Effect of symptom duration on outcomes following vitrectomy repair of primary macula-off retinal detachments.

PURPOSE: To examine the effect of symptom duration on visual and anatomical outcomes following pars plana vitrectomy repair of primary macula-off rhegmatogenous retinal detachments. METHODS: This is a retrospective, consecutive, interventional case series. All eyes underwent repair of macula-off rhegmatogenous retinal detachment with a 20-gauge, 23-gauge, or 25-gauge standard 3-port pars plana vitrectomy. Eyes with previous retinal surgery, giant retinal tear, Grade C or higher proliferative vitreoretinopathy, or less than 6 months of follow-up were excluded from the study. The main outcome measure studied was final best-corrected visual acuity (BCVA) as dependent on the duration of macular detachment symptoms. The secondary outcomes studied were single surgery anatomical success and complication rates. Visual acuity analysis was performed on all eyes that were pseudophakic by the final follow-up visit. RESULTS: Overall, 81 eyes of 81 patients met inclusion criteria, with a mean follow-up length of 55 months (range, 6-171 months) and mean duration of macular detachment symptom of 12 days (range, 1-64 days). The mean final BCVA was 20/40 (range, 20/20 to hand motion), with 70% (n = 57) of all patients obtaining 20/40 or better final BCVA. Patients with symptom duration of 6 days or less achieved better final BCVA (mean 20/25, n = 34) than patients with longer symptom duration (mean 20/50, n = 47) (t-test, P = 0.0030; α = 0.005). After 7 days of macular detachment, no significant difference was seen in final BCVA (t-test, P > 0.05). The overall single surgery anatomical success rate was 88% (71 of 81 eyes). There was no correlation between the single surgery anatomical success rate and duration of macular detachment symptom (Fisher's exact test, P > 0.10). CONCLUSION: Primary pars plana vitrectomy repair results in good final visual outcome for patients with primary macula-off rhegmatogenous retinal detachments. Surgical repair within 6 days of the symptom onset yielded better visual outcomes. After 7 days, visual outcome was not affected by the timing of the surgical repair. Anatomical outcome following pars plana vitrectomy repair is not affected by symptom duration.

Influence of hypoxia induced by minimally invasive prostatectomy on gene expression: implications for biomarker analysis.

Handling and processing of clinical specimens during and after surgical resection may significantly skew the molecular data obtained from analysis of those samples. Minimally invasive prostatectomy was used as a model to specifically study effects of surgical ischemia on gene expression in human clinical samples. Normal prostatic urethra cup biopsies were procured from 12 patients at three time points during laparoscopic radical prostatectomy. Homogeneous cells (stroma and epithelium) were microdissected. Transcript analysis of 3 oxygen-dependent, 3 oxygen-independent, and 3 control class genes was performed using quantitative RT-PCR. Data were analyzed by relative quantitation and two-sided t-test. Patient demographic and time covariates were fit by a linear mixed model. VEGF, an oxygen-dependent gene, showed significant expression alterations across three time points in epithelium (p=0.008), but not in stroma (p=0.66). Expression levels of VHL, STAT5B, and CYPA showed significant changes at the p<0.05 level in the stroma only. Effects of age, PSA, prostate size, Gleason score, surgery type, total surgery time, total ischemia time, and estimated blood loss on VEGF expression over time were not significant at the p<0.01 level. Therefore, surgical manipulation and tissue processing methods need to be taken into account when assessing prostatic biomarkers; however, resection does not dramatically alter mRNA profiles in prostate specimens.