The impact of short-term postoperative face-up position on unintentional retinal displacement after pars plana vitrectomy for rhegmatogenous retinal detachment.

OBJECTIVE: To assess the effectiveness and safety of a rigorous short-term supine position in preventing inadvertent retinal displacement after pars plana vitrectomy (PPV) with gas tamponade for rhegmatogenous retinal detachment (RRD). METHODS: We conducted a retrospective observational analysis of a case series at two ophthalmological surgical centers. We included eyes diagnosed with macula-off RRD that maintained a strict face-up position for three hours immediately after PPV with intraoperative perfluorocarbon liquid (PFCL) and 20% sulfur hexafluoride (SF6) tamponade. Fundus autofluorescence (FAF) imaging was performed at one month post-operatively to identify unintentional retinal displacement through the detection of retinal vessel prints (RVPs) on FAF imaging using an ultrawide-field (UWF) imaging system. RESULTS: A total of 29 eyes with macula-off RRD were included in the study. The average age of the participants was 59.62 years. RRD involved one quadrant in two eyes, two quadrants in fourteen eyes, three quadrants in seven eyes, and four quadrants in six eyes. UWF-FAF imaging at one month follow-up after complete reattachment of the retina revealed RVPs in seven out of the 29 eyes (24.13%), with a mean displacement of 0.22 mm. In every case the displacement occurred downward. CONCLUSION: Our results suggest that adhering to a strict face-up position for three hours after PPV with PFCL and gas tamponade for macula-off RRD may lead to a low frequency and severity of inadvertent post-operative retinal displacement.

VITRECTOMY RESULTS FOR RHEGMATOGENOUS RETINAL DETACHMENT WITH CONCOMITANT MACULAR HOLE IN NONMYOPIC PATIENTS.

PURPOSE: To report on results of pars plana vitrectomy with ILM peeling in patients with rhegmatogenous retinal detachment (RRD) and concomitant macular hole (MH) and to assess for preoperative associated conditions related to this type of RRD. METHODS: Patients undergoing surgical repair for RRD between 2014 and 2021 were reviewed, and subjects with concomitant, non-causal, macular hole were identified. We studied post-operative macular status, retinal reattachment rate and visual acuity. RESULTS: Over 532 eyes operated on for RRD, 11 (2.06%) had a concurrent non-causal macular hole. Preoperative PVR B or superior was recorded in 86 eyes (16.6%) of the entire cohort and in 6 eyes (54.54 %) with RRD and concomitant MH (p=0.00001). Severe hypotony with choroidal detachment was present in 15 eyes (2.81%) of the entire cohort and in 3 eyes (27.27%) with RRD and concomitant MH (p=<0.00001). CONCLUSIONS: RRD with concomitant MH is an infrequent association. Retinal reattachment and anatomical hole closure can be achieved in most of cases but despite this fact, functional recovery is usually not good. Preoperative PVR is a more frequent finding in this group of patients, as well as severe hypotony with choroidal detachment.

Risk factors for failure after primary vitrectomy with no scleral buckling for rhegmatogenous retinal detachment / Fatores de risco para falha de tratamento após vitrectomia primária sem retinopexia com introflexão escleral

ABSTRACT Objective To assess pre-operative conditions that could influence primary anatomical success rate in a cohort of patients with rhegmatogenous retinal detachments (RRD) treated with primary vitrectomy and no scleral buckling. Methods A retrospective analysis was performed in a group of patients that underwent primary pars plana vitrectomy with gas tamponade and without scleral buckling for RRD between 2014 and 2019, with a minimum follow-up of 4 months. Results 305 eyes of 301 patients were included; 59.01% eyes were phakic, 39.01% were pseudophakic and 1.96% aphakic. 13.11% of patients had proliferative vitreoretinopathy grade B and 3.28% proliferative vitreoretinopathy grade C at the time of diagnosis while 83.61% had proliferative vitreoretinopathy grade 0 or A. 53.1% had superior breaks, 15.4% inferior breaks and 31.5% a combination of both. Primary success rate was obtained in 90.82% of eyes (95%CI 87.58-94.06). 9.18% of eyes (95%CI 5.94-12.42) re-detached. In 3.27% the cause of re-detachment was proliferative vitreoretinopathy, and in the remaining 5.90% because of a new or a missed break, the leakage of a previously treated break, or an area of shallow peripheral detachment with no detectable break. Of 181 phakic eyes, 10.49% re-detached, whereas in over 126 aphakic or pseudophakic eyes 7.75% re-detached (p=0.42). 16.39% eyes of the entire cohort had preoperative grade B or C proliferative vitreoretinopathy, whereas 32.14% of re-detached eyes had preoperative grade B or C proliferative vitreoretinopathy (95%CI 17.29-46.99; p=0.02). Th eyes that re-detached after the first surgery had a mean of 2.5 (95%CI 1.86-3.13) retinal tears, against a mean of 1.87 (95%CI 1.73-2.00) retinal tears of those that did not re-detach after the first surgery (p=0.02). Conclusion We found location of breaks and lens status to be independent factors not related to a lower single operation success rate, whereas the number or size of breaks and preoperative proliferative vitreoretinopathy stages B or C were independent factors related to a higher likelihood of re-detachment.

RESUMO Objetivo Avaliar condições pré-operatórias que poderiam influenciar a taxa de sucesso anatômico primário em uma coorte de pacientes com descolamento de retina regmatogênico tratada com vitrectomia primária e sem introflexão escleral. Métodos Foi realizada uma análise retrospectiva em um grupo de pacientes submetidos a vitrectomia primária pars plana com tamponamento gasoso e sem introflexão escleral por desprendimento de retina regmatogênico entre os anos 2014 e 2019, com monitoramento mínimo de 4 meses. Resultados Foram incluídos 305 olhos de 301 pacientes; 59,01% dos olhos eram fáquicos, 39,01% eram pseudofáquicos, e 1,96% era afáquico; 13,11% dos pacientes tinham vitreorretinopatia proliferativa grau B, e 3,28%, vitreorretinopatia proliferativa grau C no momento do diagnóstico, enquanto 83,61% tinham vitreorretinopatia proliferativa grau 0 ou A; 53,1% tinham rasgaduras superiores; 15,4%, rasgaduras inferiores e 31,5%, uma combinação de ambas. A taxa de sucesso primário foi obtida em 90,82% dos olhos (IC95% 87,58-94,06); 9,18% dos olhos (IC95% 5,94-12,42) se redestacaram. Em 3,27%, a causa do redescolamento foi vitreorretinopatia proliferativa e, nos 5,90% restantes, por causa de uma ruptura nova ou perdida, o vazamento de uma ruptura previamente tratada, ou uma área de descolamento periférico superficial sem ruptura detectável. Dos 181 olhos fáticos, 10,49% redestacaram-se, enquanto em mais de 126 olhos afáquicos ou pseudofáquicos 7,75% redestacaram-se (p=0,42); 16,39% dos olhos de toda a coorte tinham vitreorretinopatia proliferativa pré-operatória grau B ou C, enquanto 32,14% dos olhos redescolados tinham vitreorretinopatia proliferativa pré-operatória grau B ou C (IC95% 17,29-46,99) (p=0,02). Os olhos que se redescolaram após a primeira cirurgia tiveram média de 2,5 (IC95% 1,86-3,13) lágrimas retinianas, contra uma média de 1,87 (IC95% 1,73-2,00) lágrima retiniana daqueles que não se redestacaram após a primeira cirurgia. (p=0,02). Conclusão A localização das rasgaduras e o status da lente são fatores independentes não relacionados a uma menor taxa de sucesso da operação, enquanto o número ou o tamanho das rasgaduras e estágios vitreorretinopatia proliferativa pré-operatórios B ou C foram fatores independentes relacionados a uma maior probabilidade de redescolamento.

Management of optic disc pit maculopathy: the European VitreoRetinal society optic pit study.

PURPOSE: To evaluate a variety of techniques, and their anatomical and functional results, for the treatment of optic disc pit maculopathy (ODP-M). A secondary aim was to report on results of secondary procedures in cases of initial failure or recurrence. METHODS: Multicentre retrospective study of 95 eyes with ODP-M, treated by 25 surgeons from 12 countries. Primary outcomes were anatomical resolution of subretinal fluid (SRF), intraretinal fluid (IRF) and visual acuity (VA) at 12 months. RESULTS: Higher rates of SRF and IRF resorption were achieved in eyes treated with pars plana vitrectomy (PPV) compared to external laser with or without tamponade: 64/72 (88.9%) versus 8/14 (57.1%) for SRF (p = 0.003), and 50/59 (84.7%) versus 3/10 (30%) for IRF (p = 0.002). The addition of juxtapapillary laser or internal limiting membrane (ILM) peel during PPV did not improve SRF or IRF resolution. Pars plana vitrectomy (PPV) with tamponade and PPV with tamponade plus endolaser were associated with significant visual gain. In the former group, VA improved from a mean of logMAR 0.91 (20/162), to a mean of logMAR 0.52 (20/66) at 12 months; in the latter group, VA improved from a mean of logMAR 0.82 (20/132) to a mean of logMAR 0.47 (20/59) at 12 months. Retreatments were performed in 14 eyes (15.7%), only enhancing anatomical outcomes. CONCLUSION: Vitrectomy with tamponade had better final outcomes than external laser treatment with or without gas tamponade. Laser endophotocoagulation and ILM peel provided no additional benefit. A secondary treatment resulted in anatomical but not functional improvement.

Transcriptome Analysis of Pterygium and Pinguecula Reveals Evidence of Genomic Instability Associated with Chronic Inflammation.

Solar damage due to ultraviolet radiation (UVR) is implicated in the development of two proliferative lesions of the ocular surface: pterygium and pinguecula. Pterygium and pinguecula specimens were collected, along with adjacent healthy conjunctiva specimens. RNA was extracted and sequenced. Pairwise comparisons were made of differentially expressed genes (DEGs). Computational methods were used for analysis. Transcripts from 18,630 genes were identified. Comparison of two subgroups of pterygium specimens uncovered evidence of genomic instability associated with inflammation and the immune response; these changes were also observed in pinguecula, but to a lesser extent. Among the top DEGs were four genes encoding tumor suppressors that were downregulated in pterygium: C10orf90, RARRES1, DMBT1 and SCGB3A1; C10orf90 and RARRES1 were also downregulated in pinguecula. Ingenuity Pathway Analysis overwhelmingly linked DEGs to cancer for both lesions; however, both lesions are clearly still benign, as evidenced by the expression of other genes indicating their well-differentiated and non-invasive character. Pathways for epithelial cell proliferation were identified that distinguish the two lesions, as well as genes encoding specific pathway components. Upregulated DEGs common to both lesions, including KRT9 and TRPV3, provide a further insight into pathophysiology. Our findings suggest that pterygium and pinguecula, while benign lesions, are both on the pathological pathway towards neoplastic transformation.

International Practice Patterns for the Management of Acute Postsurgical and Postintravitreal Injection Endophthalmitis: European Vitreo-Retinal Society Endophthalmitis Study Report 1.

PURPOSE: To study the practice patterns for the management of acute postoperative and postinjection endophthalmitis. DESIGN: Retrospective, interventional, nonrandomized, multicenter study. PARTICIPANTS: Data on 237 eyes diagnosed with acute endophthalmitis occurring after intraocular surgery or procedures provided by 57 retina specialists from 28 countries. MAIN OUTCOME MEASURES: Rates of pars plana vitrectomy (PPV), repeat intravitreal injection, and adjunctive therapeutic regimens (local and systemic antibiotics and steroids). RESULTS: Of 237 analyzed eyes, acute endophthalmitis secondary to cataract surgery or secondary lens implantation represented 64.6% of cases (153 eyes), whereas the remaining were secondary to intravitreal injections (35 eyes [14.8%]), PPV (29 eyes [12.2%]), and other intraocular surgeries (20 eyes [8.4%]). All eyes received intravitreal antibiotics on the same day of diagnosis. Overall, early PPV was used within the first week of presentation in 176 eyes (74.3%). There was no statistical difference in the proportion of eyes requiring a second intravitreal injection of antibiotics whether the eye was managed primarily with intravitreal antibiotics alone versus early PPV plus intravitreal antibiotics (29.5% [18 eyes] vs. 25.0% [44 eyes], respectively). Adjunctive therapies in the form of intravitreal steroids, systemic steroids, and systemic antibiotics were used in 25.3%, 21.9%, and 66.6% of eyes, respectively. The absence of disc or macular view and absence of endophthalmitis after cataract surgery were associated with an increased likelihood for early PPV (odds ratios 4.1 and 5.1, respectively). CONCLUSIONS: Pars plana vitrectomy was frequently performed regardless of the presenting vision in eyes with endophthalmitis after cataract surgery and intravitreal injections. Increased vitreous opacification was associated with a higher probability for performing PPV.

Encircling Scleral Buckling for Traumatic Severe Hypotony.

The authors report the use of an encircling scleral buckling procedure for the management of severe hypotony secondary to traumatic annular ciliochoroidal detachment (CCD) with cyclodialysis cleft. Medical records of patients with severe ocular hypotony were retrospectively reviewed. Four patients with traumatic annular CCD with cyclodialysis cleft were identified. Diagnosis of CCD was documented by ultrasound biomicroscopy and presence of cyclodialysis cleft was confirmed by gonioscopy or ultrasound biomicroscopy. All patients underwent scleral buckling surgery with an encircling band for annular CCD with cyclodialysis cleft. Intraocular pressure (IOP) and visual acuity (VA) significantly improved postoperatively. Mean IOP changed from 2.5 mm Hg ± 0.5 mm Hg to 10.75 mm Hg ± 1.1 mm Hg (P = .0129) and mean best-corrected VA changed from +0.50 ± 0.16 logMAR to +0.15 ± 0.17 logMAR (P = .0123). IOP normalization was achieved despite persistence of CCD. These results support the use of scleral buckling with an encircling band as an effective approach for severe hypotony in patients with annular CCD regardless the cyclodialysis cleft extension. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:58-63.].

Prednisolona acetato y dicloflenac sódico en el tratamiento de uveitis anterior experimental / Prednisolone acetate and sodium diclofenac in the treatment of experimental anterior uveitis

RESUMEN: Objetivo: Comparar la acción antiinflamatoria de prednisolona acetato y diclofenac sódico en uveitis anterior inducida experimentalmente en conejos. Metodos: se realizó un estudio controlado, randomizado y a doble ciego, seleccionando 18 conejos a los que se realizó una fotocoagulación del iris con laser de argón. Se los dividió en tres grupos, tratando a los conejos del grupo 1 con prednisolona acetato 1 por ciento, a los del grupo 2 con diclofenac sódico 0,1 por ciento, y a los del grupo 3 no se les realizó tratamiento. Se evaluaron los resultados por parámetros clínicos (biomicroscopía), y de laboratorio (estudios de humor acuoso de las concentraciones de proteinas totales, IgG, y fracción C3 del complemento). Resultados: En los examenes clínicos se observa una marcada disminución en la reacción inflamatoria en cámara anterior en las sucesivas observaciones en el grupo tratado con prednisolona. Conclusión: Ambas drogas se mostraron como eficaces agentes antiinfamatorios en este modelo experimental.(AU)

Prednisolona acetato y dicloflenac sódico en el tratamiento de uveitis anterior experimental / Prednisolone acetate and sodium diclofenac in the treatment of experimental anterior uveitis

RESUMEN: Objetivo: Comparar la acción antiinflamatoria de prednisolona acetato y diclofenac sódico en uveitis anterior inducida experimentalmente en conejos. Metodos: se realizó un estudio controlado, randomizado y a doble ciego, seleccionando 18 conejos a los que se realizó una fotocoagulación del iris con laser de argón. Se los dividió en tres grupos, tratando a los conejos del grupo 1 con prednisolona acetato 1 por ciento, a los del grupo 2 con diclofenac sódico 0,1 por ciento, y a los del grupo 3 no se les realizó tratamiento. Se evaluaron los resultados por parámetros clínicos (biomicroscopía), y de laboratorio (estudios de humor acuoso de las concentraciones de proteinas totales, IgG, y fracción C3 del complemento). Resultados: En los examenes clínicos se observa una marcada disminución en la reacción inflamatoria en cámara anterior en las sucesivas observaciones en el grupo tratado con prednisolona. Conclusión: Ambas drogas se mostraron como eficaces agentes antiinfamatorios en este modelo experimental.