Selezione, Abstracts e Highlights degli articoli piu' interessanti riguardanti la retina comparsi sulle riviste peer-reviewed nel mese di Settmebre 2011
a cura di Giulio Bamonte
Invest Ophthalmol Vis Sci. 2011 Sep 1;52(10):7046-51. Print 2011.
Intraocular fluid dynamics and retinal shear stress after vitrectomy and gas tamponade.
Angunawela RI, Azarbadegan A, Aylward GW, Eames I.
Source
Moorfields Eye Hospital, National Health Service (NHS) Foundation Trust, London, United Kingdom.
Mantenere una stretta postura dopo un intervento di vitrectomia con tamponamento gassoso potrebbe non essere strettamente necessario. Questo secondo il presente studio, in cui e’ stata studiata la dinamica dei fluidi intraoculari e delle forze di attrito sulla parete retinica in relazione ai movimenti dell-occhio e della testa.
Abstract
Purpose. To evaluate fluid dynamics and fluid shear stress on the retinal wall in a model eye after vitrectomy and gas tamponade in relation to saccadic eye movements and sudden head movements and to correlate the results with gas fill fraction (GF). Methods. Analyses was undertaken using high-resolution computational fluid dynamic software. The fluid volume within the eye was discretized using 6 × 10(5) elements and solved with a volume-of-fluid METHOD: The eye was abstracted to a sphere. Vertical and horizontal saccades and sudden rectilinear displacement of the head were examined. GF was varied from 20% to 80% of the eye height filled with gas. Results. Maximum shear stress during horizontal and vertical saccades was 1.0 Pa (Pascal) and 2.5 Pa, respectively, and was dependent on GF. Rapid rectilinear acceleration of the head caused a maximum shear stress of 16 Pa, largely independent of GF. Fluid sloshing within the eye decayed within 0.1 second. Stresses were maximum at the contact line and equator of the eye and were parallel to the direction of motion. Conclusions. This study predicts that saccadic eye movements and normal head movements after vitrectomy and gas tamponade generate only small fluid shear stresses on the retina that are below published norms for retinal adhesion strength. Sudden, jerking head movements generate fluid shear forces similar to retinal adhesion strength that localize to the area of gas-fluid interface. Fluid sloshing occurs after movement, but rapidly decays on cessation of movement. These results suggest that restrictive posturing after vitrectomy and gas tamponade may be unnecessary. Patients should avoid sudden head movements.
Retina. 2011 Sep;31(8):1500-4.
PRIMARY RETINAL DETACHMENT REPAIR: Comparison of 1-Year Outcomes of Four Surgical Techniques.
Schaal S, Sherman MP, Barr CC, Kaplan HJ.
Source
From the Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, Kentucky.
In questo studio retrospettivo su piu’ di 1200 pazienti operati per distacco di retina, nessuna differenza nei risultati a un anno e’ stata trovata fra chirurgia episclerale, vitrectomia o una combinazione delle due tecniche con percentuali di successo intorno al 90%. La retinopessia pneumatica ha prodotto invece risultati meno soddisfacenti con un successo chirurgico nel 68% dei casi.
Abstract
PURPOSE:
: To compare functional and anatomical outcomes of modern methods of repair of primary retinal detachment.
MATERIALS AND METHODS:
: Retrospective interventional comparative case series. A total of 1,226 patients with primary retinal detachment were included in the study. All patients completed 1-year follow-up and were divided into 4 groups: 322 patients underwent scleral buckling surgery, 442 patients underwent pars plana vitrectomy surgery, 316 patients underwent a combination of scleral buckling and vitrectomy surgery, and 56 patients underwent pneumatic retinopexy surgery for the primary repair of retinal detachment. Reattachment success rates, pre- and postoperative visual acuity, complications, and change in refractive error were reviewed.
RESULTS:
: Initial success rate for retinal reattachment was 86% for scleral buckling only, 90% for vitrectomy only, 94% for the combination of scleral buckling and vitrectomy, and 63% for pneumatic retinopexy surgery. Although patients undergoing pneumatic retinopexy had a lower initial success rate, there was no statistically significant difference in initial reattachment rates between the other three groups. There was no statistically significant difference in final visual acuity between the four groups. Complication rates varied among the techniques used.
CONCLUSION:
: Postoperative visual acuity at 1 year did not differ among the various techniques used to repair primary rhegmatogenous retinal detachments. However, scleral buckling, vitrectomy, or a combination of both resulted in an initially better anatomical success rate and fewer operative procedures than pneumatic retinopexy.
Retina. 2011 Sep;31(8):1513-1517.
ENDOPHTHALMITIS IN MICROINCISION VITRECTOMY: Outcomes of Gas-Filled Eyes.
Chiang A, Kaiser RS, Avery RL, Dugel PU, Eliott D, Shah SP, Heier J, Duker J, Hu AY, Schwartz SD, Scott IU, Pollack JS, Faia LJ, Williams GA.
Source
From the *Wills Eye Institute, Retina Service, Philadelphia, Pennsylvania; †California Retina Consultants and Research Foundation, Santa Barbara, California; ‡Retinal Consultants of Arizona, Phoenix, Arizona; §Doheny Eye Institute, University of Southern California, Los Angeles, California; ¶Ophthalmic Consultants of Boston, Boston, Massachusetts; **Tufts University School of Medicine, Boston, Massachusetts; ††Jules Stein Eye Institute, University of California Los Angeles, Los Angeles, California; ‡‡Penn State College of Medicine, Penn State Hershey Eye Center, Hershey, Pennsylvania; §§Illinois Retina Associates, SC, Joliet, Illinois; and ¶¶Associated Retinal Consultants, William Beaumont Hospital, Royal Oak, Michigan.
In questo largo studio multicentrico, l’incidenza di endoftalmiti dopo chirurgia vitreale 23-25 gauge per foro maculare e tamponamento con gas (sf6 o c3f8) e’ stata di 1 caso su 2336 occhi, con un rate dello 0,04%.
Abstract
PURPOSE:
To assess whether performing an air or gas exchange at the conclusion of a microincision vitrectomy procedure is beneficial regarding the rate of endophthalmitis.
METHODS:
This was a collaborative, multicenter, retrospective chart review of 2,336 eyes that underwent microincision sutureless vitrectomy (23 or 25 gauge) with either SF6 or C3F8 gas endotamponade for macular hole between January 2008 and December 2009. For all eyes, the search methodology was structured to identify the main outcome measure, which was the occurrence of acute postoperative endophthalmitis (<6 weeks after pars plana vitrectomy).
RESULTS:
Of the cumulative 2,336 consecutive cases over a 2-year period, only 1 (0.04%) had postoperative endophthalmitis. All eyes had near-complete gas-fluid exchange at the end of surgery; C3F8 was the most common endotamponade agent. The majority of cases were performed with 23-gauge vitrectomy. No other complications were noted.
CONCLUSION:
Endophthalmitis was a rare occurrence in this large series of gas-filled eyes after macular hole surgery (0.04%). Gas endotamponade after microincision sutureless vitrectomy may be beneficial in reducing the risk of postoperative endophthalmitis; however, additional studies are necessary to make a definitive recommendation.
Retina. 2011 Sep;31(8):1525-33.
ENDOPHTHALMITIS AFTER INTRAVITREAL INJECTION: The Importance of Viridans Streptococci.
Chen E, Lin MY, Cox J, Brown DM.
Source
From the *Retina Consultants of Houston, The Methodist Hospital, Houston, Texas; and †Rush University Medical Center, Section of Infectious Diseases, Chicago, Illinois.
Il numero di endoftalmiti dopo iniezione intravitreale e’ per fortuna basso con una incidenza dello 0,04%. Tuttavia in questo largo studio retrospettico emerge come nelle endoftalmiti dopo iniezione vitreale effettuata non in camera operatoria ma “office based”, anziche’ lo stafilococco coagulasi negativo, germe frequente nelle endoftalmiti postchirurgiche, si ritrova con alta frequena un altro batterio: lo streptococco viridans. Lo SV produce una infezione piu’ rapida e piu’ grave.
Abstract
PURPOSE:
: To determine the rate of postinjection endophthalmitis and compare microbial etiology and outcomes in office-based injection-related endophthalmitis versus those acquired after operating room procedures.
METHODS:
: Retrospective, observational case series. Consecutive cases of endophthalmitis seen at Retina Consultants of Houston between July 2000 and July 2010 were classified as postsurgical or post-intravitreal injection. Cases secondary to glaucoma surgery, trauma, and endogenous sources were excluded. Main study measures were incidence of endophthalmitis, microbiology results, and visual outcomes.
RESULTS:
: In all, 109 cases of endophthalmitis were identified: 88 postsurgical and 21 post-intravitreal injection (3 from clinical trials and 5 from outside ophthalmologists). A total of 33,580 intravitreal injections were performed at Retina Consultants of Houston (endophthalmitis rate = 0.04%, 13 of 33,580; 95% confidence interval, 0.02-0.07%). The most common organisms isolated overall were coagulase-negative staphylococci, while viridans streptococci, a component of human oral flora, was identified over three times more often in the postinjection group compared with the postsurgical group. Compared with all other culture-positive cases related to intravitreal injection, postinjection endophthalmitis secondary to viridans streptococci presented much more rapidly (P < 0.001) and final visual outcomes were much worse (P = 0.004)
CONCLUSION:
: Although the overall risk of postinjection endophthalmitis is low, viridans streptococci were identified over three times more frequently in postinjection cases compared with postsurgical cases and these cases had much worse clinical outcomes. The office-based setting for intravitreal injections may lead to a higher risk for infection from oral pathogens.
Retina. 2011 Sep;31(8):1534-40.
Same-day versus delayed vitrectomy with lensectomy for the management of retained lens fragments.
Colyer MH, Berinstein DM, Khan NJ, Weichel ED, Lai MM, Deegan WF, Katira RC, Phillips WB, Sanders RJ, Garfinkel RA.
Intervenire lo stesso giorno o dopo circa due settimane in casi di cataratta complicata da rottura capsulare con lente ritenuta, non sembra produrre differenze di risultati in questo studio su 172 casi. Il rischio piu’ alto con entrambi gli approcci e’ di avere un edema maculare cistoide post-operatorio (15%).
Abstract
PURPOSE:
: To evaluate whether performing same-day pars plana vitrectomy versus delayed pars plana vitrectomy affects visual outcomes and ocular morbidity of patients with retained lens fragments after a complicated cataract surgery.
METHODS:
: Retrospective, comparative case series of 172 eyes of 171 patients with retained lens fragments undergoing 3-port pars plana vitrectomy using 20-, 23-, or 25-gauge instrumentation between 2005 and 2008. Outcome measures included best-corrected visual acuity at 6 months, final best-corrected visual acuity, and postoperative complications such as cystoid macular edema, intraocular pressure elevation, retinal detachment, vitreous hemorrhage, choroidal hemorrhage, and endophthalmitis.
RESULTS:
: The median age was 75 ± 0.8 years. The mean time to vitrectomy for the delayed group was 15 ± 2 days. The preoperative logarithm of the minimum angle of resolution best-corrected visual acuity for immediate vitrectomy was 0.73 ± 0.09 versus 0.72 ± 0.06 for delayed vitrectomy. Six-month logarithm of the minimum angle of resolution acuity was 0.44 ± 0.09 for same-day vitrectomy compared with 0.44 ± 0.05 for delayed vitrectomy (P = 0.97, 2-tailed t-test). Of 59 eyes undergoing immediate vitrectomy, 17 (29%) experienced postoperative complications, while 38 of 113 eyes (34%), experienced complications if undergoing delayed vitrectomy (Fisher exact test, P = 0.61). Overall, the most common complication was cystoid macular edema occurring in 25 of 172 eyes (15%).
CONCLUSION:
: The outcomes of same-day pars plana vitrectomy appear to be similar to non-same-day pars plana vitrectomy. The risks and benefits related to the timing of vitrectomy after a complicated cataract surgery should be carefully discussed with each patient. Further investigation is warranted to establish an optimal time for surgical planning.
Retina. 2011 Sep;31(8):1598-602.
Natural course and funduscopic findings of polypoidal choroidal vasculopathy in a Japanese population over 1 year of follow-up.
Bessho H, Honda S, Imai H, Negi A.
Source
From the Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan.
La neovascolarizzazione polipoide presenta un alto rischio di peggioramento a un anno dalla diagnosi particolarmente nelle forme a grappolo rispetto le forme con polipi isolati.
Abstract
PURPOSE:
: To evaluate the natural course and possible funduscopic risk factors for polypoidal choroidal vasculopathy in a Japanese population.
METHODS:
: The records of 42 eyes from 41 patients (27 men and 14 women) diagnosed as having polypoidal choroidal vasculopathy located in the macula between November 1999 and October 2005 were retrospectively reviewed. The funduscopic findings at the first visit were evaluated. The changes in the best-corrected visual acuity (BCVA) from the baseline to 12 months were analyzed. The lesion types (clustered vs. nonclustered) found on indocyanine green angiography were compared for changes in the BCVA from the initial visit to 12 months.
RESULTS:
: The mean age of the subjects was 73.8 ± 8.0 years. The mean logarithm of the minimum angle of resolution (LogMAR) BCVA was 0.48 ± 4.0 at baseline and deteriorated to 0.75 ± 5.7 after 12 months, which was statistically significant (P = 0.00075). The mean LogMAR BCVA in the patients showing "nonclustered" polypoidal choroidal lesions on indocyanine green angiography was maintained for 12 months, while that of the "clustered" group decreased significantly during the same period (P = 0.0014).
CONCLUSION:
: Polypoidal choroidal vasculopathy did not show a favorable outcome in terms of the mean BCVA 12 months after the initial visit. The clustered polypoidal choroidal lesions on indocyanine green angiography may be related to poor prognosis of polypoidal choroidal vasculopathy over the natural course.
Retina. 2011 Sep;31(8):1609-19.
ANATOMICAL CORRELATES TO THE BANDS SEEN IN THE OUTER RETINA BY OPTICAL COHERENCE TOMOGRAPHY: Literature Review and Model.
Spaide RF, Curcio CA.
Source
From the *Vitreous-Retina-Macula Consultants of New York, New York; †LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear & Throat Hospital, New York, New York; and ‡Department of Ophthalmology, Callahan Eye Foundation Hospital, University of Alabama School of Medicine, Birmingham, Alabama.
In questo articolo il Dr Spaide mette in discussione l’attribbuzione alla giunzione IS-OS dei fotorecettori delle bande iper-riflettenti presenti nella retina esterna, Si tratterebbe di 4 bande: ELM, porzione ellissoide del segmento interno, cilindro di contatto fra segmento esterno e processi apicali delle cellule dell’RPE, RPE.
Abstract
PURPOSE:
: To evaluate the validity of commonly used anatomical designations for the four hyperreflective outer retinal bands seen in current-generation optical coherence tomography, a scale model of outer retinal morphology was created using published information for direct comparison with optical coherence tomography scans.
METHODS:
: Articles and books concerning histology of the outer retina from 1900 until 2009 were evaluated, and data were used to create a scale model drawing. Boundaries between outer retinal tissue compartments described by the model were compared with intensity variations of representative spectral-domain optical coherence tomography scans using longitudinal reflectance profiles to determine the region of origin of the hyperreflective outer retinal bands.
RESULTS:
: This analysis showed a high likelihood that the spectral-domain optical coherence tomography bands attributed to the external limiting membrane (the first, innermost band) and to the retinal pigment epithelium (the fourth, outermost band) are correctly attributed. Comparative analysis showed that the second band, often attributed to the boundary between inner and outer segments of the photoreceptors, actually aligns with the ellipsoid portion of the inner segments. The third band corresponded to an ensheathment of the cone outer segments by apical processes of the retinal pigment epithelium in a structure known as the contact cylinder.
CONCLUSION:
: Anatomical attributions and subsequent pathophysiologic assessments pertaining to the second and third outer retinal hyperreflective bands may not be correct. This analysis has identified testable hypotheses for the actual correlates of the second and third bands. Nonretinal pigment epithelium contributions to the fourth band (e.g., Bruch membrane) remain to be determined.
Retina. 2011 Sep;31(8):1620-6.
Functional and morphologic benefits in early detection of neovascular age-related macular degeneration using the preferential hyperacuity perimeter.
Lai Y, Grattan J, Shi Y, Young G, Muldrew A, Chakravarthy U.
Source
From *The Royal Victoria Hospital, The Belfast Health and Social Care Trust, Belfast, Northern Ireland; †Centre for Vascular and Vision Sciences, The Queen's University of Belfast, Belfast, Northern Ireland; and ‡Shanxi Eye Hospital, PR China.
Abstract
PURPOSE:
: To estimate the usefulness of preferential hyperacuity perimetry (PHP) in detecting conversion of early to late age-related macular degeneration in the Carotenoids and co-antioxidants in patients with Age-Related Maculopathy, a multicenter randomized controlled clinical trial.
METHODS:
: This was a nested case control study within the Carotenoids and co-antioxidants in patients with Age-Related Maculopathy (CARMA) clinical trial and included all participants enrolled in a single center (n = 200). Data are from participants who progressed to neovascular age-related macular degeneration (nvAMD) during time on study, Group 1 (n = 10) before the use of PHP and Group 2 (n = 10) during use of PHP. We also randomly selected 21 other participants (Group 3) who did not progress to nvAMD during time on study as a control group. Change in best-corrected visual acuity and contrast sensitivity and size of neovascular lesion at detection of conversion to nvAMD in Groups 1 and 2.
RESULTS:
: At detection of nvAMD, mean best-corrected visual acuity in Group 1 was 57.5 letters versus 67.4 in Group 2. In Group 1, the change in best-corrected visual acuity from baseline to detection of nvAMD was twice that of Group 2 (21.6 ± 9.0 versus 11.9 ± 10.7) with a mean difference of 9.7 letters (95% confidence interval, 0.41 to 19.0, P = 0.04, independent-samples t-test). The size of the neovascular lesion at detection was 3.06 mm in Group 1 versus 0.89 mm in Group 2 (P = 0.02). Two thirds of the participants in Group 2 were asymptomatic at detection of nvAMD compared with one fifth in Group 1. Preferential hyperacuity perimetry distortion maps were abnormal in 9 of 10 eyes in Group 2, which were confirmed by optical coherence tomography. Of the 21 eyes in Group 3, PHP maps were normal in 18 and abnormal in 3.
CONCLUSION:
: Preferential hyperacuity perimetry detected abnormalities in central visual function with high reliability. Eyes with nvAMD lesions detected by PHP had smaller lesions and better function when compared with the group before the introduction of PHP. The false-negative rate was <10% on PHP. The PHP distortion map was helpful in alerting clinicians to the presence of subclinical nvAMD.
Retina. 2011 Sep;31(8):1637-49.
Recovery of the neurosensory retina after macular translocation surgery is independent of preoperative macular sensitivity in neovascular age-related macular degeneration.
Mettu PS, Sarin N, Stinnett SS, Toth CA.
Source
From the Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina.
Interessaante articolo sui fattori prognostici pre e post operatori nella traslocazione maculare 360. Gli autori hanno studiato nel preoperatorio le macule da operare con una serie di esami tra cui la microperimetria con strumento Nidek, il VF-Q 25 e l’OCT. Nonostante la prognosi visiva dopo traslocazione sia in genere relativamente buona, con recupero possibile anche in occhi con funzione visiva pre-operatoria scarsa, non e’ stata trovata una correlazione con i paramentri microperimetrici pre-operatori. Alcuni aspetti visibili all’OCT come l’edema cistoide, l’elevazione dell’EPR, la presenza di fluido o di lesioni sottoretniche, correlano invece negativamente con la prognosi funzionale post-operatoria.
Abstract
PURPOSE:
: To directly assess the recovery of the retina overlying choroidal neovascularization in neovascular age-related macular degeneration and to understand the relationship between macular sensitivity and visual functional measures and retinal structural alterations as predictive factors for outcome among eyes undergoing macular translocation surgery (MT360).
METHODS:
: In a prospective, consecutive case series of 55 patients with subfoveal choroidal neovascularization undergoing MT360, we explored the relationship between macular sensitivity on the Nidek microperimeter-1 with pathologic features on optical coherence tomography and with distance and near visual acuity, reading speed, contrast sensitivity, color vision, and National Eye Institute Visual Function Questionnaire-25 composite quality-of-life (QOL) score, both before and at 1 year after MT360.
RESULTS:
: On average, there was improvement in all measures of visual function, macular sensitivity, and QOL after MT360. Preoperative median retinal sensitivity score did not predict postoperative measures of visual function, macular sensitivity, and vision-related QOL. Correlation between preoperative median retinal sensitivity score and preoperative measures of visual function and vision-related QOL was generally poor, excepting modest correlation for contrast sensitivity and color vision. However, correlation between postoperative median retinal sensitivity score and postoperative measures of visual function and vision-related QOL was uniformly modest, and change in median retinal sensitivity score correlated modestly with change in most measures of visual function and QOL. Among optical coherence tomography morphologic features, preoperative retinal pigment epithelium elevation predicted reduced postoperative contrast sensitivity (P = 0.04), while preoperative epiretinal membrane or vitreomacular traction predicted increased postoperative contrast sensitivity (P = 0.05). Preoperative cystoid macular edema, subretinal fluid, and subretinal lesion were associated with decreased median retinal sensitivity score (P values ≤0.03).
CONCLUSION:
: The authors' findings demonstrate the resilience and recovery of poorly functioning retina in neovascular age-related macular degeneration but fail to demonstrate a role for macular sensitivity as measured by Nidek microperimeter-1 in identifying irreversibly damaged retina that would not benefit from MT360.
Retina. 2011 Sep;31(8):1664-9.
THE IMPACT OF PULSE DURATION AND BURN GRADE ON SIZE OF RETINAL PHOTOCOAGULATION LESION: Implications for Pattern Density.
Palanker D, Lavinsky D, Blumenkranz MS, Marcellino G.
Source
From the *Department of Ophthalmology and †Hansen Experimental Physics Laboratory, Stanford University, Stanford, California; ‡Department of Ophthalmology, Federal University of Sao Paulo, Sao Paulo, Brazil; and §OptiMedica Corporation, Santa Clara, California.
Abstract
PURPOSE:
: Shorter pulses used in pattern scanning photocoagulation (10-20 milliseconds [ms]) tend to produce lighter and smaller lesions than the Early Treatment Diabetic Retinopathy Study standard 100-ms exposures. Smaller lesions result in fewer complications but may potentially reduce clinical efficacy. It is worthwhile to reevaluate existing standards for the number and size of lesions needed.
METHODS:
: The width of the coagulated zone in patients undergoing retinal photocoagulation was measured using optical coherence tomography. Lesions of "moderate," "light," and "barely visible" clinical grades were compared for 100, 200, and 400 μm spot sizes and pulse durations of 20 ms and 100 ms.
RESULTS:
: To maintain the same total area as in 1,000 standard burns (100 ms, moderate) with a 400-μm beam, a larger number of 20-ms lesions are required: 1,464, 1,979, and 3,520 for moderate, light, and barely visible grades, respectively. Because of stronger relative effect of heat diffusion with a smaller beam, with 200 μm this ratio increases: 1,932, 2,783, and 5,017 lesions of 20 ms with moderate, light, and barely visible grades correspond to the area of 1,000 standard burns.
CONCLUSION:
: A simple formula is derived for calculation of the required spot spacing in the laser pattern for panretinal photocoagulation with various laser parameters to maintain the same total coagulated area.
Retina. 2011 Sep;31(8):1692-8.
Morphologic differences in epiretinal membranes on ocular coherence tomography as a predictive factor for surgical outcome.
Kinoshita T, Kovacs KD, Wagley S, Arroyo JG.
Source
From the *Division of Ophthalmology, Retina Service Beth Israel Deaconess Medical Center, Boston, Massachusetts.
In questo studio su 75 pazienti gli autori correlano la morfologia della membrane epiretinica con gli outcome pot-operatori. Interessante il dato secondo cui i fori lamellari non avrebbero un beneficio dall’intervento, almeno con la tecnica descritta.
Abstract
PURPOSE:
: To evaluate whether morphologic differences in idiopathic epiretinal membranes seen on optical coherence tomography may help predict surgical outcomes.
METHODS:
: Seventy-five eyes of 74 patients who underwent primary pars plana vitrectomy with membrane peeling were retrospectively reviewed. Outcome measures included visual acuity, macular contour on optical coherence tomography, central macular thickness, and reoperation rate.
RESULTS:
: According to the preoperative macular contour, 75 eyes were categorized into 4 types: 42 eyes were included in the diffuse (DIF) type, 12 in the cystoid macular edema (CME) type, 14 in the pseudolamellar hole (PLH) type, and 7 in the vitreomacular traction (VMT) type. Surgical procedure significantly improved vision in all types except for the PLH type (DIF, P < 0.0001; CME, P = 0.0378; PLH, P = 0.838; and VMT, P = 0.0273). There was a significant relationship between pre- and postoperative macular contour. All preoperative VMT showed normal contour on postoperative optical coherence tomography but had the highest reoperation rate.
CONCLUSION:
: Surgical intervention for the PLH-type epiretinal membrane was not associated with the visual improvement seen in other epiretinal membrane types, and the VMT type had the highest reoperation rate. Future studies should evaluate the potential benefit of internal limiting membrane peeling with or without short-term gas tamponade in these cases.
Ophthalmology. 2011 Sep;118(9):1819-26. Epub 2011 May 5.
The DA VINCI Study: Phase 2 Primary Results of VEGF Trap-Eye in Patients with Diabetic Macular Edema.
Do DV, Schmidt-Erfurth U, Gonzalez VH, Gordon CM, Tolentino M, Berliner AJ, Vitti R, Rückert R, Sandbrink R, Stein D, Yang K, Beckmann K, Heier JS.
Source
Wilmer Eye Institute, Department of Ophthalmology, Johns Hopkins University, Baltimore, Maryland.
In questo studio di fase 2 il Vegf-Trap, con tutti i dosaggi testati e i protocolli di ritrattamento si dimostra superiore al trattamento laser nella terapia dell’edema diabetico. Interessante soprattutto la possibilita’ di utilizzare il farmaco ogni 2 mesi anziche’ ogni 4 settimane. Inoltre la percentuale di pz stabili a 6 mesi e’ del 93%, contro il 68% del gruppo trattato con laser. Il 34% vs il 21% migliora piu’di 15 lettere a 6 mesi.
Abstract
PURPOSE:
To determine whether different doses and dosing regimens of intravitreal vascular endothelial growth factor (VEGF) Trap-Eye are superior to focal/grid photocoagulation in eyes with diabetic macular edema (DME).
DESIGN:
Multicenter, randomized, double-masked, phase 2 clinical trial.
PARTICIPANTS:
A total of 221 diabetic patients with clinically significant macular edema involving the central macula.
METHODS:
Patients were assigned to 1 of 5 treatment regimens: 0.5 mg VEGF Trap-Eye every 4 weeks; 2 mg VEGF Trap-Eye every 4 weeks; 2 mg VEGF Trap-Eye for 3 initial monthly doses and then every 8 weeks; 2 mg VEGF Trap-Eye for 3 initial monthly doses and then on an as-needed (PRN) basis; or macular laser photocoagulation. Assessments were completed at baseline and every 4 weeks thereafter.
MAIN OUTCOME MEASURES:
Mean change in visual acuity and central retinal thickness (CRT) at 24 weeks.
RESULTS:
Patients in the 4 VEGF Trap-Eye groups experienced mean visual acuity benefits ranging from +8.5 to +11.4 Early Treatment of Diabetic Retinopathy Study (ETDRS) letters versus only +2.5 letters in the laser group (P ≤ 0.0085 for each VEGF Trap-Eye group vs. laser). Gains from baseline of 0+, 10+, and 15+ letters were seen in up to 93%, 64%, and 34% of VEGF Trap-Eye groups versus up to 68%, 32%, and 21% in the laser group, respectively. Mean reductions in CRT in the 4 VEGF Trap-Eye groups ranged from -127.3 to -194.5 μm compared with only -67.9 μm in the laser group (P = 0.0066 for each VEGF Trap-Eye group vs. laser). VEGF Trap-Eye was generally well tolerated. Ocular adverse events in patients treated with VEGF Trap-Eye were generally consistent with those seen with other intravitreal anti-VEGF agents.
CONCLUSIONS:
Intravitreal VEGF Trap-Eye produced a statistically significant and clinically relevant improvement in visual acuity when compared with macular laser photocoagulation in patients with DME.
Am J Ophthalmol. 2011 Sep;152(3):332-339.e1. Epub 2011 Jul 13.
Does laser still have a role in the management of retinal vascular and neovascular diseases?
Shah AM, Bressler NM, Jampol LM.
Source
Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Un panel di assoluti esperti in patologie retiniche discute sull’attualita’ delle terapie laser nel trattamento delle patologie vascolari retiniche.
Abstract
PURPOSE:
To discuss the current role of laser therapies in the management of retinal vascular and neovascular diseases.
DESIGN:
Perspective.
METHODS:
Laser's role in the management of diabetic retinopathy, age-related macular degeneration, and venous occlusive disease is discussed, with emphasis on comparing laser with anti-vascular endothelial growth factor (VEGF) therapy and discussion of situations where these treatment methods can be complementary.
RESULTS:
Thermal panretinal photocoagulation remains the usual practice for treatment of neovascularization in proliferative diabetic retinopathy and after venous occlusive events. Focal/grid laser still has a role for patients with macular edema resulting from diabetes or venous occlusion that is poorly responsive to anti-VEGF agents and in patients who are unable or unwilling to return for frequent injections. Focal/grid laser also is used as combination therapy with anti-VEGF agents for these indications. Focal laser can be used for extrafoveal choroidal neovascularization to avoid the treatment burden and risks of multiple injections. Photodynamic therapy may be beneficial in the treatment of central serous chorioretinopathy and idiopathic polypoidal choroidal vasculopathy and as combination therapy with anti-VEGF agents in age-related macular degeneration.
CONCLUSIONS:
Anti-VEGF agents are effective in preventing vision loss and improving vision in multiple diseases, including diabetic retinopathy, neovascular age-related macular degeneration, and retinal vein occlusions. Despite a substantial decrease in its use for these conditions in recent years, laser therapies continue to serve important roles in our ability to combat retinal pathologic features and will remain a pivotal component of our practices for at least the next several years.
Am J Ophthalmol. 2011 Sep;152(3):345-357.e3. Epub 2011 Jun 17.
Vitrectomy timing for retained lens fragments after surgery for age-related cataracts: a systematic review and meta-analysis.
Vanner EA, Stewart MW.
Source
Department of Preventive Medicine and Health Care Policy & Management, Health Sciences Center, Stony Brook University, Stony Brook, New York.
Secondo i risultati di questa metanalisi, operare il prima possible in casi di cataratta complicata con ritenzione di frammenti nucleari, porterebbe a migliori risultati post-operatori.
Abstract
PURPOSE:
To evaluate the effect of vitrectomy timing on outcomes for patients with crystalline retained lens fragments receiving vitrectomy 3+ days after cataract surgery.
DESIGN:
Systematic review and meta-analysis of retrospective interventional cases series.
METHODS:
Searches of MEDLINE (English, 1/1/85 through 7/30/2010) and article reference lists. Articles were screened for patients with crystalline retained lens fragments after surgery for age-related cataracts, discussion of vitrectomy timing, and, for the meta-analysis, patient totals for at least 1 outcome and multiple time periods, 10+ patients, and mean follow-up ≥3 months. Outcomes included visual acuity, retinal detachment, increased intraocular pressure, intraocular infection/inflammation, cystoid macular edema, and corneal edema. Data extraction was performed twice and quality assessed. Logistic regression estimated study-level odds ratios for each additional 1-week vitrectomy delay. Meta-analysis estimated summary odds ratios using random-effects models.
RESULTS:
Of 257 articles identified, there were 43 unique studies (53 articles) for the systematic review, including 27 (31 articles) for the meta-analysis. Early vitrectomies were statistically significantly associated with better outcomes for not good visual acuity (odds ratio: 1.13; 95% CI: 1.04-1.22, P = .005); bad visual acuity (odds ratio: 1.05; 95% CI: 1.01-1.09, P = .009); previtrectomy retinal detachment (odds ratio: 1.29; 95% CI: 1.01-1.65, P = .038); postvitrectomy retinal detachment (odds ratio: 1.13; 95% CI: 1.02-1.26, P = .024); increased intraocular pressure (odds ratio: 1.23; 95% CI: 1.07-1.41, P = .003); and intraocular infection/inflammation (odds ratio: 1.20; 95% CI: 1.01-1.42, P = .041). Results were robust to sensitivity analyses.
CONCLUSIONS:
This systematic review and meta-analysis found significantly better outcomes (visual acuity, retinal detachment, increased intraocular pressure, intraocular infection/inflammation) with earlier vitrectomy for retained lens fragments. Reduced vitrectomy delays may yield better patient outcomes.
Am J Ophthalmol. 2011 Sep;152(3):428-432.e1. Epub 2011 Jun 21.
Risk factors for development of choroidal detachment after scleral buckling procedure.
Auriol S, Mahieu L, Arné JL, Mathis V.
Source
Department of Ophthalmology, Retinal Center, Paule de Viguier Hospital, Toulouse, France.
In questo studio su 69 pazienti, tra i fattori di rischio predispondenti il distacco di coroide post chirurgia episclerale per distacco di retina un ruolo predominante lo avrebbero la ipertensione arteriosa e la miopia elevata.
Abstract
PURPOSE:
To determine risk factors of choroidal detachment after scleral buckling procedure for treatment of retinal detachment.
DESIGN:
Retrospective chart review.
METHODS:
The authors performed a retrospective study of 69 consecutive cases of retinal detachment from January 2007 to January 2008 treated by scleral buckling surgery. Two groups of patients were defined according to the absence or apparition of choroidal detachment, and a comparison of several parameters between these 2 groups was performed.
RESULTS:
Fifteen patients developed a choroidal detachment. The study found an average higher level of systolic blood pressure during surgery in the group with choroidal detachment than in the absence group (127.3 vs 119.1 mm Hg; P = .008). The authors also observed a statistically significant difference between the 2 groups when comparing the intraoperative peak value of systolic blood pressure (149.3 vs 138.5 mm Hg; P = .019). Finally, in the group that developed choroidal detachment, there were statistically more patients with high myopia (P = .02).
CONCLUSION:
This study highlights that the 2 main risk factors for development of choroidal detachment during scleral buckling surgery are high blood pressure during the intervention and the existence of high myopia.
Arch Ophthalmol. 2011 Sep;129(9):1180-8.
Antimicrobial resistance and ophthalmic antibiotics: 1-year results of a longitudinal controlled study of patients undergoing intravitreal injections.
Kim SJ, Toma HS.
Source
Vanderbilt Eye Institute, Department of Ophthalmology, Vanderbilt University School of Medicine, 2311 Pierce Ave, Nashville, TN 37232. Questo indirizzo e-mail è protetto dallo spam bot. Abilita Javascript per vederlo. .
L’uso frequente e ripetuto di antibiotici in collirio dopo iniezione intravitreale aumenta le resistenze della flora batterica congiuntivale.
Abstract
OBJECTIVE:
To determine antibiotic susceptibility patterns of conjunctival flora from patients undergoing intraocular injection for choroidal neovascularization after repeated exposure to ophthalmic antibiotics.
METHODS:
We conducted a randomized, controlled, longitudinal study of 48 eyes of 24 patients undergoing unilateral intraocular injection for choroidal neovascularization. Bilateral conjunctival cultures from the treated eye and untreated (control) fellow eye were taken at baseline and after each injection (before the application of povidone-iodine). Patients were randomized to ofloxacin, 0.3%; azithromycin, 1%; gatifloxacin, 0.3%; or moxifloxacin hydrochloride, 0.5% and used only their assigned antibiotic after each injection. Bacterial isolates were tested for antibiotic susceptibility to 16 different antibiotics, and analysis of bacteria DNA was performed using pulse-field gel electrophoresis. Main outcome measures included changes in antibiotic susceptibility patterns of conjunctival flora after 1 year.
RESULTS:
Coagulase-negative staphylococci (CNS) cultured from eyes repeatedly exposed to fluoroquinolone antibiotics demonstrated significantly increased rates of resistance to older-generation (P = .002) and newer-generation (P < .01) fluoroquinolones. In contrast, CNS isolated from azithromycin-exposed eyes demonstrated significantly increased resistance to macrolides (95%; P < .001) and decreased resistance to older-generation (P = .03) and newer-generation (P < .001) fluoroquinolones. There were significant increases in multiple-drug resistance of CNS isolated from treated eyes, with 81.8% and 67.5% of isolates resistant to at least 3 (P = .01) and at least 5 (P = .009) antibiotics, respectively.
CONCLUSION:
Repeated exposure of conjunctival flora to ophthalmic antibiotics selects for resistant strains. Application to Clinical Practice Repeated use of ophthalmic antibiotics after intraocular injection promotes the emergence of antimicrobial resistance. Trial Registration clinicaltrials.gov Identifier: NCT00831961
Arch Ophthalmol. 2011 Sep;129(9):1175-9.
Outcome of eyes developing retinal detachment during the early treatment for retinopathy of prematurity study.
Repka MX, Tung B, Good WV, Capone A Jr, Shapiro MJ.
Source
Wilmer Eye Institute, Wilmer 233, 600 N Wolfe St, Baltimore, MD 21287-9028. Questo indirizzo e-mail è protetto dallo spam bot. Abilita Javascript per vederlo. .
Nell’ ETROP study 63 pazienti (89 occhi) su 401 svilupparono un distacco di retina, partendo da un ROP allo stadio 4a, 4b o 5, e furono trattati con vitrectomia, chirurgia episclerale, una combinazione delle due tecniche o con osservazione. Su 70 pz con un follow up di 6 anni, in circa un terzo si e’ ottenuto il riaccollamento maculare, con una acuita’ visiva superiore a 20/200 nel 10%.
Abstract
OBJECTIVE:
To describe the structural and visual outcomes at age 6 years of retinal detachment (RD) from retinopathy of prematurity (ROP) in the Early Treatment for Retinopathy of Prematurity (ETROP) study.
METHODS:
Prospective multicenter nonrandomized series of infants with high-risk prethreshold ROP who developed an RD by 6 months corrected age treated with observation or vitreoretinal surgery.
RESULTS:
Of 401 patients, 63 (89 eyes) experienced RD. Follow-up at age 6 years was available for 70 eyes (79%) of 49 surviving patients. The RDs were stage 4A in 28 eyes (40%), stage 4B in 14 (20%), stage 5 in 13 (19%), and not classified in 15 (21%). The macula was attached in 17 of 50 eyes (34%) after vitrectomy with or without scleral buckle, in 6 of 9 (67%) after scleral buckle only, and in 2 of 11 eyes (18%) observed. An attached macula at age 6 years after vitreoretinal surgery was present in 5 of 16 eyes (31%) with stage 4A, 6 of 10 (60%) with stage 4B, and 0 of 10 with stage 5. Favorable visual acuity (>20/200) was found in 6 of 70 eyes (9%); 5 had stage 4A, and 1 was not classified.
CONCLUSIONS:
Macular attachment was achieved in approximately one-third of eyes with RD and favorable visual acuity in some eyes with stage 4A.
Br J Ophthalmol. 2011 Sep;95(9):1216-22. Epub 2011 Jan 27.
A systematic review and meta-analysis of clinical outcomes of vitrectomy with or without intravitreal bevacizumab pretreatment for severe diabetic retinopathy.
Zhao LQ, Zhu H, Zhao PQ, Hu YQ.
Source
Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, PR China; Questo indirizzo e-mail è protetto dallo spam bot. Abilita Javascript per vederlo. .
In questa review e meta analisi sull’ uso del Bevacizumab intravitreale preoperatorio in casi di retinopatia diabetica proliferante severa emerge come l’utilizzo di questo farmaco possa significativamente facilitare le manovre chirurgiche e migliorare i risultati anatomici e funzionali post-operatori. Una differenza statisticamente significativa in favore del Bevacizumab e’ stata infatti trovata per quanto riguarda l’incidenza di sanguinamento intra-operatorio e la necessita’ di endodiatermia,il tempo chirurgico, l’incidenza di emorragia vitreale post-operatoria e tempo di riassorbimento del sangue, e l'acuita’ visiva finale.
Abstract
Aims To examine possible benefits of intravitreal bevacizumab (IVB) pretreatment in vitrectomy for severe diabetic retinopathy. Methods A comprehensive literature search was performed using the Cochrane Collaboration methodology to identify randomised controlled trials and comparative studies of vitrectomy with or without IVB pretreatment for severe or complicated diabetic retinopathy. Meta-analyses were performed for intraoperative (including intraoperative bleeding, endodiathermy, iatrogenic retinal tears and mean surgical time) and postoperative outcome parameters (including best-corrected visual acuity, recurrent vitreous haemorrhage, reabsorption time of blood and other complications). Results Six randomised controlled trials and one comparative study were identified and used for comparing vitrectomy alone (142 eyes, control group) with vitrectomy with IVB pretreatment (139 eyes). The intraoperative findings showed that the incidence of intraoperative bleeding and frequency of endodiathermy were statistically significantly less in the IVB pretreatment group (p<0.01) than in the vitrectomy alone group. The IVB pretreatment group took significantly less surgical time than the control group (p=0.003). Postoperative results indicated that reabsorption time of blood was significantly shorter (p=0.04), incidence of recurrent VH was almost significantly less (p=0.05), and final best-corrected visual acuity was significantly better (p=0.003) in the IVB group than in the control group. Other complications, including final retinal detachment, and reoperation, were statistically insignificant. Conclusion IVB pretreatment in vitrectomy can achieve excellent clinical outcomes for severe diabetic retinopathy. It potentially facilitates surgeons' manoeuvres and reduces intra- and postoperative complications.
Br J Ophthalmol. 2011 Sep;95(9):1234-8. Epub 2010 Dec 13.
Surgical failure following primary retinal detachment surgery by vitrectomy: risk factors and functional outcomes.
Wickham L, Ho-Yen GO, Bunce C, Wong D, Charteris DG.
Source
Vitreoretinal Department, Moorfields Eye Hospital, City Road, London EC1V 2PD, UK; Questo indirizzo e-mail è protetto dallo spam bot. Abilita Javascript per vederlo. .
Secondo questo studio, i fattori prognostici piu’ importanti per predire l’insuccesso chirurgico dopo vitrectomia per distacco di retina primario sono l’estensione (numero di quadranti) del distacco di retina, una precedente estrazione di cataratta, l’emovitreo e la presenza pre-operatoria di PVR. La localizzazione inferiore delle rotture retiniche non determina una maggiore probabilita’ di insuccesso. Una prognosi visiva scarsa e’ legata soprattutto alla PVR e al numero di interventi eseguiti.
In questo studio e’ riportata una percentuale di redistacco del 15% circa.
Abstract
Aim To identify preoperative features associated with surgical failure following vitrectomy using data collected in a large, prospective randomised controlled trial. Outcomes of patients who redetached were then examined in more detail. Methods 615 patients were analysed as part of an randomised controlled trial investigating the use of 5-fluorouracil and low-molecular-weight heparin. Treatment status had no effect on success rates and did not therefore form part of the analyses. Failure was defined as retinal redetachment within 6 months of primary vitrectomy. Univariate logistic regression analysis was used to assess association between failure and putative risk factors (age, pathological myopia, intraocular pressure, vitreous haemorrhage, previous lens extraction, uveitis, number of retinal quadrants detached, number and distribution of retinal breaks, and grade C proliferative vitreoretinopathy (PVR)). Additional characteristics of patients were then elucidated including number of operations required to achieve retinal reattachment, surgical techniques used and final logMAR visual acuity. Results 96 patients (15.6%) redetached following surgery, and 37 failed due to PVR. Surgical failure was associated with number of retinal quadrants detached (OR per increase, 1.69 (1.33 to 2.15) p<0.001) and grade C PVR (OR 3.98 (1.47 to 10.73) p=0.006). Inferior breaks were not identified as a risk factor (p=0.602). Repeat retinal detachment surgery showed a trend towards reduced visual acuity at 6 months providing PVR did not develop. PVR resulted in a significant deterioration in visual acuity. Conclusions The extent of retinal detachment and preoperative PVR are risk factors for surgical failure following vitrectomy for primary retinal detachment. PVR was again confirmed as the major factor influencing visual outcomes.
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