a retinal tear or detachment (P = 0.0056). The sensitivity was 84.6% (confidence interval (CI) 65.0-100.0%), specificity 34.5% (CI 24.5-44.5%), positive predictive value 16.2% (CI 7.4-24.9%) and negative predictive value 94% (CI 85.4-100.0%). CONCLUSIONS The BERT is a reliable scoring system to risk stratify patients with vitreous haemorrhage. Its high sensitivity and negative predictive value can help clinicians to detect high-risk patients.
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Jung JJ, Zeng A, Komati R, Mackin AG, Skondra D, Yonekawa Y, Fineman MS, Ezon I, Rofagha S, Hoang QV. NODULAR EPIRETINAL MÜLLER CELL GLIOSIS IN THE FOVEA. Retin Cases Brief Rep 2023; 17:779-784. [PMID: 35972829 PMCID: PMC10597442 DOI: 10.1097/icb.0000000000001298] [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] [Indexed: 06/15/2023]
Abstract
PURPOSE The purpose of this study was to report the findings of a hyperreflective nodular epiretinal gliosis observed with optical coherence tomography presumed to be due to subclinical hyaloidal traction causing Mϋller cell cone gliosis. METHODS Retrospective, observational case series. RESULTS Six eyes of six patients (mean age: 57 years, range 35-81 years) presented with a nodular epiretinal gliosis and had an average follow-up interval of 26 months (range 1-82 months). The mean baseline best-corrected visual acuity was 0.25 ± 0.17 (Snellen equivalent 20/38.3 ± 16.9). Fundus photography demonstrated a yellowish lesion overlying the fovea. Optical coherence tomography imaging revealed a hyperreflective preretinal lesion with a mean vertical length of 267 μ m (range 185-497) and a mean greatest linear diameter of 312 µ m (range 124-640). There was no vitreoretinal abnormality including vitreomacular traction or epiretinal membrane noted in any eye, and two of six eyes displayed a definitive posterior vitreous detachment. These nodules may have occurred before and persisted even after a posterior vitreous detachment or may have been acquired after the posterior vitreous detachment. The nodules typically remained stable with minimal change although in one eye, a posterior vitreous detachment occurred 6 months after initial presentation and lifted the gliosis off of the retinal surface where it remained attached to the posterior hyaloid. CONCLUSION Foveal nodular epiretinal gliosis may occur due to subclinical hyaloidal traction on the Müller cell cone even without obvious vitreoretinal interface abnormality on optical coherence tomography.
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Affiliation(s)
- Jesse J. Jung
- East Bay Retina Consultants Inc., Oakland, California
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Anne Zeng
- East Bay Retina Consultants Inc., Oakland, California
| | - Rahul Komati
- Department of Ophthalmology & Visual Science, The University of Chicago, Chicago, Illinois
| | - Anna G. Mackin
- Department of Ophthalmology & Visual Science, The University of Chicago, Chicago, Illinois
| | - Dimitra Skondra
- Department of Ophthalmology & Visual Science, The University of Chicago, Chicago, Illinois
| | - Yoshihiro Yonekawa
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PN
| | - Mitchell S. Fineman
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PN
| | - Isaac Ezon
- Jersey Shore Retina Consultants, West Long Branch, New Jersey
| | - Soraya Rofagha
- East Bay Retina Consultants Inc., Oakland, California
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Quan V. Hoang
- Singapore Eye Research Institute, Singapore National Eye Centre, Duke-NUS Medical School, Singapore;
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; and
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia College of Physicians and Surgeons, New York, New York.
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10
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Boneva S, Haritoglou C, Schultheiss M, Binder S, Sebag J. [Role of vitreous in the pathogenesis of neovascular age-related macular degeneration]. Ophthalmologie 2023; 120:992-998. [PMID: 37801159 DOI: 10.1007/s00347-023-01934-1] [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] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 10/07/2023]
Abstract
Age-related changes in vitreous molecular and anatomic morphology begin early in life and involve two major processes: vitreous liquefaction and weakening of vitreo-retinal adhesion. An imbalance in these two processes results in anomalous posterior vitreous detachment (PVD), which comprises, among other conditions, vitreo-macular adhesion (VMA) and traction (VMT). VMA is more common in patients with neovascular age-related macular degeneration (nAMD) than age-matched control patients, with the site of posterior vitreous adherence to the inner retina correlating with location of neovascular complexes. The pernicious effects of an attached posterior vitreous on age-related macular degeneration (AMD) progression involve mechanical forces, enhanced fluid influx and inflammation in and between the retinal layers, hypoxia leading to an accumulation of vascular endothelial growth factor (VEGF) and other stimulatory cytokines, and probably an infiltration of hyalocytes. It has been shown that vitrectomy not only mitigates progression to end-stage AMD, but existing choroidal neovascularization regresses after surgery. Thus, surgical PVD induction during vitrectomy or by pharmacologic vitreolysis may be considered in non-responders to anti-VEGF treatment with concomitant VMA.
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Affiliation(s)
- Stefaniya Boneva
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Freiburg, Deutschland.
| | | | - Maximilian Schultheiss
- Augenklinik Herzog Carl Theodor, München, Deutschland
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Susanne Binder
- Lehrstuhl für Ophthalmologie, Sigmund Freud Universität, Wien, Österreich
| | - 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
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11
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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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12
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Romero-Morales VA, Bousquet E, Abraham N, Santina A, Somisetty S, Peiris T, Lu A, Fogel Levin M, Sarraf D. EVALUATION OF PARAVASCULAR INNER RETINAL DEFECTS USING EN FACE OPTICAL COHERENCE TOMOGRAPHY. Retina 2023; 43:1644-1652. [PMID: 37433217 DOI: 10.1097/iae.0000000000003889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
PURPOSE To evaluate the prevalence and risk factors for development of paravascular inner retinal defects (PIRDs) using en face optical coherence tomography. METHODS This is a retrospective cross-sectional study. En face and cross-sectional optical coherence tomography images were reviewed (9 × 9 mm or 12 × 12 mm). Paravascular inner retinal defects were classified as either Grade 1 (i.e., paravascular inner retinal cysts) when the lesion was confined within the nerve fiber layer without any communication to the vitreous cavity or Grade 2 (i.e., paravascular lamellar hole) when the defects communicated to the vitreous. Paravascular inner retinal defect grading was correlated with presence of high myopia, stage of posterior vitreous detachment, and presence of epiretinal membrane and retinoschisis. RESULTS Of 1,074 patients (2,148 eyes), PIRDs were detected in 261 eyes with a prevalence of 261 per 2,148 eyes (12.2%) and 176 per 1,074 patients (16.4%). A total of 116 eyes (44.4%) displayed Grade 2 PIRDs while 145 eyes (55.6%) were Grade 1. In the multivariate logistic regression model, the presence of partial/complete posterior vitreous detachment, retinoschisis, and epiretinal membrane was significantly correlated with PIRDs (OR = 2.78 [1.7-4.4], P < 0.001; OR = 2.93 [1.7-5], P < 0.001; and OR = 25.9 [2.8-242.5], P < 0.001, respectively). The presence of partial/complete posterior vitreous detachment and epiretinal membrane was also significantly associated with Grade 2 PIRDs versus Grade 1 PIRDs ( P = 0.03 and P < 0.001). CONCLUSION Our results indicate that wide-field en face optical coherence tomography facilitates the identification of PIRDs over a large area of retina with a single capture. The presence of PIRDs was significantly associated with posterior vitreous detachment, epiretinal membrane, and retinoschisis, confirming the role of vitreoretinal traction in the pathogenesis of PIRDs.
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Affiliation(s)
- Veronica A Romero-Morales
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, California
- Department of Retina, Instituto Mexicano de Oftalmología, Querétaro, México
| | - Elodie Bousquet
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, California
- Department of Ophthalmology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris Cité, Paris, France
| | - Neda Abraham
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, California
| | - Ahmad Santina
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, California
| | - Swathi Somisetty
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, California
| | - Timothy Peiris
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, California
| | - Anthony Lu
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, California
| | - Meira Fogel Levin
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, California
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel; and
| | - David Sarraf
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, California
- Greater Los Angeles VA Healthcare Center, Los Angeles, California
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13
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Chen FT. SPONTANEOUS CLOSURE OF MYOPIC MACULAR HOLE TWICE WITHOUT POSTERIOR VITREOUS DETACHMENT. Retin Cases Brief Rep 2023; 17:554-556. [PMID: 37643041 PMCID: PMC10448797 DOI: 10.1097/icb.0000000000001235] [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] [Indexed: 08/31/2023]
Abstract
PURPOSE To present a case of a myopic macular hole that spontaneously closed twice in the presence of a broadly adherent posterior hyaloid membrane. METHODS Case report. RESULTS A 49-year-old man with high myopia and pseudophakia had a full-thickness macular hole in the left eye. The hole spontaneously closed in all retinal layers before the elective surgery, but the macular hole recurred one month later. The hole started sealing again spontaneously after one month, leaving a defect in the outer retinal layers. Four months later, the outer layer defect sealed and a lamellar macular hole developed. Throughout the course, the posterior hyaloid membrane remained parallel to the macular surface. The macular morphology and the patient's vision remained stationary at the 2-year follow-up. CONCLUSION This case demonstrated that myopic macular holes can form and seal repeatedly with a broadly adherent posterior hyaloid membrane. Although bridging phenomenon was the common sign indicating the initiation of the two hole closures, different patterns of tissue regeneration ensued.
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Affiliation(s)
- Fang-Ting Chen
- Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei City, Taiwan; and
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
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14
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Tieger MG, Vavvas DG. Impact of phacoemulsification on posterior vitreous detachment formation in eyes with vitreomacular traction. Digit J Ophthalmol 2023; 29:26-30. [PMID: 37727466 PMCID: PMC10506616 DOI: 10.5693/djo.01.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Purpose To investigate the impact of phacoemulsification on posterior vitreous detachment formation in eyes with vitreomacular traction (VMT) with or without macular holes. Methods A retrospective search of the medical records was conducted to identify patients with VMT who underwent cataract surgery at Mass Eye and Ear from 2016 to 2021. Patient demographics, ocular comorbidities, and clinical characteristics were extracted from the record, and optical coherence tomography images were assessed to confirm VMT and the presence of a lamellar or full-thickness macular hole (FMTH). Patients who underwent vitrectomy prior to cataract surgery were excluded. Results A total of 22 patients (15 women [68%]) met inclusion criteria (average age, 71 years). Fifteen eyes had an associated epiretinal membrane (63%), 7 had a lamellar hole (29%), and 8 had an FTMH (33%). Epiretinal membrane was present in 3 of 7 eyes with lamellar holes (43%) and 4 of 8 with a FTMH (50%). No eyes developed a complete posterior vitreous detachment following phacoemulsification. In 2 cases, there was progression of the macular hole stage following phacoemulsification. Ten eyes underwent subsequent pars plana vitrectomy (PPV). There was no statistically significant difference in visual acuity between eyes pre- and post-phacoemulsification; however, there was a statistically significant improvement in visual acuity pre- and post-PPV. Conclusions Unlike other studies, in this case series of 24 eyes with VMT or VMT with holes, no cases of full posterior vitreous detachment occurred following unremarkable phacoemulsification or YAG capsulotomy.
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Affiliation(s)
- Marisa G. Tieger
- Retina Service, Department of Ophthalmology Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Demetrios G. Vavvas
- Retina Service, Department of Ophthalmology Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
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15
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Li JQ, Pfeil JM, Stahl A, Krohne TU. [Late sequelae of retinopathy of prematurity in infancy]. Ophthalmologie 2023; 120:588-596. [PMID: 37221277 DOI: 10.1007/s00347-023-01876-8] [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] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Retinopathy of prematurity (ROP) is one of the most frequent causes of severe visual impairment or blindness in childhood and can lead to severe late complications in children even after the initial disease has resolved. PURPOSE The present study summarizes possible late effects in childhood after treated and untreated ROP. A special focus is on the development of myopia, retinal detachment, as well as neurological and pulmonary development after anti-vascular endothelial growth factor (VEGF) treatment. MATERIAL AND METHODS This work is based on a selective literature search on late effects in childhood of treated or untreated ROP. RESULTS Preterm infants have an increased risk of developing high-grade myopia. Interestingly, several studies indicate that the risk of myopia is reduced following anti-VEGF treatment. With anti-VEGF treatment, however, late recurrences after initial response are possible even after several months, making long-term and frequent follow-up examinations essential. Controversy exists regarding the possible negative effects of anti-VEGF treatment on neurological and pulmonary development. After both treated and untreated ROP, rhegmatogenous, tractional or exudative retinal detachment, vitreous hemorrhage, high myopia and strabismus are possible late complications. DISCUSSION Children with a history of ROP with or without treatment have an increased risk for late ocular sequelae, such as high myopia, retinal detachment, vitreous hemorrhage and strabismus. A seamless transition from ROP screening to pediatric and ophthalmological follow-up care is therefore essential for timely detection and treatment of possible refractive errors, strabismus, or other amblyogenic changes.
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Affiliation(s)
- Jeany Q Li
- Zentrum für Augenheilkunde, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - Johanna M Pfeil
- Klinik und Poliklinik für Augenheilkunde, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - Andreas Stahl
- Klinik und Poliklinik für Augenheilkunde, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - Tim U Krohne
- Zentrum für Augenheilkunde, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
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16
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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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17
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Han KJ, Moon H, Woo JM, Min JK. USING RETeval SYSTEM FLICKER ELECTRORETINOGRAPHY FOR EVALUATION OF DENSE VITREOUS HEMORRHAGE. Retina 2022; 42:73-79. [PMID: 34292221 DOI: 10.1097/iae.0000000000003263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine whether the RETeval electroretinography (ERG) system can be used to evaluate eyes with dense vitreous hemorrhage (VH). METHODS This retrospective case series study included 69 eyes of 69 patients with acute dense VH. Flicker ERGs were recorded by the RETeval system, an ERG device with adhesive skin electrodes. We evaluated the flicker ERG amplitudes in eyes with VH and the ratio of the VH eye amplitudes compared with the fellow eye amplitudes for each VH cause. RESULTS In patients with rhegmatogenous retinal detachment, the amplitude ratios were extremely low (0.08 ± 0.03). To detect rhegmatogenous retinal detachment, the area under the receiver operating characteristic curve was 0.977 (95% confidence interval, 0.943-1.000) (best rhegmatogenous retinal detachment cutoff value, 0.14; sensitivity, 100.0%; and specificity, 95.4%). The flicker ERG amplitude was not significantly correlated with the initial visual acuity (ρ = -0.189, P = 0.120) but was positively correlated with the postoperative visual acuity in eyes with VH (ρ = -0.328, P = 0.006). CONCLUSION The RETeval ERG system was found to be a useful diagnostic option in situations where dense VH precluded fundus examination or posterior vitreous detachment was indistinguishable from rhegmatogenous retinal detachment.
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Affiliation(s)
- Kyu Jin Han
- Department of Ophthalmology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
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18
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Wagley S, Belin PJ, Ryan EH. UTILIZATION OF SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY TO IDENTIFY POSTERIOR VITREOUS DETACHMENT IN PATIENTS WITH RETINAL DETACHMENT. Retina 2021; 41:2296-2300. [PMID: 33990115 DOI: 10.1097/iae.0000000000003209] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare posterior vitreous detachment (PVD) identification rate between clinical examination versus spectral domain optical coherence tomography in patients with retinal detachment (RD). METHODS Data from the Primary Retinal Detachment Outcomes Study were used for this retrospective cross-sectional study of 506 patients. Spectral domain optical coherence tomography scans were reviewed to detect the separation of the posterior hyaloid face from the retina and the optic nerve on all 31 raster cuts of a 30 × 30 scan. Statistical analysis was performed to compare spectral domain optical coherence tomography-identified PVD with PVD identified on slit-lamp biomicroscopy. RESULTS There was a significant difference in the rate of PVD identification by clinical examination versus spectral domain optical coherence tomography in patients with RD. Clinical examination identified 51.58% of patients with PVD, whereas spectral domain optical coherence tomography identified 78.42% of patients with PVD. In patients with macula-on RD, 61.68% were found to have PVD on clinical examination versus 83.90% by imaging. Spectral domain optical coherence tomography identified larger number of PVD in patients with macula-off RD compared with clinical examination, 46.28% versus 75.43%, respectively. There was low agreement between the two methods (kappa score = 0.137). There was a significant difference in surgical procedure type chosen in those with versus without PVD. CONCLUSION Knowledge about the posterior hyaloid anatomy is important before undergoing RD repair. Spectral domain optical coherence tomography can better identify PVD than clinical examination in patients with RD.
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Affiliation(s)
- Sushant Wagley
- VitreoRetinal Surgery, PLLC, Pennsylvania, Edina, Minnesota
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19
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Verhoekx JSN, van Overdam KA, Gishti O, van Leeuwen R, Crama N. [Acute onset of floaters, even without flashes, is an urgent ophthalmic warning sign]. Ned Tijdschr Geneeskd 2021; 165:D5850. [PMID: 34854588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Acute onset of floaters is most likely caused by a posterior vitreous detachment (PVD). A PVD can lead to a retinal tear and subsequently to a retinal detachment with permanent vision loss if left untreated. A patient who presents to a primary care physician with acute onset of floaters, in the absence flashes or visual field loss, is often referred to an ophthalmologist without urgency. In the current Dutch general practitioners standard, acute onset or increase of floaters, without flashes or visual loss, is not included as a reason for urgent referral to an ophthalmologist. Patients who present with acute onset of floaters without flashes have a 14-23% risk of having a retinal tear. Risk factors for developing a retinal tear are high myopia, trauma, cataract surgery, or a retinal tear or retinal detachment in the past medical or family history. Patients with acute onset of floaters should be triaged for urgent ophthalmologic assessment.
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Ansari WH, Blackorby BL, Shah GK, Blinder KJ, Dang S. OCT Assistance in Identifying Retinal Breaks in Symptomatic Posterior Vitreous Detachments. Ophthalmic Surg Lasers Imaging Retina 2020; 51:628-632. [PMID: 33231695 DOI: 10.3928/23258160-20201104-04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 09/03/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Posterior vitreous detachment (PVD) is a separation of the posterior hyaloid from the retina that manifests as photopsias and floaters. Optical coherence tomography (OCT) has demonstrated posterior vitreous opacities (PVOs) that may correlate with Shaffer's sign, which may correlate with retinal breaks. PATIENTS AND METHODS Patients with symptomatic PVDs were retrospectively reviewed at a single institution by a single provider. Masked qualitative review of SD-OCTs by a single reviewer determined presence of PVOs. RESULTS Among 78 patients, PVOs were found in 32 of the patients (41%), and 19 (59%) had retinal breaks. In those without PVOs, six (13%) had a break. Sensitivity and specificity were 76.0% and 75.5%, respectively. Removing patients with vitreous hemorrhages, sensitivity, and specificity of PVOs was 82.4% and 86.4%, respectively. CONCLUSION In symptomatic PVDs, PVOs on OCT correlated with the presence of a retinal break, especially in the absence of a vitreous hemorrhage. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:628-632.].
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Kohmoto R, Fukumoto M, Sato T, Oosuka S, Kobayashi T, Kida T, Suzuki H, Ikeda T. Rhegmatogenous retinal detachment with a giant tear located in the intermediate periphery: Two case reports. Medicine (Baltimore) 2019; 98:e14271. [PMID: 30681627 PMCID: PMC6358349 DOI: 10.1097/md.0000000000014271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE We experienced 2 cases of retinal detachment (RD) with giant tears located in the intermediate periphery of the fundus. In this case report, we investigated the clinical characteristics in these 2 cases. PATIENT CONCERNS AND DIAGNOSES Case 1 involved a 63-year-old male, who became aware of metamorphopsia and decreased visual acuity (VA) in his left eye. Upon examination, he was diagnosed with a giant tear at the margin of the intermediate peripheral lattice degeneration. Case 2 involved a 54-year-old male, who became aware of decreased VA in his right eye. Upon examination, he was diagnosed with vitreous hemorrhage and a giant tear located in the upper intermediate periphery. In these 2 cases, there was no obvious previous or familial history. INTERVENTIONS In both cases, reattachment was achieved by performing vitrectomies. OUTCOMES These 2 cases were characterized by the refraction being close to emmetropia due to the flat corneal curvature, even though there was a long axial length and the eyeballs were spherically large. In both cases, the postoperative clinical course outcome was favorable and no complication occurred LESSONS:: Our findings indicate that intermediate peripheral giant tears may occur in spherically large eyeballs, and that vitreous surgery is effective in such cases. Since the risk of the onset of RD in the fellow eye is thought to be high, strict postoperative follow-up is necessary.
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Philippakis E, Astroz P, Tadayoni R, Gaudric A. Incidence of Macular Holes in the Fellow Eye without Vitreomacular Detachment at Baseline. Ophthalmologica 2018; 240:135-142. [PMID: 29895011 DOI: 10.1159/000488956] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 04/03/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE To determine the rate of macular holes (MH) occurring in the fellow eyes of eyes with MH depending on the vitreomacular interface at baseline. METHODS This was a retrospective study of patients operated on for idiopathic MH, with persistent vitreofoveal attachment in the fellow eye assessed by spectral-domain optical coherence tomography (SD-OCT). Follow-up lasted 6 months or more, and the main outcome was the occurrence of an MH. RESULTS The 77 fellow eyes included had a mean follow-up of 34.11 ± 22.3 months (6-78.4). At baseline, 31 eyes had vitreomacular traction (VMT), 35 vitreomacular adhesion, and 11 no posterior vitreous detachment. MH occurred in 19.5% of the cases (15/77). The rate of MH was significantly higher among the eyes with VMT than among the eyes without VMT at baseline (35.5 vs. 8.7%; p = 0.009). CONCLUSION One-third of eyes with VMT at baseline identified by SD-OCT will develop an MH in the following 5 years.
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Abstract
INTRODUCTION Asteroid hyalosis (AH) is characterized by mild vitreous-body liquefaction and a reduced likelihood of posterior vitreous detachment (PVD). Here, we report the clinical features of 2 cases of macular hole (MH) in eyes with AH. The extent of retinal vitreous adhesion at the time of vitreous surgery, the presence or absence of iatrogenic retinal breaks, and the postoperative course was examined in regard to the association with AH. CASE PRESENTATION Case 1 involved a 67-year-old female with decreased visual acuity in her left eye. Although preoperative optical coherence tomography examination revealed complete PVD with operculum around the fovea central region, vitreoretinal adhesion was quite strong starting at the midperiphery of the fundus, and an iatrogenic retinal break was formed at the inferior site during vitreous surgery. Endophotocoagulation was performed, and no onset of retinal detachment (RD) postsurgery was observed. Case 2 involved a 74-year-old male with metamorphopsia in his right eye. Preoperative perifoveal PVD was observed, yet vitreoretinal adhesion was strong starting at the midperiphery of the fundus and multiple iatrogenic retinal breaks had formed on the inferior, superior, and temporal sites. Moreover, RD occurred during surgery. Endophotocoagulation and gas tamponade was performed; however, postoperative RD requiring multiple reoperations occurred. CONCLUSION As with normal MH, MH with AH is thought to be caused by perifoveal PVD, yet as the vitreoretinal adhesion was found to be quite strong starting at the midperiphery of the fundus, we decided to keep the artificial PVD within a range where adhesion was loose.
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Abstract
PURPOSE To report and evaluate the clinical and optical coherence tomography (OCT) features of optic nerve hemorrhages (ONH) associated with spontaneous posterior vitreous detachment (PVD). DESIGN A prospective case series conducted at a private ophthalmic practice in Auckland, New Zealand. METHODS A consecutive series of patients presenting at a private multispecialty practice in Auckland, New Zealand, with symptoms of PVD with ONH underwent imaging of the optic nerve with digital retinal photography and OCT. The number and location of each hemorrhage were recorded, together with relevant ophthalmic and demographic data. RESULTS Twenty of 30 eyes with ONH had evidence of persistent vitreopapillary adhesion. Three patterns of adhesion were identified: central, peripheral, and combined. In all, 52 hemorrhages were identified, of which the majority were flame-shaped, although other types were seen including dot and blot hemorrhages. One subretinal hemorrhage occurred in a patient with a central vitreopapillary adhesion. CONCLUSIONS ONH hemorrhages associated with PVD are commonly found with persistent vitreopapillary adhesions as evidenced on OCT. The clinical features of ONH together with OCT imaging may help to distinguish ONH associated with PVD from other hemorrhages found on or adjacent to the optic nerve.
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Affiliation(s)
- Philip J Polkinghorne
- Department of Ophthalmology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Rodríguez A, Infante R, Rodríguez FJ, Valencia M. Spontaneous Separation in Idiopathic Vitreomacular Traction Syndrome Associated with Contralateral Full-Thickness Macular Hole. Eur J Ophthalmol 2018; 16:733-40. [PMID: 17061226 DOI: 10.1177/112067210601600512] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose Vitreomacular traction syndrome (VMTS) and full-thickness macular hole are two different well-known entities that on follow-up may be subjected to clinical modifications. Precisely, a spontaneous separation of idiopathic VMTS occurred in three eyes of three patients relieving in addition traction of the posterior hyaloid that had led also to a focal macular pigment epithelium detachment (RPE). An association to a full-thickness macular hole was observed in the contralateral eye of one of the patients. Methods This is a retrospective study of three patients evaluated with fluorescein angiography and documented with optical coherence tomography using the Stratus (OCT) model 3000, with scans analysis and protocols analysis, measuring the size and shape of vitreomacular adhesions, macular thickness changes before and after the spontaneous separation of the fractional posterior hyaloid adhesion. In addition, the vitreous was evaluated with contact lens slit lamp biomicroscopy and ultrasound. The associated contralateral macular hole in one of the patients was surgically treated. Results Two of the three eyes with spontaneous separation of the VMTS recovered 20/25 central visual acuity; the other eye maintained the initial 20/50 visual acuity. The treated macular hole recovered 20/100 corrected visual acuity. Conclusions Spontaneous separation of posterior hyaloid is a possible outcome during follow-up of idiopathic VMTS that can be well evaluated and documented with OCT while macular fluorescein angiography may be silent in cases like these presently reported. Central vision recovery can be excellent following the spontaneous separation, which releases anterior-posterior traction including on the retinal pigment epithelium and decreases macular thickness as measured with OCT. Therefore, regarding management, the indication for vitrectomy should be delayed awaiting the spontaneous release of vitreomacular traction in 4 to 6 months. The association between idiopathic VMTS in one eye and full-thickness macular hole in the opposite eye of one patient is an important pathophysiologic consideration.
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Affiliation(s)
- A Rodríguez
- Servicio Retina y Vítreo, Fundacion Oftalmologica Nacional, Facultad de Medicina, Universidad del Rosario, Bogotá, Colombia.
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Vogiatzi MG, Li D, Tian L, Garifallou JP, Kim CE, Hakonarson H, Levine MA. A novel dominant COL11A1 mutation in a child with Stickler syndrome type II is associated with recurrent fractures. Osteoporos Int 2018; 29:247-251. [PMID: 28971234 DOI: 10.1007/s00198-017-4229-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 09/14/2017] [Indexed: 10/18/2022]
Abstract
UNLABELLED This case describes a child with blindness, recurrent low-impact fractures, low bone mass, and intermittent joint pain who was found to have a novel missense mutation in COL11A1, consistent with Stickler syndrome type II. The case illustrates the phenotypic variability of the syndrome, which may include increased fragility in childhood. INTRODUCTION Stickler syndrome type II is an autosomal dominant disorder caused by mutations in the gene that encodes the type XI collagen chain α1 (COL11A1). Manifestations include craniofacial dysmorphology and ocular abnormalities that may lead to blindness, hearing loss, and skeletal anomalies that range from joint pain and arthritis to scoliosis and hypermobility. METHODS Herein, we describe a child who carried the presumed diagnosis of osteoporosis-pseudoglioma syndrome because of the combined findings of recurrent low-impact fractures due to low bone mass and blindness. The child also suffered from joint pain but had no facial dysmorphism or hearing loss. RESULTS Targeted sequencing and deletion analysis of the LRP5, COL1A1, and COL1A2 genes failed to identify any mutations, and whole exome sequence analysis revealed a novel missense mutation (c.3032C>A:p.P1011Q) in COL11A1, consistent with Stickler type II. CONCLUSION This case highlights the phenotypic variability of Stickler type II, broadens the list of differential diagnosis of increased bone fragility in childhood, and highlights utility of unbiased genetic testing towards establishing the correct diagnosis in children with frequent fractures.
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Affiliation(s)
- M G Vogiatzi
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Suite 11NW 30, Philadelphia, PA, 19104, USA.
| | - D Li
- Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - L Tian
- Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - J P Garifallou
- Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - C E Kim
- Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - H Hakonarson
- Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - M A Levine
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Suite 11NW 30, Philadelphia, PA, 19104, USA
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Schumann RG, Langer J, Compera D, Luedtke K, Schaumberger MM, Kreutzer T, Mayer WJ, Wolf A, Priglinger SG. Assessment of intravitreal ocriplasmin treatment for vitreomacular traction in clinical practice. Graefes Arch Clin Exp Ophthalmol 2017; 255:2081-2089. [PMID: 28755165 DOI: 10.1007/s00417-017-3747-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 04/06/2017] [Revised: 06/29/2017] [Accepted: 07/05/2017] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To assess treatment effects following intravitreal injection of ocriplasmin for vitreomacular traction (VMT), with or without full-thickness macular hole (FTMH), in real-life setting. METHODS This is a monocentric, retrospective, consecutive series of 82 eyes from 82 patients who underwent ocriplasmin treatment between July 2013 and December 2016. We included 57 eyes with pure VMT, 17 eyes with small FTMHs, and eight eyes with medium FTMHs. Primary outcome measures were VMT release and MH closure rates. Secondary outcomes were visual acuity (VA), morphological changes, and subjective visual impairment after 1, 3, and 6 months and at last follow-up. RESULTS After a median follow-up of 10 months, VMT release was achieved by pharmacologic vitreolysis in 57% of all eyes, whereas the macular hole closure rate was 32%. In those presenting with five or more positive prognostic factors (PPF), eyes with pure VMT showed nonsurgical traction release in 88%, and FTMHs were released in 93%, with a closure rate of 20%. Small FTMHs closed in 41% and medium FTMHs in 13%. The mean change in VA (LogMAR) was -0.07 ± 0.24 (median - 0.10) in all eyes. Subretinal fluid accumulation and ellipsoid zone changes were seen in 31% and 37% of all eyes, respectively. They were more frequent in eyes with traction release, but were self-limited. CONCLUSIONS In a real-life setting, release of VMT by ocriplasmin injection can be achieved in the majority of eyes, relying on a strict patient selection. Closure of FTMHs rather correlates with hole diameter than with presence of PPF, and remains a rare finding in medium FTMHs.
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Affiliation(s)
- Ricarda G Schumann
- Department of Ophthalmology, Ludwig-Maximilians-University, Mathildenstrasse 8, 80336, Munich, Germany.
| | - Julian Langer
- Department of Ophthalmology, Ludwig-Maximilians-University, Mathildenstrasse 8, 80336, Munich, Germany
| | - Denise Compera
- Department of Ophthalmology, Ludwig-Maximilians-University, Mathildenstrasse 8, 80336, Munich, Germany
| | - Katharina Luedtke
- Department of Ophthalmology, Ludwig-Maximilians-University, Mathildenstrasse 8, 80336, Munich, Germany
| | - Markus M Schaumberger
- Department of Ophthalmology, Ludwig-Maximilians-University, Mathildenstrasse 8, 80336, Munich, Germany
| | - Thomas Kreutzer
- Department of Ophthalmology, Ludwig-Maximilians-University, Mathildenstrasse 8, 80336, Munich, Germany
| | - Wolfgang J Mayer
- Department of Ophthalmology, Ludwig-Maximilians-University, Mathildenstrasse 8, 80336, Munich, Germany
| | - Armin Wolf
- Department of Ophthalmology, Ludwig-Maximilians-University, Mathildenstrasse 8, 80336, Munich, Germany
| | - Siegfried G Priglinger
- Department of Ophthalmology, Ludwig-Maximilians-University, Mathildenstrasse 8, 80336, Munich, Germany
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Jackson TL, Regillo CD, Girach A, Dugel PU. Baseline Predictors of Vitreomacular Adhesion/Traction Resolution Following an Intravitreal Injection of Ocriplasmin. Ophthalmic Surg Lasers Imaging Retina 2017; 47:716-23. [PMID: 27548448 DOI: 10.3928/23258160-20160808-04] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 06/07/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND OBJECTIVE To determine factors predicting response to ocriplasmin (Jetrea; ThromboGenics, Iselin, NJ) response in patients with symptomatic vitreomacular adhesion (VMA). PATIENTS AND METHODS Combined analysis of two multicenter, prospective, randomized, double-masked trials of intravitreal ocriplasmin 125 µg injection versus placebo. Patients had vitreomacular traction with or without a full-thickness macular hole (FTMH). Multivariate logistic regression was used to determine factors influencing treatment response (complete VMA release [day 28] and non-surgical FTMH closure [month 6]). RESULTS Younger age, presence of FTMH (odds ratio [OR] = 2.1; 95% confidence interval [CI], 1.1-3.7), VMA diameter of 1,500 µm or less (OR = 4.9; 95% CI, 2.0-12.4), phakic lens status (OR = 2.8; 95% CI, 1.5-5.2), and absence of epiretinal membrane (OR = 4.1; 95% CI, 2.2-7.9) predicted VMA resolution. FTMHs with apical diameter of 250 µm or less were more likely to close than larger holes (58.3% vs. 24.6%; P = .013). Both FTMH size groups had significantly greater chance of VMA resolution and FTMH closure versus controls. CONCLUSION Ocriplasmin is most effective in younger patients with focal VMA and without an epiretinal membrane. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:716-723.].
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Dugel PU, Tolentino M, Feiner L, Kozma P, Leroy A. Results of the 2-Year Ocriplasmin for Treatment for Symptomatic Vitreomacular Adhesion Including Macular Hole (OASIS) Randomized Trial. Ophthalmology 2016; 123:2232-47. [PMID: 27499517 DOI: 10.1016/j.ophtha.2016.06.043] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/31/2016] [Accepted: 06/13/2016] [Indexed: 02/02/2023] Open
Abstract
PURPOSE The Ocriplasmin for Treatment for Symptomatic Vitreomacular Adhesion Including Macular Hole (OASIS) trial was designed to evaluate the long-term efficacy and safety profile of ocriplasmin for the treatment of symptomatic vitreomacular adhesion (VMA)/vitreomacular traction, including full-thickness macular hole (FTMH). DESIGN Phase 3b, randomized, sham-controlled, double-masked, multicenter clinical trial. PARTICIPANTS Sample size was 220 subjects (146 ocriplasmin, 74 sham) randomized in a 2:1 ratio to receive intravitreal ocriplasmin 0.125 mg or sham injection. METHODS The trial involved 12 visits over 24-months. Inclusion criteria included presence of VMA and best-corrected visual acuity (BCVA) of 20/32 or worse in the study eye. Exclusion criteria included FTMH >400 μm, presence of epiretinal membrane (ERM), and aphakia in the study eye. MAIN OUTCOME MEASURES The primary efficacy end point was the proportion of subjects with pharmacologic VMA resolution at day 28. Secondary efficacy end points were assessed at month 24 and included proportion of subjects with BCVA gain from baseline, nonsurgical FTMH closure, vitrectomy, and Visual Function Questionnaire 25 (VFQ-25) outcomes. RESULTS The OASIS trial met its primary end point with pharmacologic VMA resolution at day 28 being significantly higher in the ocriplasmin group (41.7%) compared with the sham group (6.2%). The treatment effect was maintained until study end. In the ocriplasmin group, pharmacologic VMA resolution at day 28 was higher in subgroups with the following baseline characteristics compared with the complementary subgroups without them: presence of focal VMA, presence of FTMH, absence of ERM, and phakic lens status. In the ocriplasmin group, 50.5% of subjects had a ≥2-line improvement in BCVA from baseline compared with 39.1% of subjects in the sham group. The nonsurgical FTMH closure rate was 30.0% for the ocriplasmin group compared with 15.4% for the sham group. All other secondary end points also favored ocriplasmin over sham. Regarding safety, most adverse events were mild to moderate, had a short onset time, and were transient, with no new safety signals identified. CONCLUSIONS The OASIS trial demonstrates the long-term efficacy and safety of ocriplasmin, providing improved resolution of symptomatic VMA compared with previous phase 3 trials with no additional safety signals identified.
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Affiliation(s)
- Pravin U Dugel
- Retina Consultants of Arizona, Phoenix, Arizona; USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California.
| | - Michael Tolentino
- Center for Retina and Macular Disease, Winter Haven, Florida; University of Central Florida, Orlando, Florida
| | - Leonard Feiner
- Hackensack University Medical Center, Hackensack, New Jersey; NJ Retina, Ridgewood, New Jersey
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García-Pérez L, Abreu-González R, Pérez-Ramos J, García-Pérez S, Serrano-Aguilar P. Review of economic studies and budget impact analysis of ocriplasmin as a treatment of vitreomacular traction. Arch Soc Esp Oftalmol 2016; 91:257-264. [PMID: 26920947 DOI: 10.1016/j.oftal.2016.01.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 01/12/2016] [Accepted: 01/15/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To review the evidence on the cost-effectiveness of ocriplasmin as a treatment for vitreomacular traction (VMT), and to estimate the impact on the Spanish National Health System (NHS). MATERIAL AND METHODS 1) Systematic review. The following databases were searched in January 2015: MEDLINE, PREMEDLINE, EMBASE, CRD, the Cochrane Library, and key websites. Selection criteria were: full economic evaluations that compared ocriplasmin with usual care ('watch and wait' and/or vitrectomy) in patients with VMT. The outcomes to extract were costs of the alternatives and the incremental cost-effectiveness ratio. Studies of budget impact analysis were also included. The methodological quality was assessed, and a narrative synthesis of the included studies was carried out. 2) Estimation of budget impact. The impact on the budget as a result of the introduction of ocriplasmin in the NHS was estimated, including data from different sources. RESULTS Six studies were identified, none of them performed in Spain. The two best studies concluded that ocriplasmin is cost-effective in their respective countries (Canada and United Kingdom), but only in patients with certain conditions (without epiretinal membrane, for example). The results of the budget impact analysis are different between countries. The analysis for Spain showed that the introduction of ocriplasmin would mean a saving over 1 million Euros for the NHS in 5 years. CONCLUSIONS The cost-effectiveness of ocriplasmin has not been demonstrated in Spain. However, good studies performed in other countries found that ocriplasmin is cost-effective in selected patients. Given the current prices in Spain, ocriplasmin could involve a saving for the Spanish NHS.
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Affiliation(s)
- L García-Pérez
- Servicio de Evaluación, Servicio Canario de la Salud (SESCS), Tenerife, España; Fundación Canaria de Investigación Sanitaria (FUNCANIS), Tenerife, España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, España; Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Universidad de La Laguna, La Laguna, España.
| | - R Abreu-González
- Servicio de Oftalmología, Hospital Universitario Nuestra Señora de La Candelaria, Tenerife, España
| | - J Pérez-Ramos
- Servicio de Evaluación, Servicio Canario de la Salud (SESCS), Tenerife, España; Fundación Canaria de Investigación Sanitaria (FUNCANIS), Tenerife, España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, España; Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Universidad de La Laguna, La Laguna, España
| | - S García-Pérez
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, España; Agencia de Evaluación de Tecnologías Sanitarias, Instituto de Salud Carlos III, Madrid, España
| | - P Serrano-Aguilar
- Servicio de Evaluación, Servicio Canario de la Salud (SESCS), Tenerife, España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, España; Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Universidad de La Laguna, La Laguna, España.
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Hale BP, Au AK, Falk NS, Bhatnagar P, Beer PM. Flat Electroretinography and Acute Visual Loss After Ocriplasmin Injection for Vitreomacular Adhesion Complicating Macular Schisis. Ophthalmic Surg Lasers Imaging Retina 2015; 46:888-92. [PMID: 26431307 DOI: 10.3928/23258160-20150909-16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 07/10/2015] [Indexed: 11/20/2022]
Abstract
A 53-year-old woman with macular and diffuse retinoschisis complicated by presumed vitreomacular traction underwent unilateral intravitreal ocriplasmin injection. Within hours after injection, she noted a loss of vision and the perception of "negative" images in the treated eye. Electrophysiologic testing revealed flat waveforms, and optical coherence tomography (OCT) showed initial decreased central macular thickness at day 1, followed by massive increased macular thickness with subfoveal neurosensory retinal detachment at 1 week. Her central macular thickness on OCT slowly returned to baseline during a period of 1 month until development of a macula-off rhegmatogenous retinal detachment at 6 months after injection. The authors believe this unique case of vitreomacular adhesion and macular schisis complicated by post-injection visual loss and electroretinography changes may offer further insight into this unusual complication.
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Abstract
Symptomatic PVD is a common age-related problem that in some patients is associated with retinal tear and retinal detachment. Thorough ocular examination of patients with unilateral floaters and photopsias is needed to identify those at greatest risk for vision loss. Patients without retinal pathologic findings on initial examination need to be given careful instructions on what to expect and do should symptoms of retinal tear or detachment occur.
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Affiliation(s)
- Curtis E Margo
- Department of Ophthalmology, Watson Clinic, Lakeland, Florida, USA
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Li L, Du H, Li M, Hui Y. [Clinical evaluation of ocriplasmin as a vitreolytic agent]. Zhonghua Yan Ke Za Zhi 2015; 51:155-160. [PMID: 25908008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Incomplete perifoveal posterior vitreous detachment (PVD) associated with abnormal vitreomacular adhesion (VMA) can cause vitreomacular traction (VMT) and macular hole (MH) formation, which require vitrectomy treatment. Pharmacologic vitreolysis, which is intravitreal injection with vitreolytic enzymes to resolve VMA, may be used as an alternative therapy.Ocriplasmin, formerly known as microplasmin, is a recombinant truncated form of plasmin with proteolytic activity against fibronectin and laminin.It was recently approved for VMA treatment in the European Union and USA. Phase III studies indicated that ocriplasmin injection was a safe and effective treatment for selected cases of symptomatic VMA and MH. VMA release was achieved in 26.5% of ocriplasmin-injected eyes versus 10.1% of the placebo group. MH closure was achieved in 40.6% as compared with 10.6% of the placebo group.In comparison with the outcome after vitrectomy, the success rate of ocriplasmin was still far below expectation. Ocular adverse events included vitreous floaters, photopsia and profound visual decline. Its efficacy and safety need to be further evaluated in more clinical trials.
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Affiliation(s)
- Luxi Li
- Department of Ophthalmology, Xijing Hospital, The Fourth Military Medical University, The Eye Institute of PLA, Xi'an 710032, China
| | - Hongjun Du
- Department of Ophthalmology, Xijing Hospital, The Fourth Military Medical University, The Eye Institute of PLA, Xi'an 710032, China.
| | - Manhong Li
- Department of Ophthalmology, Xijing Hospital, The Fourth Military Medical University, The Eye Institute of PLA, Xi'an 710032, China
| | - Yannian Hui
- Department of Ophthalmology, Xijing Hospital, The Fourth Military Medical University, The Eye Institute of PLA, Xi'an 710032, China
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Goh YW, Ehrlich R, Stewart J, Polkinghorne P. The incidence of retinal breaks in the presenting and fellow eyes in patients with acute symptomatic posterior vitreous detachment and their associated risk factors. Asia Pac J Ophthalmol (Phila) 2015; 4:5-8. [PMID: 26068606 DOI: 10.1097/apo.0000000000000072] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To determine the incidence of retinal breaks in presenting and fellow eyes in patients with acute symptomatic posterior vitreous detachment (PVD) and their associated risk factors. DESIGN A prospective study of 101 consecutive patients presenting with acute symptomatic PVD. METHODS The PVD status and other relevant ophthalmic findings were noted for both presenting and fellow eyes at initial presentation. Patients with PVD in the fellow eye were followed up appropriately whereas those without were invited to return for a further examination 4 years later. Data analysis was performed using general linear model and logistic regression. RESULTS The mean age was 62 years. Seventy-six eyes had PVD in the presenting eyes, which were more myopic than their fellow eyes. Increased myopia and the presence of vitreous and/or retinal hemorrhage were associated with the presence of retinal tear(s) (P = 0.03 and P < 0.0001, respectively) at presentation. Twenty-three of the presenting eyes and 2 of the fellow eyes had have retinal break(s) at the first clinic visit. Of those, 14 eyes were found not to have a visible Weiss ring. Only 5.9% of the eyes (3 presenting eyes and 3 fellow eyes) developed delayed retinal break(s). CONCLUSIONS Acute symptomatic PVD is a common presentation. It is essential to perform thorough examination to both presenting eye and fellow eye at initial presentation and follow-up appointments to prevent delay of treatment to retinal break(s).
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Affiliation(s)
- Yi Wei Goh
- From the Department of Ophthalmology, Faculty of Medical Health Sciences, University of Auckland, Auckland, New Zealand
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Furino C, Cicinelli MV, Boscia F, Alessio G. In vivo evidence of epiretinal membrane formation secondary to acute macular microhole after posterior vitreous detachment. Ophthalmic Surg Lasers Imaging Retina 2014; 45:596-7. [PMID: 25347828 DOI: 10.3928/23258160-20141008-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 03/04/2014] [Indexed: 11/20/2022]
Abstract
The authors present the case of an idiopathic epiretinal membrane (ERM) secondary to an acute self-repaired macular microhole documented by optical coherence tomography (OCT). A 65-year-old phakic woman presenting with acute onset of light flashes, myodesopsia, and central negative scotoma in the right eye was diagnosed with age-related posterior vitreous detachment. Spectral-domain OCT showed a tiny defect of the outer retina, consistent with the diagnosis of macular microhole, which spontaneously closed after 4 weeks. Six months later, the patient developed a contracting ERM, and her visual acuity significantly worsened. This case represents the first in vivo documentation of retinal pigment epithelium cell migration through a macular microhole, highlighting the importance of OCT in understanding idiopathic ERM pathogenesis.
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Arias Barquet L. [Non-surgical treatment of vitreomacular traction and macular hole]. Arch Soc Esp Oftalmol 2013; 88:455-457. [PMID: 24257254 DOI: 10.1016/j.oftal.2013.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 03/14/2013] [Indexed: 06/02/2023]
Affiliation(s)
- L Arias Barquet
- Sección de Retina Médico-Quirúrgica, Servicio de Oftalmología, Hospital Universitario de Bellvitge, Bellvitge, Barcelona, España.
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Kovacević D, Markusić V. Pars plana vitrectomy for vitreomacular traction syndrome. Coll Antropol 2013; 37 Suppl 1:271-273. [PMID: 23837256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The vitreomacular traction syndrome (VMTS) is a clinical entity in which incomplete posterior vitreous detachment is causing traction on the macula. Since in some cases the traction may resolve spontaneously when complete posterior vitreous detachment occurs, vitrectomy is indicated when the duration of traction is longer than 4-6 months and is causing severe visual impairment. The purpose of this study was to investigate the efficacy and safety of pars plana vitrectomy in the treatment of macular disorders caused by vitreomacular traction. In our case the outcome of the vitrectomy and the number and severity of the surgical complications did not differ from the complications when vitrectomy was performed in eyes without vitreomacular traction. With the development of new drugs for nonsurgical treatment of vitreomacular traction by enzymatic vitreolysis, in the future vitrectomy could become restricted only to refractory cases.
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Affiliation(s)
- Damir Kovacević
- University of Rijeka, Rijeka University Hospital Center, Department of Ophthalmology, Rijeka, Croatia.
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Ermolaev AP. [On a connection of early manifestations of angle closure glaucoma and development of posterior vitreous detachment]. Vestn Oftalmol 2013; 129:24-28. [PMID: 23808176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In author's opinion development of posterior vitreous detachment (PVD) is an involutional factor which participates in pathogenesis of primary angle closure glaucoma (PACG) in predisposed eyes. Initial increase of intraocular pressure in the eyes with narrow anterior chamber angle and predisposition to PACG is closely connected with the moment of PVD development, which can be detected with ultrasonography. The author supposes that ultrasonic examination of the posterior globe to detect PVD can be used as one of monitoring method in patients predisposed to PACG.
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Takahashi A, Yoshida A, Nagaoka T, Kagokawa H, Kato Y, Takamiya A, Sato E, Yokota H, Ishiko S, Hirokawa H. Macular hole formation in fellow eyes with a perifoveal posterior vitreous detachment of patients with a unilateral macular hole. Am J Ophthalmol 2011; 151:981-989.e4. [PMID: 21514922 DOI: 10.1016/j.ajo.2011.01.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2010] [Revised: 01/10/2011] [Accepted: 01/10/2011] [Indexed: 01/04/2023]
Abstract
PURPOSE To estimate the rate of macular hole formation in fellow eyes with a perifoveal posterior vitreous detachment (PVD) and early stage 1 intrafoveal lesions in patients with a unilateral idiopathic full-thickness macular hole (MH) using optical coherence tomography (OCT). DESIGN Retrospective observational case series. METHODS Fellow eyes of consecutive patients with a unilateral full-thickness MH were examined on OCT. A subset of fellow eyes with a perifoveal PVD had been followed to investigate the rates of macular hole formation in fellow eyes with early stage 1 intrafoveal lesions. RESULTS Of 176 patients with a unilateral full-thickness MH, 42 fellow eyes (42 patients) with a perifoveal PVD were identified. During follow-up, a foveolar detachment was seen in 16 eyes, and 4 eyes had a foveal pseudocyst alone. In the 16 eyes with a foveolar detachment, 9 eyes had concurrent inner foveal splits. Within another 2 years of follow-up, OCT showed that 5 of 16 fellow eyes (31%) with a foveolar detachment developed a second full-thickness MH and 5 of 9 fellow eyes with a foveolar detachment and inner foveal splits developed a second full-thickness MH. Two of 4 eyes with a foveal pseudocyst alone developed vitreofoveal separation without hole formation. The remaining 2 eyes with a foveal pseudocyst alone remained stable at the last follow-up visit. CONCLUSIONS Fellow eyes with a foveolar detachment and a perifoveal PVD may be at high risk, and fellow eyes with a foveolar detachment and inner foveal splits might be at higher risk for progression to macular hole formation.
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Affiliation(s)
- Atsushi Takahashi
- Department of Ophthalmology, Asahikawa Medical University, Asahikawa, 2-1-1-1 Midorigaoka-Higashi, Hokkaido, Japan
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Scassa C, Bruno M, Ripandelli G, Giusti C, Scarinci F, Cupo G. Spontaneous closure of bilateral full thickness macular holes without surgery: an eleven-year follow-up. Eur Rev Med Pharmacol Sci 2011; 15:717-720. [PMID: 21796877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE AND METHOD To present a 60-year-old woman affected by bilateral full thickness macular hole, showing without surgery a spontaneous resolution of the disease in both eyes that remains unchanged during an eleven-year follow-up. To our knowledge, this clinical case is uncommon as no similar reports with such a long follow-up have been published in the scientific literature at this time. RESULTS AND CONCLUSIONS A spontaneous and bilateral closure of full thickness macular holes was detected, as a consequence of a complete posterior vitreous detachment documented by optical coherence tomography images. An initial reduction up to a complete resolution of the central macular scotoma was also observed by performing scanning laser ophthalmoscope microperimetry. Both these anatomical and functional results did not change during the whole period of follow-up. According to this study, the release or the weakening of the vitreous tractions at the foveal edges seems to play a key role in the spontaneous resolution of macular holes in not surgically treated patients.
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Affiliation(s)
- C Scassa
- Bietti Eye Foundation IRCCS, Rome, Italy
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Simon HB. On call. I'm 53 years old, and I only need glasses for reading. Recently though I've seen tiny black specs that move around in random directions. My eyes are not red, watery, or painful, but I'm worried that I may have the start of an eye disease. Harv Mens Health Watch 2010; 15:8. [PMID: 20945583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Singalavanija A, Amornrattanapan C, Nitiruangjarus K, Tongsai S. Risk factors for retinal breaks in patients with symptom of floaters. J Med Assoc Thai 2010; 93:708-713. [PMID: 20572376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To identify the risk factors of retinal breaks in patients with the symptom of floaters, and to determine the association between those risk factors and retinal breaks. MATERIAL AND METHOD A retrospective analytic study of 184 patients (55 males and 129 females) that included 220 eyes was conducted. Patient information such as age, symptoms (multiple floaters, flashing), duration of symptom, refractive error, history of cataract surgery, family history of retinal detachment, and complete eye examination were recorded. The patients were divided into two groups, the first group (control group) had symptoms of floaters and no retinal breaks, the second group (retinal breaks group) had symptoms of floaters with retinal breaks. Chi-square test, and the multiple logistic regression were used for statistical analysis. RESULTS Two hundred twenty eyes, 175 eyes of the control group and 45 eyes of the retinal breaks group were examined and included in this study. The multiple logistic regression analysis revealed that patients with multiple floaters, and floaters and flashing increased the risk of retinal breaks to 5.8 and 4.3 times, respectively, when compared to patients with single floater or floaters alone. Lattice degeneration increased the risk of retinal breaks to 5.9 times when compared to eyes that did not have lattice degeneration. CONCLUSION Multiple floaters, flashing and lattice degeneration are risk factors of retinal breaks in patients with symptoms of floaters. Therefore, it is important for the ophthalmologists to be aware of these risk factors and the patients at risk should have follow-up examinations.
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Affiliation(s)
- Apichart Singalavanija
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Abstract
CONTEXT Acute onset of monocular floaters and/or flashes represents a common presentation to primary care physicians, and the most likely diagnosis is posterior vitreous detachment (PVD). A significant proportion of patients with acute PVD develop an associated retinal tear that can lead to retinal detachment and permanent vision loss if left untreated. OBJECTIVE To quantify the association between relevant clinical variables and risk of retinal tear in patients presenting with acute-onset floaters and/or flashes and PVD. DATA SOURCES Structured MEDLINE (January 1950-September 2009) and EMBASE (January 1980-September 2009) searches and a hand search of references and citations of retrieved articles yielded 17 relevant studies. STUDY SELECTION Studies of high-level methods that related elements of the history or physical examination in patients presenting with floaters and/or flashes and PVD to the likelihood of retinal tear. RESULTS For patients with acute onset of floaters and/or flashes who are self-referred or referred to an ophthalmologist, the prevalence of retinal tear is 14% (95% confidence interval [CI], 12%-16%). Subjective visual reduction is the most important symptom associated with retinal tear (likelihood ratio [LR], 5.0; 95% CI, 3.1-8.1). Vitreous hemorrhage on slitlamp biomicroscopy is the best-studied finding with the narrowest positive LR for retinal tear (summary LR, 10; 95% CI, 5.1-20). Absence of vitreous pigment during this examination is the best-studied finding with the narrowest negative LR (summary LR, 0.23; 95% CI, 0.12-0.43). Patients initially diagnosed as having uncomplicated PVD have a 3.4% chance of a retinal tear within 6 weeks. The risk increases with new onset of at least 10 floaters (summary LR, 8.1-36) or subjective visual reduction (summary LR, 2.3-17) during this period. CONCLUSIONS Primary care physicians should evaluate patients with acute-onset floaters and/or flashes due to suspected PVD, or patients with known PVD and a change in symptoms, for high-risk features of retinal tear and detachment. Physicians should always assess these patients' visual acuity. Patients at increased risk should be triaged for urgent ophthalmologic assessment.
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Affiliation(s)
- Hussein Hollands
- Department of Ophthalmology, Queen's University, Kingston, ON, Canada.
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Abstract
In the absence of posterior vitreous detachment, vitreous cortex is adhered to the internal limiting lamina of the inner retina. This junction between the vitreous and the retina is thought to participate in the pathophysiology of diverse retinal diseases, including proliferative diabetic retinopathy and diabetic macular edema. Vitrectomy has been associated with decrease of macular edema and improvement of visual acuity in eyes of diabetic patients. Thus, many pharmacologic agents have been studied with the aim of inducing a posterior vitreous detachment in order to facilitate the surgical procedure and reduce complications of vitrectomy. More recently, different agents such as plasmin and microplasmin have shown to be able to induce a posterior vitreous detachment given as a single intravitreal injection. The aim of this article is to give a scope about the pharmacologic vitreolysis and posterior vitreous detachment studies and describe some ongoing clinical trials that will determine the efficacy and safety of these novel therapies for diabetic retinopathy.
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Affiliation(s)
- Fernando Lopez-Lopez
- Department of Ophthalmology, Complejo Hospitalario Universitario de Santiago de Compostela, Spain.
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Lorenzo-Carrero J, Perez-Flores I, Cid-Galano M, Fernandez-Fernandez M, Heras-Raposo F, Vazquez-Nuñez R, Lopez-Fuentes M. B-scan ultrasonography to screen for retinal tears in acute symptomatic age-related posterior vitreous detachment. Ophthalmology 2008; 116:94-9. [PMID: 19010551 DOI: 10.1016/j.ophtha.2008.08.040] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2008] [Revised: 08/18/2008] [Accepted: 08/18/2008] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate the performance characteristics of B-scan ultrasonography (US) as a diagnostic test for the detection of retinal tears in acute symptomatic age-related posterior vitreous detachment (PVD). DESIGN Evaluation of a diagnostic test through a cross-sectional study with prospective data collection. The study intended to meet the 14 items proposed by the Quality Assessment of Diagnostic Accuracy Studies panel. PARTICIPANTS Two hundred thirty-nine patients with acute-onset age-related PVD were consecutively enrolled in a nonreferral hospital. TESTING Comprehensive eye examination including vitreous and retinal biomicroscopy was performed on an emergency basis followed by blind B-scan kinetic US. Sensitivity, specificity and predictive values of the index test (B-scan US) were analyzed and compared with the standard reference (baseline examination). In cases of disagreement between both diagnostic methods, a new gold standard was established based on the findings of subsequent directed indirect ophthalmoscopy based on the echographic findings. Positive and negative likelihood ratios and a likelihood nomogram with pretest and posttest odds of retinal tears were calculated for B-scan US. MAIN OUTCOME MEASURES Index test performance for the detection of retinal tears secondary to age-related PVD. RESULTS Both diagnostic methods performed comparably. The sensitivity of B-scan US for detection of retinal tears was 96% and that of baseline examination was 89%. Both methods had similar negative predictive values of 99%. B-scan US specificity was 98%. The estimated pretest and posttest probability for a positive B-scan US were 10.8% and 89%, respectively. CONCLUSIONS Proper B-scan kinetic US is a noninvasive and accurate diagnostic method for the detection of retinal tears that can be reliably used in no view or small pupil cases with symptomatic PVD. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any of the materials discussed in this article.
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Schmidt JC, Mennel S, Meyer CH, Kroll P. Posterior vitreomacular adhesion: a potential risk factor for exudative age-related macular degeneration. Am J Ophthalmol 2008; 145:1107; author reply 1107-8. [PMID: 18503787 DOI: 10.1016/j.ajo.2008.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Revised: 01/17/2008] [Accepted: 03/07/2008] [Indexed: 11/28/2022]
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Abstract
PURPOSE To carry out a longitudinal study of patients with Fuchs' heterochromic uveitis (FHU) in western Sweden and to establish the factors responsible for diagnostic delay. METHODS A sample of 54 patients, 51 with monocular and three with binocular FHU, were followed for periods ranging from 8 months to 15 years. Firm diagnostic criteria were set. A detailed anamnesis regarding ocular and extraocular symptoms was taken. The eyes were repeatedly examined. Toxoplasma serology was analysed. Complications were noted. RESULTS The delay between the first visit to an ophthalmologist and diagnosis was 0-26 years. The most common first symptom was floaters. Iris heterochromia was absent in 11 patients and discrete in 26. Iris atrophy (a diagnostic criterion) was easy to miss. Chorioretinal scars were found in six patients. Toxoplasma serology was positive in 18 (35%) patients. The only serious complication was glaucoma. CONCLUSIONS The most important reason for delay in diagnosis of FHU is, in our opinion, failure to consider the disease as a diagnosis. This failure may occur because heterochromia is often missing or discrete, iris atrophy is easily overlooked, and vitreous opacities are common, often cause early symptoms and can explain prolonged workup and therapy. A connection with toxoplasmosis in individual cases cannot be excluded but toxoplasmosis cannot be considered a major aetiological factor. If detailed anamnesis is negative and diagnostic criteria are fulfilled, no further workup is required.
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Affiliation(s)
- Kerstin Norrsell
- Department of Ophthalmology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Krebs I, Brannath W, Glittenberg C, Zeiler F, Sebag J, Binder S. Posterior vitreomacular adhesion: a potential risk factor for exudative age-related macular degeneration? Am J Ophthalmol 2007; 144:741-746. [PMID: 17884003 DOI: 10.1016/j.ajo.2007.07.024] [Citation(s) in RCA: 147] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2007] [Revised: 07/17/2007] [Accepted: 07/19/2007] [Indexed: 10/22/2022]
Abstract
PURPOSE To compare the state of the posterior vitreous in exudative age-related macular degeneration (AMD) with eyes with nonexudative AMD and controls. DESIGN Prospective, observational case series. METHODS B-scan ultrasonography and optical coherence tomography (OCT) were performed in 163 eyes from 82 subjects older than 55 years, 50 eyes with exudative AMD, 57 with nonexudative AMD, and 56 control eyes. Main outcome measures were the number of eyes with complete posterior vitreous detachment (PVD) by ultrasound and the number of eyes with central vitreomacular adhesion by OCT. RESULTS By ultrasonography, 17 (34.0%) of 50 eyes with exudative AMD had PVD as compared with 41 (71.9%) of 57 eyes with nonexudative AMD (P = .00002) and 34 (60.7%) of 56 controls (P = .017). OCT detected persistent central vitreoretinal adhesion surrounded by a detached posterior vitreous cortex in 18 (36%) of 50 eyes with exudative AMD, significantly higher than in nonexudative AMD (4/57 [7%]; P < .0001) and in controls (6/56 [10%]; P = .002). CONCLUSIONS Persistent attachment of the posterior vitreous cortex to the macula may be another risk factor for the development of exudative AMD via vitreoretinal traction inducing chronic low-grade inflammation, by maintaining macular exposure to cytokines or free radicals in the vitreous gel, or by interfering in transvitreous oxygenation and nutrition of the macula. Inducing PVD may provide prophylactic benefit against exudative AMD.
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Affiliation(s)
- Ilse Krebs
- Ludwig Boltzmann Institute for Retinology and Biomicroscopic Laser Surgery, Vienna, Austria.
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