Longterm follow-up of pars plana vitrectomy for vitreous floaters: complications, outcomes and patient satisfaction.

PURPOSE: Floaters caused by degenerative or postoperative changes in the vitreous can interfere with all aspects of visual functioning. The aim of this study is to report the longterm outcome of pars plana vitrectomy (PPV) for persistent vitreous opacities. METHODS: In a retrospective, non-randomized, interventional case study we reviewed all cases of vitreous floaters that were vitrectomized at our department between 1997 and 2006. Patient complaints and satisfaction were assessed by a questionnaire administered at the end of follow-up. RESULTS: Seventy-three consecutive cases were included (61 patients). Mean Snellen best corrected visual acuity (BCVA) before surgery was 0.81. Overall, 85% of patients complained of severe or very severe difficulty caused by floaters. A total of 42% of eyes were pseudophakic, four of which were operated with combined PPV and phacoemulsification. Mean follow-up time was 37 months. Of the phakic eyes, 60% were operated for cataract during follow-up. One retinal detachment (RD) occurred immediately postoperatively (1.3%) and another four eyes developed RD during longterm follow-up 24-44 months after PPV (5.5% of cases). Postoperative BCVA remained mostly unchanged. Overall, 88% of patients were satisfied with the results of the operation. CONCLUSIONS: Some patients make considerable complaints as a result of vitreous opacities and their distress does not correlate with visual acuity. Vitrectomy is a safe and effective procedure with which to help these patients. Patients should be informed about the risk of cataract progression, unexpected inflammatory reaction and an increased risk for RD several years after PPV (5.5%).

Ciliary neurotrophic factor as a transient negative regulator of rod development in rat retina.

PURPOSE: Ciliary neurotrophic factor (CNTF) has been shown to inhibit the developmental expression of rod differentiation markers in rat retinal cultures. The present study was undertaken to investigate whether CNTF transiently inhibits rod differentiation or induces irreversible changes in the developmental fate of rod precursors. METHODS: The effects of CNTF on rod differentiation were monitored in organotypic slice cultures from early postnatal rat retinas by quantification of opsin-immunoreactive cells. The in vitro formation of the photoreceptor layer was analyzed by light and electron microscopy. The developmental expression of the CNTF receptor in photoreceptors was determined by immunoblot analysis. RESULTS: CNTF did not interfere with the generation of rod precursors, their morphologic differentiation, or the formation of the outer nuclear layer. Inhibition of rod differentiation was reversible. In the continuous presence of CNTF the number of opsin-positive cells increased at a normal rate but with a delay of 3 to 4 days. Developing rods became resistant to CNTF, both in vivo and in vitro, and this correlated temporally with the downregulation of CNTF receptor expression. Receptor downregulation was inhibited by CNTF in a dose-dependent manner. At higher CNTF concentrations with sustained receptor expression, the CNTF-induced decrease in opsin expression was accompanied by an increase in the expression of a bipolar cell marker in rod precursors located in the photoreceptor layer. CONCLUSIONS: These data indicate that, although rod precursors exhibit some phenotypic plasticity in the presence of CNTF, the factor does not induce a switch in the developmental fate of rod precursors but plays a role as a transient and reversible negative regulator of rod differentiation.