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BMJ Case Reports Feb 2022Here is presented a unique case of bilateral serous macular detachments as a side effect of topical travoprost (0.004%) therapy. Only three other cases in the literature...
Here is presented a unique case of bilateral serous macular detachments as a side effect of topical travoprost (0.004%) therapy. Only three other cases in the literature have definitively associated this side effect with other topical prostaglandins. The aetiological and pathophysiological pathways remain to be clearly elucidated but are potentially related to increased choroidal vascular permeability. In this case, the subretinal fluid resolved rapidly and completely after cessation of travoprost drops, showing it to be a reversible pathology similar to prostaglandin-associated cystoid macular oedema. This uncommon association is therefore important to consider in the differential diagnosis of serous macular detachment. Increasing ophthalmic awareness could help to prevent unnecessary investigations in undifferentiated patients without other guiding historical or examination features. This may save time and expense for the patient and health systems.
Topics: Fluorescein Angiography; Humans; Retinal Detachment; Subretinal Fluid; Tomography, Optical Coherence; Travoprost
PubMed: 35110285
DOI: 10.1136/bcr-2021-246712 -
Acta Ophthalmologica Nov 2014To investigate pathomechanisms involved in graft detachment after Descemet's membrane endothelial keratoplasty (DMEK) and its clinical implications.
PURPOSE
To investigate pathomechanisms involved in graft detachment after Descemet's membrane endothelial keratoplasty (DMEK) and its clinical implications.
METHODS
In a prospective case series, 30 eyes with Fuchs' endothelial dystrophy underwent DMEK. Intraoperatively obtained recipients' endothelium-Descemet's membranes (EDMs) were investigated histologically and immunohistochemically. The postoperative donor graft status was categorized as attached or detached. Clinical and morphological parameters were analysed between the study groups.
RESULTS
The detachment rate was 40% (12/30). There was no significant difference in postoperative visual acuity between the groups, but visual recovery was delayed in eyes with initially detached grafts. Gender, age, preoperative central corneal thickness or best corrected visual acuity did not influence the detachment rate. However, separation and disruption of the anterior banded layer (ABL) were frequently observed in patients with graft detachment, and ABL thickness was identified as a significant predictor for graft detachment. The ABL thickness was 2.5 ± 0.9 μm and 3.5 ± 1.6 μm in patients with attached and detached grafts, respectively. Immunohistologically, a deficiency of fibronectin and cytokeratin was observed within the ABL of patients with detached grafts. In contrast, a complete removal of the EDM with residual stromal collagen fragments was observed in patients with adherent grafts.
CONCLUSIONS
Incomplete removal of the EDM, with residual ABL fragments on the recipients' corneal stroma, may be a risk factor for graft detachment after DMEK. The separation and disruption of the ABL might be promoted by a deficiency of matrix proteins, stronger biomechanical properties and a firm adherence to the posterior corneal stroma.
Topics: Aged; Aged, 80 and over; Biomarkers; Corneal Endothelial Cell Loss; Descemet Membrane; Descemet Stripping Endothelial Keratoplasty; Endothelium, Corneal; Female; Fluorescent Antibody Technique, Indirect; Fuchs' Endothelial Dystrophy; Graft Rejection; Humans; Male; Middle Aged; Postoperative Complications; Prospective Studies; Risk Factors; Visual Acuity
PubMed: 24725459
DOI: 10.1111/aos.12419 -
Biomimetics (Basel, Switzerland) Jan 2023Easy detachment is as important as reliable an attachment to climbing robots in achieving stable climbing on vertical surfaces. To deal with the difficulty of detachment...
Easy detachment is as important as reliable an attachment to climbing robots in achieving stable climbing on vertical surfaces. To deal with the difficulty of detachment occurring in wheeled and track-type climbing robots using bio-inspired spines, a novel climbing robot utilizing spiny track and dual-rail mechanism is proposed in this paper. The spiny track consists of dozens of spiny feet, and the movement of each spiny foot is guided by the specially designed dual-rail mechanism to achieve reliable attachment and easy detachment. First, the design of the climbing robot and the dual-rail mechanism are presented. Then, the dual-rail model is constructed to analyze the attaching and detaching movements of the spiny feet, and a mechanical model is established to analyze the force distribution on the spiny track. Finally, a robot prototype is developed, and the analysis results are verified by the experiment results. Experiments on the prototype demonstrated that it could climb on various rough vertical surfaces at a speed of 36 mm/s, including sandpaper, brick surfaces, concrete walls with pebbles, and coarse stucco walls.
PubMed: 36648800
DOI: 10.3390/biomimetics8010014 -
Frontiers in Neuroscience 2020One may notice a relatively wide range of tactile sensations even when touching the same hard, flat surface in similar ways. Little is known about the reasons for this...
One may notice a relatively wide range of tactile sensations even when touching the same hard, flat surface in similar ways. Little is known about the reasons for this variability, so we decided to investigate how the perceptual intensity of light stickiness relates to the physical interaction between the skin and the surface. We conducted a psychophysical experiment in which nine participants actively pressed their finger on a flat glass plate with a normal force close to 1.5 N and detached it after a few seconds. A custom-designed apparatus recorded the contact force vector and the finger contact area during each interaction as well as pre- and post-trial finger moisture. After detaching their finger, participants judged the stickiness of the glass using a nine-point scale. We explored how sixteen physical variables derived from the recorded data correlate with each other and with the stickiness judgments of each participant. These analyses indicate that stickiness perception mainly depends on the pre-detachment pressing duration, the time taken for the finger to detach, and the impulse in the normal direction after the normal force changes sign; finger-surface adhesion seems to build with pressing time, causing a larger normal impulse during detachment and thus a more intense stickiness sensation. We additionally found a strong between-subjects correlation between maximum real contact area and peak pull-off force, as well as between finger moisture and impulse.
PubMed: 32372893
DOI: 10.3389/fnins.2020.00235 -
La Tunisie Medicale Feb 2023To estimate metamorphopsia prevalence, predictors and etiologies in patients operated for rhegmatogenous retinal detachment (RRD) with detached macula with successful...
AIM
To estimate metamorphopsia prevalence, predictors and etiologies in patients operated for rhegmatogenous retinal detachment (RRD) with detached macula with successful results.
METHODS
Retrospective study including 50 eyes of 50 patients who underwent pars plana vitrectomy for RRD with detached macula with standard silicone oil (SO) tamponade. Patients who had successful surgery with durable anatomic reapplication of the retina after SO removal were included. Patients were examined on day 1, day 7,1 month, and 3 months after surgery. Best corrected visual acuity, Amsler grid, fundus biomicroscopy, Spectral Domain Optical Coherence Tomography (SD-OCT) and fundus auto-fluorescence (FAF) were performed in all patients after surgery. Structural abnormalities such as macular folds, macular epiretinal membrane, cystoid macular edema, and foveal disruption of the ellipsoid layer were observed on SD-OCT. Macular displacement was identified on FAF.
RESULTS
We identified metamorphopsia as post-operative visual impairment in 27 patients among 50 (54%). Clinical assessment found that a delay > 7 days between symptoms and surgery (p < 0.001), more than 2 detached quadrants (p=0.012), and stage C of proliferative vitreoretinopathy (p=0.035) were associated to metamorphopsia. Regarding multimodal imaging findings, only macular folds and macular displacement were significantly correlated with the occurrence of postoperative metamorphopsia (p <0.001).
CONCLUSION
Metamorphopsia is a common complaint after vitrectomy for RRD. Macular rotation and folds would be the main causes after complete and durable reapplication of the retina.
Topics: Humans; Retinal Detachment; Vitrectomy; Prevalence; Retrospective Studies; Vision, Low
PubMed: 37682273
DOI: No ID Found -
Retina (Philadelphia, Pa.) Nov 2018This review aimed to determine the optimal management of retinal pigment epithelial detachments (PEDs) in neovascular age-related macular degeneration (nAMD) based on... (Review)
Review
PURPOSE
This review aimed to determine the optimal management of retinal pigment epithelial detachments (PEDs) in neovascular age-related macular degeneration (nAMD) based on review of available evidence in the literature.
METHODS
A comprehensive literature review evaluates previous retrospective and prospective studies that assessed the treatment of PEDs in nAMD.
RESULTS
Studies illustrated that anti-vascular endothelial growth factor (VEGF) therapy can be effective in eyes with PED secondary to nAMD. Similar visual outcomes are associated with different anti-VEGF treatments. Higher anti-VEGF doses may improve anatomical response, without correlation with vision improvement. Fibrovascular PEDs may be difficult to treat, but even these eyes can gain vision with anti-VEGF therapy. A retinal pigment epithelial tear may develop in 15% to 20% of eyes with PEDs after anti-VEGF therapy, especially in PEDs greater than 500 µm to 600 µm in height; however, vision may stabilize with continued therapy. Atrophy may complicate eyes with PED and nAMD after anti-VEGF therapy, especially in association with complete PED resolution.
CONCLUSION
Available literature suggests that anti-VEGF therapy is safe and efficacious for PED and nAMD. Treatment should focus on vision gains rather than PED resolution because there is no apparent correlation between anatomical and functional improvement in most eyes with PED and nAMD.
Topics: Angiogenesis Inhibitors; Bevacizumab; Fluorescein Angiography; Humans; Intravitreal Injections; Ranibizumab; Retinal Detachment; Retinal Pigment Epithelium; Tomography, Optical Coherence; Vascular Endothelial Growth Factor A; Visual Acuity; Wet Macular Degeneration
PubMed: 29697591
DOI: 10.1097/IAE.0000000000002195 -
Indian Journal of Ophthalmology Nov 2023Aggressive retinopathy of prematurity (AROP) is a severe and progressive variant of retinopathy of prematurity (ROP) rapidly forming fibrous tissue extending from the...
INTRODUCTION
Aggressive retinopathy of prematurity (AROP) is a severe and progressive variant of retinopathy of prematurity (ROP) rapidly forming fibrous tissue extending from the disc toward the posterior lens surface progressing to Stage 5 disease without traversing the classical course that includes Stages 1 to 3. Since AROP behaves differently from type 1 ROP, this study was undertaken to evaluate the surgical outcome of AROP-related detachments.
METHODS
Retrospective analysis of data from electronic medical records of babies diagnosed with AROP-related detachments who underwent micro-incision vitrectomy surgery (MIVS) was included. The demographic data, details of primary intervention (laser and/or intravitreal bevacizumab), and surgery were noted. In a subset of patients, surgical intervention was planned early at the onset of fibrovascular tissue.
RESULTS
43 eyes of 26 babies with median birth weight 1175 g and median gestational age of 29 weeks were analyzed. 42/43 eyes underwent primary intervention in form of laser and/or anti-VEGF injection before surgery. 41.8%, 25.5%, and 32.5% eyes progressed to stages 4A, 4B, and 5, respectively, requiring surgical intervention. 66% eyes underwent lensectomy and vitrectomy (LV), and 44% eyes underwent lens sparring vitrectomy (LSV). 58% eyes had attached macula. 44% eyes that had a relatively less vascular diseases had better anatomical outcome (P = 0.019). At final follow-up, 53.4% eyes followed or at least had light fixation, and 77.7% eyes undergoing LSV fixated and/or followed light compared to 33% for LV (P = 0.04).
CONCLUSION
Challenges in AROP include rapid progression to advanced stages of ROP requiring close monitoring and multiple interventions. Surgeries for AROP have a favorable anatomical and functional outcome in 58% and 53%, respectively. Eyes undergoing lens sparing vitrectomy had better visual outcomes.
Topics: Infant, Newborn; Infant; Humans; Retinal Detachment; Retinopathy of Prematurity; Follow-Up Studies; Treatment Outcome; Retrospective Studies; Vitrectomy; Gestational Age
PubMed: 37870006
DOI: 10.4103/IJO.IJO_2999_22 -
Scientific Reports Mar 2020To describe the 25-year surgical trends, long-term outcomes and risk factors affecting the outcomes of giant retinal tear-related rhegmatogenous retinal detachments...
To describe the 25-year surgical trends, long-term outcomes and risk factors affecting the outcomes of giant retinal tear-related rhegmatogenous retinal detachments (GRT-RRD). Patients' demographics, pre-operative characteristics, risk factors, operative procedures and post-operative outcomes were collected and divided into three groups - Group A: 1991 to 2015 (overall); Group B: 1991 to 2005, and Group C: 2006 to 2015. Functional and anatomical successes were monitored over a 5-year period. Multivariate logistic regression analysis was performed to identify the risk factors related to functional and anatomical success.127 eyes of 127 patients were included in the study. At 5 year, 69.4% patients had visual acuity (VA) < logMAR 1.0 with 87.5% primary anatomical success rate. While the functional outcome remained the same between group B and C, there was an increase in the anatomical success from 89.7% to 100%, albeit not statistically significant. Patients with worse presenting VA, 150 degrees or more of giant retina tear, macula-detached status and presence of PVR were associated with VA of> logMAR 1.0 (all p < 0.05). The types of surgery (TPPV vs combined SB/TPPV), number of breaks, lens extraction and additional cryotherapy were not associated with the functional or anatomical success. In conclusion, the GRT-RRD functional and structural outcomes were comparable between 1991-2005 and 2006-2015, albeit a statistically insignificant improvement of anatomical outcome over the past 25 years. Worse presenting VA, 150 degrees or more of giant retinal tear, detached macula and presence of PVR were associated with poorer visual outcome.
Topics: Cohort Studies; Female; Humans; Male; Postoperative Complications; Recurrence; Regression Analysis; Retinal Detachment; Retinal Perforations; Retrospective Studies; Risk Factors; Scleral Buckling; Time Factors; Treatment Outcome; Visual Acuity; Vitrectomy; Vitreoretinopathy, Proliferative
PubMed: 32214123
DOI: 10.1038/s41598-020-61592-0 -
Eye (London, England) May 2021To establish a scoring system to triage patients presenting with symptoms of flashes and floaters to allow safe differentiation between those with retinal tears and...
PURPOSE
To establish a scoring system to triage patients presenting with symptoms of flashes and floaters to allow safe differentiation between those with retinal tears and detachments, versus uncomplicated posterior vitreous detachments (PVDs).
METHODS
Prospective and retrospective audits of 153 patients presenting to eye casualty and vitreoretinal clinics to ascertain the clinical features most likely to be associated with retinal pathology, rather than simple PVD. We then developed a scoring system, which was applied to 160 patients in a further prospective audit.
RESULTS
The significant risk factors, symptoms and signs were identified then given a number related to their importance: male sex 1, myopia 1, blurred vision 2, shadow 2, vitreous haemorrhage 3, tobacco dust 4. The scores were summed and a total score > 3 was more likely to be a complicated PVD. Sensitivity of the scoring system was 90% (confidence interval (CI) 68.3-98.8%), specificity 80% (CI 73.2-86.9%), positive predictive value 40% (CI 25.7-55.7%), and negative predictive value 98.26% (CI 93.9-99.8%).
CONCLUSIONS
The BElfast Retinal Tear and detachment Score is an easy to apply scoring system, which has a high sensitivity and negative predictive value i.e. nearly all retinal tears or detachments are detected by the scoring system.
Topics: Humans; Male; Retinal Detachment; Retinal Perforations; Retrospective Studies; Vitreous Body; Vitreous Detachment; Vitreous Hemorrhage
PubMed: 32555518
DOI: 10.1038/s41433-020-1025-7 -
Indian Journal of Ophthalmology Feb 2021The purpose of this study is to study single surgery reattachment rate, refractive shift, surgical time, cost, and complications of pneumoretinopexy (PR) compared to...
PURPOSE
The purpose of this study is to study single surgery reattachment rate, refractive shift, surgical time, cost, and complications of pneumoretinopexy (PR) compared to scleral buckling (SB) in rhegmatogenous retinal detachments (RRDs) with superior breaks.
METHODS
Data of RRD with superior breaks, from 2013 through 2016, treated either with PR or SB surgery at a tertiary eye-care center were retrospectively reviewed. Treatment outcomes, procedural costs, refractive shift, surgical time, and complications, namely, cataract and glaucoma, were analyzed.
RESULTS
Thirty-two cases treated by PR (n = 15) and SB surgery (n = 17) fulfilled the selection criteria. Macula off RRD (91%) was the commonest presentation. Baseline parameters like duration of vision loss, presenting vision, and ocular characteristics were comparable. Single surgery retinal reattachment (66.7% PR vs. 76.5% SB) was analogous (P = 0.698). Retinal reattachment with secondary intervention was achieved in all cases at the last follow-up. Average vision gain in logMAR of 0.8 in PR and 0.6 in SB was not significantly different (P = 0.645) between the two groups, with SB group having a 1.9 Dioptre myopic shift and PR group none. Surgical time was shorter in PR versus SB at 15 versus 85 min and surgical cost (including additional surgery) was 50% less in PR. Complications like cataract progression (P > 0.99) and glaucoma (P = 0.71) were analogous among the groups. Horse-shoe tears were associated with failed primary surgery in 60% of PR and 75% of SB procedures.
CONCLUSION
In RRDs secondary to superior breaks, PR proved to be faster, more economical, and less tissue manipulative than scleral buckle surgery, with equivalent efficacy and safety profile.
Topics: Humans; Macula Lutea; Retinal Detachment; Retrospective Studies; Scleral Buckling; Treatment Outcome; Visual Acuity; Vitrectomy
PubMed: 33463581
DOI: 10.4103/ijo.IJO_1574_20