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Der Ophthalmologe : Zeitschrift Der... Sep 2020In the case of acute vitreous body hemorrhage, the ophthalmologist is faced with the question of whether spontaneous absorption can be awaited or whether a vitrectomy... (Review)
Review
In the case of acute vitreous body hemorrhage, the ophthalmologist is faced with the question of whether spontaneous absorption can be awaited or whether a vitrectomy is necessary. In addition to the intensity of the bleeding, the underlying cause also plays an important role. A thorough medical history is therefore important. The most common causes in adults include posterior vitreous detachment, diabetic retinopathy, and retinal vascular occlusion. In children, retinal vasculitis, systemic diseases, and trauma (e.g. shaken baby syndrome) must be excluded. If there is no evidence of a retinal tear or detachment using ultrasound, it is usually possible to wait a few weeks under sonographic control to assess the spontaneous tendency to resorb. Overall, the trend is towards earlier surgical interventions due to improved vitrectomy techniques and the desire for early rehabilitation of vision.
Topics: Diabetic Retinopathy; Humans; Retinal Detachment; Retinal Perforations; Vitrectomy; Vitreous Body; Vitreous Detachment; Vitreous Hemorrhage
PubMed: 32385553
DOI: 10.1007/s00347-020-01112-7 -
Experimental Eye Research Jun 2020Animal studies suggest that the retinal dysfunction in diabetic subjects that precedes overt clinical vasculopathy may be due to a retinal dopamine deficit. We analyzed... (Review)
Review
Animal studies suggest that the retinal dysfunction in diabetic subjects that precedes overt clinical vasculopathy may be due to a retinal dopamine deficit. We analyzed levels of dopamine (DA) and its primary metabolite, 3,4-dihydroxyphenylacetic acid (DOPAC), in the vitreous of diabetic and non-diabetic human subjects. Adult patients undergoing pars plana vitrectomy for non-hemorrhagic indications were prospectively recruited from the Emory Eye Center in Atlanta, GA. Vitreous samples were analyzed using high performance liquid chromatography (HPLC) to measure levels of DOPAC and DA in the vitreous specimens. Vitreous samples from 9 diabetic patients and 20 from non-diabetic patients were analyzed. No eyes had apparent diabetic retinopathy. Mean normalized DA concentration in vitreous of diabetic subjects was 0.76 ± 0.12 pg/μL vs. 0.73 ± 0.08 pg/μL in non-diabetic vitreous (p = 0.849). DOPAC concentration was 8.84 ± 0.74 pg/μL in vitreous of diabetic subjects vs. 9.22 ± 0.56 pg/μL in vitreous of non-diabetic subjects (p = 0.691). No difference was observed in the concentrations of DA and DOPAC in the vitreous of people without diabetes compared to those with diabetes without retinopathy.
Topics: Biomarkers; Diabetes Mellitus; Diabetic Retinopathy; Dopamine; Humans; Vitreous Body
PubMed: 32360553
DOI: 10.1016/j.exer.2020.108040 -
Der Ophthalmologe : Zeitschrift Der... Jan 2021Proliferative vitreoretinopathy (PVR) is one of the most important complications following vitreoretinal surgery. So far, surgical strategies have been the gold standard... (Review)
Review
BACKGROUND
Proliferative vitreoretinopathy (PVR) is one of the most important complications following vitreoretinal surgery. So far, surgical strategies have been the gold standard in treatment. Pharmacological approaches for prevention and treatment of PVR are under clinical investigation and intervene in different phases of the PVR cascade.
METHODS
The relevant literature as well as own data and experience with PVR are discussed in this review article. The most important aspects of pharmacological approaches for PVR prophylaxis and treatment are explained.
RESULTS
A prophylactic use of systemic prednisone administration as an anti-inflammatory substance showed contradictory results, while there was no additional benefit for intravitreal triamcinolone. Orally administered isotretinoin also seems to be able to minimize the formation of PVR after retinal reattachment surgery, whereas there was no improvement in the success rate in established PVR. Cell proliferation inhibitors have already been extensively studied. The combined intravitreal prophylactic approach of 5‑fluorouracil and low molecular weight heparin was recently further investigated in a multicenter, placebo-controlled study and showed a positive effect in some studies. New preclinical and experimental approaches include the inhibition of growth factors, modulation of integrin activity and the induction of apoptosis.
CONCLUSION
Most clinical studies dealt with an anti-inflammatory or antiproliferative approach. So far, no pharmacological substance has been established for the treatment of PVR but there are promising approaches for prophylaxis.
Topics: Humans; Anti-Inflammatory Agents; Retinal Detachment; Vitreoretinal Surgery; Vitreoretinopathy, Proliferative; Vitreous Body
PubMed: 32666172
DOI: 10.1007/s00347-020-01173-8 -
Vestnik Oftalmologii 2023There are two main age-related changes that can occur in the vitreous body of healthy individuals throughout life: liquefaction (synchesis) and aggregation of collagen...
There are two main age-related changes that can occur in the vitreous body of healthy individuals throughout life: liquefaction (synchesis) and aggregation of collagen fibrils into dense bundles (syneresis). Progressive age-related degradation leads to posterior vitreous detachment (PVD). At present many classifications of PVD exist, in which authors relied either on the morphological features, or on the differences in pathogenesis before and after widespread use of OCT. The course of PVD can be either normal or anomalous. Physiological PVD induced by age-related vitreous changes progresses in specific stages. The review emphasizes that PVD can occur initially not only in the central zone of the retina, but also on the periphery with further spread to the posterior pole. Anomalous PVD can lead to various negative effects on the retina, as well as on the vitreous as a result of traction in the area of vitreoretinal interface.
Topics: Humans; Vitreous Body; Vitreous Detachment; Retina; Tomography, Optical Coherence
PubMed: 37379116
DOI: 10.17116/oftalma2023139031106 -
International Ophthalmology May 2024To evaluate the levels of anxiety and depression in patients with symptomatic vitreous floaters and to determine the possible correlations of psychological implications...
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.
Topics: Humans; Male; Female; Middle Aged; Vitreous Body; Depression; Adult; Anxiety; Eye Diseases; Tomography, Optical Coherence; Surveys and Questionnaires; Aged; Case-Control Studies; Vitreous Detachment; Vision Disorders
PubMed: 38713290
DOI: 10.1007/s10792-024-03006-y -
AJNR. American Journal of Neuroradiology Jul 2022There is growing evidence of leakage of gadolinium in an impaired blood-retina barrier. We investigated gadolinium enhancement in different eye compartments and...
BACKGROUND AND PURPOSE
There is growing evidence of leakage of gadolinium in an impaired blood-retina barrier. We investigated gadolinium enhancement in different eye compartments and correlated the enhancement with specific ophthalmologic diseases.
MATERIALS AND METHODS
In a prospective clinical study (ClinicalTrials.gov Identifier: NCT05035251), 95 patients (63 with and 32 without ophthalmologic disease) were examined before and after gadolinium administration (20 and 120 minutes) with heavily T2-weighted FLAIR. The cohort was divided according to the location of pathology into anterior and posterior eye compartment groups. Relative signal intensity increase in the anterior eye chamber, vitreous body with retina, optic nerve sheath, and the Meckel cave was analyzed and correlated with the final clinical diagnosis.
RESULTS
In patients with a disorder in the anterior eye compartment, significant signal intensity increases were found in the central anterior eye chamber ( 20 minutes = .000, 120 minutes = .000), lateral anterior eye chamber ( 20 minutes = .001, 120 minutes = .005), and vitreous body with retina ( 20 minutes = .02) compared with the control group. Patients with pathologies in the posterior eye compartment showed higher signal intensity levels in the central anterior eye compartment ( 20 minutes = .041) and vitreous body with retina ( 120 minutes = .006).
CONCLUSIONS
Increased gadolinium enhancement was found in the central and lateral anterior eye compartments and the vitreous body with retina in patients with anterior eye compartment disorders 20 and 120 minutes after contrast application, suggesting impairment of the blood-aqueous barrier. In patients with a disorder in the posterior eye compartment, pathologic enhancement indicated disruption of the blood-retinal barrier that allows gadolinium to diffuse into the vitreous body with retina from posterior to anterior, opposite to the known physiologic glymphatic pathway.
Topics: Contrast Media; Gadolinium; Glymphatic System; Humans; Magnetic Resonance Imaging; Prospective Studies; Vitreous Body
PubMed: 35772805
DOI: 10.3174/ajnr.A7552 -
Survey of Ophthalmology 2020Vitreous floaters are common, related to age, myopia, genetic predisposition, and infiltration of the vitreous body. A subset of patients report symptoms impacting their... (Review)
Review
Vitreous floaters are common, related to age, myopia, genetic predisposition, and infiltration of the vitreous body. A subset of patients report symptoms impacting their quality of vision. Treatment with laser vitreolysis, the use of an Nd:YAG laser to vaporize the collagenous vitreous opacities appears to be used more frequently; however, data regarding long-term safety and effectiveness are lacking. We present currently available data regarding efficacy and safety, as well as additional considerations. Laser vitreolysis of symptomatic floaters should not be routinely performed without additional studies documenting its safety and long-term efficacy. Ideally, the procedure would be effective in most patients and be approved by the Food and Drug Administration based on the results of a Food and Drug Administration registration trial before widespread adoption.
Topics: Eye Diseases; Humans; Laser Therapy; Lasers, Solid-State; Visual Acuity; Vitrectomy; Vitreous Body
PubMed: 32135173
DOI: 10.1016/j.survophthal.2020.02.007 -
Progress in Retinal and Eye Research Sep 2019Diabetic retinopathy (DR) is one of the leading causes of visual impairment in the working-age population. DR is a progressive eye disease caused by long-term... (Review)
Review
Diabetic retinopathy (DR) is one of the leading causes of visual impairment in the working-age population. DR is a progressive eye disease caused by long-term accumulation of hyperglycaemia-mediated pathological alterations in the retina of diabetic patients. DR begins with asymptomatic retinal abnormalities and may progress to advanced-stage proliferative diabetic retinopathy (PDR), characterized by neovascularization or preretinal/vitreous haemorrhages. The vitreous, a transparent gel that fills the posterior cavity of the eye, plays a vital role in maintaining ocular function. Structural and molecular alterations of the vitreous, observed during DR progression, are consequences of metabolic and functional modifications of the retinal tissue. Thus, vitreal alterations reflect the pathological events occurring at the vitreoretinal interface. These events are caused by hypoxic, oxidative, inflammatory, neurodegenerative, and leukostatic conditions that occur during diabetes. Conversely, PDR vitreous can exert pathological effects on the diabetic retina, resulting in activation of a vicious cycle that contributes to disease progression. In this review, we recapitulate the major pathological features of DR/PDR, and focus on the structural and molecular changes that characterize the vitreal structure and composition during DR and progression to PDR. In PDR, vitreous represents a reservoir of pathological signalling molecules. Therefore, in this review we discuss how studying the biological activity of the vitreous in different in vitro, ex vivo, and in vivo experimental models can provide insights into the pathogenesis of PDR. In addition, the vitreous from PDR patients can represent a novel tool to obtain preclinical experimental evidences for the development and characterization of new therapeutic drug candidates for PDR therapy.
Topics: Aging; Diabetic Retinopathy; Humans; Vitreous Body
PubMed: 30951889
DOI: 10.1016/j.preteyeres.2019.03.002 -
Therapeutic Hypothermia and Temperature... Jun 2021Currently, there are no clear recommendations about the safety of certain temperature conditions for intraocular structures during vitreoretinal surgery; instructions on...
Currently, there are no clear recommendations about the safety of certain temperature conditions for intraocular structures during vitreoretinal surgery; instructions on the safe rate of rewarming of the vitreous cavity; and the advisability of monitoring ocular temperature in the postoperative period. The purpose was to study the dynamics of epibulbar and intraocular temperature during vitreoretinal surgery. This study included 20 patients with rhegmatogenous retinal detachment (10 eyes) and retinal detachment associated with proliferative diabetic retinopathy (10 eyes). All patients underwent vitreoretinal surgery. In all cases, the ambient temperature, the patient's body temperature, the temperature of the irrigating solution, and temperature in the anterior, mid-, and posterior vitreous were recorded during surgery. Pre- and postoperative thermometry was also performed on the outer ocular surface. During vitreoretinal surgery with room temperature irrigation solution, a decrease in temperature ( < 0.001) versus the initial one was found in all segments of the vitreous cavity. In the absence of continuous irrigation, a rapid rewarming of the vitreous cavity was noted (an average of 0.18°C/min). Our study also demonstrated the presence of regional hyperthermia of the operated eye in a number of patients (25%) in the postoperative period. Current research shows that vitreoretinal surgery is performed under conditions of uncontrolled local ocular hypothermia and is characterized by a rapid uncontrolled rewarming of the vitreous cavity after cessation of cooling, and in the postoperative period local hyperthermia of the operated eye is observed in a number of patients.
Topics: Humans; Hypothermia, Induced; Retinal Detachment; Temperature; Vitreoretinal Surgery; Vitreous Body
PubMed: 32679001
DOI: 10.1089/ther.2020.0019 -
Ophthalmic Plastic and Reconstructive...To determine if retrobulbar injection of hyaluronidase reaches the vitreous cavity, and to determine its concentration in the vitreous.
PURPOSE
To determine if retrobulbar injection of hyaluronidase reaches the vitreous cavity, and to determine its concentration in the vitreous.
METHODS
Prospective case-control study. Patients undergoing evisceration with implant for noninfective blind eyes were enrolled in the study. Before the evisceration, a retrobulbar injection of 3,000 IU of hyaluronidase (2 ml) was injected. Time from injection to in vivo sampling of posterior vitreous was noted. Vitreous samples from controls were obtained from patients undergoing vitrectomy for retinal detachment or diabetic retinopathy. Concentration of hyaluronidase was assessed in all 30 samples. An ELISA-based microtiter-technique was used to evaluate the activity of hyaluronidase by an avidin-peroxidase-based procedure using an ELISA reader. Incubations were carried out at room temperature and at 37°C. All the samples were analyzed in duplicates, and the mean of each sample was plotted on a scatter plot.
RESULTS
Total of 30 vitreous samples were analyzed, of which 15 were controls and 15 were test samples. Of the 15 test samples, injection-to-sampling time was 0 to 20 minutes in 4 samples, 20 to 40 minutes in 6 samples, and 40 to 60 minutes in 5 samples. The highest concentration of hyaluronidase detected in control and test samples were 2.9 and 3.0 µg/ml, and the lowest concentration was 1.7 and 1.5 µg/ml (SD 0.3), respectively. There was no significant difference between control and test groups.
CONCLUSION
Retrobulbar injection did not result in higher concentration of hyaluronidase in the posterior vitreous compared with controls when measured up to 60 minutes following injection.
Topics: Case-Control Studies; Humans; Hyaluronoglucosaminidase; Injections; Vitrectomy; Vitreous Body
PubMed: 34293791
DOI: 10.1097/IOP.0000000000002022