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Blood Oct 2021Primary vitreoretinal lymphoma (PVRL) is a rare form of primary central nervous system (CNS) lymphoma (PCNSL) arising in the intraocular compartment without brain... (Review)
Review
Primary vitreoretinal lymphoma (PVRL) is a rare form of primary central nervous system (CNS) lymphoma (PCNSL) arising in the intraocular compartment without brain involvement. Despite its apparent indolent clinical course, PVRL can cause permanent vision loss and CNS relapse, the major cause of death in patients with PVRL. The pathophysiology of PVRL is unknown. As in PCNSL, the transformation of the tumor cells likely originates outside the CNS, before the cells migrate to the eye and proliferate within an immune-permissive microenvironment. PVRL exhibits a biased immunoglobulin repertoire, suggesting underlying antigen selection. The diagnosis remains challenging, requiring close coordination between ophthalmologists and cytologists. Because of their rarity and fragility in the vitreous, lymphoma cells cannot always be identified. Interleukin levels, molecular biology, and imaging are used in combination with clinical ophthalmological examination to support the diagnosis of PVRL. Multi-institutional prospective studies are urgently needed to validate the equivocal conclusions regarding treatments drawn from heterogeneous retrospective or small cohort studies. Intravitreal injection of methotrexate or rituximab or local radiotherapy is effective at clearing tumor cells within the eyes but does not prevent CNS relapse. Systemic treatment based on high-dose methotrexate chemotherapy, with or without local treatment, might reduce this risk. At relapse, intensive consolidation chemotherapy followed by stem cell transplantation can be considered. Single-agent ibrutinib, lenalidomide, and temozolomide treatments are effective in patients with relapsed PVRL and should be tested as first-line treatments. Therapeutic response assessment based on clinical examination is improved by measuring cytokine levels but still needs to be refined.
Topics: Animals; Disease Management; Humans; Retina; Retinal Neoplasms; Vitreous Body
PubMed: 34036310
DOI: 10.1182/blood.2020008235 -
Clinical Microbiology and Infection :... Nov 2019Adjunctive systemic antibiotic therapy for treatment of bacterial endophthalmitis is controversial but common practice due to the severity of the disease. In the absence... (Review)
Review
BACKGROUND
Adjunctive systemic antibiotic therapy for treatment of bacterial endophthalmitis is controversial but common practice due to the severity of the disease. In the absence of guidance documents, several antibiotic regimens are being used without applying evidence-based prescribing, leading to inappropriate treatment of this serious eye condition.
OBJECTIVES
To summarize available data on intravitreal penetration of systemically administered antibiotics and to discuss their usefulness from a microbiological and pharmacological point of view.
SOURCES
We performed a systematic PubMed search of studies investigating antibiotic concentrations in the vitreous after systemic administration in humans, and selected animal models.
CONTENT
The best-documented agents achieving therapeutic levels in the vitreous are meropenem, linezolid and moxifloxacin. Vancomycin, cefazoline, ceftriaxone, ceftazidime, imipenem and trimethoprim-sulfamethoxazole reach levels justifying their use in specific situations. Available data do not support the use of ciprofloxacin, levofloxacin, aminoglycosides, aminopenicillins, piperacillin, cefepime and clarithromycin. With very limited but available promising data, the use of daptomycin and rifampicin deserves further investigation.
IMPLICATIONS
The choice of the adjunctive systemic antibiotic agent-in situations where it is considered relevant for treatment-must to date be made on an individual basis, considering microbiological aspects as well as operative status and inflammation of the eye. This review gives a systematic overview of antibiotic options and provides guidance to the clinician striving for optimal systemic antibiotic treatment of bacterial endophthalmitis.
Topics: Administration, Intravenous; Animals; Anti-Bacterial Agents; Bacterial Infections; Disease Models, Animal; Endophthalmitis; Humans; Vitreous Body
PubMed: 30771529
DOI: 10.1016/j.cmi.2019.01.017 -
Indian Journal of Ophthalmology Nov 2023
Topics: Humans; Vitrectomy; Vacuum; Vitreous Body; Retrospective Studies
PubMed: 37870030
DOI: 10.4103/IJO.IJO_3388_22 -
Translational Vision Science &... Sep 2022Vitreous substitutes are traditionally used to stabilize the retina after vitrectomy. In recent years, various approaches have been developed for using the vitreous... (Review)
Review
Vitreous substitutes are traditionally used to stabilize the retina after vitrectomy. In recent years, various approaches have been developed for using the vitreous substitute not only as a tamponade but also as a drug release system to tackle ocular diseases. This review provides an overview of the requirements for vitreous substitutes and discusses the current clinically applied as well as novel polymer-based vitreous substitutes as drug delivery systems, including their release mechanisms, efficiencies, challenges, and future perspectives.
Topics: Drug Liberation; Polymers; Retina; Vitrectomy; Vitreous Body
PubMed: 36125790
DOI: 10.1167/tvst.11.9.14 -
Molecular Vision 2020To investigate the relationship between inflammation in the vitreous and diabetic retinopathy.
PURPOSE
To investigate the relationship between inflammation in the vitreous and diabetic retinopathy.
METHODS
Vitreous samples from 21 patients with proliferative diabetic retinopathy (PDR), 21 patients with nonproliferative diabetic retinopathy (NPDR), and 21 nondiabetic patients with idiopathic epiretinal membranes (control) were studied. The interferon-gamma (IFN-γ), tumor necrosis factor-alpha (TNF-α), matrix metalloproteinase (MMP)-2, MMP-9, and adiponectin levels in the vitreous were detected in all samples with enzyme-linked immunosorbent assay (ELISA). Samples were stored at -80 °C until analyzed.
RESULTS
The TNF-α levels in the vitreous were not statistically significant between all groups (p>0.005). The mean IFN-γ levels were statistically significantly higher in patients with PDR (70.98 pg/ml) and patients with NPDR (46.61 pg/ml) than in nondiabetic patients (22.02 pg/ml). There was a difference in the IFN-γ levels in the vitreous between patients with PDR and patients with NPDR (p<0.005). The MMP-2 and MMP-9 concentrations in the vitreous were not different between all groups (p>0.05). There was a correlation between the IFN-γ and TNF-α levels. We investigated the statistically significantly decreased levels of adiponectin in the proliferative (p<0.05) and nonproliferative (p<0.05) diabetic eyes compared to the nondiabetic eyes.
CONCLUSIONS
Increased levels of IFN-γ and TNF-α in the vitreous were found in patients with diabetes compared to nondiabetic patients. Decreased levels of adiponectin in the vitreous were found in patients with diabetes compared to nondiabetic patients. The data support the hypothesis that inflammation is associated with diabetic retinopathy.
Topics: Adiponectin; Diabetic Retinopathy; Female; Humans; Inflammation; Interferon-gamma; Male; Matrix Metalloproteinase 2; Matrix Metalloproteinase 9; Middle Aged; Tumor Necrosis Factor-alpha; Vitreous Body
PubMed: 33209014
DOI: No ID Found -
Ophthalmic Surgery, Lasers & Imaging... Oct 2018Vital dyes contain complex molecules with chromophores that stain living tissues and have greatly enhanced identification and removal of transparent vitreoretinal... (Review)
Review
Vital dyes contain complex molecules with chromophores that stain living tissues and have greatly enhanced identification and removal of transparent vitreoretinal tissues during surgery. Several "chromovitrectomy" dyes are frequently used by vitreoretinal specialists, including indocyanine green, trypan blue, brilliant blue G, and triamcinolone acetonide; other dyes are also under investigation. Trypan Blue was approved by the U.S. Food and Drug Administration (FDA) for epiretinal membrane removal, and preservative-free triamcinolone acetonide was approved by the FDA for intraocular use. However, currently available chromovitrectomy dyes have their limitations, and of particular concern for some of them is the possibility for acute and chronic toxicity to the neurosensory retina and retinal pigmented epithelium. The potentially irreversible acute toxicity and other limitations, such as lack of long-term safety profiles, highlight the need for further advancements. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:788-798.].
Topics: Coloring Agents; Humans; Indocyanine Green; Intraoperative Period; Macula Lutea; Retinal Diseases; Trypan Blue; Vitreoretinal Surgery; Vitreous Body
PubMed: 30395665
DOI: 10.3928/23258160-20181002-07 -
Journal of the Mechanical Behavior of... Oct 2022Vitreoretinal mechanics plays an important role in retinal trauma and many sight-threatening diseases. In age-related pathologies, such as posterior vitreous detachment... (Review)
Review
Vitreoretinal mechanics plays an important role in retinal trauma and many sight-threatening diseases. In age-related pathologies, such as posterior vitreous detachment and vitreomacular traction, lingering vitreoretinal adhesions can lead to macular holes, epiretinal membranes, retinal tears and detachment. In age-related macular degeneration, vitreoretinal traction has been implicated in the acceleration of the disease due to the stimulation of vascular growth factors. Despite this strong mechanobiological influence on trauma and disease in the eye, fundamental understanding of the mechanics at the vitreoretinal interface is limited. Clarification of adhesion mechanisms and the role of vitreoretinal mechanics in healthy eyes and disease is necessary to develop innovative treatments for these pathologies. In this review, we evaluate the existing literature on the structure and function of the vitreoretinal interface to gain insight into age- and region-dependent mechanisms of vitreoretinal adhesion. We explore the role of vitreoretinal adhesion in ocular pathologies to identify knowledge gaps and future research areas. Finally, we recommend future mechanics-based studies to address the critical needs in the field, increase fundamental understanding of vitreoretinal mechanisms and disease, and inform disease treatments.
Topics: Humans; Retinal Perforations; Tissue Adhesions; Vitreous Body
PubMed: 35963021
DOI: 10.1016/j.jmbbm.2022.105399 -
International Journal of Molecular... Dec 2022Several common ocular diseases are leading causes of irreversible visual impairment. Over the last decade, various mainly untargeted metabolic studies have been... (Review)
Review
Several common ocular diseases are leading causes of irreversible visual impairment. Over the last decade, various mainly untargeted metabolic studies have been performed to show that metabolic dysfunction plays an important role in the pathogenesis of ocular diseases. A number of metabolites in plasma/serum, aqueous or vitreous humor, or in tears have been found to differ between patients and controls; among them are L-carnitine and acylcarnitines, which are essential for mitochondrial fatty acid oxidation. The metabolic profile of carnitines regarding a variety of diseases has attracted researchers' interest. In this review, we present and discuss recent advances that have been made in the identification of carnitines as potential metabolic biomarkers in common ocular diseases, such as age-related macular degeneration, diabetic retinopathy, retinopathy of prematurity, central retinal vein occlusion, primary open-angle glaucoma, rhegmatogenous retinal detachment, and dry eye syndrome.
Topics: Infant, Newborn; Humans; Ophthalmology; Glaucoma, Open-Angle; Carnitine; Vitreous Body; Biomarkers
PubMed: 36555822
DOI: 10.3390/ijms232416183 -
The New England Journal of Medicine Aug 2018
Topics: Diabetes Mellitus, Type 2; Eye Diseases; Female; Humans; Middle Aged; Visual Acuity; Vitreous Body
PubMed: 30134134
DOI: 10.1056/NEJMicm1712355 -
Indian Journal of Ophthalmology Jun 2019Vitreous hemorrhage is one of the most common causes of sudden, painless loss of vision in adults. This is probably one of the reasons why it has been extensively... (Review)
Review
Vitreous hemorrhage is one of the most common causes of sudden, painless loss of vision in adults. This is probably one of the reasons why it has been extensively studied and reported in literature. However, the same cannot be said when it comes to vitreous hemorrhage in the pediatric age group. The causes of vitreous hemorrhage in children tend to differ from those of adults. Not much data exist regarding their presentation and management. In addition to trauma, certain spontaneous causes such as pediatric tumors and congenital conditions assume importance while considering the differential diagnosis of vitreous hemorrhage in the pediatric age group. However, it is natural that the treating ophthalmologist is faced with challenges when a child presents with vitreous hemorrhage. In this narrative review, we have attempted to analyze the retrospective observational studies regarding pediatric vitreous hemorrhage reported in English literature till date. The article sheds some light on the prevailing epidemiology, management strategies employed and the visual outcome among different regions of the world.
Topics: Child; Disease Management; Global Health; Humans; Morbidity; Visual Acuity; Vitreous Body; Vitreous Hemorrhage
PubMed: 31124481
DOI: 10.4103/ijo.IJO_688_18