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Korean Journal of Ophthalmology : KJO Jun 2021To manage reattachment of rhegmatogenous retinal detachment using tissue adhesive (fibrin glue) in five patients.
PURPOSE
To manage reattachment of rhegmatogenous retinal detachment using tissue adhesive (fibrin glue) in five patients.
METHODS
Five eyes of five patients with rhegmatogenous retinal detachment were treated with 23-gauge pars plana vitrectomy and the application of fibrin glue (Tisseel Lyo) into the break under air without laser photocoagulation or cryopexy.
RESULTS
The median age of patients was 64 (range, 46-82) years, and the median duration of symptoms was 15 (range, 7-60) days. Three eyes had inferior and two had superior rhegmatogenous retinal detachments. Successful retinal reattachment was achieved in all cases and maintained during the followıng 10 to 24 months. The median best-corrected visual acuity improved from 2 / 100 preoperatively to a Snellen visual acuity of 20 / 50 by 6 months postoperatively. No postoperative complications were detected during the follow-up period.
CONCLUSIONS
Excellent adhesive effects of fibrin glue with respect to sealing retinal tears with no side effects were seen in our study. With further prospective studies, this technique could be an alternative method to conventional retinopexy.
Topics: Aged; Aged, 80 and over; Fibrin Tissue Adhesive; Humans; Middle Aged; Postoperative Complications; Prospective Studies; Retinal Detachment; Retinal Perforations; Retrospective Studies; Treatment Outcome; Vitrectomy
PubMed: 33596627
DOI: 10.3341/kjo.2020.0020 -
Acta Ophthalmologica Feb 2022To estimate the efficacy and safety of ocriplasmin for patients with vitreous macular traction (VMT). (Meta-Analysis)
Meta-Analysis
PURPOSE
To estimate the efficacy and safety of ocriplasmin for patients with vitreous macular traction (VMT).
METHODS
The PubMed, EMBASE and Ovid were searched up to May 2020 to identify related studies. Statistical analysis was conducted by R software version 3.6.3. Results in proportion with 95% confidence interval (CI) were calculated by means of Freeman-Tukey variant of arcsine square transformation.
RESULTS
The pooling results indicated the overall complete release rate was 50% (95% CI [45%-54%]). For VMT patients younger than 65 years old, with smaller adhesion size of VMT (<1500 μm), phakic eyes, with macular hole (MH) and subretinal fluid (SRF), while without epiretinal membrane (ERM), ocriplasmin could achieve much higher complete release rates than those under opposite conditions. The general nonsurgical closure rate of MH was 34% (95% CI [30%-37%]), and it was positively correlated with the MH size. The visual improvement rate was 45% (95% CI [32%-59%]), and it was higher for patients with VMT resolution (59%, 95% CI [41%-75%]). The secondary pars plana vitrectomy (PPV) rate for patients without MH closure or VMT resolution was about 31% (95% CI [23%-39%]). The incidence of MH progression was 10% (95% CI [4%-18%]), and other severe adverse events such as endophthalmitis, retinal detachment and retinal tear were relatively rare.
CONCLUSION
Ocriplasmin is an effective, reliable and relatively safe intervention for the treatment of VMT. The most suitable candidates were patients younger than 65 years old, with smaller adhesion size (<1500 μm), phakic eyes, with MH and SRF, while without ERM.
Topics: Aged; Epiretinal Membrane; Fibrinolysin; Fibrinolytic Agents; Humans; Intravitreal Injections; Middle Aged; Peptide Fragments; Retinal Perforations; Tissue Adhesions; Treatment Outcome; Vitreous Detachment
PubMed: 34021702
DOI: 10.1111/aos.14867 -
Eye (London, England) Apr 2023To study the development, evolution, outcomes, and prognostic factors of lamellar macular hole (LMH) in highly myopic (HM) patients.
BACKGROUND/OBJECTIVES
To study the development, evolution, outcomes, and prognostic factors of lamellar macular hole (LMH) in highly myopic (HM) patients.
METHODS
Fifty eyes from 47 HM patients with LMHs were retrospectively enrolled. Relevant pre- and post-LMH optical coherence tomography findings and visual acuity were collected. Structural progression was defined as an increase in the height of retinoschisis, and the development of foveal detachment, full-thickness macular hole, or retinal detachment.
RESULTS
Four traction-related developmental processes were identified. Type 1 LMHs (8, 16%) developed from foveal avulsion caused by vitreomacular traction. Type 2 (32, 64%) and type 3 LMHs (5, 10%) formed from ruptured parafoveal and central foveal cysts, respectively. Progressive foveal thinning caused by epiretinal membranes (ERMs) without cystic changes led to type 4 LMHs (5, 10%). Retinoschisis developed before (9 eyes), after (10 eyes), or simultaneously with (6 eyes) the LMH formation. Structural progression was noted in 50%, 53%, 0%, 100% of patients with type 1-4 LMHs, respectively. Multivariable Cox proportional hazard model showed that greater residual foveal thickness (P = 0.001, adjusted odds ratio = 0.22, 95% confidence interval [CI], 0.08 ~ 0.56), and the absence of retinoschisis were protective against structural progression. Multivariable linear regression showed that poor baseline visual acuity (P < 0.001, β = 0.74, 95% CI 0.41 ~ 1.07) and type 4 LMH predicted worse visual outcomes.
CONCLUSIONS
Four traction-related LMH developmental processes were observed in HM eyes and exhibited different evolution and outcomes. LMHs with foveal thinning induced by ERMs had the worst outcomes.
Topics: Humans; Retinal Perforations; Retrospective Studies; Retinoschisis; Follow-Up Studies; Visual Acuity; Myopia; Epiretinal Membrane; Tomography, Optical Coherence
PubMed: 35562550
DOI: 10.1038/s41433-022-02086-3 -
Ophthalmic Surgery, Lasers & Imaging... Nov 2023The aim was to study the distribution of neurofilament in peeled internal limiting membrane (ILM).
BACKGROUND AND OBJECTIVE
The aim was to study the distribution of neurofilament in peeled internal limiting membrane (ILM).
PATIENTS AND METHODS
Prospective case study. Vitrectomy and ILM peeling were performed in patients with epiretinal membrane and macular hole. ILM flap specimens were obtained as one disc area size from five locations. Immunofluorescent staining was performed with an antineurofilament heavy antibody. Using a confocal microscope, retinal cell debris density was studied using the ImageJ program.
RESULTS
Percent of stained neurofilament was 1.58 ± 1.14% in total (2.45 ± 1.37% in extranasal, 1.97 ± 0.75% in extratemporal, 1.93 ± 1.26% in juxta-nasal, 0.89 ± 0.69% in fovea, and 0.63 ± 0.46% in juxtatemporal). The Kruskal-Wallis test revealed significant differences among groups ( < 0.05). Bonferroni post hoc analysis only confirmed significant difference between juxtatemporal and extranasal groups ( < 0.05).
CONCLUSIONS
In peeled ILM flap, neurofilaments are rarely detected in the juxtatemporal area. However, they are frequently detected in the extranasal area. .
Topics: Humans; Intermediate Filaments; Basement Membrane; Retinal Perforations; Epiretinal Membrane; Fovea Centralis; Vitrectomy; Retrospective Studies; Tomography, Optical Coherence
PubMed: 37956316
DOI: 10.3928/23258160-20231011-02 -
Turkish Journal of Ophthalmology Apr 2022To evaluate the efficacy and safety of heavy silicone oil as an endotamponade in patients with recurrent or complicated retinal detachment and macular hole.
OBJECTIVES
To evaluate the efficacy and safety of heavy silicone oil as an endotamponade in patients with recurrent or complicated retinal detachment and macular hole.
MATERIALS AND METHODS
Nineteen eyes of 19 patients who underwent heavy silicone oil endotamponade for different indications were included in the study and evaluated by retrospective chart review. At each visit, patients underwent detailed ophthalmological examination and anatomical and functional outcomes, silicone oil emulsification, intraocular inflammation, presence of proliferative vitreoretinopathy, preoperative and postoperative visual acuity, and postoperative complications were recorded.
RESULTS
The study included 19 eyes of 19 consecutive patients: 13 women (68.4%) and 6 men (31.6%). The patients' median age was 60 years (interquartile range [IQR]: 44-70 years) and the median follow-up time was 19 months (IQR: 9-31 months). Indications for heavy silicone oil endotamponade were recurrent retinal detachment in 11 eyes (57.8%), inferior retinal detachment in 5 eyes (26.3%), inferior rhegmatogenous retinal detachment, recurrent macular hole in 2 patients (10.5%), and macular hole in 1 patient (5.2%). Median best corrected visual acuity was 2 logMAR (IQR: 1-2.6) preoperatively and 0.99 logMAR (IQR: 0.4-2) postoperatively (p<0.001). Postoperative anatomical success was achieved in all patients. Densiron 68 was used for endotamponade in 14 patients (73.7%), Densiron XTRA in 3 patients (15.8%), and AlaHeavy 1.07 in 2 patients. Heavy silicone oil emulsification was observed in only 3 patients (15.8%).
CONCLUSION
Although heavy silicone oil has limitations as an endotamponade, such as intraocular pressure increase, emulsification, intraocular inflammation, and the risk of complications during removal, it is a safe and effective alternative in eyes requiring inferior retinal tamponade for indications like proliferative vitreoretinopathy and recurrent macular holes.
Topics: Child, Preschool; Endotamponade; Female; Humans; Inflammation; Male; Prospective Studies; Retinal Detachment; Retinal Perforations; Retrospective Studies; Silicone Oils; Uveal Diseases; Vitrectomy; Vitreoretinopathy, Proliferative
PubMed: 35481733
DOI: 10.4274/tjo.galenos.2021.83648 -
Asia-Pacific Journal of Ophthalmology... Sep 2021
Topics: Animals; Humans; Jaw; Retinal Perforations; Sharks
PubMed: 34524138
DOI: 10.1097/APO.0000000000000412 -
Translational Vision Science &... May 2023To investigate microstructural changes and prognosis associated with retinal surface dimples after internal limiting membrane (ILM) peeling for macular holes (MHs).
PURPOSE
To investigate microstructural changes and prognosis associated with retinal surface dimples after internal limiting membrane (ILM) peeling for macular holes (MHs).
METHODS
We analyzed swept-source optical coherence tomography (SS-OCT) images of patients who underwent surgery for idiopathic MHs. The inner retinal dimples on SS-OCT images were classified into three types: unidirectional, bidirectional, and complicated bidirectional dimples.
RESULTS
Dimples were found in 97.1% of the 69 eyes (69 patients) during a mean follow-up period of 14.0 ± 11.9 months after MH surgery. Of the eyes with dimples, 83.6% had bidirectional dimples. The proportion of eyes with dimples increased from 55.3% at 1 month postsurgery to 95.5% at 3 months and 97.9% at 6 months postsurgery. However, the proportion of eyes with complicated bidirectional dimples gradually increased from 1 month (29.8%) to 3 months (46.3%) and 6 months (64.6%) postsurgery. In the multivariable generalized estimating equation model, complicated bidirectional dimples occurred more frequently in eyes with shorter axial length (P = 0.039) and longer follow-up duration (≥6 months; at 6 months: P = 0.001; at 12 months: P = 0.009).
CONCLUSIONS
Changes in retinal layers associated with retinal surface dimples after ILM peeling can occur at different retinal depths and over different time courses. These findings suggest the progression of dimple-associated remodeling of the underlying retinal layer.
TRANSLATIONAL RELEVANCE
Various types of dimples can be used as surrogates to evaluate structural changes and outcomes of MH surgery.
Topics: Humans; Retinal Perforations; Retina; Tomography, Optical Coherence
PubMed: 37223920
DOI: 10.1167/tvst.12.5.23 -
Der Ophthalmologe : Zeitschrift Der... Aug 2021Intraoperative optical coherence tomography (iOCT) has recently been introduced for the visualization of retinal structures within the operating microscope.
BACKGROUND
Intraoperative optical coherence tomography (iOCT) has recently been introduced for the visualization of retinal structures within the operating microscope.
OBJECTIVE
The aim of this study was to analyze the behavior of the retina and morphological features during surgery for retinal detachment with macular involvement.
METHODS
A retrospective analysis of 41 consecutive eyes with macula-off retinal detachment, which were treated with pars plana vitrectomy (PPV) using iOCT. A qualitative analysis of morphological features of the retina at defined moments during surgery was carried out.
RESULTS
The visualization of macular detachment with iOCT was successful in 63% of cases and in the other cases the height of retinal detachment surpassed the maximum depth of the scan by iOCT. With perfluorodecalin 53.7% of eyes showed subretinal fluid and 22% of eyes showed a wave-like configuration of the outer retinal layers. In 61% of the eyes persisting subretinal fluid could be detected under the final tamponade. The amount of subretinal fluid could not be detected intraoperatively with the naked eye. In one case a macular hole could be newly identified intraoperatively and in three cases macular detachment could not be found at the start of surgery, although a detachment had been expected.
CONCLUSION
The use of iOCT rarely leads to changes or extension of the intervention; however, it provides real-time information on intraretinal and subretinal fluid, which is sometimes in contrast to the clinical assessment. The relevance of persistent subretinal fluid and folds of the outer retinal layers after surgery remains unclear. It can be speculated whether this could serve as a prognostic factor for the postoperative outcome.
Topics: Humans; Retinal Detachment; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Visual Acuity; Vitrectomy
PubMed: 33025165
DOI: 10.1007/s00347-020-01238-8 -
Translational Vision Science &... Apr 2024The purpose of this study was to develop a deep learning algorithm, to detect retinal breaks and retinal detachments on ultra-widefield fundus (UWF) optos images using...
PURPOSE
The purpose of this study was to develop a deep learning algorithm, to detect retinal breaks and retinal detachments on ultra-widefield fundus (UWF) optos images using artificial intelligence (AI).
METHODS
Optomap UWF images of the database were annotated to four groups by two retina specialists: (1) retinal breaks without detachment, (2) retinal breaks with retinal detachment, (3) retinal detachment without visible retinal breaks, and (4) a combination of groups 1 to 3. The fundus image data set was split into a training set and an independent test set following an 80% to 20% ratio. Image preprocessing methods were applied. An EfficientNet classification model was trained with the training set and evaluated with the test set.
RESULTS
A total of 2489 UWF images were included into the dataset, resulting in a training set size of 2008 UWF images and a test set size of 481 images. The classification models achieved an area under the receiver operating characteristic curve (AUC) on the testing set of 0.975 regarding lesion detection, an AUC of 0.972 for retinal detachment and an AUC of 0.913 for retinal breaks.
CONCLUSIONS
A deep learning system to detect retinal breaks and retinal detachment using UWF images is feasible and has a good specificity. This is relevant for clinical routine as there can be a high rate of missed breaks in clinics. Future clinical studies will be necessary to evaluate the cost-effectiveness of applying such an algorithm as an automated auxiliary tool in a large practices or tertiary referral centers.
TRANSLATIONAL RELEVANCE
This study demonstrates the relevance of applying AI in diagnosing peripheral retinal breaks in clinical routine in UWF fundus images.
Topics: Humans; Retinal Detachment; Retinal Perforations; Artificial Intelligence; Deep Learning; Photography
PubMed: 38564203
DOI: 10.1167/tvst.13.4.1 -
Indian Journal of Ophthalmology Oct 2023Currently, vitrectomy is considered as the first line of treatment in the management of macular holes. Various surgical modalities have been described to obtain...
BACKGROUND
Currently, vitrectomy is considered as the first line of treatment in the management of macular holes. Various surgical modalities have been described to obtain anatomical closure. However, there are still challenges when the hole is large and chronic (>400 microns) in nature. Here we describe a modified technique of internal limiting membrane (ILM) peeling which results in the successful closure of such macular holes.
PURPOSE
To demonstrate modified ILM flap techniques in management of chronic macular holes.
SYNOPSIS
Here we have described the role of modified ILM peeling techniques in three different cases such as chronic traumatic macular hole >400 microns, chronic idiopathic macular hole >400 microns and <400 microns.
HIGHLIGHTS
This modified ILM flap technique provides the benefit of an inverted ILM flap, which helps in glial proliferation and also relives tangential traction thereby aiding in successful macular hole closure in chronic cases.
VIDEO LINK
https://youtu.be/RKVLd1mSw08.
Topics: Humans; Retinal Perforations; Epiretinal Membrane; Basement Membrane; Vitrectomy; Surgical Flaps; Retrospective Studies; Tomography, Optical Coherence
PubMed: 37787255
DOI: 10.4103/IJO.IJO_883_23