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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 -
Archivos de La Sociedad Espanola de... Oct 2019The Berger's space (BS) is a space located between the posterior capsule of the lens and the anterior hyaloid of the vitreous, structures that adhere in a circular...
INTRODUCTION AND OBJECTIVE
The Berger's space (BS) is a space located between the posterior capsule of the lens and the anterior hyaloid of the vitreous, structures that adhere in a circular manner by means of the Wieger ligament, for which the outer limit is defined by Egger's line. The aim of this article is to perform a review of the BS, as well as to present three cases in which this BS could be demonstrated by optical coherence tomography (OCT).
MATERIAL AND METHOD
A total of 90 patients from a general ophthalmology clinic were studied, on whom an anterior pole OCT was performed (Cirrus Lumera 700 Carl Zeiss Medicte, Dublin, California, United States). All patients were included consecutively, with an analysis being performed on the cornea, anterior chamber, iris, lens, and anterior vitreous, but excluding those in which the test could not be performed.
RESULTS
The posterior lens capsule, the anterior hyaloid, and the BS between both structures were observed in three patients. This is the first time in the current literature that three cases have been described, together with their characteristics (one phakic -case 1- and two pseudophakic, one of them vitreous destructuring -case 2- and the other with opacification of the posterior capsule of the lens -case 3-), using this previous pole OCT technique.
CONCLUSIONS
Knowledge of the BS is essential to understand the vitreo-lenticular junction and any complications in some cataract surgeries, as well as to also understand the pathological origin of pigment dispersion syndrome.
Topics: Aged; Eye Diseases; Female; Humans; Lens, Crystalline; Male; Middle Aged; Tomography, Optical Coherence; Vitreous Body
PubMed: 31378388
DOI: 10.1016/j.oftal.2019.06.006 -
Diabetes Apr 2022Vitreous fibrovascular membranes (FVMs), the hallmark of proliferative diabetic retinopathy (PDR), cause retinal hemorrhage, detachment, and eventually blindness....
Vitreous fibrovascular membranes (FVMs), the hallmark of proliferative diabetic retinopathy (PDR), cause retinal hemorrhage, detachment, and eventually blindness. However, little is known about the pathophysiology of FVM. In this study, we used single-cell RNA sequencing on surgically harvested PDR-FVMs and generated a comprehensive cell atlas of FVM. Eight cellular compositions were identified, with microglia as the major cell population. We identified a GPNMB+ subpopulation of microglia, which presented both profibrotic and fibrogenic properties. Pseudotime analysis further revealed the profibrotic microglia was uniquely differentiated from retina-resident microglia and expanded in the PDR setting. Ligand-receptor interactions between the profibrotic microglia and cytokines upregulated in PDR vitreous implicated the involvement of several pathways, including CCR5, IFNGR1, and CD44 signaling, in the microglial activation within the PDR microenvironment. Collectively, our description of the novel microglia phenotypes in PDR-FVM may offer new insight into the cellular and molecular mechanism underlying the pathogenesis of DR, as well as potential signaling pathways amenable to disease-specific intervention.
Topics: Cytokines; Diabetes Mellitus; Diabetic Retinopathy; Humans; Membrane Glycoproteins; Microglia; Transcriptome; Vitreous Body
PubMed: 35061025
DOI: 10.2337/db21-0551 -
Der Ophthalmologe : Zeitschrift Der... May 2020Degenerative vitreous opacities (also known as myodesopsia) can cause permanent and relevant visual impairment. Neodymium-YAG laser vitreolysis is an alternative...
Degenerative vitreous opacities (also known as myodesopsia) can cause permanent and relevant visual impairment. Neodymium-YAG laser vitreolysis is an alternative treatment option to pars plana vitrectomy for the treatment of disturbing degenerative vitreous opacities. This article critically discusses the different causes of vitreous opacities, the symptoms and functional impairments as well as clinical patient management. The aim is to support patient-oriented care and counselling of patients with vitreous opacities.
Topics: Eye Diseases; Humans; Laser Therapy; Lasers, Solid-State; Vision Disorders; Vitrectomy; Vitreous Body
PubMed: 32291480
DOI: 10.1007/s00347-020-01094-6 -
Progress in Retinal and Eye Research Nov 2020Macromolecules comprise only 2% of vitreous, yet are responsible for its gel state, transparency, and physiologic function(s) within the eye. Myopia and aging alter... (Review)
Review
Macromolecules comprise only 2% of vitreous, yet are responsible for its gel state, transparency, and physiologic function(s) within the eye. Myopia and aging alter collagen and hyaluronan association causing concurrent gel liquefaction and fibrous degeneration. The resulting vitreous opacities and collapse of the vitreous body during posterior vitreous detachment are the most common causes for the visual phenomenon of vitreous floaters. Previously considered innocuous, the vitreous opacities that cause floaters sometimes impact vision by profoundly degrading contrast sensitivity function and impairing quality-of-life. While many people adapt to vitreous floaters, clinically significant cases can be diagnosed with Vision Degrading Myodesopsia based upon echographic assessment of vitreous structure and by measuring contrast sensitivity function. Perhaps due to the ubiquity of floaters, the medical profession has to date largely ignored the plight of those with Vision Degrading Myodesopsia. Improved diagnostics will enable better disease staging and more accurate identification of severe cases that merit therapy. YAG laser treatments may occasionally be slightly effective, but vitrectomy is currently the definitive cure. Future developments will usher in more informative diagnostic approaches as well as safer and more effective therapeutic strategies. Improved laser treatments, new pharmacotherapies, and possibly non-invasive optical corrections are exciting new approaches to pursue. Ultimately, enhanced understanding of the underlying pathogenesis of Vision Degrading Myodesopsia should result in prevention, the ultimate goal of modern Medicine.
Topics: Contrast Sensitivity; Humans; Myopia; Quality of Life; Visual Acuity; Vitrectomy; Vitreous Body
PubMed: 32151758
DOI: 10.1016/j.preteyeres.2020.100847 -
Ophthalmology. Retina Jul 2020
Topics: Choroid; Humans; Retina; Retinal Detachment; Vitreous Body
PubMed: 32646560
DOI: 10.1016/j.oret.2020.02.005 -
Retina (Philadelphia, Pa.) Jul 2021Vitreoretinal surgical techniques have evolved during the last decades because of the development and evolution of pars plana vitrectomy. The introduction of modern... (Review)
Review
BACKGROUND
Vitreoretinal surgical techniques have evolved during the last decades because of the development and evolution of pars plana vitrectomy. The introduction of modern vitrectomy is credited to Robert Machemer (1933-2009). The aim of this review is to characterize the early developments of vitreous removal.
METHODS
We used the PubMed web platform to search the terms: complications of cataract surgery, vitrectomy, vitreous body, vitreous humor, vitreous humour, vitreous tap, and vitreous transplantation. Other publications were also considered as a potential source of information when referenced in relevant articles.
RESULTS
The first description of vitreous removal for treatment of eye disorders dates the 17th century; it was conducted by a Dutch surgeon Anton Nuck (1650-1692) in a case of hydrophthalmia. In English literature, the first description of vitrectomy is attributed to the American surgeon John Collins Warren (1778-1856). This method was implemented in the spontaneous dislocation of the crystalline lens. As the fibrillar structure of the vitreous once destroyed could not be regenerated, the researchers aimed to restore the chemical composition of the vitreous. For several decades, vitreous transplantation was performed for the treatment of vitreous hemorrhages and retinal detachment.
CONCLUSION
Although the achievements of vitreoretinal surgery preceding Machemer's inventions are uncommonly reported, they have contributed to the concept and understanding of the treatment modalities.
Topics: Eye Diseases; History, 20th Century; History, 21st Century; Humans; Visual Acuity; Vitrectomy; Vitreous Body
PubMed: 33595257
DOI: 10.1097/IAE.0000000000003149 -
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