MIRAgel: the immunohistochemical expression of CD3, CD34, and CD68 in the surrounding capsule.

PurposeTo study the immunohistochemical features of the capsule tissue surrounding MIRAgel episcleral buckles.Patients and methodsThis Institutional interventional clinical cohort study examined a consecutive series of 21 referred patients who required MIRAgel removal from July 2009 to July 2013. All patients with hydrated and fragmented MIRAgel episcleral buckles were included in this study. Capsule biopsies from MIRAgel episcleral buckles were obtained from all patients. Capsule specimens of seven patients with extruded silicone bands were processed as controls. Paraffin-embedded specimens were examined using light microscopy and immunohistochemistry (via the PAP horseradish peroxidase technique) to detect the expression of CD3, CD20, CD34 and CD68, and S-100 protein.ResultsInflammation with granuloma, which was primarily related to sutures, was found in all (n=36) of the MIRAgel specimens and foreign body granulomas with multinucleated giant cells, histiocytes, and macrophages (CD68+ cells) surrounded the MIRAgel fragments. Average number of CD68+ cells was higher (P<0.001) for MIRAgel than for silicone rubber. The lymphocytic inflammatory infiltrate related to the MIRAgel fragments was CD3+ and CD20- (delayed T cell-mediated immune response). Moderate neoangiogenesis was indicated by the presence of CD34+ cells.ConclusionsThe immunohistochemical analysis revealed that the immune system is able to identify the fragments of MIRAgel (after its hydrolytic degradation) as a foreign body during a delayed T cell-mediated immune response. The phagocytosis by macrophages likely triggers and perpetuates local disease. Removal of MIRAgel explants before hydrolysis should be considered.

Modelling postoperative visual acuity with and without proliferative vitreoretinopathy associated with primary rhegmatogenous retinal detachment.

PURPOSE: To find models that will explain the variability in postoperative visual acuity (VA) (logarithmic: logMAR) associated with unilateral primary rhegmatogenous retinal detachment (RD). METHODS: This was a prospective clinical cohort study of 33 patients with proliferative vitreoretinopathy (PVR: PVR

Retinal detachment: visual acuity and subretinal immunoreactive endothelin-1.

PURPOSE: To analyze whether subretinal (SRF) endothelin-1 (ET-1) - a vasoactive, mitogenic, and pro-apoptotic peptide - levels are related to visual acuity (VA) in rhegmatogenous retinal detachment (RD). PATIENTS AND METHODS: Sixty-six healthy patients between 42 and 70 years of age with unilateral RD, all candidates for scleral buckling surgery (PVR

[Vitreous luxated PC-IOLs: complications].

PURPOSE: To determine pre-, intra- and postoperative complications of posterior chamber intraocular lenses (PC-IOL) posteriorly luxated in the vitreous. METHODS: We retrospectively reviewed reports of all patients with luxated PC-IOLs at our institution (1989-1999) with a minimum follow-up of 6 months. We identified 41 eyes; 4 were excluded because of short follow-up. Thirty-seven eyes were finally considered. Twenty-one eyes had "in situ" repositioning with vitrectomy, in 9 of them perfluorocarbon liquids (Perfluoro-DK-line) (PFCL) were used to refloat the luxated lenses. Sixteen eyes had IOL exchange, in 7 of them PFCL was used to refloat the IOL. RESULTS: The average age of the patients was 67.5 years. Preoperatively, 15 eyes (40%) had ocular hypertension, 9 eyes (24%) showed epithelial corneal edema (CE), 6 eyes (16%) had light vitreous hemorrhage (VH) and 4 eyes (11%) retinal detachment (RD). Intraoperatively, 9 eyes (24%) had VH related to sulcus fixation. Postoperatively, visual acuity improved in 32 (86%) eyes. In 3 cases (8%) we found a postsurgical RD that could be iatrogenic; one eye developed glaucoma and 1 developed, epiretinal membrane. Two patients were PFCL drops. CONCLUSION: Vitrectomy normalizes IOP and CE, PFCL simplifies the surgical technique for RD, and sulcus fixated IOL allows visual restoration. The combined technique generally offers good results.

Localisation of endothelin-1 mRNA expression and immunoreactivity in the retina and optic nerve from human and porcine eye. Evidence for endothelin-1 expression in astrocytes.

We have investigated the localisation of endothelin-1 (ET-1) mRNA and ET-1-like immunoreactivity in retina and anterior portion of optic nerve from human and porcine eyes. In situ hybridisation method revealed expression of ET-1 mRNA mainly in the innermost layers of the retinas, in the retinal pigment epithelium cells as well as in the astrocytes of the optic nerve. Immunohistochemical studies showed that ET-1-like immunoreactivity appeared in the same regions where ET-1 mRNA was expressed as well as in the inner nuclear layer and in the inner segments of photoreceptors. In the nerve fibre and ganglion cell layers, astrocytes expressed both glial fibrillary acidic protein and ET-1 proteins suggesting that these cells may secrete ET-1. Expression of ETA and ETB receptors in human retina were demonstrated by reverse transcription-polymerase chain reaction. Our results demonstrated expression of ET-1 in glial, neural and vascular components of retina and optic nerve from human and porcine eyes.

[Ocular blood flow and characteristics of retinal detachment]. / Flujo sanguíneo ocular y características del desprendimiento de retina.

PURPOSE: To determine if ocular blood flow (OBF) changes in retinal detachment (RD) are related with its characteristics (extension, macular involvement, PVR or duration). METHODS: 60 patients with unilateral rhegmatogenous RD and 20 <> patients were selected. Color Doppler Ultrasound was used to measure OBF velocities in the ophthalmic artery (OA), central retinal artery (CRA) and vein (CRV) and posterior ciliary arteries (PCA) of both eyes of each patient. The IOP and RD characteristics were considered. In each case the paired Student's T test (OBF) and Wilcoxon test (IOP) were used for the statistical analysis (p<5%). RESULTS: Peak systolic (PS) and end diastolic (ED) velocities of OA, PS of CRA and PS and ED of PCA were decreased in the RD eyes compared to the normal ones (p<0.05). The PS and ED rates of OA and PS of CRA were also decreased (p<0.05) in the other eyes compared to the normal ones. Both the decrease in velocity and in the IOP were related with 2 or more quadrants of RD (p<0.05), macula detachment (p<0.05), PVR >/=C(2) (p<0.05) and duration of >/=15 days (p<0.05). CONCLUSION: RD correlates with decreased ocular blood flow velocities and IOP in both the RD as well as in the other eye. The worse the characteristics of the RD, the lower the velocities and the IOP

[Vitrectomy and perfluorocarbons in the management of luxated lenses]. / Vitrectomía y perfluorocarbonos en el tratamiento de la luxación del cristalino.

PURPOSE: To evaluate the use of vitrectomy with perfluorocarbon liquids (Perfluoro-DK-line) (PFCL) to refloat the luxated lenses of surgical etiology. Follow-up complications are considered. METHODS: The cases with vitreous posteriorly luxated lenses were reviewed between 1989 and 1999. 8 cases were found, all had similar surgery with vitrectomy and PFCL performed by the same surgeon. In two cases an anterior chamber IOL and in 6 cases a posterior chamber IOL sulcus fixated were used. RESULTS: The average age of the 8 cases with unilateral vitreous luxated lenses of no surgical etiology was 64.5 years. 3 of them were myopic with a history of spontaneous luxation with a duration of 5.9 and 10 years respectively. The other 5 cases reported a history of ocular trauma with a shorter time of luxation (between 1 week and 3 years). 7 cases (87.5%) had ocular hypertension, 6 cases (75%) showed epithelial corneal edema and one case retinal detachment preoperatively. Vitrectomy with PFCL normalized IOP and corneal edema. The complications related with decreased final VA were cystoid macular edema (1 case), macular atrophy (1 case) and retinal detachment (1 case). Only in one case a postsurgical retinal detachment was found likely to be iatrogenic. CONCLUSION: As vitrectomy with PFCL simplifies surgical technique with good results and modern sulcus fixated IOL may be used during the same surgery offering visual restoration, we believe this combined technique must be recommended always after posterior lens dislocation, to prevent complications and to preserve visual acuity.

Vitrectomía y perfluorocarbonos en el tratamiento de la luxación del cristalino / Vitrectomy and perfluorocarbons in the management of luxated lenses

Objetivo: Evaluar la utilización de vitrectomía con perfluorocarbonos líquidos (PFCL) (Perfluoro-deka-line) para reflotar cristalinos luxados en vítreo de etiología no quirúrgica. Se analizan las complicaciones durante el período de seguimiento. Métodos: Se han revisado los casos con cristalino luxado en vítreo posterior entre 1989 y 1999. Se han encontrado 8 casos, en todos la extracción de cristalino se realizó con la misma técnica de vitrectomía y uso de PFCL y por el mismo cirujano. En el mismo acto quirúrgico se colocó una lente intraocular de cámara anterior en 2 casos y en 6 casos, una, de cámara posterior saturada a sulcus. Resultados: La edad media de los 8 pacientes fue de 64,5 años. Tres eran miopes y referían luxación espontánea con una duración de 5, 9 y 10 años respectivamente. Los otros 5 casos referían historia de trauma ocular con luxación de duración más corta (entre 1 semana y 3 años). Siete de los casos (87,5 por ciento) presentaban hipertensión ocular, 6 casos (75 por ciento) edema corneal epitelial y 1 caso, desprendimiento de retina preoperatoriamente. Tras la vitrectomía con PFCL se normalizó la tensión ocular y el edema corneal. Las complicaciones que penalizaron AV final fueron: edema macular cistoide (1 caso), atrofia macular (1 caso), y desprendimiento de retina (1 caso). En un caso se produjo un desprendimiento de retina secundario que podía estar relacionado con la yatrogenia quirúrgica. Conclusión: Dada la buena evolución y simplicidad de la vitrectomía con uso de PFCL y la posibilidad de recuperación funcional con la sutura de las lentes intraoculares a sulcus en el mismo acto quirúrgico, creemos que esta intervención se debe recomendar siempre tras la luxación para evitar complicaciones y conservar la AV (AU)

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Flujo sanguíneo ocular y características del desprendimiento de retina / Ocular blood flow and characteristics of retinal detachment

Objetivo: Determinar si hay relación entre los cambios de flujo sanguíneo ocular (FSO) en el desprendimiento de retina (DR) y las características de este último (extensión, afectación de la mácula, VRP o duración).Métodos: Hemos seleccionado 60 pacientes con DR regmatógeno unilateral agudo y 20 individuos 'normales' de características similares. Hemos utilizado la Ecografía Doppler-Color para medir las velocidades de FSO en arteria oftálmica (AO), arteria central de la retina (ACR), vena central de la retina (VCR) y arterias ciliares posteriores (ACP) en ambos ojos de cada paciente. La medida de presión intraocular (PIO) y las características del DR se consideraron en cada caso. Para el análisis estadístico usamos T de Student pareada (FSO) y test de Wilcoxon (PIO) (p=2 cuadrantes (p=C2 (p=15 días (p<0,05).Conclusión: El DR asocia disminución de velocidad de FSO y de PIO tanto en el ojo del DR como en el adelfo. Más graves características del DR conllevan más bajas velocidades de FSO y más baja PIO (AU)

[Myopia: frequency of lattice degeneration and axial length]. / Miopía: frecuencia de degeneración en empalizada y longitud axial.

OBJECTIVE: To evaluate the relationship between lattice retinal degeneration and axial length of the eye in different grades of myopia. MATERIAL AND METHODS: A sample of 200 eyes from 124 myopic patients was collected by chance. The average age was 34.8 years (20-50 years) and the myopia was between 0.5 and 20 diopters (D). The eyes were grouped according to the degree of refraction defect, the mean axial length of each group (Scan A) and the frequency of lattice retinal degeneration and the relationship between these variables was studied. The possible influence of age on our results was also considered. For the statistical analysis, the SAS 6.07 program with the variance analysis for quantitative variables, and chi(2) test for qualitative variables with a 5% significance were used. A multivariable linear regression model was also adjusted. RESULTS: The highest frequency of lattice retinal degeneration occurred in those myopia patients having more than 15 D, and also in the group of myopia patients between 3 and 6 D, but this did not show statistical significance when compared with the other myopic groups. If the axial length is assessed, a greater frequency of lattice retinal degeneration is also found when the axial length is 25-27 mm and 29-30 mm, which correspond, respectively, to myopias between 3-10 D and more than 15 D. When the multivariable linear regression model was adjusted, the axial length showed the existence of lattice retinal degeneration (beta 0.41 mm; p=0.08) adjusted by the number of diopters (beta 0.38 mm; p<0.001). The determination coefficient (r(2)) was also 0.86. CONCLUSIONS: The highest number of cases of lattice retinal degeneration was found for myopias with axial eye length between 29-30 mm (more than 15 D), and 25-27 mm (between 3-10 D).

Miopía: frecuencia de degeneración en empalizada y longitud axial / Myopia: frequency of lattice degeneration and axial length

Objetivo: Valorar la relación entre la degeneración en empalizada y la longitud axial del globo ocular en los diferentes grados de miopía. Material y métodos: Se ha recogido una muestra de oportunidad de 200 ojos en 124 pacientes miopes, con una edad media de 34,8 años (20-50 años), y con un grado de miopía entre las 0,5 y 20 dioptrías. Hemos agrupado los ojos dependiendo del defecto de refracción, considerando la longitud axial media de cada grupo (Scan A) y la frecuencia de degeneración en empalizada, valorando la relación entre estas variables. También consideramos la posible influencia de la edad en nuestros resultados. Para el análisis estadístico usamos el programa SAS 6.07, con análisis de la varianza para las variables cuantitativas y el test c2 para las cualitativas considerando un nivel de significación del 5 por ciento. Se ajustó un modelo de regresión lineal multivariable. Resultados: La mayor frecuencia de empalizada se ha producido en las miopías mayores de 15 dioptrías (D) y en el grupo de miopía entre 3 y 6 D, pero sin alcanzar significación estadística, en comparación con los otros grupos de miopía. Si valoramos la longitud axial, también aparece una mayor frecuencia de degeneración en empalizada cuando la longitud axial estaba entre 25-27 mm y 29-30 mm, que correspondían, respectivamente, a grupos de miopía entre 3-10 dioptrías y más de 15 D. Al ajustar un modelo de regresión lineal multivariable, la longitud axial se relacionó con la existencia de degeneración en empalizada (beta 0,41 mm; p=0,08) ajustada por el número de dioptrías (beta 0,38 mm; p<0,001). El coeficiente de determinación (r2) fue de 0,86. Conclusiones: El mayor número de casos de degeneración en empalizada se ha producido en las miopías con una longitud axial comprendida entre los 29-30 mm (miopías mayores de 15 D) y entre los 25-27 mm (miopías entre 3-10 dioptrías). (AU)

Politetrafluoroetileno en la cirugía de indentación escleral / Polytetrafluoroethylene in scleral buckling surgery

Objetivo: Comprobar la tolerancia del PTFE expandido de 2.ª generación en la cirugía del desprendimiento de retina (DR) regmatógeno con indentación escleral.Métodos: Hemos utilizado el poli-tetra-fluoro-etileno expandido (PTFEe) en 32 casos con DR regmatógeno agudo unilateral de extensión a 2 cuadrantes de retina, sin VRP o con VRP C2. Siempre se ha utilizado como primer y único procedimiento quirúrgico. El seguimiento ha oscilado de 6 a 26 meses (media, 14 meses). Se trata de un material suave, resistente, inelástico, inerte, no alérgico, ni carcinógeno, derivado del teflón, de alta biocompatibilidad, parecido al Gore-Tex pero con mayor índice de porosidad (90 por ciento) y mayor diámetro de poro (50 µ).Resultados: No hemos encontrado complicaciones significativas (migración, infección, erosión, extrusión, etc.) con este material usado en cirugía de indentación escleral en 32 casos con DR regmatógeno. Ha mostrado excelente biocompatibilidad y tolerancia durante el período de seguimiento (media de 14 meses; máximo 26 meses).Conclusiones: Los resultados son muy esperanzadores con este material que se tolera incluso mejor, al menos a corto plazo (26 meses), que otros biomateriales. Recomendamos seguimiento a largo plazo para evaluar posibles efectos secundarios (AU)

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Miopía: prevalencia de desgarros y agujeros tróficos / Myopia: prevalence of retinal tears and round throphic holes

Objetivo: Estudiar la prevalencia de desgarros y agujeros tróficos en una población de miopes, así como su prevalencia por grupos de edad en dicha población, y su posible relación con los diferentes tipos de desprendimiento posterior de vítreo. Igualmente establecemos los cuadrantes retinianos más afectados. Material y métodos: Seleccionamos 200 ojos de 124 pacientes miopes, con una edad media de 34,65 años, y divididos en 5 grupos según el defecto de refracción. Asimismo consideramos 3 grupos de edad. A todos los pacientes se les realizó una oftalmoscopia indirecta con indentación bajo midriasis y biomicroscopia con lente de 3 espejos de Goldmann. Resultados: Aparecieron 7 desgarros en 6 ojos de los 200 estudiados, lo que representa el 3 por ciento de la totalidad, y 16 agujeros tróficos en 14 ojos de los 200 (7 por ciento). No encontramos significación estadística en la aparición de desgarros o agujeros para los diferentes grupos de miopía o de edad; tampoco con respecto a su relación con los diferentes tipos de desprendimiento posterior de vítreo. El cuadrante retiniano más afectado fue el temporal superior. Conclusiones: Los desgarros y/o agujeros tróficos que hemos encontrado (respectivamente 3 por ciento y 7 por ciento), no han mostrado relación con el tipo de desprendimiento posterior de vítreo, la edad ni el grado de miopía (AU)

[Myopia: prevalence of retinal tears and throphic holes]. / Miopía: prevalencia de desgarros y agujeros tróficos.

PURPOSE: We study the prevalence of retinal tears and holes in myopia. We consider age distribution, also retinal localization, and its relationship with the different types of posterior vitreous detachment. MATERIAL AND METHODS: 200 eyes from 124 myopic patients were selected. Average age was 34,76 years. Five groups of myopia were considered, and three groups of age. Indirect ophthalmoscopy under cycloplegia, scleral indentation and biomicroscopy with three mirror Goldmann contact lens were performed in all the patients. RESULTS: 7 tears were found in 6 eyes out of the 200 myopic eyes studied (3%), and 16 holes in 14 eyes (7%). No statistical relationship was found for tears or holes between the different groups of myopia or age, neither considering the different types of posterior vitreous detachment. Superotemporal retinal quadrant was more frequently involved by these lesions. CONCLUSIONS: The tears and round trophic holes found (3% and 7% respectively) did not show relationship with posterior vitreous detachment type, age nor myopic grade.

[Polytetrafluoroethylene in scleral buckling surgery]. / Politetrafluoroetileno en la cirugía de indentación escleral.

PURPOSE: To evaluate the tolerance of PTFEe (second generation) for scleral buckling (SB) surgery of rhegmatogenous retinal detachment (RD). METHODS: We have used a new material: wide porous expanded polytetrafluoroethylene (PTFEe) for SB of 32 cases with rhegmatogenous RD of extention

Laser interferometry: preoperative functional predictive value in retinal detachment.

PURPOSE: To determine the functional predictive value of laser interferometry (LI) in retinal detachment (RD). METHODS: Laser interferometry with test field diameters of 3 degrees and 8 degrees, both with and without light, was tested preoperatively in 42 eyes with rhegmatogenous RD that were candidates for scleral buckling. Snellen visual acuity (VA) and LI (four test fields) were tested preoperatively and postoperatively (1 week, and 1, 3, and 7 months). Sensitivity and specificity of LI to predict postoperative (7 months after surgery) VA improvement was calculated. Chi-square and Spearman correlation tests were used for statistical analysis. RESULTS: Statistically significant Snellen VA improvement (P = 0.02) was first found 7 months after surgery. Laser interferometry at 3 degrees without light showed statistically significant improvement 3 months after surgery (P = 0.05). Laser interferometry at 3 degrees without light showed the highest sensitivity (93%) and specificity (87%) values. The best correlation between preoperative LI and postoperative Snellen VA (7 months after surgery) was also found with 3 degrees LI without light (r = 0.71, P = 0.002). CONCLUSION: Laser interferometry (3 degrees without light) was useful in predicting VA improvement in cases with RD preoperatively and postoperatively. Laser interferometry at 3 degrees without light showed the best correlation with postoperative Snellen VA.

Long-term complications of silicone and hydrogel explants in retinal reattachment surgery.

OBJECTIVE: To compare long-term complications of silicone sponge, silicone rubber, and MIRAgel used as episcleral buckling elements. METHODS: Medical reports were reviewed of 805 patients with cryotherapy and episcleral buckle for rhegmatogenous retinal detachment who were operated on by 1 of us (M.R.-P.) between March 1984 and December 1997. Average follow-up was 76 months. Symptoms and signs of infection or rejection were considered. Care was taken in buckling element removal, considering the material used for scleral buckling (detailed operative note), duration of the buckle, cause of removal, and culture of the removed element. RESULTS: A total of 757 patients were included in the study. Removal of the implant was necessary in 10 patients (1.3%). Silicone sponge (3 [9%] of 32 patients) was more frequently removed than was silicone rubber (2 [0.6%] of 360 patients) or MIRAgel (5 [1.3%] of 386 patients). Silicone sponge needed to be removed a short time after surgery, showing symptoms of acute infection and positive cultures. Silicone rubber was removed 1 year after surgery with symptoms of chronic infection and positive cultures, and MIRAgel implants were removed after long-term follow-up (7-10 years), showing positive cultures in only 20%. CONCLUSION: Periodic long-term follow-up previously recommended for use of other materials also must be recommended for MIRAgel use because of long-term alterations in its chemical composition and eventual swelling of material.

Intraocular lens replacement: advantages of a bimanual technique with preset endoillumination.

Performing a vitrectomy using a bimanual technique with a preset light inserted in the inferonasal quadrant of the eye leaves both hands free to grasp an intraocular lens (IOL) completely dislocated into the vitreous cavity. Two additional scleral grooves with flaps (surgeon's view) at the 2:30 and 8:30 o'clock positions (right eye) or at the 3:30 and 9:30 o'clock positions (left eye) allow the haptics to be guided to the desired positions in the ciliary sulcus. This technique allows permanent, controllable relocation of the IOL. The haptics of the IOL can be visualized while the suture is placed, and the IOL finally rests near the horizontal meridian, away from the corneoscleral wound.