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Iovino C, Rosolia A, Damiano L, Iodice CM, Di Iorio V, Testa F, Simonelli F. Pars Plana Vitrectomy in Inherited Retinal Diseases: A Comprehensive Review of the Literature. Life (Basel) 2023; 13:1241. [PMID: 37374028 DOI: 10.3390/life13061241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/04/2023] [Accepted: 05/21/2023] [Indexed: 06/29/2023] Open
Abstract
Inherited retinal diseases (IRDs) are a group of clinically and genetically heterogeneous disorders that may be complicated by several vitreoretinal conditions requiring a surgical approach. Pars plana vitrectomy (PPV) stands as a valuable treatment option in these cases, but its application in eyes with such severely impaired chorioretinal architectures remains controversial. Furthermore, the spreading of gene therapy and the increasing use of retinal prostheses will end up in a marked increase in demand for PPV surgery for IRD patients. The retinal degeneration that typically affects patients with hereditary retinal disorders may influence the execution of the surgery and the expected results. Considering the importance of PPV application in IRD-related complications, it is fundamental to try to understand from the literature what is adequate and safe in posterior eye segment surgery. Use of dyes, light toxicity, and risk of wounding scar development have always been themes that discourage the execution of vitreoretinal surgery in already impaired eyes. Therefore, this review aims to comprehensively summarize all PPV applications in different IRDs, highlighting the favorable results as well as the potential precautions to consider when performing vitreoretinal surgery in these eyes.
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Affiliation(s)
- Claudio Iovino
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Andrea Rosolia
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Luciana Damiano
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Clemente Maria Iodice
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Valentina Di Iorio
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Francesco Testa
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Francesca Simonelli
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
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Ngo WK, Fisher YL, Silverman RH, Tsang SH, Spaide RF. Scleral Thickness in Autosomal Dominant Best Vitelliform Macular Dystrophy. Retin Cases Brief Rep 2023; Publish Ahead of Print:01271216-990000000-00168. [PMID: 37104812 PMCID: PMC11090254 DOI: 10.1097/icb.0000000000001433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
PURPOSE To investigate the posterior and equatorial scleral thickness in patients with autosomal dominant Best disease, a condition that has chronic subretinal fluid. METHODS Retrospective study involving patients with Best disease and age-matched controls. Participants were evaluated with contact B-scan ultrasonography and enhanced depth imaging optical coherence tomography to evaluate scleral thickness in the posterior pole and equator. Univariate analysis and generalized estimating equations were used. RESULTS Of 9 patients with genetically proven Best disease and 23 age-matched controls, there was no significant difference in the age or the gender proportion between groups. Subfoveal choroidal thickness and axial length were not significantly different between groups. Both posterior scleral (OD; 1.38mm vs. 0.89mm, P<.001 and OS; 1.39mm vs. 0.83mm, P<.001) and equatorial scleral (OD; 0.61mm vs. 0.42mm, P=.003, and OS; 0.55mm vs. 0.41mm, P=.017) thicknesses were much greater in cases as compared with controls. Multivariate analysis showed male sex and having Best disease were each significant predictors of posterior scleral thickness and Best disease was the sole significant predictor for equatorial scleral thickness. CONCLUSION BEST1 gene may have a developmental role leading to having a thicker sclera, influencing disease manifestation, and contributing to the accumulation of subretinal fluid in Best disease.
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Affiliation(s)
- Wei Kiong Ngo
- Vitreous Retina Macula Consultants of New York, New York, NY, United States
- Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Medical Center, New York, NY, United States
- Jonas Children’s Vision Care and Bernard & Shirlee Brown Glaucoma Laboratory, Department of Ophthalmology, Columbia University, New York, NY, United States
| | - Yale L. Fisher
- Vitreous Retina Macula Consultants of New York, New York, NY, United States
| | - Ronald H. Silverman
- Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Medical Center, New York, NY, United States
| | - Stephen H. Tsang
- Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Medical Center, New York, NY, United States
- Jonas Children’s Vision Care and Bernard & Shirlee Brown Glaucoma Laboratory, Department of Ophthalmology, Columbia University, New York, NY, United States
- Department of Pathology & Cell Biology, Institute of Human Nutrition, & Columbia Stem Cell Initiative, Columbia University, New York, NY, United States
| | - Richard F. Spaide
- Vitreous Retina Macula Consultants of New York, New York, NY, United States
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Padhy SK, Parameswarappa DC, Agarwal K, Takkar B, Behera S, Panchal B, Ramappa M, Padhi TR, Jalali S. Clinical and visual electrophysiological characteristics of vitelliform macular dystrophies in the first decade of life. Indian J Ophthalmol 2022; 70:2516-2525. [PMID: 35791148 PMCID: PMC9426046 DOI: 10.4103/ijo.ijo_2186_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: To evaluate patterns of pediatric vitelliform macular dystrophy (PVMD). Methods: This is a retrospective analysis of Indian children with vitelliform macular dystrophy (VMD) presenting within the first decade of life. Records were evaluated for clinical findings, family screening, and investigative findings including optical coherence tomography (OCT), fundus autofluorescence (FAF), full-field electroretinogram (ERG) and electrooculogram (EOG). Electrophysiology was scrutinized and audited for acquisition and interpretation errors. Findings on follow-up were also recorded. Results: 46 eyes of 24 patients were included. Mean age at presentation was 7.17 ± 2.17 years. Mean follow-up duration was 1.55 ± 1.69 years. Best disease was the commonest type of VMD detected (21 patients), while autosomal recessive bestrophinopathy was seen in three cases. Mean logMAR BCVA was 0.364 which decreased to 0.402 on follow-up. Hyperopia was noted in 29 out of 46 eyes (mean being +3.87 D, range ebing +0.75 to +8.75 D). Four eyes of four children had choroidal neovascular membrane at presentation, while another child developed while in follow-up. Solid type subretinal deposit was the commonest OCT finding (n = 29/38) and central hyper FAF was the commonest pattern (n = 18/32). EOG was available for review in 32 eyes, but was unreliable in 11 eyes. Seven eyes demonstrated complete absence of light rise on EOG. Conclusion: PVMD can present in advanced forms. Progression to complications with loss of visual acuity can happen within the first decade of life. EOG shows grossly suppressed waveforms in the light phase in a large number of such children.
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Affiliation(s)
- Srikanta Kumar Padhy
- Vitreoretina and Uveitis Services, Mithu Tulasi Chanrai Campus, L V Prasad Eye Institute, Bhubaneswar, Odisha, India
| | | | - Komal Agarwal
- Srimati Kanuri Santamma Centre for Vitreoretinal Diseases, Hyderabad, Telangana, India
| | - Brijesh Takkar
- Srimati Kanuri Santamma Centre for Vitreoretinal Diseases; The Centre of Excellence for Rare Eye Diseases; Indian Health Outcomes, Public Health and Economics (IHOPE) Research Centre, Hyderabad, Telangana, India
| | - Shashwat Behera
- Vitreoretina and Uveitis Services, Kode Venkatadri Chowdary Campus, L V Prasad Eye Institute, Vijayawada, Andhra Pradesh, India
| | - Bhavik Panchal
- Vitreoretina and Uveitis Services, GMR Varalalakshmi Campus, L V Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
| | - Muralidhar Ramappa
- The Centre of Excellence for Rare Eye Diseases; Jasti V Ramanamma Children's Eye Care Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Tapas Ranjan Padhi
- Vitreoretina and Uveitis Services, Mithu Tulasi Chanrai Campus, L V Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Subhadra Jalali
- Srimati Kanuri Santamma Centre for Vitreoretinal Diseases; Jasti V Ramanamma Children's Eye Care Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India
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Bonilha VL, Bell BA, DeBenedictis MJ, Hagstrom SA, Fishman GA, Hollyfield JG. Cellular Changes in Retinas From Patients With BEST1 Mutations. Front Cell Dev Biol 2020; 8:573330. [PMID: 33154968 PMCID: PMC7591587 DOI: 10.3389/fcell.2020.573330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/03/2020] [Indexed: 11/24/2022] Open
Abstract
Best disease (BD), also known as vitelliform macular dystrophy, is an inherited disease of the central retina caused by more than 300 pathogenic variants in the BEST1 gene. The phenotype of BD is variable, and there are just a few reports on the histopathology of eyes from donors with BD. Here, we describe the histopathological comparison of donor’s eyes from two patients with BD. Eyes obtained from 85-year-old (donor 1) and 65-year-old (donor 2) donors were fixed within 25 h postmortem. Perifoveal and peripheral retinal regions were processed for histology and immunocytochemistry using retinal-specific and retinal pigment epithelium (RPE)-specific antibodies. Three age-matched normal eyes were used as controls. DNA was obtained from donor blood samples. Sequence analysis of the entire BEST1 coding region was performed and identified a c.886A > C (p.Asn296His) variant in donor 1 and a c.602T > C (p.Ile201Thr) variant in donor 2; both mutations were heterozygous. Fundus examination showed that donor 1 displayed a macular lesion with considerable scarring while donor 2 displayed close to normal macular morphology. Our studies of histology and molecular pathology in the perifovea and periphery of these two BD donor eyes revealed panretinal abnormalities in both photoreceptors and RPE cellular levels in the periphery; donor 1 also displayed macular lesion. Our findings confirm the phenotypic variability of BD associated with BEST1 variants.
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Affiliation(s)
- Vera L Bonilha
- Department of Ophthalmic Research, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, United States.,Department of Ophthalmology, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Brent A Bell
- Department of Ophthalmic Research, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, United States.,Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, United States
| | - Meghan J DeBenedictis
- Department of Ophthalmic Research, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Stephanie A Hagstrom
- Department of Ophthalmic Research, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, United States.,Department of Ophthalmology, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Gerald A Fishman
- Pangere Center at The Chicago Lighthouse for People Who Are Blind or Visually Impaired, Chicago, IL, United States
| | - Joe G Hollyfield
- Department of Ophthalmic Research, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, United States.,Department of Ophthalmology, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, United States
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Al-Abri M, Al-Hinai A, Al Zuhaibi S, Ganesh A, Al Ghafri A, Al-Thihli K. Normal electro-oculography in a young Omani male with genetically confirmed best disease complicated by choroidal neovascularization. Oman J Ophthalmol 2019; 12:37-41. [PMID: 30787533 PMCID: PMC6380146 DOI: 10.4103/ojo.ojo_74_2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Best vitelliform macular dystrophy (VMD) is an autosomal dominant macular dystrophy caused by heterozygous mutations in the bestrophin1 gene. Patients with this condition typically have an abnormal electrooculogram. We report a case of a 16-year-old male who presented with gradual progressive vision loss in the right eye. Ophthalmic assessment included funduscopy, optical coherence tomography (OCT), fluorescein angiography, electro-oculography, electroretinography, and genetic testing. Visual acuity was 20/500 and 20/20 in the right and left eyes, respectively. Ophthalmoscopy revealed round yellow lesions in both foveae similar to what is typically seen in Best disease. A subretinal hemorrhage surrounding the right foveal lesion was also noted. OCT demonstrated an elevated neurosensory retina with a subretinal lesion in the right macula. Fluorescein angiography of the right eye confirmed the presence of choroidal neovascularization. Genetic analysis of VMD2/BEST1 sequences confirmed the diagnosis of Best disease. However, contrary to what was expected, the patient's electro-oculography was normal. The findings of this case support a small number of previous reports demonstrating cases of Best disease with normal electro-oculography. While an abnormal electro-oculography along with the typical features of Best disease confirms the diagnosis, a normal result may not exclude the diagnosis. Genetic testing is probably the most important test for establishing the diagnosis of Best disease.
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Affiliation(s)
- Mohamed Al-Abri
- Department of Ophthalmology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Ahmed Al-Hinai
- Department of Ophthalmology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Sana Al Zuhaibi
- Department of Ophthalmology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Anuradha Ganesh
- Department of Ophthalmology, Sultan Qaboos University Hospital, Muscat, Oman
| | | | - Khalid Al-Thihli
- Department of Genetics, Sultan Qaboos University Hospital, Muscat, Oman
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